Search Results (540)

Background: Traditional visual-tactile methods, radiographic interpretation including CBCT imaging, clinical judgement and supplementary aids such as fluorescence-based devices are pivotal components of the restorative diagnostic process in detecting dental caries and defective or failed restorations. However, when evaluating the restorability of a tooth compromised by extensive and deep caries, whether associated with a failed restoration or not, the conventional approach may not provide sufficient diagnostic information to establish a definitive restorative diagnosis without first removing failing restoration, caries or both. Objective: This manuscript presents caries clearance management (CCM) as a novel comprehensive clinical diagnostic restorative procedure designed to assist dentists in making a final restorative diagnosis regarding the restorability of a tooth compromised by extensive caries, fractured tooth cusp(s) or a failed large direct/indirect restoration without caries or a combination of all of them. Practical implications: CCM involves removing the failed direct/indirect restorations and selective removal of carious tissue while preserving the greatest amount of sound tooth structure as possible. Following this clinical diagnostic procedure and an assessment of dental pulp and periodontium, the clinician proceeds through a decision-making process to determine the final restorative diagnosis. This allows the dentist to advise the patient on a suitable complex restorative treatment plan. Conclusions: The manuscript introduces caries clearance management (CCM) as a structured clinical diagnostic procedure, to assist dentists to determine the restorability of compromised teeth by extensive caries, fractured teeth or failed large direct or indirect restorations. Full article

Biomimetic restorative dentistry aims to preserve tooth structure and achieve optimal aesthetic harmony with surrounding dentition. The principles and protocols associated with biomimetic restorative dentistry are designed to enhance the longevity of the restoration. The use of flowable CRs is increasingly common; however, the effect of viscosity on the discoloration has not been clearly established. This in vitro study aimed to assess the color stability of flowable CRs with varying viscosities following immersion in common staining solutions and subsequent repolishing. A total of 250 disc-shaped specimens (8 mm × 2 mm) were prepared from five CRs with different viscosity profiles: high-viscosity (Spectra STHV, Dentsply, Milford, DE, USA), medium-viscosity (Estelite Universal Flow Medium, Tokuyama Dental Co., Tokyo, Japan), bulk-fill (Estelite Bulk-Fill Flow, Tokuyama Dental Co., Tokyo, Japan; SDR Plus, Dentsply, Milford, DE, USA), and packable (Estelite Posterior, Tokuyama Dental Co., Tokyo, Japan). After polymerization and baseline color measurements, specimens were immersed in coffee, tea, cola, red wine, or distilled water for 144 h. Color values were recorded before and after staining, and again following repolishing. Color changes (ΔE₁, ΔE₂, ΔE₃) were calculated using the CIE Lab system and statistically analyzed via two-way ANOVA and Tukey HSD (α = 0.05). Both the CR type and the staining solution substantially affected the color change. SDR Plus exhibited the highest ΔE values. Red wine caused the most discoloration. Repolishing enhanced color in selected groups. Full article

Background: A major challenge in adhesive dentistry, often leading to restoration failure, is microleakage. This in vitro comparative study was designed to assess microleakage at the tooth–composite interface. The investigation aimed to compare the sealing efficacy of two commonly used adhesive systems. Methods: Standardized Class I cavities were prepared on 20 extracted human molars and randomly divided into two groups (n = 10 each). Group A was treated with a fifth-generation total-etch adhesive (OptiBond™ Solo Plus, Kerr Corporation, Orange, CA, USA), and Group B received a seventh-generation self-etch adhesive (Adhese® Universal VivaPen®, Ivoclar Vivadent AG, Schaan, Liechtenstein). All restorations were completed using Herculite XRV composite resin. Microleakage was evaluated using dye penetration analysis after immersion in 2% methylene blue for 10 days, followed by longitudinal sectioning and microscopic measurement at 500× magnification. Results: The fifth-generation adhesive group showed a mean microleakage of 0.2503 ± 0.1921 mm, while the seventh-generation group recorded 0.2484 ± 0.1764 mm. Statistical analysis using an independent t-test revealed no significant difference between the groups (p = 0.696). Conclusions: Both adhesive systems demonstrated comparable performance in minimizing microleakage under standardized conditions. Although the total-etch group exhibited slightly lower numerical values, the difference was not statistically significant. These findings suggest that both adhesive approaches can be clinically effective when applied appropriately. Full article

Biomimetic restorative treatments in pediatric dentistry increase the longevity of the restoration compared to traditional methods and aim to preserve the natural tooth structure. Prefabricated zirconia crowns have been developed as aesthetic alternatives to stainless steel crowns for full-coronal restorations of primary teeth. This study aimed to compare the fracture resistance and microleakage of two different posterior zirconia crown brands—NuSmile^® (USA) and ProfZrCrown^® (Turkey)—cemented with either conventional glass ionomer cement (GIC) or resin-modified glass ionomer cement (RMGIC). Eighty extracted primary molars were divided into four groups (n = 20). Crowns were cemented with Ketac™ Cem Radiopaque (GIC) or Ketac™ Cem Plus (RMGIC), in accordance with the manufacturers’ instructions, and then subjected to thermocycling. Fracture resistance was tested on 40 samples by applying an increasing compressive load until failure, with values recorded in Newtons (N). The remaining 40 samples were immersed in basic fuchsin dye for microleakage testing and evaluated under a stereomicroscope at 30× magnification. The results revealed that the ProfZrCrown^®/RMGIC group exhibited significantly higher fracture resistance compared to the NuSmile^®/RMGIC group (p < 0.05). No statistically significant differences were found among the other groups. Although no significant differences in microleakage were observed among the groups (p > 0.05), crowns cemented with GIC demonstrated higher microleakage levels. Within the limitations of this in vitro study, ProfZrCrown^® may be considered a promising alternative for aesthetic posterior restorations in pediatric dentistry. Full article

This study assessed and compared the shear bond strength of self-adhesive and self-etching resin cements for indirect aesthetic restorations to dentin. Four different materials, lithium disilicate ceramics, zirconia ceramics, polymethyl methacrylate (PMMA) composites, and hybrid materials, were used for indirect restorations cemented to dentin. The null hypothesis was that there would be no differences in shear bond strength between the investigated materials. Eighty extracted human molars were used. Eighty dentin specimens with a flat surface were prepared and randomly distributed in groups of 10 (n = 10). From each material (Cerasmart 270, Initial LiSi Blok, Katana ZR Noritake, and Crowntec Next Dent), 20 blocks were made and cemented to the dentin samples. Half of the blocks from each material were cemented to dentin using self-etching resin cement (Panavia V5), and the other half using self-adhesive resin cement (i-CEM). After the specimens were prepared, a laboratory test was conducted to evaluate the shear bond strength. The fracture type was determined using a light microscope, and SEM confirmed the results. The results were statistically analysed. All materials cemented with self-etching cements (Panavia V5) showed statistically higher shear strength values than those cemented with self-adhesive resin cement (i-CEM). In the specimen groups where self-adhesive cement (i-CEM) was used, Cerasmart 270 bonded statistically better. A statistical difference was found between all groups of materials cemented with self-etching cement. The Initial LiSi Block showed the strongest bond, followed by Katana Zr Noritake, Crowntec NextDent, and Cerasmart 270. Adhesion fracture to dentin was observed for all groups cemented with i-CEM. This study highlights the superior performance of self-etching cements in terms of shear bond strength. 10-Methacryloyloxydecyl dihydrogen phosphate (10-MDP), a functional monomer, was found to enhance adhesion strength significantly. However, using self-adhesive cements was associated with a weaker bond to dentin, highlighting the importance of the right cementing agent in restorative dentistry. Full article

Additive manufacturing (3D printing) using Computer-Aided Design (CAD) has emerged as a cost-effective alternative to subtractive milling in restorative dentistry, offering reduced material waste and lower production costs. This study aimed to compare the physical properties, specifically water sorption, water solubility, and surface roughness, of milled and 3D-printed hybrid resin composite materials. Standardized disk-shaped samples were fabricated using a digital workflow. The additive group included 15 samples printed with a DLP printer using CROWNTEC resin at three different orientations (0°, 45°, and 90°), with five samples prepared at each printing orientation. The subtractive group consisted of specimens milled from the SHOFU DISK hybrid resin composite. Surface roughness samples were also prepared for both methods. Statistical analysis using one-way ANOVA, post hoc tests, and paired t-tests revealed significant differences among groups in all tested properties (p < 0.001). Subtractive manufacturing consistently outperformed additive techniques. Among the printed groups, orientation at 0° showed the most favorable outcomes. Moreover, polishing significantly improved surface roughness in both manufacturing methods (p < 0.001). These findings emphasize the influence of the fabrication method and printing orientation on the clinical performance of hybrid resin composites, highlighting the importance of polishing in optimizing the surface quality for 3D-printed restorations. Full article

Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to prevent complications such as pulp necrosis or infection, which can compromise long-term prognosis. Fragment reattachment offers a conservative, esthetically favorable approach when the fractured segment is intact, with outcomes comparable to composite restorations. This case report underscores the importance of timely intervention and advanced restorative techniques in pediatric dentistry. Case Presentation: A 16-year-old male presented with a complicated crown fracture of the upper left central incisor sustained during a soccer game. The fracture extended subgingivally with pulp exposure. The patient preserved the fragment in saline. Treatment involved fragment reattachment using a dentin bonding agent and flowable composite resin, followed by single-visit root canal therapy due to delayed presentation (48 h). A glass fiber post was placed to reinforce the restoration due to significant coronal loss. Three years of follow-up visits (1, 3, 6, 12, 24, and 36 months) revealed no clinical or radiographic complications, with the tooth remaining asymptomatic and functional. Conclusions: This case underscores the effectiveness of fragment reattachment when combined with meticulous technique and long-term monitoring. Full article

Background/Objectives: Anterior dental trauma in adolescents presents complex restorative challenges due to ongoing craniofacial development and high aesthetic expectations. This study evaluated the long-term clinical performance of feldspathic ceramic veneers and lithium disilicate crowns used in the anterior region following dental trauma in adolescents. Methods: A total of 209 restorations were placed in 85 adolescents (50 females, 35 males), aged 11.1–17.9 years (mean age: 15.1 years). Of these, 144 were lithium disilicate crowns, and 65 were feldspathic ceramic veneers. All restorations were fabricated using minimally invasive protocols and followed up for periods ranging from 3 to 60 months. Outcomes were assessed based on standardized clinical criteria for success and failure. Results: Lithium disilicate crowns exhibited superior long-term performance, with the majority of failures occurring in feldspathic veneers (p < 0.001), primarily due to chipping or structural fracture. Age and gender had no statistically significant influence on failure rates. Conclusions: Both feldspathic and lithium disilicate ceramic restorations represent viable treatment options for anterior dental trauma in adolescents. However, lithium disilicate demonstrates greater mechanical reliability, particularly in teeth with significant hard tissue loss. These results support the use of durable ceramic materials in adolescent restorative protocols involving dental trauma. Full article

The integration of artificial intelligence (AI) and advanced digital workflows is revolutionising full-arch implant dentistry, particularly for geriatric patients with edentulous and atrophic arches, for whom achieving both prosthetic passivity and optimal aesthetic outcomes is critical. This narrative review evaluates current challenges in intraoral scanning accuracy—such as scan distortion, angular deviation, and cross-arch misalignment—and presents how innovations like the Medit SmartX AI-guided workflow and the Scan Ladder system can significantly enhance precision in implant position registration. These technologies mitigate stitching errors by using real-time scan body recognition and auxiliary geometric references, yielding mean RMS trueness values as low as 11–13 µm, comparable to dedicated photogrammetry systems. AI-driven prosthetic design further aligns implant-supported restorations with facial symmetry and smile aesthetics, prioritising predictable midline and occlusal plane control. Early clinical data indicate that such tools can reduce prosthetic misfits to under 20 µm and lower complication rates related to passive fit, while shortening scan times by up to 30% compared to conventional workflows. This is especially valuable for elderly individuals who may not tolerate multiple lengthy adjustments. Additionally, emerging AI applications in design automation, scan validation, and patient-specific workflow adaptation continue to evolve, supporting more efficient and personalised digital prosthodontics. In summary, AI-enhanced scanning and prosthetic workflows do not merely meet functional demands but also elevate aesthetic standards in complex full-arch rehabilitations. The synergy of AI and digital dentistry presents a transformative opportunity to consistently deliver superior precision, passivity, and facial harmony for edentulous implant patients. Full article

There is insufficient evidence regarding the cytotoxicity of restorative 3D-printing resins, used as part of the digital workflow in dentistry. This study presents a novel comparative evaluation of cell viability and adhesion using human Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs), a less commonly used but clinically relevant cell line in dental biomaterials research. The aim of this study was to evaluate the cell viability of WJ-MSCs seeded on 3D-printed resins intended for temporary restorations. Resin discs of three commercial 3D-printing resins (NextDent C&B, Leaf Dental C&B, and UNIZ Temp) and a conventional self-curing acrylic resin (NicTone) were used. WJ-MSCs were cultured on the specimens for 1, 4, and 10 days. Cell viability was assessed using the PrestoBlue assay, Live/Dead immunofluorescence staining, and 7AAD/Annexin V staining. Cell adhesion was evaluated using scanning electron microscopy. Direct exposure to the 3D-printed resins and the self-curing acrylic caused slight reductions in cell viability compared to the control group in both microscopic analyses. 7AAD/Annexin V showed the highest percentage of viable WBCs for the conventional acrylic (34%), followed by UNIZ (35%), NextDent (42%), and Leaf Dental (36%) (ANOVA p < 0.05 Tukey’s post-hoc test p < 0.05). These findings suggest that 3D-printed resins could be considered safe for use in temporary restorations. Full article

Background/Objectives: Additive manufacturing (AM) technology has emerged as an innovative approach in dentistry. Recently, manufacturers have developed permanent resins engineered explicitly for the fabrication of definitive prostheses using AM techniques. This systematic review evaluated the mechanical and physical properties of 3D-printed permanent resins in comparison to milled resins and hybrid ceramics for the fabrication of indirect dental restorations. Methods: Three electronic databases—Scopus, Web of Science, and PubMed—were searched for English-language articles. Two independent researchers conducted study selection, data extraction, quality assessment, and the evaluation of the certainty of evidence. In vitro studies assessing the mechanical and physical properties of the permanent resins were included in this review. Results: A total of 1779 articles were identified through electronic databases. Following full-text screening and eligibility assessment, 13 studies published between 2023 and 2024 were included in this qualitative review. The investigated outcomes included physical properties (surface roughness, color changes, water sorption/solubility) and mechanical properties (flexural strength, elastic modulus, microhardness). Conclusions: Three-dimensionally printed permanent resins show promising potential for fabricating indirect dental restorations. However, the current evidence regarding their mechanical and physical properties remain limited and inconsistent, mainly due to variability in study methodologies. Full article

Background: Mesenchymal stem cells (MSCs), multipotent and immune-regulatory cells derived from tissues such as bone marrow, dental pulp, and periodontal ligament, emerged as promising agents in regenerative dentistry. Their clinical applications include endodontic tissue regeneration, periodontal healing, and alveolar bone repair, addressing critical challenges in dental tissue restoration. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO. We searched PubMed, Scopus, and Web of Science databases for open-access, English-language clinical trials and observational studies published from 2015 to 2025. Studies focusing on the application of MSCs in dental tissue regeneration were included based on predefined eligibility criteria. Results: Out of 2400 initial records, 13 studies met the inclusion criteria after screening and eligibility assessment. Most studies investigated MSCs derived from dental pulp and periodontal ligament for regenerating periodontal tissues and alveolar bone defects. The majority reported improved clinical outcomes; however, variations in MSC sources, delivery methods, sample sizes, and follow-up periods introduced methodological heterogeneity. Conclusions: MSCs show significant potential in enhancing bone and periodontal regeneration in dental practice. Nonetheless, the current evidence is limited by small sample sizes, short follow-up, and inconsistent methodologies. Future large-scale, standardized clinical trials are required to validate MSC-based regenerative therapies and optimize treatment protocols. Full article

Additive manufacturing (AM) has emerged as a transformative technology in dentistry, enabling the production of patient-specific dental applications with reduced costs and fabrication times. Despite the growth of applications, a consolidated understanding of current 3D printing technologies, materials, and performance in dental settings remains fragmented. Here, we perform a Systematic Literature Review (SLR) using the PRISMA protocol, retrieving 19 closely related primary studies. The evidence is synthesized across three axes: application domain, AM technology, and critical quality parameters. Dental restorations, prosthetics, crowns, and implants are the most common applications, while fused deposition modeling, stereolithography, digital light processing, selective laser sintering, and laser-directed energy deposition are the most used technologies. AM materials include polymers, metals, and emerging biomaterials. Key quality determinants include dimensional accuracy, wear and corrosion resistance, and photosensitivity. Notably, biocompatibility and cytotoxicity remain underexplored yet critical factors for ensuring long-term clinical safety. The evidence also suggests a lack of in vivo studies, insufficient tribological and microbiological testing, including limited data degradation pathways of AM materials under oral conditions. Understanding that there are disconnects between the realization of the clinical and the economic benefits of 3D printing in dentistry, future research requires standardized testing frameworks and long-term biocompatibility validation. Full article

Deep margin elevation (DME) is a widely adopted technique for managing subgingival cervical proximal margins by repositioning them to a supragingival location. This approach enhances access, visibility, and control in these anatomically challenging areas. This narrative review aimed to evaluate current evidence on the indications, materials, clinical protocols, and outcomes of DME. A structured search was conducted in PubMed, the Cochrane Library and Scopus up to February 2025, using keywords such as “deep margin elevation”, “proximal box elevation” and “subgingival margin.” Clinical studies, in vitro investigations, relevant reviews and reports in English were included. A total of 59 articles were selected based on eligibility criteria. The hypothesis was that DME can serve as a reliable alternative to surgical crown lengthening in appropriate cases. A variety of materials have been investigated for use as the intermediate layer, with composite resins of varying viscosities and filler compositions being preferred due to their favorable long-term mechanical properties. DME may reduce the need for surgical intervention while maintaining periodontal health; however further randomized clinical trials are needed to clarify the material selection, establish long-term outcomes, and standardize clinical protocols. Understanding the indications, limitations, and protocol of DME is critical for achieving biologically sound and predictably functional restorations. Full article