Search Results (363)

Background/Objectives: To summarize evidence on whether anodization of titanium implant abutments modifies abutment surface/physical properties, peri-implant soft tissue esthetics, and biological outcomes compared with machined titanium and alternative abutment materials. Methods: This focused narrative review used a structured, reproducible literature search with dual-reviewer screening and data extraction. The study selection pathway was summarized using a PRISMA-style flow diagram for transparency. Searches of PubMed/MEDLINE, EMBASE, CENTRAL, and Google Scholar were performed, supplemented by gray literature screening and manual searching. Laboratory, animal, and human clinical studies evaluating anodized titanium abutments were eligible. Data were synthesized qualitatively across prespecified domains (surface or physical properties, esthetic outcomes, and biological outcomes). Because the work was designed as a narrative review, protocol registration and formal risk of bias appraisal were not undertaken. Results: Thirty-five studies were included (twenty-five in vitro, three animal, and seven human clinical). Anodization modified oxide layer characteristics and surface chemistry, and was commonly associated with increased hydrophilicity. Esthetically, pink or yellow anodized titanium generally reduced discoloration compared with uncolored titanium, particularly when soft tissue and restorative material thickness were sufficient, whereas zirconia most consistently produced the most favorable color outcomes. In vitro studies frequently reported improved early soft tissue cell responses and, in selected protocols, reduced bacterial adhesion. Reported clinical differences in inflammation indices and peri-implant marginal bone changes were small or inconsistent. Conclusions: Anodization can improve the optical masking of titanium and alter surface wettability and chemistry, but evidence for sustained clinical biological benefit remains limited. Current evidence supports anodization primarily as an esthetic adjunct, while long-term peri-implant biological outcomes appear to be driven by multiple clinical factors beyond surface modification. Full article

Background/Objectives: Tooth impaction and transposition are developmental dental anomalies that pose significant challenges in orthodontics, oral surgery, and restorative dentistry. These anomalies disrupt normal occlusal development and complicate diagnosis and treatment planning because of altered anatomy, a higher risk of adjacent tooth resorption, associated pathology such as cyst formation, and biomechanical challenges during orthodontic intervention. Methods: Three paediatric patients with complex eruption disturbances, including impacted incisors, impacted primary molars, and transposed maxillary canines, were managed using individualised conservative orthodontic approaches. The cases involved obstruction by supernumerary teeth, ectopic eruption with space loss, and tooth transposition complicated by root dilaceration and malocclusion. Comprehensive clinical and radiographic assessment, including CBCT when indicated, guided treatment planning. Management strategies included staged surgical interventions, space maintenance using 2 × 4 appliances, bite opening, and controlled orthodontic traction with modified biomechanics to minimise the risk of root resorption and interference with adjacent teeth. Results: Favourable functional and aaesthetic outcomes were achieved in all cases, although certain limitations such as incomplete root development, residual spacing, localised restorative complications, and difficulty in correcting root angulation of dilacerated adjacent teeth were observed. Conclusions: Careful diagnosis using advanced imaging, combined with conservative orthodontic and surgical approaches, can achieve satisfactory functional and esthetic outcomes while minimising complications. Further longitudinal studies are recommended to evaluate long-term stability and optimise treatment protocols. Full article

Background: The White Esthetic Score (WES) is a standardized clinician-reported index that assesses the esthetic quality of a single-tooth restoration by comparison with a natural reference tooth, typically the contralateral tooth. It evaluates five domains: tooth form, crown outline/volume, color (hue/value), surface texture, and translucency/characterization. Each domain is scored from 0 to 2 (major discrepancy, minor discrepancy, no discrepancy), yielding a total score of 0–10; higher scores indicate a closer match. Although developed for single-tooth implant restorations, WES has also been applied to natural teeth and tooth-supported restorations. Methods: This comprehensive review summarizes case-report evidence applying WES to tooth-supported restorations, outlining the concept, scoring method, documentation requirements, and available data on reliability and interpretation. A case illustration is also presented in which a patient received eight anterior veneers; outcomes were assessed using all WES parameters. Results: Published reports support WES as a practical qualitative tool to assess esthetic outcomes in tooth-supported restorations. In the presented case, the veneers achieved a WES of 9, reflecting marked improvement in tooth form, crown outline/volume, color, surface texture, and translucency/characterization. Conclusions: The comprehensive review indicates WES is feasible for routine clinical use in practice, but agreement varies by parameter and improves with standardized photography and examiner calibration; some components show lower inter-rater agreement than simpler soft-tissue indices. Because correlations between WES and patient satisfaction are inconsistent, WES should be complemented with patient-reported outcome measures. Common thresholds consider WES ≥ 6 acceptable. Clinical use for crowns and veneers should emphasize case selection, standardized records, and combined clinician- and patient-centered outcome reporting. Full article

Multilayer 4Y/5Y-PSZ zirconia materials have been developed to combine strength and translucency in monolithic “all-in-one” dental restorations. This study evaluated the flexural strength of different layers (incisal, transition, and dentin) in four commercially available multilayer zirconia systems using three-point bending tests in accordance with ISO 6872. A total of 360 CAD/CAM-fabricated bar-shaped specimens were prepared from the materials CE (Cercon yo ML, DentsplySirona), KA (Katana YML, Kuraray Noritake), PZ (3D ProZir, Aidite), PE (IPS e.max ZirCAD Prime esthetic), and assigned to layer-specific groups based on their position within the discs. After sintering and standardized surface finishing, specimens were tested under three-point bending conditions. Fracture strength was calculated and statistically analysed. Microstructural and fractographic analyses were performed to assess grain structure and to identify fracture origins. The results demonstrated significant differences in flexural strength both among materials and between layers. In general, dentin layers exhibited the highest strength, reaching mean values up to 1143 MPa, while incisal layers showed significantly lower values, with minima around 572 MPa. Only one material (CE) maintained flexural strength above the ISO threshold of 800 MPa across all layers, qualifying for unrestricted (class 5) clinical use. Other materials showed limitations, particularly in the more translucent incisal regions (KA, PE). One material fell below the ISO threshold (PZ). Weibull moduli revealed differences in reliability, with moduli ranging from 4.7 to 16.5. Fractographic evaluation identified typical fracture patterns such as surface grinding defects and internal porosity, but no abnormal fracture origins. The strength gradient corresponds to microstructural differences, particularly grain size and phase composition, influenced by yttria content. Increased translucency in incisal layers is associated with reduced mechanical performance. These findings emphasize that, despite aesthetic advantages, layer-dependent strength variations must be considered when selecting multilayer zirconia for clinical applications, especially in long-span restorations. Full article

Objective: The purpose of these two clinical cases reports was to present the variations in the surgical and prosthetic procedures related to an implant-supported fixed dental prosthesis (FDP) in the edentulous maxilla, following a fully guided implantation protocol and immediate loading. Case presentation: Two patients, one with terminal dentition and one with a completely edentulous maxilla, expressed the desire for immediate rehabilitation with an FDP and avoidance of multiple and complex surgical procedures. The clinical protocol for both cases included meticulous presurgical planning combining radiographic examination, diagnostic wax-up (conventional or digital), prosthetically driven digital planning of implant placement, fabrication of a surgical guide for fully guided implant installation, and delivery of a screw-retained fixed restoration. There was no report of any implant failure; the FDPs could be delivered as planned, and both patients expressed their satisfaction with the functional and esthetic outcomes. The clinical situation was stable at the recall. Full article

Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions. Full article

Background/Objectives: Long-term clinical data on direct posterior composite restorations are scarce, particularly beyond simple survival outcomes. This study aimed to characterize the long-term functional, esthetic, and biological behavior of posterior composite restorations after nearly three decades of service using selected FDI criteria and to assess changes across available follow-up examinations, including within a predefined sub-cohort. Methods: This observational follow-up involved 21 patients with 57 posterior composite restorations placed in 1995–1996 at the Department of Operative Dentistry, Goethe University Frankfurt, by undergraduate dental students under supervision. The 2025 follow-up used FDI criteria to assess functional, aesthetic, and biological properties, classifying outcomes as clinically acceptable, intervention needed, or failure. Descriptive analyses were applied to the entire cohort. Longitudinal analyses were conducted on a sub-cohort of 14 patients with 27 restorations at three time points. Exploratory analyses assessed associations with restoration factors, caries experience, and gingival health. Results: In 2025, 54.4% of restorations were clinically acceptable, 28.1% required intervention, and 17.5% were failures. Functional criteria remained mostly acceptable, though form and contour showed the highest mean values. In the longitudinal sub-cohort, significant changes over time were observed in anatomical form and occlusal wear. Retention, marginal adaptation, proximal contact, and surface luster did not change significantly. Biologically, restorations available for direct assessment had low incidences of secondary caries, hard-tissue defects, and postoperative sensitivity or pulpal issues. Conclusions: Posterior composite restorations can function for nearly three decades but gradually deteriorate in certain aspects. Long-term changes mainly involve cumulative functional aging of the anatomical form and occlusal wear, rather than widespread biological failure. These findings underline the importance of differentiated long-term assessment and support conservative management approaches where clinically feasible before replacement is undertaken. Full article

Background/Objectives: Tooth discoloration can influence the esthetic outcome of restorative treatments. Recently, 3D-printed ceramic-filled hybrid materials have been introduced for dental restorations using digital workflows. The aim of this in vitro study was to evaluate the influence of 3D-printed ceramic-filled hybrid veneers on the final color of discolored teeth using spectrophotometric measurements. Methods: Twenty-five extracted human anterior teeth without caries or restorations were prepared for veneer restorations using standardized reduction protocols. Artificial discoloration was induced by applying light-cured color coatings to the buccal surfaces of the specimens. The prepared teeth were digitally scanned, and veneers with a thickness of 1 mm were designed and fabricated using a 3D printing system and a ceramic-filled hybrid material. Color measurements were performed with a spectrophotometer and recorded in the Commission Internationale de l’Éclairage L*a*b* (CIELAB) color system. Measurements were obtained at four stages: after creation of discoloration, after two weeks of immersion in physiological saline solution, after veneer placement using neutral try-in gel, and after two months of immersion following veneer placement. Color differences were calculated using three color difference formulas (ΔE*ab, ΔE94, and ΔE00). Results: The placement of the 3D-printed veneers produced substantial modifications in the optical characteristics of the discolored substrates, reflected by reduced chroma values and significant color differences between the baseline and veneer stages. After two months of immersion, only minor variations in color coordinates were observed. The calculated color differences between the veneer stage and the post-immersion stage remained low across all evaluated color difference formulas, indicating good short-term color stability of the veneered specimens. Conclusions: Within the limitations of this pilot in vitro study, 3D-printed ceramic-filled hybrid veneers demonstrated the ability to effectively modify the color of discolored substrates while maintaining relatively stable optical properties after two months of immersion. These restorations may represent a promising and cost-effective option for the esthetic management of discolored teeth. Full article

Background and Objectives: Conventional dental adhesives doped with magnetic nanoparticles (MNPs) hold the promise of preventing microleakages. However, esthetic concerns have motivated the quest for coatings capable of masking the dark color of MNPs. This study aims to quantify regional chromatic differences between teeth restored using dental adhesives with different MNP content. Materials and Methods: We prepared cavities in 42 artificial molars and 9 extracted teeth and divided them into 6 groups: Group 0 (G0), G1, and G2, comprising 14 artificial teeth each and G0e, G1e, and G2e, comprising 3 extracted teeth each. In G0 and G0e, we applied the commercial adhesive, in G1 and G1e we applied the adhesive loaded with MNPs with dual coating (SiO₂ followed by Ca(OH)₂), whereas in G2 and G2e we applied the adhesive doped with uncoated MNPs. For the statistical analysis of color differences, we employed Bland–Altman plots and the one-sample t-test. Results: G1 was similar to G0 in terms of color coordinate distribution, whereas G2 was different. Compared to G0, dental fillings from G1 had mean differences of (−0.56, 0.18, −0.07) in the CIELAB color coordinates (L*, a*, b*), respectively, whereas the mean differences between G2 and G0 were (−15.6, −3.5, −15.7). The CIEDE2000 color differences were 1.5 [1.3, 1.6] between G1 and G0 (mean [95% confidence interval]) and 17.0 [16.0, 18.0] between G2 and G0. Nevertheless, 24.4% of the point pairs compared exceeded the acceptability limit for color difference (1.8). Conclusions: Although the silica and calcium hydroxide coating is highly effective in alleviating the esthetic impact of MNP-laden dental adhesives, further research is warranted to reduce between-specimen variability. Full article

Background/Objectives: Immediate provisionalization in the esthetic zone is a well-documented but technique-sensitive procedure, and the choice of provisional connection geometry, with or without an antirotational index, remains debated. The aim of this retrospective single-arm cohort clinical study was to evaluate the clinical performance of a digitally planned, guide-delivered provisionalization protocol using prefabricated provisional crowns connected to 5-degree Morse taper implants without an antirotational index, with emphasis on emergence profile shaping and peri-implant tissue stability at one year; Methods: Twenty consecutive single-implant cases treated according to the standardized protocol from January 2024 onward and completing at least one year of follow-up after definitive crown delivery by the February 2026 data-lock date were included (19 female, 1 male; mean age 38.1 ± 12.7 years; 18 anterior and 2 premolar sites). All implants were placed with primary insertion torque ≥ 30 N·cm (mean 34.75 ± 2.55 N·cm) and immediately restored with a digitally designed, non-antirotational provisional crown. Primary outcome was provisional retention without major intervention; secondary outcomes included biologic complications, papilla score, marginal bone change at T0–T3 and T3–T4, and buccal contour change (T0 vs. T2 intraoral scan superimposition). Wilson 95% confidence intervals, Fisher’s exact test, and Mann–Whitney U test were used (α = 0.05); Results: Provisional retention without major intervention was 75.0% (15/20; 95% CI 53.1–88.8). Biologic complications were uncommon (bleeding on probing, suppuration, midfacial recession, and chairside adjustment, each 5.0%). Mean total marginal bone loss at one year was 0.37 ± 0.20 mm; mean buccal contour gain was 1.41 ± 0.48 mm. A complete papilla was preserved in 70.0% of cases. Conclusions: Digitally planned, guide-delivered provisionalization on a non-antirotational 5-degree Morse taper interface appears clinically feasible for emergence profile shaping in the esthetic zone, with favorable peri-implant tissue outcomes at one year. Full article

Oral and Maxillofacial Surgery (OMFS) is a surgical specialty with a distinctive position at the intersection of medicine and dentistry. This unique expertise enables reliable reconstructions of complex head and neck defects, with a focus on function, esthetics, and quality of life. This review examines the historical progression, current practices, and prospective directions of head and neck reconstruction, with particular emphasis on the essential contributions of Oral and Maxillofacial Surgeons (OMSs). Beginning with early reconstructive efforts in ancient civilizations and progressing through the transformative advancements of the Renaissance, the introduction of anesthesia and antiseptics, and innovations during periods of war, the specialty has evolved in response to increasing clinical complexity. The contemporary era is characterized by the integration of microvascular reconstruction, dental rehabilitation, and advanced imaging modalities, enhancing the restoration of occlusal function, facial aesthetics, and overall quality of life. Emerging innovations such as patient-specific three-dimensional printed hardware, tissue engineering, regenerative medicine, artificial intelligence, and supermicrosurgical techniques are expected to further reshape reconstructive approaches. These technological advances aim to reduce the number of surgical steps, improve biological reconstruction, and enhance diagnostic and planning capabilities. However, they also raise ethical considerations and validation challenges that warrant careful assessment. In conclusion, Oral and Maxillofacial Surgeons continue to play a central and expanding role in head and neck reconstruction and rehabilitation. Owing to comprehensive training and technological expertise, the specialty is uniquely positioned to advance value-based, multidisciplinary care while persistently striving to improve functional, aesthetic, and quality-of-life outcomes for patients with complex craniofacial defects. Full article

This case report describes a digital workflow for the aesthetic rehabilitation of a 30-year-old male patient with unaesthetic anterior teeth. The treatment incorporated AI-assisted smile design software (SmileCloud Biometrics) for 2D/3D digital planning and patient communication. Six lithium disilicate veneers (IPS e.max CAD) were fabricated using CAD/CAM technology following mock-up-guided minimally invasive preparation (0.2–0.9 mm reduction). The restorations were adhesively cemented under rubber dam isolation. One-week follow-up confirmed aesthetic integration, occlusal harmony, and patient satisfaction. This case illustrates how digital workflows with AI-assisted tools can support veneer rehabilitation through data-informed planning and conservative preparation while maintaining aesthetic outcomes. Full article

High-translucency zirconia (HTZ) has superior esthetic properties, but its unreliable resin bonding limits minimally invasive anterior restorations. An in situ surface modification was developed to synthesize CaZrO₃ particulates on pre-sintered HTZ for enhanced bonding durability. HTZ specimens were randomized into control (Zr-c) and calcium-modified (Zr-Ca) groups; Zr-Ca was treated with NaF/HCl mixture, calcium chloride glycerol solution, NaOH incubation (80 °C, 2 h), and sintering. Surface characteristics were characterized by SEM/EDS, AFM, X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and FTIR. Flexural strength was tested via three-point bending; shear bond strength (SBS) was evaluated immediately and after 5000 thermocycles with resin cements (with/without 10-MDP). Zr-Ca showed uniform surface particulates, increased roughness, enhanced wettability, and surface Ca; XRD/FTIR/XPS confirmed CaZrO₃ and Ca-O-P species (after MDP). Zr-Ca with 10-MDP-containing resin adhesive had significantly higher SBS before/after aging (predominantly mixed failures), with flexural strength within clinical limits. In situ CaZrO₃ formation on HTZ strengthens MDP-mediated resin bonding and thermocycling resistance while preserving mechanical integrity, providing a feasible strategy for durable adhesion. Full article

Tooth structure anomalies, though not frequently described, can be observed in the external appearance not only of humans but also of dogs. The emergence of an oversized set of teeth is not solely an esthetic and health problem, but often also leads to behavioral issues. In the commonly available medical literature, there are many cases describing the occurrence and treatment of double teeth, both in the incisors and in the cheek teeth. In this article, the authors describe a clinical case of a one-year-old female Golden Retriever dog diagnosed with a double tooth in her permanent dentition. The complex morphology of the affected tooth posed a considerable diagnostic and therapeutic challenge. Surgical separation of the tooth was performed, requiring an individualized treatment approach and the adaptation of protocols derived primarily from human dentistry. This case highlights the diagnostic and clinical decision-making difficulties associated with such anomalies. It also emphasizes the importance of tailored therapeutic strategies for managing rare dental developmental abnormalities in dogs. The teeth were successfully surgically separated, and thus the present report contributes to the limited body of literature on double teeth in veterinary patients and provides practical insight into their management. This description of the first case of this type in veterinary dentistry aims to encourage readers to explore the topic of double teeth and demonstrates a non-standard way of thinking and dealing with such a tooth. The presented case is unique from both a diagnostic and therapeutic perspective. Previous publications have focused on these abnormalities as separate entities, failing to consider their simultaneous occurrence within a single tooth. The therapeutic approach employed also deserves particular attention. The most commonly recommended approach involves extraction of the affected teeth; however, in this case, an attempt was made to separate and preserve them, representing a novel clinical approach. Full article

Despite advances in dental materials and digital color registration systems, esthetic matching remains a clinical challenge for both dental students and experienced professionals. A comprehensive narrative review was conducted through bibliographic searches in PubMed, Scopus, Web of Science, and PsycINFO databases from January 2015 to January 2026. The evidence was synthesized using a four-dimensional analytical framework encompassing technological, cognitive–psychological, educational, and clinical-contextual factors. Quantitative synthesis revealed substantial variability in shade matching success rates, with intraoral scanners demonstrating pass rates ranging from 31.3% to 78.2% across devices, while spectrophotometers achieved superior repeatability (ICC > 0.9) but faced interpretive barriers. Cognitive load theory explains the performance deterioration, with novices being particularly susceptible to retinal fatigue and metamerism under non-standardized lighting conditions. The proposed paradigm shift involves redefining shade selection from a purely technical task to a cognitive skill that requires deliberate perceptual calibration, structured educational protocols, and hybrid digital visual workflows. To improve esthetic predictability, educational programs need to integrate longitudinal training in color science with objective feedback mechanisms. Clinical workflows should adopt hybrid calibration-centric protocols that position technology as a verification tool, rather than a replacement for clinical judgment. Understanding the multidimensional nature of shade matching difficulty enables the development of evidence-based educational protocols and clinical workflows, ultimately improving esthetic outcomes. Full article