Search Results (62)

Background/Objectives: The aim of this study was to evaluate the level of awareness among dental students and practitioners regarding the utilization of endocrowns in clinical settings, along with any differences in knowledge based on gender, educational level, and workplace. Methods: A cross-sectional online survey-based study was conducted, including 1154 participants from various dental institutions across Saudi Arabia. The questionnaire included demographic data and closed-ended questions focused on knowledge and awareness of endocrowns. Data was analyzed using statistical tests, including chi-square, to see any significant differences. Results: Most participants (81%) had knowledge about endocrowns, mainly from their colleagues. Knowledge levels and preferences (like the use of lithium disilicate and adhesive resin cement) differed based on gender, educational level, and workplace. Male participants and undergraduates showed better awareness in some areas. Faculty members mostly depend on college training, while private practitioners obtain most of their information from workshops. Conclusions: Males showed significant superiority in knowledge about endocrown usage. Colleges were the most prevalent source of information regarding endocrown restorations. Significant molar tooth loss and restricted inter-arch space were the most common reasons for utilizing endocrowns. Moreover, endocrowns were considered a viable alternative to traditional post and core. Full article

This study aimed to investigate the bonding strength and durability of titanium alloys bonded to zirconia-based materials produced using subtractive and additive digital methods. Two titanium alloy groups (N = 20) and two zirconia ceramic groups (N = 60) were fabricated using CAD/CAM milling from prefabricated discs (Ti-ML and Zr-ML), and 3D printing via SLM (Ti-3D) and DLP/LCM systems (Zr-3D). The specimens were bonded with dental cement to form four test groups: Zr-ML/Ti-ML, Zr-ML/Ti-3D, Zr-3D/Ti-ML, and Zr-3D/Ti-3D. Half of the specimens in each group underwent thermocycling to assess the effect of aging on bond strength. The density, microhardness, and surface morphology were evaluated, along with the shear bond strength and failure modes of the resin composites. Statistical differences were analyzed using one-way ANOVA and Tukey’s HSD test across all groups. The 3D-printed specimens of both materials exhibited higher microhardness and lower surface roughness than the milled specimens. The shear bond strength (SBS) was the highest in the Ti-ML/Zr-ML combination group before and after thermocycling, which had more cohesive failures, whereas the lowest bond strength was observed in the Ti-3D/Zr-ML group. The adhesion between titanium and zirconia-based materials was the strongest when both were fabricated using subtractive methods, followed by additive and mixed-method combinations. Full article

Background/Objectives: This in vitro study investigated the retention of three different geometrical designs of short titanium base (Ti-base) abutments used in implant-supported zirconia crowns. The advent of digital technology has facilitated the integration of Ti-base abutments into implant dentistry by improving time efficiency, precision, and patient comfort. Methods: Three types of short Ti-base abutments were evaluated: Geo SRN multibase^® (Group A), Herilink^® (Group B), and TS Link^® (Group C), each with a height of 4 mm and gingival height of 1 mm (n = 20 per group). Zirconia crowns (LUXEN^® Smile S2, DentalMax, Republic of Korea) were modified for the testing setup and fabricated using CAD/CAM technology, then bonded to the abutments with RelyX^® Luting 2 resin-modified glass ionomer cement. Pull-out tests were conducted at a crosshead speed of 1 mm/min to assess retention. Results: One-way ANOVA and post hoc Tukey tests revealed significant differences in retention values among the different abutment shapes (p < 0.05). The mean retention forces were 194.65 N for Group A, 241.33 N for Group C, and 360.20 N for Group B. Conclusions: The geometrical design of Ti-base short abutments significantly affects the retention of CAD/CAM zirconia crowns, with hexagonal shapes (Group B) demonstrating superior retention. Clinically, selecting an abutment design with enhanced mechanical retention may improve the long-term success of implant-supported restorations. Full article

Objective: Selecting suitable materials and luting agents for single crowns is critical yet challenging, as dentists must consider different factors. This study aimed to assess dentists’ preferences for materials and luting agents under different clinical conditions and evaluate the nonclinical factors influencing their preferences. Methods: A paper-based survey supplemented with photographs illustrating anterior and posterior single-crown preparation designs was used, incorporating three clinical scenarios for each as examples. Participants provided demographic data and were asked to select their preferred material and luting agent for each scenario. Comparisons between the crown material/luting agent choices and dentist/practice characteristics were performed. Significant differences were determined using the chi-square test. Results: Overall, 262 (87.3%) dentists participated in this survey. The top-selected material for anterior preparation designs was lithium disilicate; monolithic zirconia was the most selected for posterior preparation designs. Dual-cure resin was the most selected luting agent for all anterior and posterior clinical scenarios, except for posterior subgingival preparation design. There was a significant association between the dentist’s age and the selection of material and luting agent (p < 0.05) in all clinical scenarios, except for the luting agent selection in the posterior subgingival preparation designs (p < 0.05). Other nonclinical factors yielded mixed results; some preparation designs showed significant differences, while others did not, depending on the clinical scenario. Conclusions: Reliance on new materials and luting agents that require minimally invasive treatment with dental ceramics and resin cement is increasing. However, the choice of materials and luting agents is influenced by clinical presentation and nonclinical factors, making it crucial for dentists to be aware of these factors when selecting materials for single-crown restorations. Clinical Implications: An overall trend was observed for the use of strong monolithic ceramics with adhesive resin cements. These findings could assist dentists in reviewing and re-evaluating material choices in their clinical practices, both at a national and regional level. Additionally, the findings could be useful for dental policy makers, wholesale suppliers, and retail distributors in making future decisions. Full article

This study aimed to evaluate the influence of different fluoride-containing toothpastes on fluoride uptake, surface roughness, and microhardness of six ion-releasing restorative dental materials, including glass hybrids (EQUIA Forte HT with and without coating), glass ionomer cements (Fuji IX), resin-modified GICs (Fuji II LC), alkasites (Cention Forte), and ion-releasing composites (Luminos UN and Activa). Specimens were prepared and subjected to a four-day brushing protocol using six toothpastes with varying fluoride formulations (NaF, SnF2, SMFP) and concentrations. Fluoride uptake was assessed by measuring fluoride release using an ion-selective electrode, while surface roughness and microhardness were assessed before and after brushing. Results revealed significant variations in fluoride uptake, with Fuji IX and EQUIA Forte HT showing the highest release, particularly when brushed with NaF-based toothpastes (Duraphat 5000 and 2800). Surface roughness increased post-brushing, with the greatest changes observed in Activa, while microhardness decreased across most materials, except for coated EQUIA Forte HT, which exhibited improved compactness. Resin-based composites, such as Luminos UN and Activa, demonstrated lower fluoride uptake and minimal changes in microhardness compared to GICs. The findings underscore the importance of material composition and toothpaste formulation in influencing fluoride dynamics, surface properties, and mechanical performance of restorative materials. Full article

Background: Resin-bonded fixed dental prostheses (RBFDPs) have become an increasingly popular minimally invasive solution for replacing missing anterior teeth. However, their long-term success is influenced by factors such as bridge design and material selection. Methods: This systematic review and meta-analysis aimed to assess the impact of different bridge designs on the clinical performance and failure risks of anterior ceramic RBFDPs. A comprehensive search of electronic databases was conducted to identify clinical studies published in English up to January 2025. Nine studies, including randomized controlled trials, cohort studies, and clinical trials, met the inclusion criteria. Results: The analysis revealed that single-retainer RBFDPs demonstrated lower failure rates than two-retainer models (RR: 0.36, 95% CI: 0.17–0.75). Among failure types, fractures were significantly less common in cantilever designs compared to two-retainer designs (RR: 0.25, 95% CI: 0.09–0.73), while no significant differences were observed in debonding rates (OR: 0.40, 95% CI: 0.015–1.10). Conclusions: In terms of material selection, all-ceramic RBFDPs in cantilever designs exhibited significantly lower failure rates (RR: 0.12, 95% CI: 0.03–0.43), whereas metal-ceramic RBFDPs showed no significant difference in failure rates based on bridge design (RR: 0.56, 95% CI: 0.21–1.53). These findings suggest that all-ceramic cantilever RBFDPs may offer superior long-term outcomes, highlighting the importance of precise preparation and cementation protocols for clinical success. Full article

BioFlx crowns (BFCs) have been introduced in the dental market, combining the flexibility of stainless steel crowns (SSCs) with the esthetic appeal of preformed zirconia crowns. However, the existing literature does not provide adequate insights regarding the retentive strength of various types of luting cement with these newly developed BFCs. Therefore, this study aimed to evaluate and compare the retentive strength of BFCs and SSCs with different types of luting cement (glass ionomer cement [GIC], resin-modified glass ionomer cement [RMGIC], self-adhesive resin cement [SARC], and polycarboxylate cement [PXC]). A total of 160 standardized resin dies were fabricated and divided into two groups based on the type of crown (BFCs or SSCs). Each group was further subdivided into four subgroups (20/group) based on the luting cement used for cementing the crown on the die. A pullout test was performed using a universal testing machine to measure the retentive strength required for crown dislodgement. The residual cement in the crown was scored to determine the cement failure pattern. Data were analyzed using two-way analyses of variance (ANOVAs) to evaluate the interaction between the cement and the type of crown on retentive strength, followed by an independent t-test. Furthermore, Welch’s ANOVA and Dunnett’s T3 test were used to assess the impact of various types of luting cement on the retentive strength of each crown. The CFP was assessed by comparing the scores using descriptive statistics. Statistical significance was set at p < 0.05. The mean retentive strength of SSCs and BFCs was the highest with SARC (560.29 ± 8.74 N; 657.72 ± 20.60 N), followed by RMGIC (534.20 ± 22.84 N; 454.90 ± 7.95 N) and GIC (435.14 ± 8.66 N; 237.68 ± 9.37 N), while the lowest was with PXC (365.67 ± 19.11 N; 131.26 ± 5.37 N). A significant difference in retention was observed between the crowns (p < 0.05). Cement failure primarily manifested as adhesive failures in the SARC and RMGIC groups; however, both adhesive and cohesive failures occurred in the GIC and PXC groups. Thus, SSCs demonstrate significantly higher retention than BFCs across all types of luting cements, except when using SARC. Within the limitations of this in vitro study, SSCs emerge as the preferred choice for full-coverage restorations that require optimal retention and durability. Nevertheless, BFCs with SARC provide a viable alternative when esthetic considerations are prioritized. Full article

Objectives: This study evaluates the effectiveness of laser surface texturing (LST) using a Surface Transition Machine (STM) on pre-sintered zirconia, comparing its impact on surface characteristics and shear bond strength (SBS) with resin cement to conventional sandblasting techniques. Methods: Zirconia specimens were treated with either STM or sandblasting, followed by surface analysis through scanning electron microscopy (SEM) and White Light Interferometry (WLI), wettability assessment via contact angle measurements, and SBS testing with resin cement and a 10-MDP-containing primer. Results: SEM and WLI revealed significant surface alterations in STM-treated zirconia, producing microscale textures. STM-treated surfaces exhibited significantly lower contact angles (28.4 ± 10.0°) compared to untreated (78.2 ± 8.0°) and sandblasted (79.2 ± 5.7°) surfaces, indicating enhanced wettability (p < 0.05). SBS was highest in the STM with primer group (46.3 ± 8.3 MPa) and STM without primer (43.4 ± 4.3 MPa), both of which significantly outperformed sandblasting with primer (30.06 ± 3.09 MPa) and sandblasting alone (9.8 ± 3.7 MPa) (p < 0.05). Conclusions: These findings suggest that STM-based LST is a more effective method for improving zirconia surface characteristics and adhesion in dental restorations, simplifying bonding procedures, and potentially offering better clinical outcomes than conventional sandblasting. Full article

Background and Objectives: The manufacturing of single crowns using hybrid abutments is an alternative that may be interesting in clinical practice, combining the advantages of the different materials used in a personalized design for each case. The purpose of this in vitro study was to evaluate the torque loss, survival, reliability, failure mode, and strain distribution of implant-supported prostheses with zirconia (Zir) and cobalt–chromium (Co-Cr) hybrid abutments. Materials and Methods: Abutments were milled by CAD/CAM and divided into two groups according to the materials used, Zir and Co-Cr, and cemented on titanium bases screwed to dental implants. Monolithic zirconia crowns were cemented on the abutments. The implant/abutment/crown sets were subjected to thermomechanical cycling (n = 10) (2 Hz, 140 N, 1 × 10⁶ cycles, immersed in water at 5–55 °C) to evaluate the torque loss. The single load to fracture test (SLF) was performed to design the loading profiles (light, moderate, and aggressive) of the step-stress accelerated life testing (SSALT) (n = 21) to evaluate the survival and reliability. The representative fractured specimens were analyzed under optical and scanning electron microscopy. The digital image correlation (DIC) (n = 1) was performed using specimens embedded in polyurethane resin models that received static point loading, and the strain distribution was analyzed. Results: There was no difference in torque loss, survival, or reliability between zirconia and Co-Cr abutments. An analysis of the fractured surfaces showed that the abutments presented the same failure mode, where the fracture probably started in the titanium base/screw. The zirconia abutment model presented only compressive strains around the implant, while the Co-Cr abutment model showed tensile and compressive strains in the middle of the implant; however, all strains were within the clinically acceptable limits. There was a strain concentration in the titanium base close to the implant platform for both groups. Conclusions: Zirconia and Co-Cr hybrid abutments presented similar torque loss, survival, reliability, and failure modes, but the abutment material influenced the strain distribution around the implant. The titanium base screw was the weakest link in the system. Full article

The rapid evolution of lithium silicate-based glass ceramics in the field of dental ceramics has led to the availability of different compositions in the market. This in vitro study was conducted to assess an effective protocol for recementing de-bonded lithium silicate-based glass ceramics by evaluating the shear bond strength of three reseating methods. The study included IPS e.max^® CAD, Vita Suprinity^®, Celtra Duo^®, and n!ce as lithium-based glass ceramics. The samples underwent a series of preparation steps, including embedding in acrylic resin, hand polishing, etching with 5% hydrofluoric acid, and application of universal primer and adhesive as per manufacturer instructions. Subsequently, adhesive resin cement was applied to the ceramic tablets, and shear bond strength was assessed using a standardized method. The findings revealed that no single method demonstrated significantly superior results compared to the others. However, it was observed that etching with 5% hydrofluoric acid for 20 s yielded favorable outcomes in terms of time efficiency and standardized results. Additionally, it was noted that although sandblasting increased surface area, it did not enhance bond strength due to unfavorable surface disturbance. In conclusion, the study suggests that etching with 5% hydrofluoric acid for 20 s is a favorable protocol for reseating de-bonded lithium disilicate-based glass ceramics, offering both time efficiency and consistent results for clinicians. Full article

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures. Full article

Fracture resistance is an important parameter used to predict the performance of indirect dental restorations. The purpose of this in vitro study was to assess the fracture load of posterior milled nanoceramic crowns, in comparison with the lithium disilicate crowns, after fatigue loading, for two different restoration occlusal thicknesses. Forty test metal dies were fabricated by duplicating a master metal model consisting of an anatomic abutment preparation of the maxillary first premolar for a single crown. The dies were divided into two groups of 20 each for the fabrication of nanoceramic (Lava Ultimate) and lithium disilicate (IPS e.max CAD) single crowns. Each material group was further divided into two sub-groups of 10 dies each, based on crown occlusal thickness, of 0.5-mm and 0.75-mm (n = 10). Dental Type V stone dies poured from polyvinyl siloxane impressions of the test metal dies were laboratory scanned in order to design and mill 40 ceramic crowns. The crowns were cemented on to the test metal dies with a self-adhesive resin luting cement. All crowns were thermocycled (2500 cycles) and mechanically loaded (250,000 cycles) in a chewing simulator followed by static loading until failure, and the values noted. The data were statistically analyzed by 2-way ANOVA and Tukey HSD post-hoc multiple comparison tests (α = 0.05). The mean fracture loads ranged from 1022 to 1322 N for nanoceramic crowns and from 1145 to 1441 N for the lithium disilicate crowns. Two-way ANOVA revealed insignificant differences between the nanoceramic and lithium disilicate crowns (p > 0.05) in terms of fracture load. Significant differences were noted in the fracture resistance of crowns based on occlusal thickness (303 N; p = 0.013) regardless of the material used. Multiple comparisons by Tukey HSD post-hoc test showed insignificant differences between the four material-occlusal thickness groups (p > 0.05). The nanoceramic crowns were found to be comparable with lithium disilicate crowns in terms of fracture load. The mean fracture loads of all of the tested crowns were within the normal physiological masticatory load limits. Based on the fracture-resistance results, nanoceramic crowns seem to be suitable for clinical use for the tested occlusal thicknesses. Full article

There is a vast amount of published literature concerning dental veneers; however, the effects of tooth preparation, aging, veneer type, and resin cement type on the failure of dental veneers in laboratory versus clinical scenarios are not clear. The purpose of the present narrative review was to determine the principal factors associated with failures of dental veneers in laboratory tests and to understand how these factors translate into clinical successes/failures. Articles were identified and screened by the lead author in January 2024 using the keywords ‘‘dental veneer”, “complication”, “survival rate”, “failure”, and “success rate” using PubMed/Medline, Scopus, Google Scholar, and Science Direct. The inclusion criteria included articles published between January 1999 and January 2024 on the topics of preparation of a tooth, aging processes of the resin cement and veneer, translucency, thickness, fabrication technique of the veneer; shade, and thickness of the resin cement. The exclusion criteria included articles that discussed marginal and internal fit, microhardness, water sorption, solubility, polishability, occlusal veneers, retention, surface treatments, and wear. The results of the present review indicated that dental veneers generally have a high survival rate (>90% for more than 10 years). The amount of preserved enamel layer plays a paramount role in the survival and success rates of veneers, and glass-ceramic veneers with minimal/no preparation showed the highest survival rates. Fracture was the primary failure mechanism associated with decreased survival rate, followed by debonding and color change. Fractures increased in the presence of parafunctional activities. Fewer endodontic complications were associated with veneer restorations. No difference was observed between the maxillary and mandibular teeth. Clinical significance: Fractures can be reduced by evaluation of occlusion immediately after cementation and through the use of high-strength veneer materials, resin cements with low moduli, and thin layers of highly polished veneers. Debonding failures can be reduced with minimal/no preparation, and immediate dentin sealing should be considered when dentin is exposed. Debonding can also be reduced by preventing contamination from blood, saliva, handpiece oil, or fluoride-containing polishing paste; through proper surface treatment (20 s of hydrofluoric acid etching for glass ceramic followed by silane for 60 s); and through use of light-cured polymerization for thin veneers. Long-term color stability may be maintained using resin cements with UDMA-based resin, glass ceramic materials, and light-cure polymerization with thin veneers. Full article

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth. Full article

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner’s ability, each case analysis, and the patient’s wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition. Full article