Search Results (1,405)

Non-carious cervical lesions (NCCLs) present restorative challenges due to substrate sclerosis and marginal stress concentration, making the adhesive strategy a key determinant of long-term performance. This systematic review and frequentist random-effects network meta-analysis, conducted in accordance with PRISMA 2020 and the PRISMA-NMA extension and prospectively registered in PROSPERO, compared restorative strategies defined by etching approach, adhesive category, and restorative material, with marginal adaptation and retention loss as the primary outcomes. PubMed, Web of Science, Cochrane Library, Embase, and Scopus were searched without restrictions (25 January 2026), supplemented by alternative retrieval methods. Randomized clinical trials in permanent teeth evaluating at least two etching-based strategies (etch-and-rinse, self-etch, selective-etch, and/or resin-modified glass ionomer cement (RMGI)) were included. Risk of bias was assessed using RoB 2 and certainty of evidence with CINeMA. Seventy-four trials were eligible. Connected networks were established for marginal adaptation (57 studies; 28 interventions; 6798 patients; 1772 events) and retention loss (61 studies; 33 interventions; 7338 patients; 584 events). Selective-etch with a universal adhesive and nanocomposite reduced marginal adaptation failure compared with RMGI, whereas certain self-etch and non-universal combinations increased risk. For retention loss, selective-etch and etch-and-rinse protocols combined with universal adhesives and nanocomposites showed lower failure rates, while some self-etch or non-universal adhesive strategies performed less favorably. Overall confidence was predominantly high, with downgrading mainly due to imprecision and heterogeneity. Strategies incorporating selective enamel etching or etch-and-rinse approaches combined with universal adhesives and nanocomposites demonstrated the most consistent clinical advantages. Full article

Background and objectives: White spot lesions (WSLs) represent a common enamel demineralization complication associated with fixed orthodontic treatment. Resin infiltration is widely used as a minimally invasive approach to arrest lesion progression and improve esthetics; however, the influence of lesion severity on treatment effectiveness remains insufficiently understood. This in vitro study aimed to investigate how different severities of white spot lesions influence the structural, optical, and mechanical outcomes of resin infiltration. Materials and Methods: Ninety extracted human premolars were subjected to controlled acidic demineralization to produce mild, moderate, and severe lesions. All specimens were treated using a standardized resin infiltration protocol. Lesion depth, resin penetration, optical masking effect (ΔE), and surface microhardness were evaluated using confocal microscopy, spectrophotometry, and Vickers hardness testing. Results: Lesion depth increased significantly with demineralization duration (p < 0.001). Resin penetration showed a strong positive correlation with lesion depth (r = 0.81), while infiltration efficiency was highest in moderate lesions. Optical masking effectiveness decreased significantly with increasing lesion severity (p < 0.01). Surface microhardness improved significantly after infiltration in all groups, with the greatest recovery observed in moderate lesions. Conclusions: Lesion severity significantly influences the structural, optical, and mechanical outcomes of resin infiltration. Early and moderately developed WSLs respond more favorably to infiltration treatment, emphasizing the importance of timely intervention during orthodontic therapy. The integrated evaluation of penetration depth, color masking, and microhardness recovery provides a comprehensive understanding of how lesion severity influences the performance of resin infiltration. Full article

Background: Heimler syndrome (HS) is a rare autosomal recessive disorder representing the mildest end of the peroxisome biogenesis disorder spectrum. It is caused by hypomorphic mutations in peroxisomal assembly genes, most commonly PEX1 and PEX6, and is characterized by sensorineural hearing loss, amelogenesis imperfecta, and retinal dystrophy. Due to phenotypic overlap with other inherited sensory disorders, particularly Usher syndrome, diagnosis of this condition is frequently delayed. Methods: We investigated two unrelated Saudi families presenting with congenital hearing loss and retinal dystrophy who were initially diagnosed with Usher syndrome. Detailed clinical evaluation, including comprehensive ophthalmologic and audiologic assessments, was performed. Whole-exome sequencing (WES) was conducted to identify the underlying genetic cause, followed by variant filtering and in silico pathogenicity prediction. Results: We identified a novel homozygous missense variant, p.Val97Gly (V97G), in the PEX6 gene that co-segregated with the disease phenotype in both families. This variant was absent from major population databases, including dbSNP, the 1000 Genomes Project, ExAC, and gnomAD, and was predicted to be deleterious by multiple in silico prediction tools. Clinically, affected individuals presented with congenital sensorineural hearing loss, pigmentary retinal dystrophy with electrophysiological evidence of cone–rod dysfunction, enamel abnormalities consistent with amelogenesis imperfecta, and mild dysmorphic facial features, supporting a diagnosis within the Heimler syndrome spectrum. Conclusions: Our findings expand the mutational spectrum of PEX6 and highlight Heimler syndrome as an important differential diagnosis in patients presenting with Usher-like phenotypes. To the best of our knowledge, this study represents the first report of the PEX6 p.Val97Gly variant associated with Heimler syndrome in a Saudi population, underscoring the value of whole-exome sequencing for accurate diagnosis and genetic counseling in individuals with inherited sensory disorders. Full article

Background/Objectives: Despite advances in preventive dental care, tooth enamel erosion remains a relevant concern, and very few comparisons of surface topography have been carried out under controlled conditions in the laboratory. This study primarily aimed to conduct a qualitative morphological evaluation, supported by semi-quantitative image analysis, of the effects of commonly consumed beverages on human enamel morphology and colour, and to explore their relationship with beverage acidity in an in vitro model. Methods: Forty-two human teeth were allocated at random into seven different groups, each containing six molars. These groups were Coca-Cola, orange juice, lemon juice, coffee, chlorhexidine, regular mouthwash without chlorhexidine, and one control group. Following a 24 h exposure to a simulated saliva environment at 37 °C, the test samples were then subjected to a five-day erosion cycle. SEM analysis was used to examine the enamel alterations after evaluating the morphology of the enamel surface and by digital image analysis. Results: Scanning electron microscopy, SEM, showed how erosion of the teeth’s surface increased with the acidity of the drink. The extensive exposure of the crystal prisms, along with the severe loss of intercrystalline material and honeycomb weathering patterns, was all brought about by Coca-Cola and lemon juice. The moderate erosion brought on by orange juice in tests resulted in partially exposed prisms. Both the mouthwashes and the coffee exhibited similar impacts on the tooth enamel in a microscopic view. Minimal enamel prism rods were exposed due to either the coffee or the mouthwash. The surface characteristics were found through a digital image analysis, which indicated alterations in surface texture. Conclusions: Under these immersion conditions, highly acidic beverages produced the most pronounced enamel surface changes, whereas coffee induced mainly staining and neutral mouthwashes caused minimal modification. These results reflect qualitative morphological trends and should not be interpreted as clinical outcomes. Full article

This study evaluated the potential protective effect of a synthesized self-antibacterial nano-hydroxyapatite (nano-HA) toothpaste against erosive changes in the enamel surface induced by a cola-based soft drink, based on a qualitative scanning electron microscopy (SEM) study, in comparison with conventional fluoride toothpaste. Thirty extracted human premolars were sectioned to obtain enamel specimens and randomly assigned into a control group and experimental groups in which fluoride or synthesized nano-HA toothpaste was applied either before or after cola exposure (n = 5 per group). Enamel surface morphology was qualitatively assessed using SEM, and surface roughness (Ra) was estimated using a semi-quantitative approach based on SEM image analysis using ImageJ software. Antibacterial activity was evaluated using the agar diffusion method to explore the potential additional benefits of the synthesized self-antibacterial nano-HA formulation. SEM observations showed that, after cola exposure, specimens treated with nano-HA exhibited less surface erosion than fluoride-treated groups. Post-treatment with nano-HA results in a denser and more uniform surface layer with fewer structural defects. Similarly, enamel treated with nano-HA after cola exposure showed a statistically significant reduction in surface roughness compared with the fluoride group (p < 0.05). These findings suggest that nano-HA provides greater protective effects against acid-induced enamel surface erosion. Furthermore, nano-HA indicated potential antibacterial activity against S. aureus and E. coli. Overall, nano-HA toothpaste provided enhanced protection against acid-induced enamel erosion with additional antibacterial effects. Full article

Background/Objectives: Young adulthood is a transitional period associated with changes in lifestyle and preventive dental attendance, which may influence caries risk. In routine practice, the use of comprehensive caries risk assessment systems is often limited by time and diagnostic requirements, highlighting the need for simplified diagnostic screening tools. This study aimed to develop and clinically validate a simplified, questionnaire-based caries risk assessment tool derived from the CAMBRA framework for use in young adults. Methods: An observational cross-sectional study was conducted among 246 Romanian young adults aged 18–25 years. The instrument was designed to enable rapid caries risk stratification based exclusively on questionnaire data, without radiographic or laboratory investigations. Internal consistency, test–retest reliability, and construct validity were evaluated by comparison with clinically recorded indicators, including DMFT values, early enamel changes, visible dental plaque, and active carious lesions. Results: The questionnaire showed acceptable internal consistency (Cronbach’s alpha = 0.71) and good temporal stability (ICC = 0.82). Higher caries risk categories were consistently associated with unfavorable clinical findings, including increased DMFT values, a higher prevalence of early enamel changes, greater plaque accumulation, and more frequent active caries (p < 0.01). Conclusions: The simplified CAMBRA-based questionnaire demonstrated satisfactory reliability and clinical relevance in young adults. It may serve as a practical diagnostic screening and decision-support tool for risk-based caries prevention in routine and community dental settings. Full article

Background: Biomimetic principles have gained significant traction in contemporary dentistry. For this reason, biomimetic restorative materials have been designed with the goal of recreating the mechanical and optical behavior of natural dental tissues. However, the level to which these materials resemble the properties of enamel and dentin remains uncertain. Methods: A systematic review was carried out according to the PRISMA guidelines. Electronic searches were performed in PubMed and Scopus to identify in vitro studies examining restorative materials promoted as biomimetic. These included polymer-infiltrated ceramic network (PICN) materials, resin matrix systems (RMS), and short fiber-reinforced composites (SFRCs). Natural enamel and dentin served as reference comparators. Target outcomes included mechanical properties (flexural strength, fracture toughness, Vickers hardness, elastic modulus) and optical properties (translucency parameter and color matching). Results: PICN achieved hardness and translucency values closely resembling the natural enamel, while RMS approached the mechanical properties of natural dentin. SFRC showed high fracture resistance, comparative to dentin. Conclusions: Current biomimetic restorative materials exhibit promising mechanical and optical performance. Nevertheless, no single material fully reproduces the multifaceted behavior of natural dental tissues. Further studies with standardized testing protocols are needed to determine their clinical relevance. Full article

Background/Objectives: Root canal procedures on multi-rooted teeth, including first molars, depend on experience, tactile perception, and anatomical knowledge to avoid perforation in the furcation region. Studies using various methodologies and populations have reported discrepant findings on pulpal floor thickness. No study using micro-computed tomography (Micro-CT), the gold standard, has been conducted on a Black South African sample to evaluate pulpal floor thickness. Methods: In this cross-sectional, descriptive, quantitative study, Micro-CT scans of 91 maxillary and 77 mandibular first molars were reconstructed in 3D and oriented according to a reference plane along the cemento-enamel junction using Avizo software. Measurements were taken from the midpoint of the pulpal chamber floor to the perpendicular point on the furcation. In maxillary molars, an additional measurement between the mesiobuccal and distobuccal roots was taken. The effects of arch, side, age, and sex were assessed. Results: Neither sex, arch, nor side had a significant influence on the pulpal floor thickness. The central mandibular and maxillary pulpal floor thicknesses increased significantly with aging, while the effect on the buccal maxillary pulpal floor thickness was not significant. The mean central mandibular and maxillary pulpal floor thicknesses were 2.66 and 2.83 mm, respectively, while the buccal maxillary pulpal floor thickness was significantly smaller at 2.37 mm. Conclusions: More accurate and repeatable findings compared to the literature could be attributed to the use of Micro-CT, which provides higher resolution images, and to Avizo, which enables precise localization of 3D points. Variations from the literature might also be explained by differences in the age and geographical origin of the samples. 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

Dental hard tissues, through their remarkable resistance to degradation, represent one of the most durable biological materials available for postmortem investigation. The preparation of undecalcified or ground sections allows microscopic visualization of enamel, dentin and cementum structures, which can preserve chronological, physiological, or environmental information. This review provides a comprehensive overview of the forensic applications of dental hard tissue ground sections, focusing on methodological principles, interpretive potential and practical constraints. The literature in forensic odontology highlights their relevance for age estimation through tooth cementum annulation, identification of neonatal and accentuated stress lines, and the assessment of thermal or chemical alterations. While these methods have proven scientific validity in anthropology and histology, their forensic implementation remains limited by heterogeneity in protocols and interpretative subjectivity. Standardization of preparation techniques, digital imaging, and integration with complementary analyses such as micro-CT or SEM could enhance the reliability and medico-legal relevance of this classical but underused approach. Full article

Background/Objectives: The performance of the adhesive system used for bonding fundamentally influences the success of fixed orthodontic treatment. To withstand masticatory forces and prevent bracket debonding, it is critical to achieve optimal shear bond strength (SBS), improving treatment time. The aim of this study was to compare the shear bond strength and adhesive remnant index (ARI) of orthodontic brackets bonded using LED light-curing units with intensities of 3200 mW/cm² at two different exposure times, evaluated after 24 h and 14 days. Methods: Eighty extracted permanent premolars were randomly divided into four experimental groups. Brackets were bonded using Transbond XT adhesive and cured with a VALO™ Ortho Cordless unit (3200 mW/cm²) for 3 or 6 s. SBS was measured using a universal testing machine, and the ARI was assessed under a stereomicroscope at 40× magnification. Results: Increased light intensity and longer curing time significantly improved SBS values. The highest bond strengths were observed in groups cured with 3200 mW/cm² for 6 s, after 14 days. ARI scores showed that longer curing reduced adhesive remnants on the enamel. Statistical analysis confirmed significant differences among groups. Conclusions: Therefore, clinicians may achieve better bonding performance and easier enamel clean-up by using high-intensity lights with adequate curing duration. Full article

Background/Objectives: Interproximal reduction (IPR), also known as dental stripping, is a commonly used orthodontic technique to gain space, avoid extractions, and correct tooth size discrepancies, particularly in contemporary orthodontics and clear aligner therapy. The aim of this systematic review was to update the evidence from the last 10 years regarding the dental and periodontal effects associated with IPR. Methods: A systematic review of the literature was conducted including studies published between January 2015 and July 2025. Searches were performed in PubMed, SciELO, LILACS, Cochrane Library, and Google Scholar. Primary studies reporting dental and/or periodontal outcomes related to IPR were included. Study selection and data extraction were performed following PRISMA guidelines. Results: Twelve studies met the inclusion criteria, comprising in vitro and in vivo designs. The available evidence indicates that IPR is associated with transient changes in enamel surface roughness and minimal increases in pulp temperature, which remains below critical thresholds when appropriate techniques and cooling measures are used. No consistent evidence of increased caries risk, periodontal deterioration, or tooth sensitivity was reported. Surface polishing and fluoride application were frequently associated with more favorable outcomes. Conclusions: Based on the available evidence from the last decade, IPR appears to be a clinically safe orthodontic procedure when performed with proper technique, adequate case selection, and appropriate finishing protocols. However, heterogeneity among study designs highlights the need for further well-designed clinical studies to strengthen the evidence base. 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: 22q11.2 deletion syndrome (22q11.2 DS) is a rare genetic syndrome characterized by high phenotypic variability, with an incidence of approximately 1:4000 live births. Most of the existing literature consists of case reports or case series, making it challenging to obtain large cohorts for data comparison and drawing generalizable conclusions. Aim: The aim of this article is to share the clinical experience of patients with 22q11.2 DS who were previously evaluated by Child Neuropsychiatry and underwent odontoiatric procedures at the Dental Unit of the Policlinico di Bari. Methods: We report three clinical cases of pediatric patients with 22q11.2 DS who were managed at the University Dental Unit of the Policlinico di Bari for dental procedures, including pre/post-treatment images and child neuropsychiatric characteristics. Results: Cleft lip and cleft palate are the most commonly encountered facial malformations. Enamel hypoplasia and hypomineralizations, caries, dental agenesis, and hypodontia are reported with variable frequency in almost all studies considering the oral health of these patients. Our experience is coherent with the data present at the moment. The clinical examinations showed diffuse hypomineralization and several caries, concordant with the literature. One patient received moderate sedation and another received general anesthesia; oral prophylaxis, fluoride application, pulp therapy, extractions of hopeless teeth and restorations of carious and hypomineralized teeth were performed. Conclusions: 22q11.2 DS is a genetic condition with a variable prognosis, but current trends show that patients often reach adulthood, primarily due to advancements in cardiology, which was previously the leading cause of mortality in these patients. From this perspective, collaboration among various medical specialties is crucial to implement holistic patient management programs and early interventions. Full article

Objectives: This systematic review evaluated enamel surface alterations and residual composite following the removal of clear aligner attachments, with particular emphasis on the influence of removal techniques, instrument selection, operator experience, and the use of magnification on enamel preservation and cleaning efficiency. Methods: A comprehensive electronic search was performed in PubMed, Scopus, Embase, Web of Science, and Scielo up to October 2025. In vitro, ex vivo, and clinical studies assessing enamel loss, residual composite, surface roughness, or removal time after clear aligner attachment removal were included. Study selection, data extraction, and methodological assessment followed the PRISMA 2020 guidelines and Cochrane Handbook recommendations. Risk of bias was evaluated using a modified Joanna Briggs Institute checklist for laboratory-based studies. Due to substantial methodological heterogeneity, a narrative synthesis was conducted. Results: Of 656 identified records, three in vitro/ex vivo studies were assessed for eligibility. Reported enamel loss ranged from approximately 15 µm to more than 50 µm, depending on the removal protocol and visualization conditions. Residual composite covered approximately 20–40% of the treated enamel surface. Multi-step protocols combining tungsten carbide burs with silicone polishers under magnification demonstrated the most favorable balance between composite removal efficiency and enamel preservation. Fiberglass burs were associated with smoother enamel surfaces but increased enamel loss, whereas one-step polishing systems (OneGloss, Enhance, SM104) resulted in reduced surface roughness and shorter procedural time. The use of magnification loupes (≥2.5×) consistently improved removal precision and reduced residual composite. Meta-analysis was not feasible due to heterogeneity in outcome measures and testing methodologies. Overall risk of bias was deemed acceptable. Conclusions: Based on the limited number of available in vitro/ex vivo studies, removal of clear aligner attachments appears to be associated with measurable enamel loss and residual composite, largely influenced by the instruments and visualization aids used. Sequential carbide–silicone polishing protocols performed under magnification appear promising based on limited in vitro/ex vivo evidence, demonstrating a favorable balance between composite removal and enamel preservation under controlled laboratory conditions. However, given the scarcity of evidence and absence of clinical trials, these findings cannot be directly extrapolated to routine clinical practice. Further well-designed studies are required before definitive clinical recommendations can be established. Full article