Search Results (261)

The aim was to evaluate the shear-bond strength (SBS) of experimental short fiber-reinforced CAD/CAM composites (SFRC-CAD) and commercial CAD/CAM composites (Cerasmart 270) to different luting resin composites before and after hydrothermal aging. Discs (2 mm) obtained from SFRC-CAD and Cerasmart 270 were air-particle abraded and treated with a primer (G-CEM One Enhancing Primer) with or without universal adhesive (G2 Bond). A fiber-reinforced flowable composite (everX Flow) and a self-adhesive resin cement (G-CEM One) were used as luting materials under direct or indirect curing conditions. Thirty-two experimental groups were determined based on restorative material, bonding protocol, luting resin, curing technique, and aging procedure (n = 8/group). SBS was measured after 24 h of water storage or following hydrothermal aging. Data were analyzed using nonparametric statistical tests (p < 0.05). No statistically significant differences in SBS were observed between everX Flow and G-CEM One regardless of the bond application (p > 0.05). SFRC-CAD bonded with everX Flow and universal adhesive demonstrated significantly higher SBS than the corresponding Cerasmart groups (p < 0.05), whereas no significant differences were observed between comparable groups when G-CEM One was used. Failure mode analysis showed predominantly adhesive and mixed failures, with no cohesive failures within SFRC-CAD. Overall, the everX Flow proved to be an effective luting material, indicating that this material may be suitable for luting CAD/CAM indirect restorations. Full article

Background/Objectives: The clinical application of CAD/CAM restorative materials continues to evolve due to increasing demand for aesthetic, durable, and minimally invasive indirect restorations. Hybrid nanoceramics, such as Grandio disc (VOCO GmbH, Cuxhaven, Germany), are increasingly used in indirect restorative dentistry due to their favourable combination of mechanical strength, polishability, wear resistance, and bonding potential. One challenge associated with adhesive protocols for CAD/CAM materials lies in achieving durable bonds with resin cements. Extensive post-polymerization during fabrication reduces the number of unreacted monomers available for chemical interaction, thereby limiting the effectiveness of traditional adhesive strategies and necessitating specific surface conditioning approaches. This study aimed to evaluate, in a preliminary, non-inferential manner, the influence of several combined conditioning protocols on surface micromorphology, elemental composition, and descriptive SBS trends of a CAD/CAM hybrid nanoceramic. This work was designed as a preliminary pilot feasibility study. Due to the limited number of specimens (two discs per protocol, each providing two independent enamel bonding measurements), all bond strength outcomes were interpreted descriptively, without inferential statistical testing. This in vitro study investigated the effects of various surface conditioning protocols on the adhesive performance of CAD/CAM hybrid nanoceramics (Grandio disc, VOCO GmbH, Cuxhaven, Germany) to dental enamel. Hydrofluoric acid (HF) etching was performed to improve adhesion to indirect resin-based materials using two commercially available gels: 9.5% Porcelain Etchant (Bisco, Inc., Schaumburg, IL, USA) and 4.5% IPS Ceramic Etching Gel (Ivoclar Vivadent, Schaan, Liechtenstein), in combination with airborne-particle abrasion (APA), silanization, and universal adhesive application. HF may selectively dissolve the inorganic phase, while APA increases surface texture and micromechanical retention. However, existing literature reports inconsistent results regarding the optimal conditioning method for hybrid composites and nanoceramics, and the relationship between micromorphology, elemental surface changes, and adhesion remains insufficiently clarified. Methods: A total of ten composite specimens were subjected to five conditioning protocols combining airborne-particle abrasion with varying hydrofluoric acid (HF) concentrations and etching times. Bonding was performed using a dual-cure resin cement (BiFix QM) and evaluated by shear bond strength (SBS) testing. Surface morphology was examined through environmental scanning electron microscopy (ESEM), and elemental composition was analyzed via energy-dispersive X-ray spectroscopy (EDS). Results: indicated that dual treatment with HF and sandblasting showed descriptively higher SBS, with values ranging from 5.01 to 6.14 MPa, compared to 1.85 MPa in the sandblasting-only group. ESEM revealed that higher HF concentrations (10%) created more porous and irregular surfaces, while EDS indicated an increased fluorine presence trend and silicon reduction, indicating deeper chemical activation. However, extending HF exposure beyond 20 s did not further improve bonding, suggesting the importance of protocol optimization. Conclusions: The preliminary observations suggest a synergistic effect of mechanical and chemical conditioning on hybrid ceramic adhesion, but values should be interpreted qualitatively due to the pilot nature of the study. Manufacturer-recommended air abrasion alone may provide limited adhesion under high-stress conditions, although this requires confirmation in studies with larger sample sizes and ageing simulations. Future studies should address long-term durability and extend the comparison to other hybrid CAD/CAM materials and to other etching protocols. Full article

Background/Objectives: This systematic review and meta-analysis aimed to evaluate the clinical performance and survival of bulk-fill resin composite restorations in posterior primary teeth, compared with conventional resin composites and glass ionomer cements (GICs). Methods: The protocol was registered in PROSPERO (CRD42024539097) and conducted according to PRISMA guidelines. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, and Cochrane databases up to December 2025. Randomized clinical trials (RCTs) evaluating bulk-fill resin composite restorations in primary molars were included. Restoration survival was considered the primary clinical endpoint. Secondary outcomes included marginal integrity, marginal discoloration, color match, postoperative sensitivity, secondary caries, retention, and anatomical form, assessed using USPHS or FDI criteria. Meta-analyses were performed for color match, marginal discoloration, and marginal integrity using a random-effects model. Comparisons involving GICs were synthesized descriptively. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated using GRADE. Results: Six RCTs involving 1220 restorations in children aged 3 to 10 years were included, with follow-up periods ranging from 6 to 24 months. Survival rates were high across all materials. Meta-analyses up to 12 months showed no significant differences between bulk-fill and conventional resin composites for color match, marginal discoloration, or marginal integrity. Most RCTs were judged as having low risk of bias, with one study presenting some concerns. The certainty of evidence was rated as moderate, mainly due to imprecision related to sample size and limited reporting of confidence intervals. Conclusions: Bulk-fill resin composites demonstrate clinical performance and survival comparable to conventional resin composites in posterior restorations of primary teeth over follow-ups of up to 12 months. Based on RCTs with predominantly low risk of bias and moderate certainty of evidence, bulk-fill composites represent a reliable and efficient restorative option in pediatric dentistry. Full article

Background and Objectives: ACTIVA BioACTIVE Restorative is a resin–ionomer hybrid marketed as a bioactive material for pediatric restorations, yet its specific performance in primary teeth has not been systematically synthesized. The study aim was to evaluate clinical and laboratory outcomes of ACTIVA in primary dentition compared with established restorative materials. Methods: Following a PRISMA-aligned, OSF-registered protocol, PubMed, Scopus, and Web of Science were searched to 18 October 2025 for full-text clinical trials and in vitro studies involving ACTIVA in primary teeth or primary dentin. Eligible designs included randomized or prospective clinical studies and standardized in vitro experiments. Primary outcomes were clinical and radiographic success; secondary outcomes included placement time, shear bond strength, and calcium-ion release. Results: Three randomized clinical trials (86 children, 305 restorations) and one in vitro study met the inclusion criteria. At 12 months, clinical success with ACTIVA ranged from 97.5 to 97.8% versus 95.0–97.8% for bulk-fill and conventional composites. At 24 months, a split-mouth trial reported clinical success of 93.0% for ACTIVA and 95.3% for compomer, with radiographic success of 86.0% and 88.3%, respectively, remaining within the predefined non-inferiority margin. ACTIVA required a mean of 2.4 ± 0.6 min less placement time than compomer. In vitro, shear bond strength to primary dentin was higher for ACTIVA than for an RMGIC (4.29 ± 0.65 vs. 2.47 ± 0.32 MPa), with greater calcium-ion release at 21 days (0.77 ± 0.13 vs. 0.53 ± 0.12 ppm). Conclusions: Within 1–2 years of follow-up, ACTIVA shows clinical performance in primary molars comparable to compomer, bulk-fill, and conventional composites, while offering shorter placement time and favorable bio-interactive behavior. Full article

This study aimed to evaluate the effects of thermal cycling and restorative material type on surface roughness of material surfaces and dental interfaces using a non-contact profilometer. Ninety Class V cavities (2 mm × 4 mm × 2 mm in height, width, and depth) were prepared on extracted third molars and restored with four bio-interactive materials (Equia Forte, Cention-N, Activa BioActive Restorative, Fuji II LC) and one composite resin (Solare-X) (n = 18/group). After polishing (Optidisc), initial surface roughness (Sa, µm) was measured following 24 h immersion in distilled water. Measurements were performed at cement/material (400 × 1600 μm²), enamel/material (1600 × 400 μm²), and material surfaces (800 × 800 μm²). Samples underwent 10,000 thermal cycles (5–55 °C) to simulate aging, and roughness was re-measured. Data were analyzed with two-way repeated measures ANOVA and Tukey’s post hoc test (p < 0.05). Solare-X showed the lowest roughness, while Fuji II LC and Activa BioActive Restorative were smoother than Cention-N and Equia Forte (p < 0.01). All materials exhibited significant roughness increases after thermal cycling (p < 0.01). Cement/material and enamel/material interfaces consistently showed higher roughness than material surfaces (p < 0.01). Thermal cycling significantly increased surface roughness of all tested materials. Interfaces demonstrated greater roughness than material surfaces, indicating higher susceptibility to plaque retention and potential risk for long-term restoration success. Full article

Background: Preservation of tooth structure is a key principle in pediatric dentistry, where restorative materials must balance mechanical strength with the preservation of pulp vitality and minimally invasive techniques. The aim of this in vitro study, as it relates to pediatric dentistry, was to investigate the flexural strength of common composite resins, glass ionomer cements, and resin-modified glass ionomer cement within standardized and homogeneous laboratory conditions. Methods: This study evaluated the flexural strength of seven restorative materials: four composites (Filtek™ Z250, Filtek™ Supreme XT, Gradia, Premise), two GICs (Ketac™ Molar Easymix, GC Fuji IX GP), and one RMGIC (Vitremer). Standardized specimens were prepared and tested using a three-point bending protocol with a universal testing machine (Zwick-Roell Z005). A total of 49 specimens were fabricated and analyzed. Statistical analysis was performed with a one-way ANOVA followed by Tukey’s post hoc test. Results: The flexural strength value of composite resins was significantly greater than that of the glass ionomer and resin-modified glass ionomer cements (p < 0.001). Filtek™ Z250 had the highest flexural strength, and Vitremer, a resin-modified glass ionomer cement, exhibited intermediate performance. Ketac™ Molar Easymix had the lowest values among conventional glass ionomer cements, whilst the flexural strength values obtained for GC Fuji IX GP were similar to some composite materials but with higher variability. Conclusions: Composite resins remain the most durable option for pediatric restorations in stress-bearing areas, whereas RMGICs provide a compromise between mechanical performance and biological advantages such as fluoride release and biocompatibility. Conventional GICs, despite their lower flexural strength, retain clinical relevance in low-load sites and for patients at a high risk of caries. Material selection in pediatric dentistry should therefore be tailored to the child’s age, tooth location, and functional demands to ensure long-lasting, minimally invasive restorations. This study involved only mechanical properties alone, and biological aspects, such as fluoride release and biocompatibility, were not considered. Material selection in pediatric dentistry should therefore take into account mechanical requirements, restorative location, and clinical environment. Full article

Objectives: This study evaluated and compared the sealing ability and elemental composition of a resin-based endodontic sealer (AH Plus) used with three root canal obturation techniques: single cone (SC), lateral compaction (LC), and warm vertical condensation (WVC). The investigation focused on microstructural characteristics, interfacial integrity, and elemental distribution within filled root canals. Material and Methods: Sixty extracted single-root teeth were instrumented using the ProTaper Gold system and randomly assigned to three groups (n = 20) according to the obturation technique. The AH Plus Jet sealer was applied in all cases. Following obturation, samples were subjected to radiographic investigation and analyzed using optical microscopy and scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDX) to assess the sealing performance and chemical composition. Results: Radiographic and microscopic assessments indicated that the SC method showed strong gutta-percha adhesion to dentin with a thin cement layer, whereas WVC provided excellent adaptation and penetration of gutta-percha. The LC technique demonstrated good adhesion but displayed occasional structural irregularities. SC has the thicker adhesion layer with uneven distribution regarding coronal, median, and apical, regions ranging from 45 to 80 μm, while WVC ensures a thin and uniform sealing layer of about 35 μm in all regions. SEM and EDX analyses detailed the interfacial microstructure and confirmed the presence of carbon (C), oxygen (O), calcium (Ca), zinc (Zn), barium (Ba), and sulfur (S) across all groups. Conclusions: All three obturation techniques (SC, WVC, LC) achieved effective sealing when combined with the AH Plus sealer. The main difference between the methods consists of the sealer layer thickness and its even distribution regarding gutta-percha cones. Full article

Ion exchange resins are commonly utilized for treating liquid radioactive waste within nuclear power plants; however, the disposal of these waste resins presents a new challenge. In this study, magnesium silicate hydrate cement (MSHC) was used to immobilize the waste resin, and the immobilization effectiveness of the MSHC-solidified body were assessed by mechanical properties, durability, and leaching performance. Hydration heat, X-ray diffraction (XRD), thermogravimetric analysis (TGA), scanning electronic microscopy (SEM), and mercury intrusion porosimetry (MIP) were used to study the hydration process of the MSHC-solidified body containing Cs⁺, Sr²⁺, and Cs⁺/Sr²⁺ waste resins. The results demonstrated that the presence of waste resins slightly delayed the hydration reaction process of MSHC and reduced the polymerization degree of the M-S-H gel, and the composition of the hydration products were not changed. The immobilization mechanism for radionuclide ions in resin included both mechanical encapsulation and surface adsorption, and the leaching of Cs⁺ and Sr²⁺ from MSHC-solidified body followed the FRDIM. When the content of the waste resin was 25%, the MSHC-solidified body exhibited satisfactory compressive strength, freeze-thaw resistance, soaking resistance, and impact resistance. These results strongly indicated that MSHC possessed the ability to effectively immobilize ion exchange resins. Full article

Background: The bonding compatibility between calcium silicate-based bioceramic cements and restorative materials is critical for long-term success in pediatric dentistry. This study compared the shear bond strength (SBS) of contemporary biointeractive restorative materials to two widely used bioceramics, NeoMTA Plus (NM) and Biodentine (BD). Methods: Eighty acrylic resin blocks with standardized cavities were filled with either NM or BD (n = 40 each) and subdivided into four restorative groups: nanohybrid composite (Filtek Ultimate), giomer (Beautifil II), bioactive restorative (Activa BioActive Restorative), and high-viscosity glass ionomer cement (Fuji IX GP Extra) (n = 10 each). All restorations followed a standardized etch-and-bond protocol. SBS was measured using a universal testing machine, and failure modes were assessed under a stereomicroscope. Data were analyzed using one-way ANOVA and Tukey’s HSD (p < 0.05). Results: BD exhibited significantly higher SBS values than NM (p < 0.001). In the BD group, Filtek Ultimate and Beautifil II achieved the highest and statistically comparable SBS, outperforming Activa BioActive Restorative and Fuji IX GP Extra (p < 0.05). In the NM group, no significant differences were found among materials. Adhesive failures predominated in NM (85%), while BD showed more cohesive failures (50%). Conclusions: Biodentine demonstrated superior bonding stability to restorative materials, with composite resin and giomer performing best. Giomer’s bioactivity and ion release make it a viable alternative to composite resin in suitable clinical contexts. Full article

Background/Objectives: The marginal adaptation of CAD/CAM restorations remains a key determinant of long-term clinical success, particularly in minimally invasive preparations. This in vitro study evaluated and compared the marginal gap of three CAD/CAM restorative materials—Cerasmart, G-CAM, and IPS Empress CAD—using standardized preparation and SEM measurement protocols. Methods: A total of 18 crowns were fabricated, of which 9 presented margins sufficiently interpretable under SEM and were included in the pooled quantitative analysis (n = 362 measurement points). Marginal gaps were recorded at 45×, 100× and 450× magnification using a Jeol JSM 25S scanning electron microscope. Normality and variance homogeneity were verified prior to parametric testing. Results: When pooled per material group, the mean ± SD marginal gap values were 18.53 ± 14.15 µm for Cerasmart, 21.60 ± 14.89 µm for G-CAM, and 47.09 ± 16.93 µm for IPS Empress CAD. All values fell below the contemporary clinical threshold of <70 µm for adhesive cementation. Pairwise comparison showed a large difference between IPS Empress CAD and the two resin-based materials, whereas the difference between Cerasmart and G-CAM was small. Conclusions: Hybrid and resin nano-ceramic CAD/CAM materials demonstrated narrower marginal gaps compared with the glass ceramic tested, likely due to their lower elastic modulus and greater seating accommodation during cementation. Within the limits of this in vitro design, all materials exhibited marginal adaptation consistent with current clinical acceptability criteria. Full article

In response to the problem of high energy consumption caused by inefficient temperature control of energy storage aggregates in traditional building envelope structures, this study developed a decanoic acid–stearic acid composite phase-change ceramsite aggregate to improve the thermal performance of buildings and promote the utilization of solid waste resources. Based on the theory of minimum melting, composite phase-change materials were screened through thermodynamic models. The capric acid–stearic acid (CA-SA) melt system, whose theoretical phase-transition temperature falls within the building indoor thermal environment control range (18–26 °C), was preferred as the experimental object of this study, and its characteristics were verified through step cooling curves and thermal property tests. Subsequently, the ceramsite adsorption process was optimized, and the encapsulation process was studied. Finally, the encapsulation performance was evaluated through thermal stability and stirring crushing rate tests. The results showed that the phase-transition temperature of the decanoic acid–stearic acid melt system was 24.83 °C, which accurately matched the indoor thermal environment control requirements. The ceramsite particles treated by a physical vibrating screen can reach equilibrium after 30 min of adsorption at room temperature and pressure, which is both efficient and economical. The encapsulation layer of sludge biochar cement slurry with a water–cement ratio of 0.5 and a biochar content of 3% has both thermal conductivity and encapsulation integrity. The thermal stability test showed that the percentage of leakage of sludge biochar cement slurry and epoxy resin encapsulated aggregates was 0%, and the thermal stability rating was “very stable”. However, the percentage of leakage of unencapsulated and spray-coated encapsulated aggregates was as high as 193% and 40%, respectively. The results of the mixing and crushing rate test show that although the mixing and crushing rate of sludge biochar cement slurry encapsulation is slightly higher, its production cost is much lower than that of epoxy resin, and it is also environmentally friendly. This study improves the thermal performance of buildings by using composite phase-change ceramsite aggregate, and simultaneously realizes the resource utilization of sludge biochar, providing a solution for building energy saving and efficiency that combines environmental and engineering value. Full article

Background: Ion-releasing and bioactive restorative materials are an integral part of restorative dentistry, especially in light of minimally invasive and esthetic intervention strategies. Their strength and mechanical properties directly influence their durability and indicated use. Methods: This study aimed to comparatively analyze the compressive strengths, flexural strengths, and flexural moduli of bioactive Alkasite (Cention N) and other ion-releasing restorative materials, specifically a resin-modified glass ionomer (RMGIC, Fuji II LC) and a compomer (Dyract XP). Cylindrical and bar-shaped specimens were fabricated from each material (n = 6 per material and conducted test) and subjected to mechanical strength testing (compressive and flexural strength) using a 2 kN cell universal testing machine (Instron 5944) with a crosshead speed of 0.5 mm/min. Statistical analysis, using one-way ANOVA and Tukey’s HSD post hoc tests, was conducted. Results: The results revealed significant differences in mechanical properties between the tested materials. Dyract XP showed the greatest compressive and flexural strengths (170.79 ± 23.59 MPa and 114.09 ± 30.78 MPa) (p < 0.01). Fuji II LC had a significantly greater flexural modulus (10.21 ± 4.46 GPa) than Dyract XP. Conclusions: The findings indicated that the investigated compomer could produce stronger restorations than the investigated alkasite and RMGIC, which would make them preferred for posterior teeth restoration. However, the alkasite Cention N might still be a good option for the treatment of carious lesions in areas with less occlusal stress. Full article

Background/Aim: Immature permanent teeth with necrotic pulps present thin dentinal walls and open apices, making them highly susceptible to cervical fractures even after apexification. This study aimed to compare stress distribution patterns produced by different coronal base materials following mineral trioxide aggregate (MTA) apexification using three-dimensional finite element analysis (FEA). Materials and Methods: A CBCT-based model of a maxillary immature incisor was reconstructed and modified to simulate six restorative scenarios: control (sound tooth), MTA + conventional glass ionomer cement (GIC), MTA + resin-modified glass ionomer cement (RMGIC), MTA + bulk-fill flowable composite, MTA + conventional composite resin, and MTA + flowable composite resin. A 100 N oblique load (45°) was applied, and von Mises stress, displacement, and periodontal ligament strain were analyzed. Inter-model comparisons were performed using one-way ANOVA with Tukey post hoc tests (p < 0.05). Results: All models exhibited maximum stress concentration in the cervical third of the root. Bulk-fill flowable composite and RMGIC generated lower cervical stress and more homogeneous distribution compared with GIC or conventional composite resin. Conventional composite resin produced the highest stress concentration due to its higher stiffness. Derived biomechanical metrics confirmed statistically significant differences between groups (p < 0.05). Conclusions: The coronal base material strongly affects the biomechanical behavior of immature incisors restored after MTA apexification. Selecting low-modulus, stress-dissipating materials such as bulk-fill flowable composites or RMGICs may minimize cervical stress and potentially reduce fracture risk. These computational findings warrant validation through in vitro and clinical studies. Full article

This study evaluated the effect of delay time and storage conditions after airborne-particle abrasion on the shear bond strength between base metal alloys (BMA) and self-adhesive resin cement. It also assessed whether vacuum sealing or re-airborne-particle abrasion could counteract the time-related degradation of bond strength. Sixty BMA specimens were airborne-particle-abraded and divided into six groups (n = 10): immediate bonding; 1-day, 7-day, and 14-day delays; 14-day vacuum-sealed; and 14-day delay with re-airborne-particle abrasion. Resin cement was applied to standardized bond areas, and composite rods were bonded. All specimens were stored in water at 37 °C for 24 h before shear bond strength testing. Failure modes were examined under a stereomicroscope. One-way ANOVA revealed significant differences among groups (p < 0.05). Immediate bonding yielded the highest strength (26.50 ± 2.74 MPa). Bond strength declined with delays, namely, 1-day (21.19 ± 4.94 MPa), 7-day (15.20 ± 4.52 MPa), and 14-day (16.01 ± 4.69 MPa), with no significant difference between the 7- and 14-day groups. Vacuum sealing for 14 days preserved bond strength (25.92 ± 3.94 MPa) comparable to immediate bonding. Re-airborne-particle abrasion restored bond strength (20.66 ± 3.70 MPa). Prolonged delays resulted in 100% adhesive failures, whereas immediate bonding and intervention groups showed 80% adhesive and 20% mixed failures. Delayed bonding after airborne-particle abrasion significantly reduces bond strength due to oxide layer formation on the BMA surface. However, surface sealing might prevent surface oxidation and maintain bonding potential, while re-airborne-particle abrasion can restore bond strength when delays are unavoidable. Clinically, bonding should be performed immediately after airborne-particle abrasion, or appropriate surface management protocols should be implemented to maintain optimal adhesion. Full article

The aim of this pilot in vitro study is to investigate the fracture strength of hybrid abutment crowns (HACs) made of a 3D-printable, tooth-colored, ceramic-reinforced composite (CRC). Based on an upper first premolar, a crown was designed, and specimens were additively fabricated from a composite material (VarseoSmile Crown plus) (N = 32). The crowns were bonded to standard abutments using a universal resin cement. Half (n = 16) of the samples were subjected to artificial aging, during which three samples suffered minor damage. All specimens were mechanically loaded at an angle of 30° to the implant axis. In addition, an FEM simulation was computed. Statistical analysis was performed at a significance level of p < 0.05. The mean fracture load without aging was 389.04 N (SD: 101.60 N). Two HACs suffered screw fracture, while the crowns itself failed in all other specimens. In the aged specimens, the mean fracture load was 391.19 N (SD: 143.30 N). The failure mode was predominantly catastrophic crown fracture. FEM analysis showed a maximum compressive stress of 39.79 MPa, a maximum tensile stress of 173.37 MPa and a shear stress of 60.29 MPa when loaded with 389 N. Within the limitations of this pilot study, the tested 3D-printed hybrid abutment crowns demonstrated fracture resistance above a clinically acceptable threshold, suggesting promising potential for clinical application. However, further investigations with larger sample sizes, control groups, and clinical follow-up are required. Full article