Sara Abtahi, Shamim Mirzaboland, Allahyar Geramy, Marzieh Alikhasi, Hakimeh Siadat
Objectives
This study investigates how titanium-base (Ti-base) abutment height, crown design, and force angulation affect biomechanics in an anterior single-implant restoration, using finite element analysis.
Material and Methods
A three-dimensional anterior maxilla model was constructed with linear elastic properties. Two Ti-base heights (3.5, 5.5 mm) and two crown heights (8, 11 mm) were tested as monolithic zirconia or bilayer (zirconia core veneered with lithium disilicate). A 146 N load was applied at the cingulum at 45° or 65°. von Mises stress (VMS) was computed in the crown, abutment, and surrounding bone.
Results
A 3.5 mm Ti-base with an 8 mm monolithic zirconia crown (SSZ) produced the lowest crown and abutment VMS. The highest crown VMS occurred in the 11 mm bilayer crown on a 5.5 mm Ti-base (LLZEX) at 45°, while the highest abutment VMS occurred in the 3.5 mm Ti-base with an 8 mm bilayer crown (SSZEX) at 65°. An increase in crown height raises crown stresses, whereas the impact of abutment height depends on configuration and angle. In bone, 45° loading increased VMS compared with 65° across all models.
Conclusions
In anterior single-implant models, the lowest restoration stresses were achieved with a short crown on a 3.5-mm Ti-base and monolithic zirconia. Long crowns (11 mm) increased crown stresses, and abutment height should be tailored to material and anticipated loading direction rather than adjusted by a single rule. Oblique loading consistently raised bone stress compared with 65°, underscoring the need to optimize for axial force transmission.
{"title":"Effect of Crown to Titanium Base Ratio and Force Angle on the Biomechanical Behavior of Dental Implants With CAD/CAM Zirconia and Lithium Disilicate Crowns: A Finite Element Analysis","authors":"Sara Abtahi, Shamim Mirzaboland, Allahyar Geramy, Marzieh Alikhasi, Hakimeh Siadat","doi":"10.1002/cre2.70296","DOIUrl":"10.1002/cre2.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study investigates how titanium-base (Ti-base) abutment height, crown design, and force angulation affect biomechanics in an anterior single-implant restoration, using finite element analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A three-dimensional anterior maxilla model was constructed with linear elastic properties. Two Ti-base heights (3.5, 5.5 mm) and two crown heights (8, 11 mm) were tested as monolithic zirconia or bilayer (zirconia core veneered with lithium disilicate). A 146 N load was applied at the cingulum at 45° or 65°. von Mises stress (VMS) was computed in the crown, abutment, and surrounding bone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A 3.5 mm Ti-base with an 8 mm monolithic zirconia crown (SSZ) produced the lowest crown and abutment VMS. The highest crown VMS occurred in the 11 mm bilayer crown on a 5.5 mm Ti-base (LLZEX) at 45°, while the highest abutment VMS occurred in the 3.5 mm Ti-base with an 8 mm bilayer crown (SSZEX) at 65°. An increase in crown height raises crown stresses, whereas the impact of abutment height depends on configuration and angle. In bone, 45° loading increased VMS compared with 65° across all models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In anterior single-implant models, the lowest restoration stresses were achieved with a short crown on a 3.5-mm Ti-base and monolithic zirconia. Long crowns (11 mm) increased crown stresses, and abutment height should be tailored to material and anticipated loading direction rather than adjusted by a single rule. Oblique loading consistently raised bone stress compared with 65°, underscoring the need to optimize for axial force transmission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dawei Zhang, Shijie Zhu, George Pelekos, Lijian Jin, Patrick Rijkschroeff
Objectives
This study aims to test a conceptual mediation model wherein periodontitis is associated with mortality through direct pathways and indirectly via accelerated biological aging.
Material and Methods
We analyzed six cycles of National Health and Nutrition Examination Survey data with mortality follow-up of 250 months. Weighted descriptive statistics were used to compare group characteristics, Kaplan–Meier analysis to evaluate periodontitis-mortality associations and generalized linear models to examine the links between periodontitis and biological aging. Cox proportional hazards models integrated with restricted cubic splines were utilized to explore the association between biological age and mortality, and mediation analyses quantified the mediation of biological aging. Additionally, age, gender, and smoking status subgroup analyses were conducted.
Results
Moderate/severe periodontitis was associated with a significantly elevated all‑cause mortality risk (18.31% vs. 10.88% in no/mild periodontitis) and greater biological age advancement (PhenoAge: 1.22 years; KDM: 0.68 years). Biological age acceleration exhibited a non-linear association with mortality, with hazard ratios rising sharply beyond a threshold (PhenoAge: 16.4 years; KDM: 31.8 years). Mediation analysis showed that biological age partially mediated the periodontitis–mortality association, with indirect effect hazard ratios of 1.085 (95% CI: 1.067–1.106) for PhenoAge advance and 1.027 (95% CI: 1.016–1.040) for KDM advance in all‑cause mortality, though the proportion mediated was modest and varied across subgroups.
Conclusions
Our findings support the hypothesis that biological aging (assessed by PhenoAge and KDM advances) plays a significant, though partial, mediating role in the link between periodontitis and elevated mortality.
{"title":"The Mediating Role of Biological Age Advance in the Association Between Periodontitis and Mortality: Biological Aging Links Periodontitis to Mortality","authors":"Dawei Zhang, Shijie Zhu, George Pelekos, Lijian Jin, Patrick Rijkschroeff","doi":"10.1002/cre2.70305","DOIUrl":"10.1002/cre2.70305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to test a conceptual mediation model wherein periodontitis is associated with mortality through direct pathways and indirectly via accelerated biological aging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We analyzed six cycles of National Health and Nutrition Examination Survey data with mortality follow-up of 250 months. Weighted descriptive statistics were used to compare group characteristics, Kaplan–Meier analysis to evaluate periodontitis-mortality associations and generalized linear models to examine the links between periodontitis and biological aging. Cox proportional hazards models integrated with restricted cubic splines were utilized to explore the association between biological age and mortality, and mediation analyses quantified the mediation of biological aging. Additionally, age, gender, and smoking status subgroup analyses were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Moderate/severe periodontitis was associated with a significantly elevated all‑cause mortality risk (18.31% vs. 10.88% in no/mild periodontitis) and greater biological age advancement (PhenoAge: 1.22 years; KDM: 0.68 years). Biological age acceleration exhibited a non-linear association with mortality, with hazard ratios rising sharply beyond a threshold (PhenoAge: 16.4 years; KDM: 31.8 years). Mediation analysis showed that biological age partially mediated the periodontitis–mortality association, with indirect effect hazard ratios of 1.085 (95% CI: 1.067–1.106) for PhenoAge advance and 1.027 (95% CI: 1.016–1.040) for KDM advance in all‑cause mortality, though the proportion mediated was modest and varied across subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings support the hypothesis that biological aging (assessed by PhenoAge and KDM advances) plays a significant, though partial, mediating role in the link between periodontitis and elevated mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uterine Sensitization-Associated Gene 1 (USAG-1) is a bone morphogenetic protein (BMP) antagonist vital for tooth regeneration that is expressed in kidney, gingiva, and dental tissues.
Material and methods
We analyzed recent studies focusing on USAG-1 and its involvement in BMP and Wnt signaling pathways related to dental tissue repair and regeneration. Preclinical models and clinical trial data were examined to evaluate the efficacy of USAG-1 inhibition as a therapeutic strategy. In addition, publicly available single-cell RNA sequencing and STRING databases were analyzed to investigate the gene expression of USAG-1 in human tissues and its protein interactions, respectively.
Results
RNA-seq analysis confirmed that USAG-1 is expressed in a subset of secretory cell types in kidney, jaw, and gingiva that are important for cell growth and morphogenesis. Recent studies have also demonstrated that inhibiting USAG-1 facilitates tooth regeneration by activating BMP-mediated morphogenesis and improving outcomes in preclinical models. Engineered monoclonal antibodies that target USAG-1 have shown that blocking the protein product of this gene can promote third dentition and alleviate congenital tooth agenesis. Clinical trials utilizing this antibody are currently underway, with prospects for commercial applications within the next decade. Despite these advancements, challenges related to safety, specificity, and delivery mechanisms remain.
Conclusions
This review underscores the transformative potential of USAG-1-based therapies in regenerative dentistry, offering a paradigm shift in dental care by enabling biologically authentic tooth regeneration. However, the realization of these advancements in clinical practice requires overcoming significant barriers, including ensuring safety, optimizing delivery systems, and addressing ethical concerns. Continued interdisciplinary research is essential to fully harness the potential of USAG-1 in regenerative dentistry.
{"title":"USAG-1 and Regenerative Dentistry, Therapeutic Implications and Future Directions: Review of the Literature","authors":"Zahra Moradi, Mohammadreza Karimi, Shirin Kolahdouz, Narges Arya, Vahid Akheshteh, Fatemeh Ayanzadeh, Yasmina Aalizadeh, Hanieh Moravvej, Marzie Keshavarzi, Amar Basri","doi":"10.1002/cre2.70301","DOIUrl":"10.1002/cre2.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Uterine Sensitization-Associated Gene 1 (USAG-1) is a bone morphogenetic protein (BMP) antagonist vital for tooth regeneration that is expressed in kidney, gingiva, and dental tissues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>We analyzed recent studies focusing on USAG-1 and its involvement in BMP and Wnt signaling pathways related to dental tissue repair and regeneration. Preclinical models and clinical trial data were examined to evaluate the efficacy of USAG-1 inhibition as a therapeutic strategy. In addition, publicly available single-cell RNA sequencing and STRING databases were analyzed to investigate the gene expression of <i>USAG-1</i> in human tissues and its protein interactions, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RNA-seq analysis confirmed that <i>USAG-1</i> is expressed in a subset of secretory cell types in kidney, jaw, and gingiva that are important for cell growth and morphogenesis. Recent studies have also demonstrated that inhibiting USAG-1 facilitates tooth regeneration by activating BMP-mediated morphogenesis and improving outcomes in preclinical models. Engineered monoclonal antibodies that target USAG-1 have shown that blocking the protein product of this gene can promote third dentition and alleviate congenital tooth agenesis. Clinical trials utilizing this antibody are currently underway, with prospects for commercial applications within the next decade. Despite these advancements, challenges related to safety, specificity, and delivery mechanisms remain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review underscores the transformative potential of USAG-1-based therapies in regenerative dentistry, offering a paradigm shift in dental care by enabling biologically authentic tooth regeneration. However, the realization of these advancements in clinical practice requires overcoming significant barriers, including ensuring safety, optimizing delivery systems, and addressing ethical concerns. Continued interdisciplinary research is essential to fully harness the potential of USAG-1 in regenerative dentistry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the 6-month clinical success of atraumatic restorative treatment (ART) and silver-modified atraumatic restorative treatment (SMART) in primary molars of children with early childhood caries (ECC), and to assess the impact of these treatments on oral health-related quality of life (OHRQoL).
Materials and Methods
A randomized controlled split-mouth trial included 32 children (aged 3–7 years) with 68 primary molars exhibiting active dentin carious lesions (ICDAS II scores 4 or 5). Each child received one ART restoration using high-viscosity glass ionomer cement and one SMART restoration with silver diamine fluoride, followed by HVGIC in the same session. Clinical success was assessed after 6 months, using modified ART criteria. Parents completed the Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) at baseline and after 6 months to assess changes in OHRQoL. Data analysis included chi-square, Fisher's exact test, Student's t-test with effect sizes reported, and a significance level set at 95%.
Results
Of the 68 restorations (34 ART, 34 SMART), 6-month success rates were 67.6% for ART and 70.5% for SMART, with no statistically significant difference (p = 0.66). SMART showed slightly better caries arrest. Class I restorations had higher success rates than Class II for both techniques. Failures were mainly due to wear and marginal integrity loss. Mean ECOHIS scores improved from 16.9 at baseline to 10.13 at 6 months, though the change was not statistically significant (p = 0.125).
Conclusion
SMART and ART techniques showed similar short-term clinical outcomes, with SMART showing a minor, nonsignificant advantage in caries management. Failures in ART were more often linked to active caries and pulp involvement, suggesting that SMART may enhance caries arrest. Placement of both restorations did not significantly affect OHRQoL.
Clinical Significance
Incorporating SDF may improve caries arrest and the effectiveness of GIC restorations in primary molars.
{"title":"Atraumatic Versus Silver-Modified Atraumatic Restorative Treatment in Primary Molars: A Randomized Clinical Trial on Minimally Invasive Caries Management and Oral Health-Related Quality of Life","authors":"Sana K. Solh, Ahmed A. Holiel, Ahmad S. Tarabaih","doi":"10.1002/cre2.70299","DOIUrl":"10.1002/cre2.70299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the 6-month clinical success of atraumatic restorative treatment (ART) and silver-modified atraumatic restorative treatment (SMART) in primary molars of children with early childhood caries (ECC), and to assess the impact of these treatments on oral health-related quality of life (OHRQoL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A randomized controlled split-mouth trial included 32 children (aged 3–7 years) with 68 primary molars exhibiting active dentin carious lesions (ICDAS II scores 4 or 5). Each child received one ART restoration using high-viscosity glass ionomer cement and one SMART restoration with silver diamine fluoride, followed by HVGIC in the same session. Clinical success was assessed after 6 months, using modified ART criteria. Parents completed the Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) at baseline and after 6 months to assess changes in OHRQoL. Data analysis included chi-square, Fisher's exact test, Student's <i>t</i>-test with effect sizes reported, and a significance level set at 95%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 68 restorations (34 ART, 34 SMART), 6-month success rates were 67.6% for ART and 70.5% for SMART, with no statistically significant difference (<i>p</i> = 0.66). SMART showed slightly better caries arrest. Class I restorations had higher success rates than Class II for both techniques. Failures were mainly due to wear and marginal integrity loss. Mean ECOHIS scores improved from 16.9 at baseline to 10.13 at 6 months, though the change was not statistically significant (<i>p</i> = 0.125).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SMART and ART techniques showed similar short-term clinical outcomes, with SMART showing a minor, nonsignificant advantage in caries management. Failures in ART were more often linked to active caries and pulp involvement, suggesting that SMART may enhance caries arrest. Placement of both restorations did not significantly affect OHRQoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Significance</h3>\u0000 \u0000 <p>Incorporating SDF may improve caries arrest and the effectiveness of GIC restorations in primary molars.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT07023939.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vertical root fracture (VRF) in endodontically treated molars (ETMs) is a multifactorial condition. However, the relationship between residual pericervical and apical dentine in ETMs and VRF has yet to be fully assessed. This study aimed to investigate the association between residual pericervical and apical dentine and VRF in ETMs.
Material and Methods
ETMs with VRFs (44 cases) and those without VRFs (92 controls) were included. Residual dentine at pericervical level and apical terminus of root canal filling (RCF) were assessed based on the ratio between the mesiodistal widths of the RCF and root on periapical radiographs. The ratio was converted into four categories: “intact canal”, “minimum preparation”, “traditional preparation”, and “excessive preparation” based on calculated cut-off values. History of root canal re-treatment (reRCT), and time from the primary root canal treatment (pRCT) were assessed as cumulative factors. Descriptive and logistic regression analyses were used to identify risk factors for VRF. Receiver operating characteristic curves were constructed, and the corresponding area under the curve (AUC) was used to determine the model as a diagnostic tool.
Results
“Excessive” category at both pericervical and apical dentine was more frequently observed in teeth with VRF (81.8%; 36/44, 61.4%; 27/44) than in the control group (65.2%; 60/92, 10.9%; 10/92). Residual apical dentine, tooth type, history of reRCT, and time from pRCT ≥ 15 years were significantly associated with VRF in the multiple binary logistic regression analyses (p < 0.05).
Conclusions
Successful pRCT with minimum canal preparation, particularly at the apical level, is essential to minimize the likelihood of VRF. In ETMs with an isolated periodontal probing depth ≥ 5 mm, assessing residual apical dentine, tooth type, reRCT history, and time since pRCT can effectively differentiate VRF from non-VRF teeth (AUC, 0.940; p < 0.001), offering valuable diagnostic guidance.
目的：根管治疗磨牙（ETMs）的垂直根断裂（VRF）是一种多因素疾病。然而，etm和VRF中残留的宫颈周和根尖牙本质之间的关系尚未得到充分的评估。本研究旨在探讨etm中残留的宫颈周和根尖牙本质与VRF之间的关系。材料和方法：纳入有vrf的etm（44例）和无vrf的etm（92例）。根据根尖周围x线片上根管充填的中远端宽度与根的比值，对颈周水平残余牙本质和根尖端充填（RCF）进行评估。根据计算出的截止值，将该比率转换为“完整管”、“最小准备”、“传统准备”和“过度准备”四类。再根管治疗史（reRCT）和原根管治疗时间（pRCT）作为累积因素进行评估。描述性和逻辑回归分析用于确定VRF的危险因素。构建受试者工作特征曲线，并利用相应的曲线下面积（AUC）确定模型作为诊断工具。结果：与对照组相比，VRF组颈周牙本质和根尖牙本质“过度”类别发生率分别为81.8%、36/44、61.4%、27/44，分别为65.2%、60/92、10.9%、10/92。在多元二元logistic回归分析中，残余根尖牙本质、牙齿类型、reRCT史以及pRCT≥15年的时间与VRF显著相关(p)。结论：pRCT的成功与最少的根管准备，特别是在根尖水平，对于最小化VRF的可能性至关重要。在孤立牙周探诊深度≥5 mm的etm中，评估残余根尖牙本质、牙齿类型、rect病史和时间，因为pRCT可以有效区分VRF和非VRF牙齿(AUC, 0.940; p
{"title":"Association Between Residual Pericervical and Apical Dentine and Vertical Root Fracture in Endodontically Treated Molars: A Case-Control Study","authors":"Kwangsoon Lee, Shanon Patel, Manjeet Ahlowalia, Ruth Perez Alfayate, Federico Foschi","doi":"10.1002/cre2.70293","DOIUrl":"10.1002/cre2.70293","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Vertical root fracture (VRF) in endodontically treated molars (ETMs) is a multifactorial condition. However, the relationship between residual pericervical and apical dentine in ETMs and VRF has yet to be fully assessed. This study aimed to investigate the association between residual pericervical and apical dentine and VRF in ETMs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>ETMs with VRFs (44 cases) and those without VRFs (92 controls) were included. Residual dentine at pericervical level and apical terminus of root canal filling (RCF) were assessed based on the ratio between the mesiodistal widths of the RCF and root on periapical radiographs. The ratio was converted into four categories: “intact canal”, “minimum preparation”, “traditional preparation”, and “excessive preparation” based on calculated cut-off values. History of root canal re-treatment (reRCT), and time from the primary root canal treatment (pRCT) were assessed as cumulative factors. Descriptive and logistic regression analyses were used to identify risk factors for VRF. Receiver operating characteristic curves were constructed, and the corresponding area under the curve (AUC) was used to determine the model as a diagnostic tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>“Excessive” category at both pericervical and apical dentine was more frequently observed in teeth with VRF (81.8%; 36/44, 61.4%; 27/44) than in the control group (65.2%; 60/92, 10.9%; 10/92). Residual apical dentine, tooth type, history of reRCT, and time from pRCT ≥ 15 years were significantly associated with VRF in the multiple binary logistic regression analyses (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successful pRCT with minimum canal preparation, particularly at the apical level, is essential to minimize the likelihood of VRF. In ETMs with an isolated periodontal probing depth ≥ 5 mm, assessing residual apical dentine, tooth type, reRCT history, and time since pRCT can effectively differentiate VRF from non-VRF teeth (AUC, 0.940; <i>p</i> < 0.001), offering valuable diagnostic guidance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to evaluate the effect of sodium dicholoroisocyanurate (NaDCC) as intracanal medicament on the dentin microhardness and fracture resistance of teeth compared to calcium hydroxide (CH).
Material and Methods
Root canals of mandibular premolars (n = 153) were instrumented and randomized into two treatment groups and an untreated control group (n = 51). Treatment groups received either NaDCC or CH. After 1 week, 1 month, or 3 months, 17 teeth were randomly selected from each group, and two root cylinders were obtained: one for fracture resistance and the other for microhardness test. Two-way ANOVA, one-way ANOVA, and Tukey post hoc tests were used for statistical analysis.
Results
The microhardness and fracture resistance in the control and CH groups were not affected by time (p > 0.05). However, NaDCC caused significant decreases in dentin microhardness after 1 month and 3 months (p < 0.001) as well as in fracture resistance (p < 0.05) after 1 month. The groups comparison at each time point showed no significant differences in microhardness and fracture resistance after 1 week (p > 0.05). However, after 1 month, a significant reduction in microhardness and fracture resistance was detected for NaDCC and in the fracture resistance for CH (p < 0.05). After 3 months, compared to the control group, lower microhardness in NaDCC and CH groups and lower fracture resistance in CH group were detected (p < 0.05).
Conclusion
Short-term application of NaDCC and CH did not adversely affect dentin microhardness. However, prolonged use reduced dentin microhardness, and both medicaments significantly decreased fracture resistance compared with the control group. Limiting the duration of intracanal medicament application is therefore recommended.
{"title":"The Effects of Sodium Dichloroisocyanurate and Calcium Hydroxide as Intracanal Medicaments on Microhardness and Fracture Resistance of Dentin: An In Vitro Study","authors":"Fereshte Sobhnamayan, Alireza Adl, Negin Firouzi, Saeed Moravej, Samina Gavahianjahromi","doi":"10.1002/cre2.70294","DOIUrl":"10.1002/cre2.70294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the effect of sodium dicholoroisocyanurate (NaDCC) as intracanal medicament on the dentin microhardness and fracture resistance of teeth compared to calcium hydroxide (CH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Root canals of mandibular premolars (<i>n</i> = 153) were instrumented and randomized into two treatment groups and an untreated control group (<i>n</i> = 51). Treatment groups received either NaDCC or CH. After 1 week, 1 month, or 3 months, 17 teeth were randomly selected from each group, and two root cylinders were obtained: one for fracture resistance and the other for microhardness test. Two-way ANOVA, one-way ANOVA, and Tukey post hoc tests were used for statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The microhardness and fracture resistance in the control and CH groups were not affected by time (<i>p</i> > 0.05). However, NaDCC caused significant decreases in dentin microhardness after 1 month and 3 months (<i>p</i> < 0.001) as well as in fracture resistance (<i>p</i> < 0.05) after 1 month. The groups comparison at each time point showed no significant differences in microhardness and fracture resistance after 1 week (<i>p</i> > 0.05). However, after 1 month, a significant reduction in microhardness and fracture resistance was detected for NaDCC and in the fracture resistance for CH (<i>p</i> < 0.05). After 3 months, compared to the control group, lower microhardness in NaDCC and CH groups and lower fracture resistance in CH group were detected (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Short-term application of NaDCC and CH did not adversely affect dentin microhardness. However, prolonged use reduced dentin microhardness, and both medicaments significantly decreased fracture resistance compared with the control group. Limiting the duration of intracanal medicament application is therefore recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maribasappa Karched, Mohammad Irshad, Jawad M. Behbehani
Objectives
Antifungal drug resistance poses a major challenge in treating oral Candida infections. This study aimed to evaluate the antifungal activity of Honokiol, alone and combined with Fluconazole, against oral Candida isolates, and to investigate its mechanism of action via ergosterol biosynthesis inhibition and cell wall disruption.
Material and Methods
Susceptibility testing was performed using CLSI (M27-A3) methodology on 16 oral Candida isolates, 8 endodontic isolates, and the reference strain ATCC 24433. Minimum inhibitory concentrations (MICs) of Honokiol and Fluconazole were determined alone and in combination. Ergosterol inhibitory assays and scanning electron microscopy (SEM) were used to assess cell wall integrity and morphological changes.
Results
Honokiol exhibited MICs of 16–64 µg/mL (oral isolates), 16 µg/mL (endodontic isolates), and 32 µg/mL (ATCC 24433). In combination with Fluconazole, Honokiol's MICs decreased 4-fold (4–16 µg/mL), while Fluconazole's MICs dropped 2- to 4-fold (1–32 µg/mL). Synergy was confirmed by a 95.61% reduction in fungal growth (OD600) compared to controls. SEM revealed severe cell wall distortion, rupture, and cytoplasmic leakage. Honokiol significantly inhibited ergosterol biosynthesis, disrupting cellular integrity.
Conclusion
Honokiol demonstrates potent antifungal activity against oral Candida isolates by targeting ergosterol biosynthesis and compromising cell wall integrity. Its synergistic enhancement of Fluconazole's effect suggests clinical potential as an adjunct therapy, potentially reducing resistance and lowering required drug doses in oral and endodontic candidiasis.
{"title":"Synergistic Antifungal Effects of Honokiol and Fluconazole Against Oral Candida: Implications for Managing Drug-Resistant Infections","authors":"Maribasappa Karched, Mohammad Irshad, Jawad M. Behbehani","doi":"10.1002/cre2.70251","DOIUrl":"10.1002/cre2.70251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Antifungal drug resistance poses a major challenge in treating oral <i>Candida</i> infections. This study aimed to evaluate the antifungal activity of Honokiol, alone and combined with Fluconazole, against oral <i>Candida</i> isolates, and to investigate its mechanism of action via ergosterol biosynthesis inhibition and cell wall disruption.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Susceptibility testing was performed using CLSI (M27-A3) methodology on 16 oral <i>Candida</i> isolates, 8 endodontic isolates, and the reference strain ATCC 24433. Minimum inhibitory concentrations (MICs) of Honokiol and Fluconazole were determined alone and in combination. Ergosterol inhibitory assays and scanning electron microscopy (SEM) were used to assess cell wall integrity and morphological changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Honokiol exhibited MICs of 16–64 µg/mL (oral isolates), 16 µg/mL (endodontic isolates), and 32 µg/mL (ATCC 24433). In combination with Fluconazole, Honokiol's MICs decreased 4-fold (4–16 µg/mL), while Fluconazole's MICs dropped 2- to 4-fold (1–32 µg/mL). Synergy was confirmed by a 95.61% reduction in fungal growth (OD600) compared to controls. SEM revealed severe cell wall distortion, rupture, and cytoplasmic leakage. Honokiol significantly inhibited ergosterol biosynthesis, disrupting cellular integrity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Honokiol demonstrates potent antifungal activity against oral <i>Candida</i> isolates by targeting ergosterol biosynthesis and compromising cell wall integrity. Its synergistic enhancement of Fluconazole's effect suggests clinical potential as an adjunct therapy, potentially reducing resistance and lowering required drug doses in oral and endodontic candidiasis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Javier Flores-Fraile, Alba Belanche Monterde, Francesca Gorassini, Álvaro Zubizarreta-Macho, Artak Heboyan, Cosimo Galletti
Introduction
There is no current evidence in the literature that clearly guides clinicians in selecting the most effective polishing protocol in lingual orthodontics. This study aimed to compare the reduction of adhesive remnants after polishing customized lingual composite brackets using tungsten carbide, fine diamond, and Arkansas burs.
Methods
A total of 504 extracted teeth were included and randomly assigned to three groups according to bur type (n = 168). Brackets were bonded and debonded following a standardized protocol, and digital scans were obtained before and after polishing. Each bur was tested at both low speed (contra-angle) and high speed (turbine).
Results
Tungsten carbide burs produced the greatest reduction in cement thickness under both rotary conditions. At low speed, the mean Pre–Post thickness differences were 0.64 mm (TUN), 0.31 mm (ARK), and 0.37 mm (DIA). At high speed, differences were 0.45 mm (TUN), 0.39 mm (ARK), and 0.41 mm (DIA). Statistically significant differences were found between the tungsten carbide group and both the Arkansas and diamond groups (p < 0.005), with no differences between the latter two.
Conclusion
Tungsten carbide burs removed significantly more adhesive than Arkansas and diamond burs, regardless of rotary speed. These findings support clinical decision-making by helping optimize polishing protocols in lingual orthodontics.
目前尚无文献证据明确指导临床医生在舌正畸中选择最有效的抛光方案。本研究旨在比较使用碳化钨、细金刚石和阿肯色毛刺抛光定制舌复合托槽后粘合剂残留的减少情况。方法：选取拔牙504颗，按牙型随机分为3组（n = 168）。支架按照标准协议粘合和剥离，并在抛光前后进行数字扫描。每个bur都在低速（对角）和高速（涡轮）下进行了测试。结果：碳化钨毛刺在两种旋转条件下均能最大程度地减少水泥厚度。低速时，平均Pre-Post厚度差为0.64 mm （TUN）、0.31 mm （ARK）和0.37 mm （DIA）。高速时，差异为0.45 mm （TUN）、0.39 mm （ARK）和0.41 mm （DIA）。结论：无论转速如何，碳化钨组与阿肯色组和金刚石组相比，碳化钨毛刺去除的黏合剂明显多于阿肯色组和金刚石组。这些发现通过帮助优化舌正畸抛光方案来支持临床决策。
{"title":"Cement Remnants Thickness After Polishing With Tungsten, Diamond, and Arkansas Bur Using Composite Customized Lingual Brackets","authors":"Javier Flores-Fraile, Alba Belanche Monterde, Francesca Gorassini, Álvaro Zubizarreta-Macho, Artak Heboyan, Cosimo Galletti","doi":"10.1002/cre2.70302","DOIUrl":"10.1002/cre2.70302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is no current evidence in the literature that clearly guides clinicians in selecting the most effective polishing protocol in lingual orthodontics. This study aimed to compare the reduction of adhesive remnants after polishing customized lingual composite brackets using tungsten carbide, fine diamond, and Arkansas burs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 504 extracted teeth were included and randomly assigned to three groups according to bur type (<i>n</i> = 168). Brackets were bonded and debonded following a standardized protocol, and digital scans were obtained before and after polishing. Each bur was tested at both low speed (contra-angle) and high speed (turbine).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Tungsten carbide burs produced the greatest reduction in cement thickness under both rotary conditions. At low speed, the mean Pre–Post thickness differences were 0.64 mm (TUN), 0.31 mm (ARK), and 0.37 mm (DIA). At high speed, differences were 0.45 mm (TUN), 0.39 mm (ARK), and 0.41 mm (DIA). Statistically significant differences were found between the tungsten carbide group and both the Arkansas and diamond groups (<i>p</i> < 0.005), with no differences between the latter two.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tungsten carbide burs removed significantly more adhesive than Arkansas and diamond burs, regardless of rotary speed. These findings support clinical decision-making by helping optimize polishing protocols in lingual orthodontics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic kidney disease (CKD) is relatively common in patients with rheumatoid arthritis (RA). Periodontitis and periodontopathic Porphyromonas gingivalis are risk factors for CKD. However, the association of serum immunity to P. gingivalis and its peptidylarginine deiminase (PPAD), as well as periodontitis severity, with CKD in relation to RA has not been elucidated. The present study evaluated whether or not serum immunoglobulin G (IgG) titers against P. gingivalis and PPAD and periodontitis severity are associated with CKD in patients with RA and periodontitis.
Methods
Demographic, comorbidity, rheumatologic, and periodontal data were collected from 127 patients with RA and periodontitis in a retrospective cohort study. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and/or proteinuria of ≥ 3 months’ duration. Serum IgG titers against P. gingivalis and PPAD were determined using an electrochemiluminescence immunoassay.
Results
Twenty patients showed an eGFR < 60 mL/min/1.73 m2, while no patients had proteinuria. The 20 CKD patients were significantly older (p = 0.002), had higher percentages of former smokers (p = 0.01), had more sites with probing depth and clinical attachment level ≥ 4 mm (p = 0.03 and p = 0.02), and had higher levels of serum creatinine and eGFR (p < 0.001 for both) and anti-P. gingivalis IgG titers (p = 0.04) than the 107 non-CKD patients. A significant association was observed between anti-P. gingivalis IgG titers and eGFR (p < 0.001 for both) by bivariate and multivariate analyses and between anti-P. gingivalis IgG titers and CKD (p < 0.001) using a multiple logistic regression analysis after adjusting for age, gender, smoking status, comorbidity, RA condition, and RA-related drugs.
Conclusions
These results suggest that serum IgG titers against P. gingivalis, but not against PPAD, are associated with CKD in patients with RA and periodontitis.
{"title":"The Association Between Serum Immunoglobulin G Titers Against Porphyromonas gingivalis and Chronic Kidney Disease in Patients With Rheumatoid Arthritis and Periodontitis: A Retrospective Cohort Study","authors":"Tetsuo Kobayashi, Satoshi Ito, Noriko Sugita, Akira Murasawa, Hajime Ishikawa, Koichi Tabeta","doi":"10.1002/cre2.70271","DOIUrl":"10.1002/cre2.70271","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Chronic kidney disease (CKD) is relatively common in patients with rheumatoid arthritis (RA). Periodontitis and periodontopathic <i>Porphyromonas gingivalis</i> are risk factors for CKD. However, the association of serum immunity to <i>P. gingivalis</i> and its peptidylarginine deiminase (PPAD), as well as periodontitis severity, with CKD in relation to RA has not been elucidated. The present study evaluated whether or not serum immunoglobulin G (IgG) titers against <i>P. gingivalis</i> and PPAD and periodontitis severity are associated with CKD in patients with RA and periodontitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Demographic, comorbidity, rheumatologic, and periodontal data were collected from 127 patients with RA and periodontitis in a retrospective cohort study. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m<sup>2</sup> and/or proteinuria of ≥ 3 months’ duration. Serum IgG titers against <i>P. gingivalis</i> and PPAD were determined using an electrochemiluminescence immunoassay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients showed an eGFR < 60 mL/min/1.73 m<sup>2</sup>, while no patients had proteinuria. The 20 CKD patients were significantly older (<i>p</i> = 0.002), had higher percentages of former smokers (<i>p</i> = 0.01), had more sites with probing depth and clinical attachment level ≥ 4 mm (<i>p</i> = 0.03 and <i>p</i> = 0.02), and had higher levels of serum creatinine and eGFR (<i>p</i> < 0.001 for both) and anti-<i>P. gingivalis</i> IgG titers (<i>p</i> = 0.04) than the 107 non-CKD patients. A significant association was observed between anti-<i>P. gingivalis</i> IgG titers and eGFR (<i>p</i> < 0.001 for both) by bivariate and multivariate analyses and between anti-<i>P. gingivalis</i> IgG titers and CKD (<i>p</i> < 0.001) using a multiple logistic regression analysis after adjusting for age, gender, smoking status, comorbidity, RA condition, and RA-related drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results suggest that serum IgG titers against <i>P. gingivalis</i>, but not against PPAD, are associated with CKD in patients with RA and periodontitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lala Cabbarova, Ali Rıza Tunçdemir, Reza Mohammadi
Purpose
The objective of this study was to biomechanically compare the All-on-Four and All-on-Six implant configurations combined with various framework materials by assessing stress distribution in peri-implant bone, implants, and prosthetic structures using finite element analysis (FEA).
Materials and Methods
This study investigated the biomechanical behavior of six different framework materials titanium, zirconia, PEEK, PEKK, Trilor and Trinia in full-arch, implant-supported fixed prostheses using the All-on-Four and All-on-Six concepts in a total edentulous mandible. A three dimensional finite element model of the mandible, incorporating cortical and trabecular bone as well as mucosal tissue, was developed based on CBCT data. In the All-on-Four configuration, two anterior implants were placed axially and two posterior implants were tilted distally at 30°. The All-on-Six model featured axially placed anterior implants, with posterior implants angled at 15° in the premolar and 30° in the molar regions. Multi-unit abutments were used for all implants. Frameworks were digitally designed in a Toronto prosthesis configuration using each material, and a monolithic zirconia superstructure was applied as the veneering material. All models were subjected to a simulated vertical masticatory load of 150 N. Maximum principal stress values were assessed in the peri-implant bone, while von Mises stress distributions were analyzed in the framework, implants, and fixation screws.
Results
The highest stress accumulation was observed in the All-on-Four configuration, particularly around the cantilever region and distal implants. Materials with low elastic modulus (PEEK and PEKK) caused higher stress transmission to peri-implant bone and connection components. In contrast, rigid materials (titanium and zirconia) provided a more balanced load distribution and resulted in lower stress concentrations. Glass fiber-reinforced composite frameworks (Trilor and Trinia) remained within clinically acceptable biomechanical limits.
Conclusion
The findings of this study indicated that both implant configuration and framework material properties play a critical role in the biomechanical performance and long-term success of the prosthesis.
{"title":"Biomechanical Evaluation of Framework Materials in All-on-Four Versus All-on-Six Prostheses: A Finite Element Study","authors":"Lala Cabbarova, Ali Rıza Tunçdemir, Reza Mohammadi","doi":"10.1002/cre2.70277","DOIUrl":"10.1002/cre2.70277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The objective of this study was to biomechanically compare the All-on-Four and All-on-Six implant configurations combined with various framework materials by assessing stress distribution in peri-implant bone, implants, and prosthetic structures using finite element analysis (FEA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study investigated the biomechanical behavior of six different framework materials titanium, zirconia, PEEK, PEKK, Trilor and Trinia in full-arch, implant-supported fixed prostheses using the All-on-Four and All-on-Six concepts in a total edentulous mandible. A three dimensional finite element model of the mandible, incorporating cortical and trabecular bone as well as mucosal tissue, was developed based on CBCT data. In the All-on-Four configuration, two anterior implants were placed axially and two posterior implants were tilted distally at 30°. The All-on-Six model featured axially placed anterior implants, with posterior implants angled at 15° in the premolar and 30° in the molar regions. Multi-unit abutments were used for all implants. Frameworks were digitally designed in a Toronto prosthesis configuration using each material, and a monolithic zirconia superstructure was applied as the veneering material. All models were subjected to a simulated vertical masticatory load of 150 N. Maximum principal stress values were assessed in the peri-implant bone, while von Mises stress distributions were analyzed in the framework, implants, and fixation screws.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The highest stress accumulation was observed in the All-on-Four configuration, particularly around the cantilever region and distal implants. Materials with low elastic modulus (PEEK and PEKK) caused higher stress transmission to peri-implant bone and connection components. In contrast, rigid materials (titanium and zirconia) provided a more balanced load distribution and resulted in lower stress concentrations. Glass fiber-reinforced composite frameworks (Trilor and Trinia) remained within clinically acceptable biomechanical limits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings of this study indicated that both implant configuration and framework material properties play a critical role in the biomechanical performance and long-term success of the prosthesis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12834504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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