Search Results (397)

Objectives: Variations in composite resin composition and aging time remain one of the main reasons for replacing esthetic restorations. This in vitro study aimed to evaluate the microtensile bond strength of a low-shrinkage composite resin on a demineralized dentin surface following adhesive interface degradation. Methods: Seventy-eight extracted human molars were prepared, and artificial caries lesions were induced. For microtensile bond strength (μTBS) testing, 60 teeth were randomly assigned to six experimental subgroups (n = 10 per subgroup) based on restorative system and thermal cycling condition. An additional 18 teeth were randomly assigned to six experimental subgroups (n = 3 each) for SEM analysis. Three restorative systems were evaluated, Z250 (conventional resin), K (Kalore resin), and P90 (Filtek P90 resin), each subjected to two thermal cycling conditions: without thermal cycling (NTC) and 12,000 thermal cycles (TC). Results: In the NTC groups, Z250 exhibited a significantly higher bond strength (25.29 ± 10.91 MPa) compared to K (9.69 ± 11.63 MPa) and P90 (9.81 ± 8.49 MPa) (p < 0.05). Following TC, a numerical decrease in bond strength was observed across all groups. Z250 (13.00 ± 10.76 MPa) maintained a significantly higher bond strength compared to K (4.30 ± 6.40 MPa) and P90 (0 ± 0 MPa) (p = 0.001). Notably, the P90 group showed a near-complete loss of bond strength after TC (0 ± 0 MPa), which was a statistically significant reduction compared to its NTC condition (p = 0.002). SEM analysis revealed a predominance of mixed failures in most experimental groups, while the P90 TC group showed a clear predominance of adhesive failures. Conclusions: This study demonstrates that the conventional Bis-GMA resin (Z250) consistently exhibited superior bond strength to demineralized dentin compared to the low-shrinkage resins (Kalore and Filtek P90) under both non-aged and aged conditions. While all materials experienced a reduction in bond strength after thermal cycling, the Filtek P90 system showed a catastrophic loss of adhesion after aging, indicating its particular susceptibility to degradation. These results emphasize the critical roles of resin chemistry and adhesive system selection in long-term bond durability in compromised dentin. Full article

Glass ionomer cements (GICs) are considered functionally biomimetic as they participate in ion-exchange processes that partially resemble the behavior of natural enamel and dentin, chemically bond to dental hard tissues, and release fluoride. While GICs are designed to interact with aqueous oral environments, their exposure to dietary beverages may affect their esthetic stability and water-related behavior within the oral environment. For biomimetic restorative materials to perform successfully in the oral environment, they must maintain not only bioactive properties but also esthetic stability and resistance to water-related degradation during exposure to dietary beverages. This study evaluated beverage-induced color changes, water sorption, and water solubility of six GICs following their immersion in coffee, tea, berry juice, cola, and distilled water (n = 5 per material per solution). Color measurements were recorded at baseline and after 2, 4, 6, and 8 weeks using a spectrophotometer, and color change (ΔE) values were calculated using the CIE L*a*b* system. Specimen mass was measured at baseline, after 8 weeks of immersion and then after 4 weeks of desiccation. Data were analyzed using repeated-measures Analysis of Variance (ANOVA) and Fisher’s least significant difference post hoc tests (α = 0.05). The results showed time, material, and solution significantly affected ΔE (p < 0.001). Tea produced the greatest discoloration overall, followed by coffee. ChemFil exhibited the greatest staining susceptibility, while Fuji II showed the lowest staining susceptibility. Water sorption and solubility were material- and solution-dependent. Clinically relevant discoloration of GICs was found when immersed in common beverages over time, with tea showing the strongest staining effect. These findings indicate that although GICs exhibit biomimetic characteristics through their interaction with tooth structures and aqueous environments, their long-term esthetic stability and resistance to environmental challenges should also be considered when selecting restorative materials for clinically visible areas. Full article

The study aimed to evaluate the effect of chlorhexidine (CHX), chlorin p6-mediated photodynamic therapy (PDT), magnesium oxide nanoparticles (MgONPs), and Clp6-functionalized MgONPs on smear layer removal and shear bond strength of a two-step etch-and-rinse adhesive to caries-affected dentin. Seventy-five human permanent molars with occlusal carious lesions and ICDAS scores of four and five were included. Twenty-five samples were used to prepare dentin discs 2 mm in thickness. The remaining samples, along with 25 discs, were arbitrarily allocated into five disinfectant groups, with n = 15 per group (10 teeth and 5 discs). Group I: Control, Group II: 2% CHX, Group III: Clp6-mediated PDT, Group IV: MgONPs, and Group V: Clp6-functionalized MgONPs. SL removal assessment, nanoparticle characterization, and EDX were performed using SEM. Fifty CAD were etched, followed by fifth-generation adhesive application and composite build-up. SBS and failure modes were evaluated with a universal testing machine and stereomicroscope, respectively. Group 4 (MgONPs) specimens displayed the maximum cleaning of SL (1.11 ± 0.13) and the highest SBS (10.32 ± 0.18 MPa). However, minimum SL removal (2.87 ± 0.94) and bond strength (7.42 ± 0.25 MPa) were exhibited by Group 1 (No disinfectant) samples. MgONPs possess the potential to be used as a cavity disinfectant, as they efficiently remove SL from CAD and augment the bond integrity outcomes. Full article

This study evaluated eleven resin cements used as core build-up materials by examining the following properties: (a) push-out force between root dentin and the fiber post; (b) pull-out force between the fiber post and the core build-up material; (c) shear bond strength of the resin cement to root dentin; (d) flexural strength of the resin cement; and (e) flexural modulus of elasticity of the resin cement. The purpose of this investigation was to clarify the relationships between recently available universal adhesives, core build-up materials, resin cements, and fiber posts. All experiments were performed at two evaluation periods: after 1 day of water storage (Base) and after 20,000 thermocycles (TC 20k). For the push-out test, simulated post spaces were prepared in single-rooted human premolars. The specimens were sectioned perpendicular to the long axis into 2 mm-thick slices and then subjected to push-out testing to assess the bond strength of the dentin–resin cement–fiber post complex. No significant differences in bonding performance were found between Base and TC 20k. These findings suggest that universal adhesives used for pretreatment of multiple substrates in fiber post cementation can provide not only strong but also durable adhesion over time. Full article

In computer-aided design/computer-aided manufacturing (CAD/CAM) restorations for severely damaged teeth, the cavity floor or proximal margins may be elevated with composite resin to improve adhesion. This in vitro study investigated how different surface pretreatment methods affect the shear bond strength (SBS) of hybrid CAD/CAM materials to dentin or composite surfaces, simulating clinical situations of composite elevation. Hybrid CAD/CAM samples were bonded to dentin or composite substrates following different surface pretreatment protocols and cemented using a dual-cure adhesive resin cement. The samples were thermocycled and subjected to shear bond strength testing, and failure modes were analyzed. The SBS in the sandblasting (SB)+Dentin group and hydrofluoric acid (HF)+Dentin was significantly higher than that in the SB+Composite and HF+Composite groups (p < 0.05). Untreated+composite and untreated+dentin groups showed significantly lower SBS (p < 0.05). Failure mode analysis revealed a predominance of cohesive failures in the SB+Dentin group, while adhesive failures were more frequently observed in most of the other groups. SB-treated and HF-etched hybrid CAD/CAM materials showed more favorable bonding behavior to dentin than to composite, highlighting that bonding to the elevated composite layer may be less effective than bonding directly to prepared dentin. Full article

Objective: The biocompatibility of adhesive systems is essential for the long-term success of restorative dental procedures due to their close proximity to dentin and pulpal tissues. This study aimed to evaluate the cytotoxic effects of adhesive systems with different pH values on L929 mouse fibroblast cells under in vitro conditions. Materials and Methods: Four commercially available adhesive systems with different pH values—All-Bond Universal, G-Premio Bond, Tokuyama Bond Force II, and Clearfil Universal Bond Quick—were evaluated. Cytotoxicity was assessed using the MTT assay at four different concentrations (0.1%, 0.01%, 0.001%, and 0.0001%) and three incubation periods (24, 48, and 72 h). Cell viability data were analyzed using two-way analysis of variance followed by Bonferroni post hoc tests. Cytotoxicity was interpreted according to ISO 10993-5 criteria. Results: All adhesive systems exhibited concentration-dependent cytotoxicity, with significant reductions in cell viability observed only at the highest concentration (0.1%). At lower concentrations, no cytotoxic effects were detected. Despite having the highest pH value, All-Bond Universal consistently demonstrated the lowest cell viability. In contrast, Tokuyama Bond Force II showed the most favorable cytocompatibility profile, with relatively higher cell viability values over time. Morphological analysis supported the quantitative findings, revealing pronounced cellular alterations at high concentrations and preserved fibroblastic morphology at lower concentrations. Conclusions: adhesive systems demonstrate cytotoxic effects in a concentration-dependent manner, and pH alone is insufficient to predict their biocompatibility. Monomer composition and formulation characteristics appear to play a more critical role in determining cytotoxic behavior. These findings emphasize the importance of appropriate adhesive handling and isolation techniques to minimize tissue exposure and enhance clinical safety. Full article

Background/Objectives: Demineralization around orthodontic brackets may compromise enamel integrity and alter the mechanical stability of the bracket–adhesive–enamel interface, thereby influencing bond performance and clinical outcomes. This study aimed to evaluate the effect of enamel demineralization on the fatigue-based shear bond strength (SBS) of different orthodontic brackets. Methods: Seventy-five extracted maxillary premolars subjected to demineralization were allocated into five groups (n = 15 per group). Victory metal (Group 1), APC Clarity Advanced ceramic (Group 2), Clarity Self-ligating ceramic (Group 3), Gemini metal (Group 4), and Clarity Advanced ceramic (Group 5) brackets were bonded to the tooth surfaces using Transbond XT (3M Unitek, Monrovia, CA, USA). The mean demineralization values of the specimens were recorded before demineralization (T0) and after exposure to an artificial cariogenic environment (T1). Fatigue-based SBS was evaluated under cyclic loading (10 N, 0.5 Hz) at a crosshead speed of 300 mm/min using a closed-loop controlled, low-cycle fatigue testing machine and expressed as the number of shear strokes to failure. The level of statistical significance was set at p < 0.05. Results: No significant differences in demineralization were observed among the groups at T0 (p > 0.05); however, all groups showed significant increases at T1 (p < 0.05), with Group 1 demonstrating significantly lower demineralization than the other groups (p < 0.05). Fatigue-based SBS was higher in Groups 1, 3, and 5 than in Groups 2 and 4, as indicated by a greater number of shear strokes to failure (p < 0.05). In Groups 2 and 4, a statistically significant negative correlation was observed between changes in enamel demineralization and the number of shear strokes to failure (p < 0.05). No hard tissue damage was observed in Group 5 during fatigue testing. Conclusions: Increased demineralization may adversely affect fatigue-based SBS and increase the risk of hard tissue damage. Under plaque-related demineralization conditions, Victory metal and Clarity Advanced ceramic brackets may demonstrate more favorable fatigue bond behavior; however, further in vitro and in vivo studies are required to confirm these findings. Full article

This study evaluated the effect of saliva contamination at different stages of application of an acetone-based universal adhesive on dentin bond strength. Seventy-two caries-free third molars were assigned to six groups (n = 12) according to contamination step. Specimens underwent shear bond strength testing. To determine the SBS, each bonded specimen was subjected to an SBS test in a universal testing machine (Shimadzu Autograph AGS-X; Shimadzu Corp., Kyoto, Japan) equipped for operating at a crosshead speed of 1 mm/min. Data were analyzed using one-way analysis of variance (ANOVA) followed by Tamhane’s T2 test for post hoc multiple comparisons with p ˂ 0.05 as the significance level. Saliva contamination significantly affected dentin bond strength (p < 0.001). The highest bond strength was observed in the post-polymerization contamination group with adhesive reapplication (12.32 MPa), whereas the lowest values were recorded when contamination occurred after the initial adhesive application (6.37 MPa). Overall, contamination prior to polymerization resulted in reduced bond strength, while reapplication of adhesive after polymerization improved bonding performance. Within the limitations of this in vitro study, salivary contamination adversely influences the dentin bonding effectiveness of acetone-based universal adhesives, particularly when it occurs before curing. However, adhesive reapplication following post-polymerization contamination may partially compensate for this effect. Full article

Background/Objective: Resin-based composite (RBC) gained wide popularity in dentistry due to its excellent biocompatibility, superior aesthetics, and good bonding to enamel and dentine. However, they have several shortcomings, including mechanical insufficiency and shrinkage tendency. Many researchers have utilized nanoparticles (NPs) as a reinforcing filler for RBCs. This article focused on assessing the impact of three different nanoparticles, ZrO₂, TiO_2, and SiO_2, with concentrations of 3 wt% and 7 wt%, on the elastic modulus (E) and fracture toughness (K_IC) of one commercial light-activated dental resin composite. Methods: 140 rectangular specimens were constructed according to ISO 4049 with dimensions (25 × 2 × 5 ± 0.03 mm) and (25 × 2 × 2 ± 0.03 mm) for fracture toughness and elastic modulus, respectively. Specimens were categorized into four main groups based on nanofiller types. Control: plain without filler (CC) and three modified ones with ZrO₂ (ZC), TiO₂ (TC), and SiO₂ (SC). Furthermore, modified groups were divided into two subgroups according to nanofiller concentration, 3 and 7 wt% (ZC3, ZC7, TC3, TC7, SC3, and SC7), n = 10. Mechanical testing for fracture toughness was completed using a single-edge notched beam, while a three-point bending test was used for elastic modulus. Analysis of data was based on two-way ANOVA and Bonferroni post hoc (α = 0.05). Results: ZrO₂ provided the most substantial improvement in both E and K_IC, with the optimal performance observed at 3 wt% for stiffness and 7 wt% for toughness. TiO₂ groups also enhanced these properties at both concentrations; however, the gains were less pronounced compared to ZrO₂. SiO₂ improved mechanical performance at 3 wt%, but a higher loading of 7 wt% resulted in reduced values. Conclusions: Resin-based composite modified with 3 wt% of NPs tends to possess higher fracture toughness and modulus of elasticity. Fracture toughness enhancement was concentration-dependent with ZrO₂ NPs, where the best result was obtained with 7 wt%. Nanoparticle-reinforced composite, particularly ZrO₂, may be suitable for prosthodontic applications. Full article

Background: This in vitro study evaluated the effects of two different adhesive application approaches (total-etch and self-etch) and gallic acid (GA) pretreatment on the dentin microshear bond strength (μSBS) of a universal adhesive system. Bond strength was assessed both before thermal aging and following aging procedures simulating approximately 1 and 5 years of clinical service. Materials and Methods: One hundred twenty intact human incisors were allocated to experimental groups according to the adhesive strategy, presence or absence of gallic acid (GA) pretreatment, and thermocycling regimen (0, 10,000, or 50,000 cycles). A universal adhesive system (G-Premio BOND) in combination with a nanohybrid composite resin was applied in accordance with the manufacturers’ instructions. Microshear bond strength (µSBS) was determined using a universal testing device. The obtained data were analyzed by three-way ANOVA and subsequently compared using Tukey’s post hoc test at a significance level of 0.05. Results: In the total-etch approach, pretreatment with gallic acid (GA) resulted in significantly greater µSBS values than those observed in the corresponding untreated specimens under all aging conditions (no thermocycling: 18.53 ± 0.99 vs. 11.33 ± 0.81 MPa; 1-year: 19.86 ± 0.82 vs. 11.60 ± 0.58 MPa; 5-year: 19.04 ± 0.62 vs. 10.28 ± 0.83 MPa; p = 0.001). A comparable trend was noted for the self-etch strategy, where GA application significantly enhanced bond strength compared with the non-treated groups (no thermocycling: 21.70 ± 0.98 vs. 14.19 ± 1.17 MPa; 1-year: 22.60 ± 0.50 vs. 14.94 ± 0.85 MPa; 5-year: 22.32 ± 0.59 vs. 12.94 ± 0.84 MPa; p = 0.001). Across all thermocycling conditions, the self-etch mode consistently produced higher bond strength values than the total-etch mode. Thermal aging did not significantly influence µSBS in the GA-treated groups. In contrast, in the absence of GA pretreatment, thermocycling led to a reduction in bond strength, particularly after the 5-year aging protocol. Conclusions: Gallic acid pretreatment significantly improved dentin bond strength and contributed to the preservation of bond durability after thermal aging. The highest µSBS values were obtained when the self-etch approach was combined with gallic acid (GA) pretreatment, suggesting that GA may serve as a beneficial adjunct for improving the durability and long-term performance of resin–dentin bonds. 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

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

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