Search Results (1,295)

Background: The White Esthetic Score (WES) is a standardized clinician-reported index that assesses the esthetic quality of a single-tooth restoration by comparison with a natural reference tooth, typically the contralateral tooth. It evaluates five domains: tooth form, crown outline/volume, color (hue/value), surface texture, and translucency/characterization. Each domain is scored from 0 to 2 (major discrepancy, minor discrepancy, no discrepancy), yielding a total score of 0–10; higher scores indicate a closer match. Although developed for single-tooth implant restorations, WES has also been applied to natural teeth and tooth-supported restorations. Methods: This comprehensive review summarizes case-report evidence applying WES to tooth-supported restorations, outlining the concept, scoring method, documentation requirements, and available data on reliability and interpretation. A case illustration is also presented in which a patient received eight anterior veneers; outcomes were assessed using all WES parameters. Results: Published reports support WES as a practical qualitative tool to assess esthetic outcomes in tooth-supported restorations. In the presented case, the veneers achieved a WES of 9, reflecting marked improvement in tooth form, crown outline/volume, color, surface texture, and translucency/characterization. Conclusions: The comprehensive review indicates WES is feasible for routine clinical use in practice, but agreement varies by parameter and improves with standardized photography and examiner calibration; some components show lower inter-rater agreement than simpler soft-tissue indices. Because correlations between WES and patient satisfaction are inconsistent, WES should be complemented with patient-reported outcome measures. Common thresholds consider WES ≥ 6 acceptable. Clinical use for crowns and veneers should emphasize case selection, standardized records, and combined clinician- and patient-centered outcome reporting. Full article

Multilayer 4Y/5Y-PSZ zirconia materials have been developed to combine strength and translucency in monolithic “all-in-one” dental restorations. This study evaluated the flexural strength of different layers (incisal, transition, and dentin) in four commercially available multilayer zirconia systems using three-point bending tests in accordance with ISO 6872. A total of 360 CAD/CAM-fabricated bar-shaped specimens were prepared from the materials CE (Cercon yo ML, DentsplySirona), KA (Katana YML, Kuraray Noritake), PZ (3D ProZir, Aidite), PE (IPS e.max ZirCAD Prime esthetic), and assigned to layer-specific groups based on their position within the discs. After sintering and standardized surface finishing, specimens were tested under three-point bending conditions. Fracture strength was calculated and statistically analysed. Microstructural and fractographic analyses were performed to assess grain structure and to identify fracture origins. The results demonstrated significant differences in flexural strength both among materials and between layers. In general, dentin layers exhibited the highest strength, reaching mean values up to 1143 MPa, while incisal layers showed significantly lower values, with minima around 572 MPa. Only one material (CE) maintained flexural strength above the ISO threshold of 800 MPa across all layers, qualifying for unrestricted (class 5) clinical use. Other materials showed limitations, particularly in the more translucent incisal regions (KA, PE). One material fell below the ISO threshold (PZ). Weibull moduli revealed differences in reliability, with moduli ranging from 4.7 to 16.5. Fractographic evaluation identified typical fracture patterns such as surface grinding defects and internal porosity, but no abnormal fracture origins. The strength gradient corresponds to microstructural differences, particularly grain size and phase composition, influenced by yttria content. Increased translucency in incisal layers is associated with reduced mechanical performance. These findings emphasize that, despite aesthetic advantages, layer-dependent strength variations must be considered when selecting multilayer zirconia for clinical applications, especially in long-span restorations. Full article

Objective: The purpose of these two clinical cases reports was to present the variations in the surgical and prosthetic procedures related to an implant-supported fixed dental prosthesis (FDP) in the edentulous maxilla, following a fully guided implantation protocol and immediate loading. Case presentation: Two patients, one with terminal dentition and one with a completely edentulous maxilla, expressed the desire for immediate rehabilitation with an FDP and avoidance of multiple and complex surgical procedures. The clinical protocol for both cases included meticulous presurgical planning combining radiographic examination, diagnostic wax-up (conventional or digital), prosthetically driven digital planning of implant placement, fabrication of a surgical guide for fully guided implant installation, and delivery of a screw-retained fixed restoration. There was no report of any implant failure; the FDPs could be delivered as planned, and both patients expressed their satisfaction with the functional and esthetic outcomes. The clinical situation was stable at the recall. Full article

Background: Unilateral progressive condylar growth (UPCG) represents a complex clinical condition characterized by abnormal enlargement of the mandibular condyle, leading to progressive facial asymmetry and functional impairment. Objectives: The aim of this review is to analyze the biological, clinical, and therapeutic factors guiding condylectomy, assess the current role and scope of proportional condylectomy, and propose an algorithm to guide its indication in patients with UPCG. Methods: A narrative review was conducted to analyze the biological, clinical, and therapeutic factors involved in the indication for condylectomy in patients with progressive unilateral condylar growth. Studies including patients diagnosed with unilateral condylar hyperplasia or condylar osteochondroma who underwent surgical treatment were considered to evaluate clinical indications, timing of intervention, and outcomes. Special attention was given to the concept of proportional condylectomy. Results: Current evidence indicates that early intervention may control disease progression, reduce the severity of residual deformity, and minimize the need for secondary orthognathic surgery. The integration of clinical findings, three-dimensional imaging, and patient-specific factors is essential for appropriate treatment planning. Conclusions: Based on these considerations, a structured clinical algorithm is proposed to guide decision-making in patients with unilateral progressive condylar growth. This approach supports individualized treatment strategies aimed at optimizing functional and esthetic outcomes. Full article

Background and Clinical Significance: Advanced periodontitis destroys tooth-supporting structures and causes pathologic tooth migration (PTM) and functional and esthetic repercussions. This report illustrates how non-surgical periodontal therapy (NSPT) addresses such concerns. Case Presentation: A 34-year-old woman (healthy, who quit smoking) complained of a space between her upper front teeth. Based on clinical and radiographic data, she had localized periodontitis stage III grade C with intrabony defects, deep pockets, and a diastema between teeth # 12 and 11. The treatment plan involved improvement of self-performed oral hygiene measures and NSPT. Initially, improvements in plaque, bleeding, and pocket depth scores were observed. Non-surgical re-treatment of residual sites was associated with further improvements and complete closure of the diastema, along with patient satisfaction with the outcome. Conclusions: The potential of NSPT in improving periodontal clinical parameters and the association with spontaneous tooth repositioning and apparent filling of intrabony defects radiographically is demonstrated, ultimately addressing the patient’s functional and esthetic concerns. Full article

Mohs Micrographic Surgery (MMS) is considered the most conservative and preserving procedure for removing cutaneous tumors. The major disadvantage of MMS is that tumor involvement in tissue may be underestimated. This may lead to large excisions necessitating complex reconstruction with profound effects on cosmetic results. Some patients refuse complex reconstruction and demand simple closure of post-MMS skin defects. This retrospective cohort study describes our technique of serial Mohs excisions of large non-melanoma skin cancers for patients refusing flaps or skin graft reconstructions. A total of 51 patients who underwent MMS according to the described technique February 2020–May 2021 were included. The mean age was 76.5 (range 63–94) years and 55% were male. More than half of the lesions were on the nose. Mean lesion sizes were 14.25–55 mm depending on location. Most cases required two surgeries and only one needed a third surgery. Postsurgical defects were repaired using primary closure in 90% of cases. Mean follow-up was 31 months (range 6–48) with no evidence of local recurrence. In conclusion, this approach of serial excisions with MMS can be performed safely and achieve better cosmetic outcomes for patients presenting with large skin tumors of the face or other functionally important areas. Full article

Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions. Full article

This study aimed to formulate and evaluate a facial serum containing Cannabis extract, a prebiotic blend of glycerin, lactitol, and xylitol, as well as heat-treated Lactobacillus plantarum HEAL19, a non-viable probiotic-derived ingredient (postbiotic) that preserves beneficial structural components and biological activity. Additionally, alternative preservatives were tested to replace conventional ones, aligning with environmentally and consumer-friendly cosmetic trends. The formulation underwent stability testing, physicochemical analysis, and microbiological control, including a challenge test to assess preservative efficacy. The efficacy of the formulation was investigated through a randomized, placebo-controlled pilot study involving sixteen healthy female volunteers aged 24–53 years. Participants were instructed to apply the active serum to one side of the face and the placebo preparation to the opposite side twice daily for a period of 30 days. Study endpoints were evaluated through clinical measurements of transepidermal water loss (TEWL), skin hydration, elasticity, and skin surface topography, together with participant-reported outcome questionnaires. Results demonstrated that the formulation possessed suitable physicochemical properties and microbiological stability. The serum was well tolerated and improved skin hydration. Participants reported enhanced esthetic appearance and perceived efficacy. These findings support the potential of combining innovative active ingredients with alternative preservatives in skin-friendly cosmetic formulations. Full article

Background/Objectives: Long-term clinical data on direct posterior composite restorations are scarce, particularly beyond simple survival outcomes. This study aimed to characterize the long-term functional, esthetic, and biological behavior of posterior composite restorations after nearly three decades of service using selected FDI criteria and to assess changes across available follow-up examinations, including within a predefined sub-cohort. Methods: This observational follow-up involved 21 patients with 57 posterior composite restorations placed in 1995–1996 at the Department of Operative Dentistry, Goethe University Frankfurt, by undergraduate dental students under supervision. The 2025 follow-up used FDI criteria to assess functional, aesthetic, and biological properties, classifying outcomes as clinically acceptable, intervention needed, or failure. Descriptive analyses were applied to the entire cohort. Longitudinal analyses were conducted on a sub-cohort of 14 patients with 27 restorations at three time points. Exploratory analyses assessed associations with restoration factors, caries experience, and gingival health. Results: In 2025, 54.4% of restorations were clinically acceptable, 28.1% required intervention, and 17.5% were failures. Functional criteria remained mostly acceptable, though form and contour showed the highest mean values. In the longitudinal sub-cohort, significant changes over time were observed in anatomical form and occlusal wear. Retention, marginal adaptation, proximal contact, and surface luster did not change significantly. Biologically, restorations available for direct assessment had low incidences of secondary caries, hard-tissue defects, and postoperative sensitivity or pulpal issues. Conclusions: Posterior composite restorations can function for nearly three decades but gradually deteriorate in certain aspects. Long-term changes mainly involve cumulative functional aging of the anatomical form and occlusal wear, rather than widespread biological failure. These findings underline the importance of differentiated long-term assessment and support conservative management approaches where clinically feasible before replacement is undertaken. Full article

Background/Objectives: Tooth discoloration can influence the esthetic outcome of restorative treatments. Recently, 3D-printed ceramic-filled hybrid materials have been introduced for dental restorations using digital workflows. The aim of this in vitro study was to evaluate the influence of 3D-printed ceramic-filled hybrid veneers on the final color of discolored teeth using spectrophotometric measurements. Methods: Twenty-five extracted human anterior teeth without caries or restorations were prepared for veneer restorations using standardized reduction protocols. Artificial discoloration was induced by applying light-cured color coatings to the buccal surfaces of the specimens. The prepared teeth were digitally scanned, and veneers with a thickness of 1 mm were designed and fabricated using a 3D printing system and a ceramic-filled hybrid material. Color measurements were performed with a spectrophotometer and recorded in the Commission Internationale de l’Éclairage L*a*b* (CIELAB) color system. Measurements were obtained at four stages: after creation of discoloration, after two weeks of immersion in physiological saline solution, after veneer placement using neutral try-in gel, and after two months of immersion following veneer placement. Color differences were calculated using three color difference formulas (ΔE*ab, ΔE94, and ΔE00). Results: The placement of the 3D-printed veneers produced substantial modifications in the optical characteristics of the discolored substrates, reflected by reduced chroma values and significant color differences between the baseline and veneer stages. After two months of immersion, only minor variations in color coordinates were observed. The calculated color differences between the veneer stage and the post-immersion stage remained low across all evaluated color difference formulas, indicating good short-term color stability of the veneered specimens. Conclusions: Within the limitations of this pilot in vitro study, 3D-printed ceramic-filled hybrid veneers demonstrated the ability to effectively modify the color of discolored substrates while maintaining relatively stable optical properties after two months of immersion. These restorations may represent a promising and cost-effective option for the esthetic management of discolored teeth. Full article

Crohn’s disease (CD) is a chronic inflammatory bowel disease requiring accurate and timely diagnosis. Current diagnostic tools may be invasive, costly, or insufficiently specific. Surface-enhanced Raman spectroscopy may enable rapid, minimally invasive detection of disease-associated biochemical alterations in serum. This cross-sectional pilot study included age- and sex-matched patients with Crohn’s disease and healthy controls. Serum samples were analyzed using surface-enhanced Raman spectroscopy. Spectral data were preprocessed and analyzed using principal component analysis-linear discriminant analysis and partial least squares-discriminant analysis. Classification performance was evaluated using leave-one-out cross-validation. Variable importance in projection scores was used to identify discriminatory vibrational bands. Fifty-four participants fulfilled the clinical inclusion criteria, while 51 participant-level spectra were retained for final classification analysis. PCA-LDA differentiated CD from healthy controls with a sensitivity of 85.19%, specificity of 91.67%, accuracy of 88.24%, and AUC of 0.881. PLS-DA showed slightly higher performance, with a sensitivity of 88.89%, specificity of 95.83%, accuracy of 92.16%, and AUC of 0.937. Relevant discriminatory bands were observed at 498, 639, 728, 813, 1136, 1205, 1443, 1579, and 1657 cm⁻¹, suggesting alterations in purine metabolism, protein structure, lipid composition, and nucleic acid-associated signals. Serum-based SERS combined with multivariate analysis showed promising ability to distinguish patients with CD from healthy controls in this pilot cohort. Larger multicenter studies are required to validate these findings and assess clinical applicability. Full article

Background: Patient-reported outcome measures (PROMs) are essential for assessing postoperative morbidity and patient-centered treatment value after periodontal plastic surgery. This study evaluated PROMs following the modified coronally advanced tunnel (MCAT) combined with subepithelial connective tissue graft (SCTG) and different adjunctive biomaterials. Methods: This retrospective pooled secondary analysis included 64 patients treated for 275 gingival recessions using MCAT + SCTG with physiological saline (control), 24% EDTA, enamel matrix derivative (EMD), or cross-linked hyaluronic acid (HA). PROMs were the primary outcomes and included postoperative pain and swelling assessed using a 0–100 mm visual analogue scale (VAS), together with binary symptom measures recorded on days 1, 2, 4, 7, and 14. Patient satisfaction, esthetic perception, and willingness to recommend treatment were also assessed. Clinical and esthetic outcomes at 12 months served as reference parameters. Results: Early postoperative pain differed significantly between groups on days 1, 2, and 7 (p = 0.016, 0.024, and 0.033, respectively). Edema also varied significantly on days 2, 4, and 14 (p = 0.011, 0.001, and 0.001, respectively). The HA group showed lower pain scores on days 2 and 4, whereas EDTA was associated with greater early discomfort. Despite these differences, long-term satisfaction, esthetic perception, willingness to recommend treatment, and root coverage outcomes were high and comparable among groups (p > 0.05). Conclusions: MCAT + SCTG provides predictable and stable outcomes for multiple gingival recessions, regardless of adjunctive biomaterial. However, PROMs revealed differences in early postoperative morbidity, supporting their integration into clinical decision-making alongside clinician-reported outcomes. Full article

Clear aligner therapy has become increasingly widespread in contemporary orthodontics, relying on composite resin attachments to enhance force transmission and improve the predictability of tooth movement. The physicochemical and mechanical properties of these biomaterials play a crucial role in attachment durability, dimensional stability, and esthetic performance during treatment. This systematic review aimed to evaluate how different composite resin types influence the mechanical, optical, and functional performances of orthodontic attachments used in clear aligner therapy. A systematic literature search was conducted in the PubMed, Scopus, and Cochrane databases for studies published between 2015 and 2025, following PRISMA guidelines. In vitro studies and clinical trials evaluating composite resins used for attachment fabrication were included. Fifteen studies met the eligibility criteria, including eleven laboratory investigations and four clinical studies. The evaluated outcomes comprised shear bond strength, wear resistance, surface roughness, microhardness, color stability, and accuracy of attachment reproduction. Overall, all evaluated composite resins demonstrated shear bond strength values within clinically acceptable ranges. However, significant differences were observed in the material performances depending on the resin composition and viscosity. Nanohybrid and high-viscosity composite resins were generally associated with improved mechanical resistance, reduced wear, and greater dimensional stability, although SBS outcomes should be interpreted in light of the bonding protocols used. In contrast, flowable composite resins showed improved handling and adaptation to attachment molds but presented higher susceptibility to surface degradation and discoloration. The findings suggest that the composition and properties of composite resins significantly influence the mechanical and optical behavior of orthodontic attachments. Optimizing material selection according to biomechanical demands and esthetic requirements may improve attachment longevity and treatment predictability in clear aligner therapy. Clinicians should prioritize nanohybrid or high-viscosity composite resins for high-load attachments and use flowable composite resins materials when adaptation and esthetics are critical. Full article

Background and Objectives: Conventional dental adhesives doped with magnetic nanoparticles (MNPs) hold the promise of preventing microleakages. However, esthetic concerns have motivated the quest for coatings capable of masking the dark color of MNPs. This study aims to quantify regional chromatic differences between teeth restored using dental adhesives with different MNP content. Materials and Methods: We prepared cavities in 42 artificial molars and 9 extracted teeth and divided them into 6 groups: Group 0 (G0), G1, and G2, comprising 14 artificial teeth each and G0e, G1e, and G2e, comprising 3 extracted teeth each. In G0 and G0e, we applied the commercial adhesive, in G1 and G1e we applied the adhesive loaded with MNPs with dual coating (SiO₂ followed by Ca(OH)₂), whereas in G2 and G2e we applied the adhesive doped with uncoated MNPs. For the statistical analysis of color differences, we employed Bland–Altman plots and the one-sample t-test. Results: G1 was similar to G0 in terms of color coordinate distribution, whereas G2 was different. Compared to G0, dental fillings from G1 had mean differences of (−0.56, 0.18, −0.07) in the CIELAB color coordinates (L*, a*, b*), respectively, whereas the mean differences between G2 and G0 were (−15.6, −3.5, −15.7). The CIEDE2000 color differences were 1.5 [1.3, 1.6] between G1 and G0 (mean [95% confidence interval]) and 17.0 [16.0, 18.0] between G2 and G0. Nevertheless, 24.4% of the point pairs compared exceeded the acceptability limit for color difference (1.8). Conclusions: Although the silica and calcium hydroxide coating is highly effective in alleviating the esthetic impact of MNP-laden dental adhesives, further research is warranted to reduce between-specimen variability. Full article

This single-center, split-mouth, single-blind pilot randomized trial compared patient morbidity, healing and root coverage between the subepithelial connective tissue graft (SCTG) and the de-epithelialized free gingival graft (D-FGG) when combined with the modified coronally advanced tunnel (MCAT) technique in multiple adjacent gingival recessions. Sixteen systemically healthy patients with bilateral Miller Class I/II (Cairo RT1) recessions were enrolled, and contralateral sides were randomly allocated to MCAT + SCTG (control) or MCAT + D-FGG (test) by means of sequentially numbered, opaque, sealed envelopes (SNOSE). Patient-reported outcomes (pain, chewing discomfort, bleeding) and the Landry Healing Index were assessed at 1 and 2 weeks; recession depth, mean root coverage (mRC) and Root Coverage Esthetic Score (RES) were evaluated at 6 months. Both techniques achieved high mRC (test: 94.22% ± 10.28%; control: 94.60% ± 9.99%) and RES (test: 8.02 ± 0.63; control: 8.14 ± 0.77), with no statistically significant intergroup differences. Donor-site pain was significantly lower in the D-FGG group, whereas early chewing discomfort and bleeding were higher. Because the trial was not powered for equivalence or non-inferiority, these preliminary findings are hypothesis-generating and require confirmation in adequately powered trials. Full article