Journal of dentistry最新文献

Objectives: This study compared the esthetic performance of a conventional resin infiltrant and a bioactive adhesive in the management of white spot lesions (WSLs) as assessed by patient and clinician satisfaction.

Methods: In this split-mouth randomized clinical trial, 20 patients with anterior WSLs were enrolled. Lesions in one quadrant received ICON resin infiltration, the contralateral quadrant received a bioactive adhesive (Hi-Bond Universal) following surface conditioning with 15 % hydrochloric acid. At the one-month follow-up, patients and two calibrated clinicians independently assessed esthetic changes. With 20 evaluations per quadrant, this resulted in 40 patient evaluations and 80 clinician evaluations, 40 per each clinical assessor. Evaluations were performed using a 100 mm visual analog scale (VAS), with scores categorized into 5 levels and then dichotomized into 'satisfactory' and 'unsatisfactory' outcomes as pre-specified in the study protocol.

Results: Both treatments effectively masked WSLs. Patients reported an identical satisfaction rate of 80 % for both materials (p > .999). Clinicians also found no significant difference between the treatment materials (p = .344). Inter-assessor agreement was fair for both groups (κ = 0.318-0.340), with statistically significant agreement in the ICON group, (p = .043).

Conclusions: Both the conventional resin infiltrant and the bioactive adhesive achieved favorable esthetic outcomes. While clinicians consistently provided more critical ratings than patients, no statistically significant differences were detected between the two treatment protocols. The findings suggest that bioactive adhesives are a viable alternative option for the initial management of white spot lesions.

Clinical significance: A bioactive adhesive combined with 15 % HCl pretreatment provides effective masking of post-orthodontic WSLs. At one month, this protocol achieved patient and clinician satisfaction results that did not differ significantly from those of specialized resin infiltration, suggesting its utility as a practical alternative in clinical practice.

Objectives: This study aims to synthesize the incremental net monetary benefit (INMB) of fluoride varnish (FV) application in comparison with other caries preventive interventions in children.

Data: Of 836 studies identified, a total of 23 studies were included. The majority of FV intervention studies conducted in comparison with oral health education (OHE) (n=5), treatment as usual (TAU) (n=3), and pit and fissure sealant intervention (n=5), toothbrushing intervention (n=5), and no intervention (n=7). Only model-based studies on FV conducted in high-income countries (HICs), from a healthcare provider/payer perspective, comparing with other caries preventive interventions (OHE, TAU, or no intervention), irrespective of the setting, were eligible for pooling. A total INMB was calculated. The overall meta-analysis of FV compared with other caries preventive interventions revealed that the total INMB was $124.1 (95%CI: -$1.3×10⁴, $1.3×10⁴, I²=0%), showing no significant difference in the cost-effectiveness between FV and other caries preventive interventions.

Sources: A literature search was performed using electronic databases (PubMed, Web of Science, Scopus, and the Cochrane Library) for studies published from inception to January 2024. Risk of bias was assessed using a modified Economic Evaluations Bias checklist.

Study selection: Two independent reviewers identified cost-effectiveness studies reporting dental health and/or generic health outcomes of FV application. Sub-group meta-analyses by type of comparators, study design, perspective, country income level, effect measure, and type of setting used were performed to pool INMB across studies.

Conclusions: Considering the limited evidence, the cost-effectiveness of FV application is uncertain in HICs from healthcare provider/payer perspective.

Clinical significance: Overall, the evidence highlights the potential economic value of fluoride varnish in caries prevention, especially in settings lacking robust cost-effectiveness data. The findings can guide policy decisions in resource-constrained environments where generating local evidence is challenging.

Protocol registration: Registered at PROSPERO (CRD42023483985).

Source of funding: The authors declare that there was no funding for this study.

Objective: To evaluate and compare the enamel wear resulting from manual and electric toothbrushing following acid erosion, using natural human enamel specimens. The study aimed to quantify both surface tissue loss and subsurface prism alterations.

Methods: Twenty-four caries-free extracted human molars were decoronated and sectioned to expose natural buccal enamel surfaces. Samples were divided into two groups (manual vs electric) and subjected to four cycles of citric acid erosion (pH 2.7) followed by controlled brushing (30 strokes per cycle, total 120) using a non-fluoridated toothpaste slurry. Brushing force was standardised to 290-295g. Step height changes were measured via non-contact laser profilometry, and enamel prism alterations were assessed using scanning electron microscopy (SEM). Statistical analysis was performed using Shapiro-Wilk test (normality), two-way ANOVA, and Bonferroni's post hoc test (α = 0.05).

Results: Electric toothbrushes caused significantly greater enamel wear compared to manual brushes across all erosion-abrasion intervals (p < 0.0001). Mean step height increased from 1.38(0.42) µm to 3.65(0.39) µm for manual brushing and from 1.71(0.22) µm to 5.13(0.28) µm for electric brushing. SEM revealed deeper subsurface prism deformation (30-50 µm) in manual samples, whereas electric samples exhibited shallower changes (10-15 µm) with a ∼10 µm interface gap.

Conclusion: Electric toothbrushes resulted in significantly more surface enamel loss on acid-eroded natural teeth compared to manual toothbrushes. The nature of subsurface changes differed by brushing mode, with implications for the mechanical impact of brush types on compromised enamel.

Clinical significance: Brushing technique and toothbrush type influence the extent of enamel wear on eroded surfaces. These findings underscore the importance of tailored oral hygiene advice, particularly for individuals with dietary acid exposure or early signs of erosion.

Objectives: To evaluate the effects of composition and finishing on the physicomechanical and biological properties of additively manufactured resin-ceramic composites (AM RCs) for definitive restorations under simulated oral environments with different pH levels.

Methods: Disk- and bar-shaped specimens were fabricated with 4 AM RCs (Crowntec [CT], Freeprint Crown [FP], VarseoSmile TriniQ [TQ], and VarseoSmile Crown plus [CP]). The specimens underwent either polishing or glazing and were immersed in artificial saliva at neutral and acidic pH levels (37°C, 7 days). Each saliva-conditioned specimen was evaluated for microhardness (HV), flexural strength (FS), protein adsorption (OD), water sorption (WS), and bacterial adhesion (BA). Cell morphology and migration were evaluated. A 3-way aligned rank transform analysis of variance was performed for HV, FS, OD, WS, and BA, followed by Bonferroni-adjusted Mann-Whitney U tests (α=0.05).

Results: CT showed the highest HV (P<0.001). CT had the highest FS, whereas CP had the lowest (P<0.05). Glazed AM RCs showed lower OD than polished AM RCs in acidic saliva (P<0.001). For WS, FP was the highest in neutral saliva, while TQ was the highest in acidic saliva (P<0.05). BA was significantly affected by salivary pH (P<0.001).

Conclusion: CT showed superior physicomechanical properties. In acidic saliva, all AM RCs showed lower OD after glazing, whereas BA increased regardless of composition or finishing.

Clinical significances: Material composition affects the physicomechanical behavior of AM RCs, while salivary pH influences their biological responses. Under acidic salivary conditions, surface glazing may be beneficial, although it does not effectively reduce bacterial adhesion.

Objectives: Orifice barriers (OBs) are commonly placed as sub-seals following root canal treatment, to resist microbial leakage if the primary coronal seal fails. However, despite numerous in vitro studies, clinical evidence supporting their efficacy is limited. This is the first systematic review of the in vivo endodontic literature evaluating OB effectiveness in root filled teeth (RFT), addressing a critical research gap.

Data sources: MEDLINE, Embase, CENTRAL, Web of Science and Scopus were systematically searched from inception through 16^th May 2025. Articles were screened using Covidence by two independent reviewers. Risk of bias and certainty of evidence assessments were undertaken to assess methodological rigour of included studies.

Study selection and results: Seven studies met the inclusion criteria. OBs improved outcomes for teeth with radicular cracks in two small single-arm cohort studies (90.6% success & 96.6% survival at 2-4years; 100% at 1-3years). OBs were associated with lower apical periodontitis (AP) in one cross-sectional study (p < 0.005), while in a second, positioning the root filling/coronal restoration interface apical to marginal bone level was associated with lower AP (p < 0.005). Two remaining cohort studies showed no significant benefit for OBs in RFT. One randomised controlled trial showed no benefit of OBs, but follow-up was only one year. Heterogeneity among studies precluded meta-analysis.

Conclusions: Very low certainty in vivo evidence supports OBs in cracked RFT, but there is little evidence for OBs elsewhere. The limitations identified underscore the need for well-designed prospective in vivo studies to validate the evidence base for OBs.

Clinical significance: OB placement apical to radicular cracks may improve success and survival for cracked RFT, with specialist referral for treatment under microscopy recommended in such cases. OBs may play a role in creating a well-sealed coronal restoration following RCT, but further clinical research is required to determine their efficacy.

Objectives: This study aimed to evaluate the effect of 1,10-Phenanthroline (Phen) on dentin bond durability and to explore its potential interactions with matrix metalloproteinase-8 (MMP-8) and type I collagen.

Methods: Dentin specimens were etched with 35% phosphoric acid and pretreated with deionized water (DW), 2% chlorhexidine (CHX), ethanol (EtOH, Phen solvent), 0.01 mM Phen, 1 mM Phen, and 100 mM Phen. Following the application of a universal adhesive and composite resin, the specimens were divided into non-aged and aged (10,000 thermocycles) subgroups for microshear bond strength (μSBS), failure mode, nanoleakage, and in situ zymography analyses. Molecular docking was performed to assess Phen's binding affinity to MMP-8 and dentin collagen.

Results: Non-aged groups showed comparable μSBS. After aging, the 1 mM and 100 mM Phen groups maintained bond strength, with no significant reduction observed. These groups also showed a tendency for reduced nanoleakage and lower MMP activity at the bonding interface compared to the DW and CHX groups. Moreover, the EtOH group demonstrated results comparable to the DW group, confirming that EtOH does not contribute to the efficacy of the Phen solution and that the observed benefits are attributable solely to Phen. Molecular docking suggested favorable binding energies for Phen with both type I collagen (-4.64 kcal/mol) and MMP-8 (-7.37 kcal/mol), involving hydrogen bonds.

Conclusion: 1,10-Phenanthroline significantly improves the durability of the resin-dentin bond. Its superior performance over CHX is attributed to a dual-site mechanism that directly stabilizes collagen and potently inhibits MMP-8, thereby protecting the hybrid layer from degradation.

Clinical significance: The results suggest that 1,10-Phenanthroline pretreatment could be a promising strategy to improve the long-term stability of adhesive restorations in clinical dentistry.

Objectives: To map the clinical evidence regarding the applications, advantages, and limitations of bulk-fill composite resins in restorative dentistry.

Data: The study protocol was registered on the Open Science Framework platform (doi: [removed for peer review]). This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Sources: Comprehensive searches were performed in Medline (PubMed), ProQuest (Dissertations & Theses), SciELO, Scopus, Virtual Health Library (VHL), and Web of Science (WoS). The search was initially conducted in February 2025 and updated in November 2025. Study selection was performed by two reviewers independently.

Study selection: A total of 1,837 records were identified (1,806 from the initial search and 31 from the update). Full-text analysis was conducted for 80 studies from the initial search. Ultimately, 65 studies were definitively included in the review (58 from the initial search and 7 from the update), consisting of a descriptive synthesis and a thematic analysis.

Conclusions: Clinical evidence supports bulk-fill resins as a resource-efficient alternative to incremental layering with comparable survival rates. Although they simplify procedures, longevity relies on the adhesive strategy and technical execution rather than material chemistry. Future standardized trials are required to minimize the data heterogeneity observed in the current literature.

Clinical significance: Bulk-fill composite resins are predictable and effective materials for direct restorations, providing a simplified and reliable alternative to the traditional incremental layering technique.

Objectives: This study investigated clinical factors and oral functional behaviors associated with vertical root fractures (VRFs) in endodontically treated teeth (ETT).

Methods: Forty-nine matched pairs of patients who attended the Graduate Endodontic Clinic between 2017 and 2024 were included. Each pair consisted of one patient with a VRF in an ETT and one matched control without a VRF. Matching was based on sex, age, tooth type, and duration since root canal treatment. Retrospective clinical and radiographic data were collected to assess tooth-related factors, including root canal filling length, type of restoration, type of post, adjacent teeth, and opposing dentition. At the recall visit, occlusal characteristics, tooth wear, bony exostosis, and mandibular plane angle were examined and patients completed structured interviews regarding oral functional behaviors at the time of VRF detection. Univariable logistic regression was performed, and variables with p < 0.05 were entered into a multivariable model. Mandibular angles were compared using independent t-tests.

Results: Metal posts, protrusive occlusal interference, unilateral chewing, and frequent intake of hard or sticky foods were significantly associated with VRF. Multivariate analysis confirmed all of these factors, except sticky food intake, as independent predictors, whereas the remaining variables were not significant.

Conclusions: Unilateral chewing and consumption of hard foods were strongly associated with VRFs, along with the presence of metal posts and protrusive occlusal interference.

Clinical significance: Assessing occlusal patterns, masticatory behaviors, and post type in endodontically treated teeth is important. Early identification and management of these factors may help reduce VRF occurrence and improve long-term prognosis.

Introduction/objective: Preconception-to-lactation oral care lacks universal standardized protocols, and the rising prevalence of pregnancy-related oral diseases demands safe, effective clinical guidelines. This study analyzed relevant literature to explore oral care strategies for women in this period.

Data/sources: A literature search was conducted in PubMed and Web of Science up to December 2025 using keywords including "perinatal", "pregnancy" and terms related to oral/dental diseases. The findings indicate that periodontal infections, pulp-involved caries and third molar pericoronitis are common oral diseases in women from preconception to lactation, with periodontitis and acute pulpitis linked to adverse pregnancy outcomes. Clinical management of oral diseases during this period must adhere to the core principles of safety, necessity, comfort, and multidisciplinary collaboration, with the second trimester being the optimal window for elective dental procedures. Dental imaging examinations are safe with lead shielding, as the radiation dose is far below the established safety threshold. Medications should prioritize low-risk options (e.g., lidocaine, amoxicillin) in accordance with FDA classification and the Pregnancy and Lactation Labeling Rule. Clinically recommended safe therapeutic approaches include basic periodontal treatment, chemomechanical minimally invasive caries excavation, and restoration with resin or glass ionomer cements. Comprehensive preconception oral examinations, standardized prenatal oral hygiene and avoiding unnecessary invasive procedures/high-risk drugs are key to protecting maternal and fetal health.

Conclusions: Women from preconception to lactation face common oral diseases linked to adverse pregnancy outcomes; second-trimester elective dental care is optimal, with safe imaging, low-risk meds and preconception exams key for maternal-fetal health.

Clinical significance: Perinatal oral disease management safeguards maternal-fetal health by following safety-core principles, adopting evidence-based safe diagnostics/therapies and prioritizing preconception screening & prenatal preventive oral care.