Search Results (92)

Background: Early detection of dental caries is essential for effective oral health management. Current diagnostic workflows rely heavily on radiographic imaging, which involves infrastructure requirements, workflow coordination, and resource considerations that may limit frequent use in high-throughput or resource-constrained settings. These contextual factors motivate exploration of adjunct screening concepts that could support front-end triage decisions within existing care pathways. This study evaluates, in simulation, whether modeled tooth-percussion response signals contain sufficient discriminative information to justify further translational and managerial investigation. Implementation costs, workflow optimization, and economic outcomes are not evaluated directly; rather, the objective is to assess whether the technical preconditions for a potentially scalable screening concept are satisfied under controlled in silico conditions. Methods: An in silico model of tooth percussion was developed in which enamel, dentin, and pulp/root structures were represented as a simplified layered mechanical system. Impulse responses generated from simulated tapping were used to compute the modeled surface-vibration response (enamel-layer displacement), which served as a proxy for a measurable percussion-related signal (e.g., contact vibration), rather than a recorded acoustic waveform. Carious conditions were simulated through depth-dependent reductions in stiffness and effective mass and increases in damping to represent enamel and dentin demineralization. A synthetic dataset of labeled simulated signals was generated under varying structural parameters and measurement-noise assumptions. Machine-learning models using Mel-frequency cepstral coefficient (MFCC) features were trained to classify healthy teeth, enamel caries, and dentin caries at a screening (triage) level. Results: Under baseline simulation conditions, the classifier achieved an overall accuracy of 0.97 with balanced macro-averaged F1-score (0.97). Misclassifications occurred primarily between healthy and enamel-caries categories, whereas dentin-caries cases were most consistently identified. When measurement noise and structural variability were increased, performance declined gradually, reaching approximately 0.90 accuracy under the most challenging simulated scenario. These results indicate that discriminative information is present within the modeled signals at a screening (triage) level, meaning that higher-risk categories can be distinguished probabilistically rather than with definitive diagnostic certainty. Sensitivity and specificity trade-offs were not optimized in this study, as the objective was to assess separability rather than to define clinical decision thresholds. Conclusions: Within the constraints of the in silico model, simulated tooth-percussion response signals demonstrated discriminative patterns between healthy, enamel caries, and dentin caries categories at a screening (triage) level. These findings establish technical plausibility under controlled simulation conditions and support further investigation of percussion-based screening as a potential adjunct to clinical assessment. From a healthcare management perspective, the present results address a prerequisite question—whether such signals contain sufficient information to justify translational research, rather than demonstrating workflow optimization, cost reduction, or system-level impact. Clinical validation, threshold optimization, and implementation studies are required before managerial or operational benefits can be evaluated. Full article

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

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/Objectives: This article presents a novel approach that combines the Palatal Silicone Key and Injection Molding techniques as a viable alternative for complex anterior cases with high esthetic demands, where layering multiple shades is essential to achieve a natural appearance, rather than using a single monochromatic composite. Methods: The Palatal Silicone Key technique utilizes a silicone index to transfer palatal and incisal anatomy from a diagnostic wax-up, allowing freehand layering of proximal and buccal surfaces with multiple composite shades. The Injection Molding technique provides a simpler and more predictable workflow by using a transparent silicone index to replicate the wax-up. However, the original injection technique relies on a single-shade composite, limiting the esthetic outcomes. In the presented case canines and first premolars were reshaped to replace congenitally missing lateral incisors. Palatal surfaces were built with medium-viscosity enamel shade composite using the silicone key, and dentin anatomy was sculpted freehand with dentin shade composite. Buccal anatomy was restored by injecting enamel shade flowable composite into the transparent index. Results: This combined protocol facilitated the precise transfer of the wax-up, minimizing adjustments, while the use of multiple composite shades reproduced the natural translucency of adjacent teeth, resulting in highly esthetic restorations. Conclusions: Handling traditional composites in complex anterior cases can be time-consuming and technique-sensitive. The presented combination of techniques, while requiring a high level of skill and precision, integrates the strengths of both approaches, enabling a minimally invasive, additive workflow with reduced clinical time and more predictable esthetic outcomes. Full article

Background and Objectives: Preheated composite resins have been proposed as an alternative to conventional luting agents due to their improved resistance, color stability, and adaptation. This review aims to critically evaluate the current literature on the use of preheated composites as luting agents exclusively on dentin and enamel, focusing on their mechanical behavior, optical properties, and biological effects, in order to determine whether they provide superior clinical outcomes compared with conventional resin cements. Materials and Methods: A comprehensive literature search from 2015 to 2025 was conducted in accordance with PRISMA-ScR guidelines. Eligible studies included in vitro investigations comparing the preheated composite with other luting agents performed on human, bovine, analog dentin or enamel substrates. Studies meeting these criteria were screened, evaluated, and synthesized. Results: Fifteen studies met the inclusion criteria: nine focused on the mechanical performance, and the remaining six studies examined additional properties such as color stability, pulpal temperature changes during preheating, film thickness characteristics, and the influence on marginal discrepancy. Conclusions: Preheated composite resins offer improved mechanical properties, marginal adaptation, and fracture resistance compared with conventional luting agents. However, their performance is highly technique-sensitive, and clinical outcomes depend on operator skill, restoration thickness, and material selection. Preheating generally does not compromise color stability, but it can elevate pulpal temperature, particularly when residual dentin is thin. Overall, preheated composites have potential clinical advantages, provided that careful handling and appropriate application are ensured. Full article

Dental pain often arises from the compromised integrity of the tooth pulp due to dental injury or caries. The dentin–pulp complex has long been considered to be central to the unique biology of dental pain. Most trigeminal ganglion afferents projecting into tooth pulp are myelinated neurons, which lose their myelination at the site of peripheral dentin innervation. The pulpal afferents likely combine multiple internal and external stimuli to mediate nociception and maintain pulp homeostasis. Transient receptor potential (TRP) ion channels in neurons and odontoblasts, along with mechanosensitive ion channels such as Piezo, form a key molecular hub for pulpal nociception by sensing thermal, chemical, and hydrodynamic stimuli. Among these, TRP vanilloid 1 (TRPV1) mediates nociception and the release of calcitonin-gene-related peptides (CGRPs), while TRP canonical 5 (TRPC5) mediates cold pain. TRP melastatin 8 (TRPM8) mediates the transduction of hyperosmotic stimuli. Pulpitis elevates endogenous TRPV1 and TRPA1 agonists, while inflammatory mediators sensitize TRP channels, amplifying pain. CGRP recruits immune cells and promotes bacterial clearance and reparative dentinogenesis, yet the roles of TRP channels in these processes remain unclear. Future studies should use advanced multi-omics and in vivo or organotypic models in animal and human teeth to define TRP channel contributions to pain, immune responses, and regeneration. Understanding neuronal and non-neuronal TRP channel interactions and their integration with other ion channels may enable novel analgesic and regenerative strategies in dentistry. Full article

The intra- and intercellular signaling molecule nitric oxide (NO) is produced in endothelial cells by the activity of endothelial NO synthase (eNOS). Upon formation, NO diffuses into the underlying vascular smooth muscle cells, where it activates NO-sensitive guanylyl cyclase (NO-GC) resulting in the production of cyclic guanosine 3′,5′-monophosphate (cGMP) from guanosine 5′-triphosphate (GTP). Inducing vasodilatation, inhibiting platelet aggregation and leukocyte adhesion, and inhibiting the proliferation and migration of vascular smooth muscle cells, the NO-cGMP signaling leads to a number of anti-inflammatory processes. Inflammation-dependent elevated concentrations of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in blood vessels of inflamed dental pulp induce an uncoupling of eNOS and oxidized NO-GC, leading to a disruption of NO-cGMP signaling. Endothelial dysfunction in inflamed dental pulp alters cell–cell and cell–matrix interactions, reducing the regenerative and reparative potential of the dentin–pulp complex in response to carious lesions. In the therapeutic management of caries, it is essential to consider the presence of endothelial dysfunction in the inflamed dental pulp. The utilization of NO-GC stimulators and activators in indirect and direct pulp capping materials may enhance the regeneration and repair potential of inflamed dental pulp. Full article

Background: Immediate Dentine Sealing (IDS) is a well-established adhesive strategy that protects freshly cut dentine and enhances the clinical performance of indirect restorations. While its mechanical benefits are extensively documented, the surface morphology and chemical nature of the sealed dentine, particularly following provisionalisation and reactivation, remain under-characterised. Understanding this bonding substrate is critical for optimising adhesion and long-term outcomes. Methods: This narrative review synthesises the literature on the morphological and chemical features of dentine following IDS, focusing on the distinction between cross-sectional and surface-level characterisation, as well as the analytical techniques employed. Results: Most studies concentrate on internal bond strength and failure analysis, with only a limited subset incorporating surface-sensitive methods such as top-down SEM or optical non-contact profilometry. Quantitative and chemically resolved data on the reactivated dentine surface, the dentine surface after cleaning or abrasion, prior to cementation are scarce, and standardised analytical protocols are lacking. Conclusions: The bonding interface in IDS, namely the reactivated dentine surface, is underexplored. Future research should apply advanced, non-destructive techniques to characterise this clinically relevant substrate and guide the development of adhesive systems tailored to IDS-treated dentine. Full article

Premixed bioceramic sealers represent a recent advancement in endodontic obturation, combining bioactivity, moisture-induced mineralization and favorable handling properties. When used with warm gutta-percha techniques, these calcium silicate-based sealers are exposed to elevated temperatures that may influence their physicochemical behavior and interfacial performance. This review aimed to summarize current evidence on premixed bioceramic sealers used in conjunction with thermoplastic obturation techniques. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2020 and July 2025 evaluating the physicochemical properties, bioactivity, sealing ability, fracture resistance, clinical outcomes and retreatability of premixed bioceramic sealers under warm obturation conditions. No meta-analysis was performed—this review provides a narrative synthesis of the available evidence within this scope. Twenty-five studies met the inclusion criteria. In vitro and ex vivo data indicate that premixed bioceramic sealers generally maintain chemical stability and bioactivity when exposed to clinically relevant heating protocols, with favorable dentinal tubule penetration, interfacial adaptation and the formation of calcium silicate hydrate, and hydroxyapatite at the sealer–dentin interface. These characteristics are associated with improved filling homogeneity, potential reinforcement of root dentin and high rates of periapical healing reported in limited short-term clinical studies. However, the evidence also highlights important challenges, including technique-sensitive retreatability, material remnants after re-instrumentation and concerns regarding overextension, and long-term dimensional stability. Within the limitations of predominantly in vitro and short-term clinical evidence, premixed bioceramic sealers used with warm gutta-percha techniques appear to be promising functional materials that combine mechanical sealing with bioactive and mineralizing potential. Standardized protocols and robust long-term clinical studies are needed to confirm their durability, retreatability and prognostic impact in routine endodontic practice. Full article

Background/Objectives: Gingival recession (GR), characterized by the apical displacement of the gingival margin leading to root exposure, risk of root caries, dentine hypersensitivity (DH), and plaque accumulation. This study aimed to evaluate the awareness, causes, and consequences of gingival recession among adults in Saudi Arabia. Methods: A cross-sectional self-reported survey was conducted from September 2023 to December 2024, involving 619 participants (51.53% male). Participants were recruited through dental clinics, community centers, and online platforms across multiple regions in Saudi Arabia to ensure diverse demographic and socioeconomic representation. A validated 27-question survey collected data on demographics, oral hygiene practices, and GR awareness and related factors. Statistical analysis was performed using SAS 9.4, with significance set at p < 0.05. Results: The prevalence of GR was 26.66%, dental plaque was the most frequently reported causing factor, followed by medical conditions (45.4%). Aesthetic concerns were the most recognized consequence (78.4%) followed by periodontitis and tooth mobility and tooth loss (58.5%). Medical disease (Odds Ratio OR = 2.149, p < 0.0001), trauma (OR = 1.515, p = 0.0078), and rough brushing (OR = 1.431, p = 0.0233) were identified as significant risk factors for gingival recession. The association between gingival recession (GR) and its perceived consequences was generally not statistically significant. However, a significant relationship was observed with dental caries (p = 0.0472). Conclusions: Gingival recession awareness among Saudi adults was influenced by age, gender, smoking, and oral hygiene factors. The findings emphasize the importance of raising awareness and promoting preventive strategies targeting modifiable risk factors to reduce GR prevalence and clinical impact. Full article

Background: The use of zirconia-based restorations has increased in dentistry due to their aesthetics, high strength, and biocompatibility. However, achieving durable adhesion between resin cements and zirconia remains a challenge in restorative dentistry. Adhesive failures can lead to complications ranging from dentin hypersensitivity to the loss of the restored tooth. This review evaluates the impact of surface treatments based on silica coatings as a strategy to improve the adhesion of resin cements to zirconia. Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed in Scopus, Web of Science, PubMed, EBSCO, and ScienceDirect. In vitro studies were included if they (1) evaluated silica-based coatings on zirconia surfaces; (2) measured bond strength at the zirconia–cement interface through shear tests (MPa) and reported failure type (adhesive, cohesive, mixed); (3) used ≥8 specimens per group; and (4) included an untreated zirconia control group. Data were extracted and compared for conditions before and after thermocycling in the studies that reported this procedure. Results: The average bond strength for silica-coated zirconia was 15 MPa without thermocycling and 11.97 MPa after thermocycling, regardless of the coating technique. These values were significantly higher than those of untreated zirconia (8.45 MPa and 6.41 MPa, respectively). Cohesive and mixed failures predominated in silica-treated groups, suggesting more effective adhesion compared to controls, which presented mainly adhesive failures. Conclusions: Silica coatings, especially when combined with adhesion promoters, MDP-based primers, significantly enhance the bond strength of resin cements to zirconia. This reduces the risk of secondary caries, sensitivity, restoration debonding, and potential tooth fractures. However, the effectiveness of these coatings varies depending on the technique used, suggesting the need to standardize protocols to optimize clinical outcomes. Full article

Although caries is declining in industrialized countries, early childhood caries and molar–incisor hypomineralization (MIH) remain clinically relevant. To meet the demand for effective and well-tolerated preventive strategies, hydroxyapatite (HAp) has gained attention as a biocompatible, fluoride-free agent. A structured narrative review was conducted to evaluate recent clinical evidence on the use of HAp. A PubMed search identified clinical trials from the past five years that investigated HAp-based products. Studies were included if they reported clinical outcomes related to remineralization, caries prevention, or desensitization. Fifteen clinical studies met the inclusion criteria. HAp seems to be a safe and effective alternative to flouride, especially for children or individuals at risk of overexposure. While both agents show similar efficacy in caries prevention, HAp may offer additional advantages in managing hypersensitivity and MIH. Compared to other remineralizing agents, such as calcium sodium phosphosilicate, HAp demonstrated comparable efficacy. Combination therapies show the most promising results. Future research should explore synergies of active ingredients and include standardized long-term studies to substantiate the clinical relevance of HAp. Full article

The purpose of this in silico study was to evaluate the main difference of the adhesion strength of direct and semi-direct composite resin restorations in dentin using micro-tensile testing (μTBS) and finite element analysis (FEA). This in silico study employed cohesive zone traction and shear laws to investigate interfacial damage in both restoration groups. Tridimensional finite element models of both restoration specimens were created. A 20 μm thick resin cement layer was created for the semi-direct case. The Clearfil SE Bond 2 adhesive system and the restorative material, Ceram X Spectra ST HV composite resin, were used on both restorations. The numerical bond strength of both restoration techniques was evaluated using two different analysis assumptions. In the first assumption, the numerical analysis procedure included only the non-linear behavior of dentin and the von Mises damage criterion, whereas cohesive zone models were included in the second analysis assumption. The influence of dentin-adhesive cohesive mechanical properties was studied using values reported in the literature, and a sensitivity study helped improve the correlation between experimental and numerical results. The mechanical properties of the composite cohesive zone were defined assuming that the interface strength of dentin and composite follows the values reported by the manufacturer of Spectra ST. Damage initiation and progression were analyzed, and strains and stresses of the cohesive zone models (CZM) were compared with the corresponding perfect bonded models. The experimental µTBS results for the direct restoration strategy showed an adhesive strength of 38.156 ± 10.750 MPa, while the CZM predicted a slightly higher value of 40.4 ± 10.8 MPa. For the indirect restoration strategy, the experimental adhesive strength was 25.449 ± 10.193 MPa, compared to a numerically predicted strength of 28.1 ± 9.3 MPa. Overall, the CZM tends to overestimate the adhesive strength relative to experimental values. The statistical analysis of dentin extension strains for direct (DR) and semi-direct (SR) group models reveals that the SR configuration yields higher strain levels. Hence, these results suggest that, assuming identical dentin properties across both restoration groups, the material configuration in the direct restoration offers better mechanical protection to the dentin. These findings highlight the critical role of incorporating damage mechanics to more accurately characterize stress distribution during tooth rehabilitation. Full article

This investigation aims to evaluate the biocompatibility and assess the cytotoxicity of synthesized ZnO/Ag heterojunction nanorods with commercially available root canal sealers in India. Among the commercially available root canal sealers, zinc oxide (ZnO) eugenol-based sealers are widely utilized as per Grossmann’s requirements. However, these ZnO eugenol-based sealers often experience solubility issues and tissue reactions in contact with periapical tissues. To overcome the inexplicable reactivity of ZnO eugenol-based sealers, nano ZnO and nano ZnO/Ag heterojunction materials have been developed via a wet-chemical approach and studied to assess their biocompatibility and cytotoxicity. The findings of our study revealed that nano ZnO/Ag heterojunction material possesses a higher degree of biocompatibility and low cytotoxicity as compared to conventional ZnO eugenol-based sealers, attributed to its high surface-to-volume ratio, the enhanced penetration of nanosized sealers into dentinal tubules, and the synergistic spillover sensitization effect of nano ZnO combined with Ag nanoclusters. From this comparative evaluation of root canal sealers, the usage of nano ZnO/Ag heterojunction materials was found to be significantly advantageous over commercial zinc oxide eugenol-based sealers and may find profound usage with a long shelf-life. Full article

Background/Objectives: This study evaluates the effectiveness of a toothpaste containing Java Tea and Little Ironweed in alleviating tooth sensitivity compared to a conventional potassium nitrate toothpaste. Methods: A total of 90 healthy patients aged 18–70 with up to two teeth exhibiting gingival recession were recruited into this study. All selected teeth had a visual analog scale (VAS) score ≥ 4 in response to tactile or air blast stimuli. Excluded teeth included those requiring restoration or participants undergoing treatments affecting sensitivity or taking pain medication/anti-sensitivity agents. Participants were randomly divided into three groups and instructed to brush twice daily with different toothpastes. The S1 group was prescribed toothpaste containing Java Tea and Little Ironweed extract, the S2 group was prescribed toothpaste containing Java Tea and Little Ironweed extract with 0.7% potassium nitrate, and the S3 group was prescribed toothpaste containing potassium nitrate. VAS scores were recorded at baseline, 2 weeks, and 4 weeks. Data were then compared and statistically analyzed between the groups. Results: For the tactile test, the final number of included teeth was 47 in the S1 group, 46 in the S2 group, and 22 in the S3 group. For the air blast test, the number of teeth included was 38 in the S1 group, 30 in the S2 group, and 27 in the S3 group. At baseline, mean VAS scores were comparable across groups for both tactile (S1: 6.89 ± 0.98; S2: 6.65 ± 1.52; S3: 6.82 ± 1.99) and air blast tests (S1: 7.39 ± 1.15; S2: 7.53 ± 1.31; S3: 6.89 ± 2.12). All groups showed significant reductions in VAS scores from baseline at both 2 and 4 weeks. A Kruskal–Wallis test indicated significant between-group differences in VAS scores at 2 and 4 weeks (p = 0.001). Post hoc analysis (Dunn’s test with Bonferroni correction) at 2 weeks revealed that the S1 group had significantly higher VAS scores than those of S2 (tactile p = 0.001, air blast p = 0.001) and S3 (tactile p = 0.002, air blast p = 0.018). By 4 weeks, the S2 group demonstrated superior efficacy, with significantly lower VAS scores compared to those of S1 (tactile p < 0.001, air blast p = 0.030) and S3 (tactile p = 0.035, air blast p = 0.001). Conclusions: All tested toothpastes effectively reduced dentin hypersensitivity over the study period. Potassium nitrate toothpaste provided more rapid initial relief, when compared to the herbal formulation alone; however, both achieved similar outcomes by 4 weeks. The herbal toothpaste supplemented with potassium nitrate demonstrated superior efficacy and may offer a promising natural alternative for managing dentin hypersensitivity. Full article