Search Results (1,499)

Background/Objectives: Non-carious cervical lesions (NCCLs) are common defects in adults that can lead to dentin hypersensitivity and aesthetic concerns, for which composite resin restorations currently represent the gold standard of care. However, evidence regarding the long-term clinical superiority of high-filled injectable composites and Er,Cr:YSGG laser-based cavity preparation remains limited. The present study aimed to compare the 1-year clinical performance of two different surface preparation protocols (Er,Cr:YSGG laser vs. conventional bur preparation with phosphoric acid etching) and two composite resin types (high-filled injectable vs. conventional paste-type) in the restoration of NCCLs. Methods: In this prospective, split-mouth, randomized controlled clinical trial, a total of 168 NCCLs in 27 patients were restored. Lesions were randomly allocated to four groups according to the combination of surface preparation (Er,Cr:YSGG laser or phosphoric acid etching) and high-filled injectable composite (G-ænial Universal Injectable) or paste-type composite (G-ænial Anterior). The same universal adhesive system was used in all cases. Clinical evaluations were performed by a blinded examiner at 1 week, 6 months, and 12 months, using the FDI World Dental Federation criteria. Results: At the 1-year follow-up, 25 patients and 150 restorations were available for evaluation, corresponding to a recall rate of 98.22%. High clinical acceptability was observed in all groups with respect to aesthetic, functional, and biological parameters. Retention was 100% in the acid-etched paste-type composite group and ranged from 94.7% to 97.4% in the remaining groups, with no statistically significant differences among groups (p > 0.05). A transient increase in postoperative sensitivity was detected in the laser groups at the 1-week evaluation (p = 0.026); however, sensitivity scores declined to zero in all groups at 6 months and 1 year. Conclusions: High-filled injectable composites demonstrated 1-year clinical performance comparable to that of conventional paste-type composites in the restoration of NCCLs. Er,Cr: YSGG laser-based cavity conditioning produced outcomes similar to conventional phosphoric acid etching with respect to retention, marginal adaptation, and biological compatibility. The early increase in laser-related postoperative sensitivity was transient and did not compromise long-term clinical success. Taken together, the ease of application and favorable clinical performance of injectable composites indicate that these materials constitute a reliable alternative for the restoration of non-carious cervical lesions. Full article

(1) Background/Objectives: Gap formation contributes to the clinical failure of partial crowns. Therefore, it was analyzed at the interfaces between restoration, luting material, and tooth in partial crowns made of lithium disilicate ceramic (LS2) and nanohybrid composite (RBC) after thermomechanical loading (TCML) using optical coherence tomography (OCT). (2) Materials and Methods: Sixteen human mandibular molars were restored with CAD/CAM partial crowns made of LS2 (IPS e.max^® CAD) or RBC (Tetric^® CAD) using adhesive cementation (Variolink^® Esthetic DC). The restorations were imaged by OCT (1550 nm, 28 kHz) at t0 = 24 h, t1 = 90 days of water, t2 = after TCML with 480,000 loading cycles, and t3 = TCML with 1,200,000 loading cycles. Gap lengths (%) at interface 1 (partial crown-luting material) and interface 2 (luting material–enamel/dentin) were quantified. Groupwise and pairwise comparison of OCT parameters was conducted using the Mann–Whitney U, Friedman, and Conover–Iman tests with Bonferroni correction (α = 0.05). (3) Results: At interface 1, LS2 showed a larger median gap length than RBC (ceramic = 48.4%; composite = 5.2%, p < 0.01). At interface 2, the largest median gap length for LS2 was measured at the dentin (ceramic = 59.7%; composite = 52.5%), while for RBC, the enamel was more affected (ceramic = 26.2%; composite = 36.9%). (4) Conclusions: OCT enables reliable gap detection in partial crowns under functional loading and is therefore suitable for monitoring adhesive interface integrity. Under in vitro conditions, both materials demonstrated stable adhesive performance without debonding, while material-dependent differences in gap formation and distribution were observed. Full article

The objective of this in vitro study was to investigate the effects of dentin pretreatment protocols and thermocycling on the shear bond strength (SBS) of a self-adhesive resin cement (Maxcem elite chroma) on dentin. A total of 168 extracted human third molars were randomly divided into four main groups according to dentin pretreatment: no treatment, 10% polyacrylic acid, Optibond universal, and Scotchbond universal plus. Half of these were subjected to thermocycling (5000 cycles; 5–55 °C). Composite resin rods were bonded using the self-adhesive resin cement, and SBS was measured with a universal testing machine. Two-way ANOVA showed that dentin pretreatment and thermocycling significantly affected SBS, with significant interaction between factors (p < 0.001). The highest SBS was observed in the Optibond universal group (18.71 ± 0.43 MPa), while the lowest SBS occurred in the 10% polyacrylic acid-treated group after thermocycling (2.69 ± 0.39 MPa). Thermocycling significantly reduced SBS in all groups. These results indicate that pretreatment with a compatible universal adhesive improves bond durability, whereas 10% polyacrylic acid pretreatment adversely affects bonding performance. Full article

This study evaluated the effects of different provisional luting cement removal methods on the shear bond strength (SBS) of resin cement to dentin following immediate dentin sealing (IDS) performed with two adhesive systems. A total of 168 extracted, caries-free human third molars were used, of which 144 were allocated for SBS testing and 24 for scanning electron microscopy (SEM) analysis. Specimens were assigned according to the IDS protocol (no IDS, IDS with OptiBond FL, or IDS with G2-Bond), followed by provisional cementation using an eugenol-free temporary cement. Contaminated surfaces were subsequently cleaned with a hand scaler, aluminum oxide (Al₂O₃) air abrasion, or Katana Cleaner prior to final bonding with a dual-cure resin cement. SBS was measured after 24 h of water storage, and surface morphology was evaluated by SEM at 2500× magnification. IDS significantly increased SBS under uncontaminated conditions, with G2-Bond-based IDS exhibiting higher bond strength values than specimens without IDS. However, provisional cement contamination significantly reduced SBS regardless of the cleaning method applied, and none of the tested protocols fully restored the bond strength observed in uncontaminated IDS-treated dentin. SEM analysis revealed residual cement remnants and surface alterations after cleaning, even in specimens that appeared macroscopically clean. Within the limitations of this in vitro study, IDS enhances resin–dentin bonding when contamination is avoided; however, current mechanical and chemical cleaning methods are insufficient to completely recover bond strength compromised by provisional cement contamination, highlighting the importance of preventing contamination and preserving IDS layer integrity during indirect restorative procedures. Full article

The management of dental caries has evolved from the traditional mechanical approach of “extension for prevention” to a biologically oriented philosophy centered on preserving natural tooth structures. Minimally invasive dentistry (MID) emphasizes early detection, risk assessment, prevention, and conservative intervention based on the lesion’s activity and depth. This review outlines current evidence on non-operative, micro-invasive, and minimally invasive strategies, including fluoride therapy, remineralizing agents such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), self-assembling peptides that promote biomimetic enamel repair, sealants, and resin infiltration. Minimally invasive operative methods employ advanced technologies for selective tissue removal—chemomechanical systems (Carisolv, Papacarie, Brix3000), sono-and airabrasion, and new-generation polymeric and ceramic burs (SmartBur, Cerabur) designed to preserve sound dentin. Laser photoablation, particularly with erbium lasers (Er:YAG, Er,Cr:YSGG), enables precise cavity preparation with minimal thermal and mechanical stress. These approaches enhance patient comfort, reduce anesthesia requirements, and maintain tooth vitality. Despite limitations related to cost, equipment, and operator sensitivity, MID represents not only a set of refined clinical techniques but also a comprehensive, evidence-based treatment philosophy founded on biological principles, structural preservation, and the promotion of long-term oral health. Full article

Background and Objectives: The regeneration of the pulp–dentin complex represents an alternative to conventional root canal treatment, aiming to preserve tooth biology and function. Cell-free regenerative endodontic therapy (CF-RET) exploits endogenous stem cells from the periapical region without ex vivo cell manipulation. Despite growing interest, the biological mechanisms, clinical indications, and predictability of CF-RET remain not clearly defined. This structured narrative review aimed to update a previous review by analyzing recent human studies on CF-RET. Materials and Methods: This review was conducted using the PRISMA 2020 guidelines to guide transparent reporting of the literature search and study selection process and was registered in PROSPERO (CRD420251075131). In vitro and in vivo human studies published between January 2017 and December 2024 investigating CF-RET were included, while studies involving cell transplantation, non-human models, case reports, and reviews were excluded. Study selection, data extraction, and quality assessment using the QuADS tool were performed, and the evidence was synthesized using a qualitative narrative approach. Results: Sixty-four studies were included. In vitro studies reported favorable effects of growth factors, exosomes, and biomimetic scaffolds on stem cell viability, migration, proliferation, odontogenic differentiation, and angiogenesis, while neurogenic differentiation was less consistently investigated. Scaffold composition, microstructure, and rheological properties were also considered. In vivo studies mainly focused on immature teeth with incomplete root development and demonstrated positive clinical and radiographic outcomes, including root development and canal diameter reduction. Conclusions: The current evidence supports the biological potential of CF-RET as a regenerative approach; however, substantial heterogeneity, the limited number of clinical studies and the absence of standardized protocols preclude definitive conclusions, highlighting the need for further well-designed translational and clinical investigations considering clinical applicability. Full article

Background/Objectives: This study aimed to compare the cleaning efficacy, biomechanical stress distribution under simulated occlusal loading after instrumentation, and irrigant dynamics of three NiTi rotary systems, namely ProTaper Gold, TruNatomy, and SlimShaper, using a combined experimental, finite element analysis (FEA), and computational fluid dynamics (CFD) approach. Methods: Transparent 3D replicas of mandibular mesial roots filled with a gel-like pulp tissue were instrumented with the three systems (n = 13 per group). Standardized irrigation was performed with 4% NaOCl delivered through IrriFlex^® needles positioned 2 mm from the working length. Cleaning effectiveness was assessed through digital image analysis, FEA simulation of occlusal loading, and CFD evaluation of irrigation flow, wall shear stress, and dynamic pressure. Results: All systems left residual tissue, with no statistically significant differences in cleaning efficacy among them (p > 0.05). Descriptively, ProTaper Gold showed the lowest mean residual tissue (0.15 ± 0.25%), followed by SlimShaper (2.50 ± 3.81%) and TruNatomy (4.20 ± 5.12%). CFD revealed that ProTaper Gold generated the highest irrigant velocities and wall shear stresses, while SlimShaper showed the highest dynamic pressure. FEA indicated that ProTaper Gold produced the highest stress concentrations, especially in the pericervical dentin, whereas TruNatomy and SlimShaper preserved more dentin. Conclusions: Cleaning efficacy was comparable across systems. CFD/FEA from representative models illustrated patterns of irrigant dynamics and dentin preservation without supporting system superiority. Full article

Dual-cure composite cements are an important element of modern dental prosthetics, enabling a stable and long-lasting bond between prosthetic restorations and tooth tissues. Thanks to the combined mechanism of chemical- and light-curing polymerization, they are characterized by high clinical versatility. Despite their wide application, the impact of storage/pre-conditioning temperature on the mechanical properties of dual-cure composite cements remains unclear. The study evaluated the shear bond strength (SBS) of the bond between four dual cements—Bifix Hybrid Abutment (VOCO GmbH, Cuxhaven, Germany), MaxCem Elite (Kerr Corporation, Orange, CA, USA), EnaCem HF (Micerium, Avegno, Italy), and Multilink Automix (Ivoclar Vivadent, Schaan, Lichtenstein)—and dentin depending on their storage temperature (25 °C or 50 °C) and curing method. The tests were carried out on extracted human permanent teeth. The cements were divided into two temperature groups—stored for 7 days at 25 °C or stored for 7 days at 50 °C—and then each of these two temperature groups was divided into two groups—light- and chemically cured (dual-cured, LC) and chemically cured only (CC). Dual-cured cements showed higher shear bond strength at 25 °C. Storage at 50 °C lowered the SBS values, especially for the purely chemically bound cements. LC Bifix Hybrid Abutment achieved the highest SBS at 25 °C, but at 50 °C its properties deteriorated. EnaCem HF showed higher strength at a lower temperature; MaxCem Elite was stable at both temperatures, whereas Multilink Automix showed lower SBS at 50 °C. The study showed that the chemical composition of cements, especially the presence of a benzoyl peroxide (BPO) initiating system, can play a key role in their SBS when bonded to teeth tissue and stability at different storage temperatures. MaxCem Elite showed the best resistance to temperature changes—it achieved the highest temperature stability in both temperature groups. Full article

Background/Objectives: In the context of minimally invasive dentistry, photodynamic therapy (PDT) is regarded as a biologically oriented method for controlling microbial activity during caries excavation. Brix 3000 is a modern material used in chemo-mechanical removal of carious lesions, enabling selective elimination of infected dentin. The present study compares the antimicrobial effectiveness of Brix 3000 and adjunctive PDT performed with the FotoSan 630 Intro Kit. Methods: This study included 30 children aged 4–7 years with carious lesions on primary molars classified as ICDAS II code 06. The lesions were allocated into two groups: Group 1 (the control group), encompassing 15 lesions excavated using Brix 3000 only, and Group 2 (the experimental group), encompassing 15 lesions excavated with Brix 3000 followed by adjunctive PDT with the FotoSan 630 Intro Kit. A total of 75 microbiological samples were collected: 30 from infected dentin before excavation, 30 from partially infected dentin after Brix 3000, and 15 (experimental group only) after subsequent PDT. Results: The results revealed a wide diversity of cariogenic microorganisms in the infected dentin, with S. mutans being the most frequently isolated and present in the highest quantities. Using Brix 3000 reduced microbial diversity and quantity following excavation of partially infected dentin, although S. mutans persisted at lower levels. Conclusions: After the additional photodynamic disinfection, no microorganisms were isolated from the partially infected dentin. Adjunctive PDT provides localized, non-invasive antimicrobial disinfection and can be integrated into minimally invasive caries management in primary teeth. Full article

Background: Post-extraction alveolar ridge is an important factor affecting dental implant restoration. Among myriads of bone grafting materials, dentinal grafts are gaining faster popularity among clinicians. Unlike conventional xenografts derived from animal sources, these autogenous materials may offer advantages in terms of biocompatibility and cost. Objective: This article aims to compare their performance with other commonly used materials, like xenografts, or natural blood clots and to examine whether they could maintain bone quality and quantity during socket healing with better properties than the rest of the graft materials in terms of implants success rate. Methods: This search was conducted in multiple medical databases (PubMed/MEDLINE, Scopus, Cochrane Library, Embase, and Google Scholar) for studies published between 2015 and 2025. This search focused exclusively on randomized controlled trials. The study quality was assigned by using the Cochrane Risk of Bias 2 tool, performing statistical pooling of results using random-effects meta-analysis when appropriate. Results: Eight randomized controlled trials involving 249 patients and 281 bone graft sites were selected according to inclusion and exclusion criteria. Dentinal grafts produced significant increase in formation of new bone compared to xenografts (12.4% greater, 95% CI: 6.8–18.0%, p < 0.001). The grafts also resorbed more completely, leaving less foreign material behind (8.6% less residual material, p < 0.001). Importantly, implants placed in bone preserved with dentinal grafts showed comparable stability and success rates to those in bone treated with xenografts. When compared to allowing sockets to heal naturally, dentinal grafts dramatically reduced bone loss by 60–70% horizontally and 65–75% vertically. Remarkably only minor complications were observed (2.2%), with no serious adverse events across all studies. Conclusions: Our analysis indicates that dentinal grafts represent a viable and potentially superior alternative to conventional xenografts for not only preserving alveolar bone after tooth extraction but also in any existing bone defects. The evidence particularly supports using partially demineralized preparations. These materials demonstrate excellent biocompatibility, produce good bone quality, and offer cost advantages. Full article

This study aimed to evaluate the effect of preheating on the push-out bond strength (PBS) and microhardness (HV) of fiber-reinforced flowable and injectable composites and to compare them with dual-cure resin–cement for post cementation. Fifty premolars were endodontically treated, and post spaces were prepared. Specimens were divided into five groups (n = 10) based on the resin luting material. After adhesive application, fiber posts were luted with dual-cure resin–cement (LinkForce), fiber-reinforced flowable composites (EverX Flow; non-heated/preheated), and injectable composites (G-aenial Universal Injectable; non-heated/preheated). After 24 h, roots were sectioned (coronal, middle, apical) for PBS testing (Instron). For HV, 10 specimens per resin luting material were prepared, and top/bottom microhardness was measured to assess the depth of cure. Data were analyzed with two-way ANOVA and post hoc Tukey tests (p < 0.05). Both types of resin luting material and preheating significantly affected PBS and HV (p = 0.0001). Preheated EverX Flow showed significantly higher PBS and HV than LinkForce, while G-aenial Injectable exhibited the lowest values (p < 0.05). Within each resin luting material, PBS significantly decreased from the coronal to the apical region (p = 0.0001). Preheated fiber-reinforced flowable composites demonstrate improved microhardness and adhesion, offering a reliable alternative to the dual-cure resin–cements for fiber post cementation. Full article

Background/Objectives: Dental caries is one of the most prevalent chronic diseases in childhood. Rotary bur handpiece excavation has been the standardised mechanical benchmark for infected dentine removal in the primary dentition, but it is associated with noise, vibration, and nociceptive triggers that influence behavioural cooperation in paediatric patients. CMCR gels have been developed for selective softening and excavation of infected primary dentine without macroscopic removal of adjacent sound tissue at the protocol-defined site. The objective of this review was to systematically synthesise the evidence on chemomechanical caries removal (CMCR) using Papacarie or Brix 3000 compared with infected dentine excavation using rotary bur handpiece instrumentation in the primary (deciduous) dentition, focusing on excavation effectiveness, paediatric procedural tolerance, anaesthetic requirement, dentine surface morphology at the excavation interface, and protocol-level operative duration per primary molar. Methods: A systematic search was performed in PubMed, Web of Science, and Scopus for English-language studies from database inception to 31 December 2023. Although no eligible paediatric dental records addressing CMCR gels for excavation of infected primary dentine were identified before 2009, the earlier literature was not intentionally excluded; rather, it did not retrieve topic-specific matches meeting the eligibility criteria. Clinical and in vitro investigations evaluating CMCR gels (Papacarie or Brix 3000) for excavation of infected primary dentine in primary molars were eligible. Outcomes were aggregated qualitatively by excavation approach and reported per primary molar at the individual study protocol level. Quantitative pooling or meta-analysis was not conducted due to heterogeneity in study designs and lack of unified denominators across the included literature. Results: Fifteen studies were included (randomised clinical trials, observational clinical investigations, clinical comparative studies, and in vitro assessments) evaluating infected dentine excavation in primary molars. CMCR gels achieved successful excavation of infected primary dentine with dentine preservation at the adjacent non-infected interface without macroscopic loss of sound tissue. Individual study protocols that reported paediatric pain outcomes during primary-molar excavation registered lower pain scores, reduced acoustic/vibratory stress, lower anaesthetic escalation cycles, and decreased local anaesthesia requirement per primary molar compared with rotary bur handpiece excavation arms. Dentine surfaces analysed under SEM protocols at the infected excavation interface described patent tubules, absence of compacted smear at the interface, preserved intertubular dentine, and no iatrogenic gouging or macrofracture of non-infected primary dentine per molar at the individual study level. Operative duration for CMCR ranged from 10 to 25 min per primary molar per tooth, while rotary bur handpiece excavation required 3–10 min per primary molar per tooth, depending on cavity extension and dentine hardness, as defined by each study protocol. Microleakage and bond-strength assays performed in vitro at the individual protocol level did not register disadvantage signals traceable to adhesive or sealing incompatibility following CMCR gel excavation per primary molar. Conclusions: CMCR with Papacarie or Brix 3000 enables protocol-level selective excavation of infected primary dentine in primary molars, reducing acoustic, vibratory, and nociceptive triggers that influence behaviour and local anaesthetic requirement per primary molar. Clinical inference should be restricted to infected dentine excavation per primary-molar denominators, avoiding extrapolation to all caries depths or all deciduous-tooth types. Standardised paediatric primary-molar infected dentine excavation trials with homogeneous denominators, bias-controlled outcome instruments, and longitudinal follow-up are required to strengthen cavity-depth indications, pulp-proximal excavation reliability, and restorative longevity guidance in the primary dentition clinical workflow. Full article

This scoping review mapped the available evidence on marine algae-derived bioactive compounds, focusing on their biological activities related to collagen stabilization, matrix metalloproteinase (MMP) inhibition, and enamel remineralization in dental hard tissues. Four electronic databases (PubMed, Scopus, Embase, and Web of Science) were systematically searched following a predefined protocol. Original experimental studies involving human or animal dental hard tissues were included. Nine studies met the inclusion criteria. Brown algal derivatives, including fucoxanthin, fucosterol, and phloroglucinol, exhibited significant MMP inhibition and, in selected compounds, collagen cross-linking, contributing to enhanced mechanical properties and improved stability of collagen-rich matrices. In contrast, red algae extracts such as Lithothamnion calcareum primarily promoted enamel remineralization, achieving surface microhardness recovery comparable to or superior to 0.05% sodium fluoride. Alginate, a brown algae-derived polysaccharide, also demonstrated functional potential as a scaffold biomaterial through strong hydroxyapatite adsorption and suitability for three-dimensional scaffold fabrication. Overall, marine algae-derived compounds demonstrate biologically relevant activities that modulate collagen stability, enzymatic function, and mineral deposition processes. These findings highlight the pharmacological potential of marine bioactive compounds, with dental hard tissues representing a primary application context. However, further validation using clinically relevant models is required. Full article

Ex vivo human tooth culture models preserve the native dentine–pulp complex and offer a translational platform to study pulp-capping biomaterials. This systematic review aimed to synthesize the evidence on histological pulp tissue responses to calcium silicate-based cement (CSCs) used for direct pulp capping in human tooth culture models. The review followed PRISMA 2020 guidance. Eligible studies were ex vivo whole human tooth culture models with direct pulp exposure treated with commercial or experimental CSCs and reporting histological outcomes. Risk of bias was assessed using the QUIN tool. Thirteen studies were included. Most used immature human third molars (from 15- to 19-year-old patients) and culture periods up to 28 days, with a minority extending observation to 45–90 days. Across hydraulic CSCs, Biodentine was the most frequently evaluated material, followed by ProRoot MTA and several experimental hydraulic and resin-modified formulations. Overall, hydraulic CSCs were consistently associated with biocompatible pulp responses and a pro-mineralization pattern characterized by periexposure mineralized foci/osteodentin-like tissue; where assessed, immunohistochemistry supported odontoblast-like differentiation. In contrast, the resin-modified CSC TheraCal LC and other experimental resin-modified CSCs showed more heterogeneous findings, with reports of absent, delayed, or less prominent mineralization compared with reference hydraulic CSCs. In intact human tooth culture models, hydraulic CSCs show reproducible biocompatibility and early mineralization features consistent with reparative dentinogenesis, whereas resin-modified CSCs demonstrate more variable histological performance. Full article

Background: Autogenous tooth-derived grafts have been proposed as an alternative to xenografts for alveolar ridge preservation, offering biological similarity to bone and potentially more favorable remodeling. This study compared the healing outcomes of a collagenated xenograft, and a tooth-derived graft prepared with an automated processing device. Methods: Six Beagle dogs underwent bilateral extraction of the third and fourth mandibular premolars. Each animal contributed two sockets grafted with root-derived particulate prepared using an automated device for tooth cleaning, grinding, and demineralization, and two sockets grafted with a collagenated xenograft, all covered by a collagen membrane. After 3 months, histological sections were analyzed to assess crestal dimensions and the relative proportions of mature (lamellar) and immature bone (woven/parallel fibered), residual graft material, and soft tissues. Results: Lingual crest height did not differ between groups, whereas the buccal crest was slightly higher at xenograft sites compared with the tooth-graft sites. The tooth-graft group exhibited significantly fewer residual particles (0.5 ± 1.1%) and a higher proportion of total bone (65.6 ± 9.1%) compared with the xenograft group, which showed 19.7 ± 16.0% graft remnants (p = 0.032). Corticalization at the socket entrance was observed predominantly in the tooth-graft sites. No inflammatory infiltrates were detected in the examined section. Conclusions: Tooth-derived grafts promoted an almost complete replacement by vital bone with minimal residual material, whereas xenografts provided slightly better buccal contour preservation but resulted in regenerated tissues containing persistent graft particles. The biological differences observed may have implications for subsequent implant placement. Full article