Journal of Esthetic and Restorative Dentistry最新文献

Objective: To evaluate the clinical performance of 3D-printed resin composite three-unit fixed dental prostheses (FDPs) in posterior regions in patients with and without bruxism over approximately 28 months.

Methods: Forty patients requiring replacement of a single missing posterior tooth were enrolled in this prospective clinical study conducted between April 2022 and January 2025 at the University of Siena, Siena, Italy. Patients were allocated to either a bruxism group (n = 20) or a non-bruxism group (n = 20), based on clinical signs and patient self-report using the STAB questionnaire. All abutments were prepared according to standardized guidelines and digitally scanned; FDPs were designed with CAD software and fabricated via DLP 3D-printing using a biocompatible resin composite. Prostheses were cemented with a self-adhesive resin cement. Clinical performance was assessed at baseline and scheduled recalls using modified USPHS criteria. Statistical analysis included t-tests or Mann-Whitney U tests for continuous data and Fisher's exact test for categorical variables (α = 0.05).

Results: After a mean follow-up of 28 months, most restorations in both groups were rated Alpha. One clinically unacceptable fracture occurred in the bruxism group, while no failures were recorded in the non-bruxism group. Restoration wear was significantly more frequent among bruxists (40%) compared with non-bruxists (10%) (p = 0.02). No significant between-group differences were observed for other USPHS parameters, and no biological complications occurred.

Conclusions: 3D-printed resin composite FDPs showed favorable short-term clinical performance in both bruxist and non-bruxist patients, though bruxism was associated with increased wear.

Trial registration: ClinicalTrials.gov identifier: NCT01935796.

Objectives: This systematic review and network meta-analysis aimed to compare and rank the clinical performance of ormocer-based resin composites versus conventional resin-based composites in posterior Class I and II restorations.

Materials and methods: Electronic searches were conducted in PubMed, Web of Science, Cochrane Library, Embase, and Scopus up to October 2025. Randomized controlled and prospective clinical trials evaluating ormocer-based versus conventional resin composites with at least 6-month follow-ups were included. Primary outcomes were marginal adaptation, retention, and fracture, assessed using USPHS or FDI criteria. A random-effects NMA was performed using the netmeta package (R), calculating risk ratios and P-scores across 6-, 12-, 24-, and 36-month intervals. Risk of bias was assessed with RoB 2, and certainty of evidence through CINeMA.

Results: Twelve trials (2006-2024; 1158 restorations) met eligibility. Across all time points, ormocer-based materials including hybrid and bulk-fill variants showed no statistically significant differences versus conventional methacrylate composites for marginal adaptation, retention, or fracture (RR = 1.0 with 95% CIs spanning unity). Treatment rankings based on p-scores were closely clustered (≈0.3-0.6), indicating probabilistic equivalence. Most studies showed a low overall risk of bias; the CINeMA appraisal supported moderate confidence in the main contrasts.

Conclusions: Across 6-36 months, ormocer-based composites (including hybrid and bulk-fill formulations) showed no statistically significant differences versus conventional methacrylate-based composites for marginal adaptation, retention, or fracture, and treatment rankings were closely clustered, indicating probabilistic equivalence rather than superiority. The certainty of evidence was overall moderate, primarily limited by imprecision and reduced network density at longer follow-ups.

Clinical significance: Bis-GMA-free ormocer formulations may help reduce exposure to BPA-related eluates without compromising clinical performance, although longer follow-up is warranted.

Trial registration: PROSPERO; registration number CRD420251172319.

Background: Dental fluorosis produces enamel opacities and discolorations that compromise esthetics and often require minimally invasive treatments. Although several modalities are available including microabrasion, bleaching, resin infiltration, and remineralization, their comparative performance remains unclear.

Objective: To evaluate and rank the esthetic masking efficacy of minimally invasive treatments for dental fluorosis using a network meta-analysis.

Methods: A systematic review and network meta-analysis were conducted in accordance with PRISMA-NMA. Seven controlled clinical studies (13 interventions; 555 participants) met eligibility criteria. Random-effects network models were performed in R and independently replicated in MetaInsight. Treatment rankings were generated with SUCRA/P-scores, and certainty of evidence was assessed using CINeMA.

Results: Multimodal protocols combining microabrasion with in-office bleaching achieved the highest esthetic performance across immediate, three-month, and 6-month evaluations. Microabrasion + in-office bleaching (MAB + IOB) ranked first (highest SUCRA probability) and produced the largest ΔE improvements, followed by MAB + IOB + CPP-ACP and MAB + RI. Resin infiltration alone showed consistent, clinically meaningful effects and emerged as the most effective standalone technique. In contrast, microabrasion alone, CPP-ACP, and sodium hypochlorite demonstrated modest or unstable changes. Cross-platform triangulation between R and MetaInsight produced fully concordant effect estimates and identical treatment hierarchies. CINeMA indicated no major incoherence and moderate confidence for most comparisons.

Conclusion: Combined minimally invasive strategies, particularly MAB + IOB, with or without CPP-ACP, provide the greatest and most durable esthetic masking of fluorosis-related discoloration. Resin infiltration remains the strongest single-modality option. Remineralization and oxidizing agents alone show limited effectiveness. These findings establish a clinically relevant hierarchy to guide conservative management of dental fluorosis.

Clinical significance: Sequential multimodal protocols integrating surface modification, bleaching, and resin-based refractive adjustment maximize esthetic outcomes while preserving enamel, supporting their use as first-line approaches for mild-to-moderate fluorosis.

Trial registration: PROSPERO; registration number CRD420251234096.

Objective: To assess the influence of various bonding protocols on the fracture resistance and failure mode of CAD/CAM-milled hybrid resin composite occlusal overlays.

Materials and methods: Fifty sound human premolars (n = 50) were sectioned to expose superficial dentin surrounded by enamel. Each specimen was digitally scanned and restored with a CAD/CAM-milled hybrid resin composite overlay designed in Exocad DentalCAD. The restorations were assigned to five groups (n = 10) based on the luting protocol: Group I, Calibra Ceram; Group II, SDR Flow; Group III, heated Grandio; Group IV, Panavia F2 (self-etch), and Group V, Calibra Universal (self-adhesive). All specimens underwent thermomechanical aging simulating 1 year of clinical service, followed by compressive load testing at 1 mm/min until fracture. Failure modes were examined under magnification. Statistical significance was set at p < 0.05.

Results: Group III (heated Grandio) exhibited the highest mean fracture load (1728.28 ± 156.64 N), whereas Group II (SDR Flow) showed the lowest (835.49 ± 151.69 N). Groups I, IV, and V demonstrated intermediate, statistically comparable values (p > 0.05). Tukey's HSD confirmed significant differences between Groups II and all others (p < 0.001) and between Group III and Groups IV-V (p < 0.001).

Conclusions: Bonding strategy significantly affects the mechanical performance of hybrid resin composite overlays. All tested protocols achieved clinically acceptable strength based on ISO DIS 6872, confirming milled hybrid resin overlays as a conservative and durable restorative option.

Clinical significance: Selecting an optimal bonding strategy, particularly using heated resin composites, can enhance the durability and fracture resistance of conservative CAD/CAM hybrid resin overlays, offering a viable minimally invasive alternative to full-coverage crowns.

Objectives: To evaluate the effect of the washing process on the mechanical and optical properties of a 3D printed resin indicated for indirect restorations and to determine possible solutions to reverse the negative effects of excessive washing.

Methods: A 3D printed resin (Sprintray Ceramic Crown) was used to test three-point flexural strength, Vickers hardness, degree of conversion on the surface (DC_s) and 0.1 mm depth of the material (DC_d), translucency parameter (TP), and color changes (ΔE). Samples were divided into five groups based on their washing process, including manufacturer's recommendation as a negative control (NC), excessive washing in a pre-programmed washing unit as a positive control (PC), PC cleaning followed by brushing with 99% isopropyl alcohol (EC), PC cleaning followed by coating with a thin layer of uncured resin (RC), and PC cleaning followed by infiltrating resin into the surface with a brush (RI). Data were analyzed with a one-way ANOVA test and Tukey post hoc analysis (α = 0.05).

Results: Excessive washing (PC) resulted in a significant reduction in flexural strength, DC_s, DC_d, and TP in comparison to NC (p < 0.001) and exceeding the acceptable threshold (ΔE > 2.8). Among the three approaches to reverse the negative effect of excessive washing (EC, RC, and RI groups), only RI resulted in flexural strength, hardness, DC_d, and TP with no significant difference from the NC group (p < 0.05) and color changes below the perceptible threshold (ΔE < 1.1).

Conclusion: Excessive washing resulted in lower flexural strength, surface hardness, degree of conversion, and translucency. Among different methods to reverse these negative effects, infiltration of fresh resin was the most effective method.

Clinical significance: Excessive washing of 3D printed resin intended for long term indirect restoration in a pre-programmed washing unit resulted in a significantly weaker and more opaque material, resulting in compromised clinical performance of the material and potentially lower light penetration for curing of the resin cement. Infiltration of fresh resin was an effective method to regain mechanical and optical properties.

Objective: The aim of the present study was to evaluate the surface roughness and wear effect of three different ceramic materials.

Materials and methods: Thirty ceramic discs (10/group) were fabricated: Lithium disilicate (IPS e.max CAD, Ivoclar Vivadent, Switzerland); Zirconia (Zolid Gen-X, Amanngirrbach, Austria); Zirconia reinforced lithium disilicate (Vita Suprinity, Vita Zahnfabrik, Germany). Ceramic specimens underwent surface roughness measurements, thermocycling (10,000 cycles), then used to abrade opposing materials for 250,000 cycles. Opposing material wear was quantified using a scanner and software for wear effect measurements. Statistical analyses included Kruskal-Wallis, Dunn, Wilcoxon Signed Ranks, and Spearman's correlation tests (α = 0.050).

Results: Median values (for all surface roughness parameters and wear effect) showed significant differences between the study groups (p < 0.050). All study groups showed a significant increase in the median surface roughness values after wear (p < 0.050). No significant correlation was found between surface roughness and wear effect (p > 0.050).

Conclusions: There was a statistically significant difference in the median surface roughness (before and after wear) and wear effect between the study groups. No significant correlation was found between ceramic surface roughness and their wear effect.

Objective: To compare and critically evaluate dye-based methods used for microleakage assessment, particularly focusing on dye penetration and dye extraction techniques, their advantages and drawbacks.

Materials and methods: An electronic search of PubMed and Scopus databases was conducted to identify relevant articles from 2020 to 2025. After eligibility assessment, a total of 45 articles were included in this review, followed by data extraction and qualitative analysis.

Results: Both dye penetration and dye extraction methods face significant challenges, including lack of standardization, methodological variability, and limited correlation with clinical outcomes. The identified confounding factors, such as anatomical variations, dye properties, sectioning errors, and measurement inconsistencies, heavily influence the reliability of results. While dye penetration enables localization of leakage pathways, it is limited by two-dimensional analysis and random cutting axis. Dye extraction, although more objective, is destructive and lacks spatial information. Recommendations for protocol standardization and methodology improvement include the use of anatomically matched samples or 3D-printed replicas, thermomechanical aging, fluorescent dyes and advanced imaging techniques for nondestructive three-dimensional analysis, such as confocal laser scanning microscopy (CLSM) and micro-computed tomography (micro-CT).

Conclusion: Although in vitro microleakage testing continues to face validity concerns, well-designed studies with rigorous controls still provide valuable insights. Future research should focus on combining in vitro techniques with in vivo and long-term clinical studies to improve the translation of findings into clinical practice.

Objective: To review the biological and clinical relevance of prosthetic design, specifically the emergence profile and restorative angle in influencing peri-implant tissue health, and to illustrate how biologically driven prosthetic modifications can resolve inflammation and support peri-implant stability.

Overview: This narrative review synthesizes current evidence on the anatomy and function of the implant supracrestal complex, focusing on how restorative contour, abutment height, and emergence geometry impact soft tissue adaptation and marginal bone maintenance. It integrates recent findings from histological, clinical, and preclinical studies and highlights the role of CAD/CAM workflows in achieving biologically favorable restorations. A clinical case report illustrates the correction of peri-implant inflammation and bone loss through the redesign of a concave, polished emergence profile on a taller titanium base.

Conclusions: Restorative angle and emergence profile are critical, modifiable elements of implant-supported prostheses. When designed in accordance with biological parameters, they contribute significantly to tissue health and long-term esthetic outcomes. Suboptimal designs may promote plaque accumulation and inflammation, even in compliant patients. Biologically oriented, digitally guided prosthetic designs represent a key strategy in preventing peri-implant disease.

Clinical significance: Long-term peri-implant health depends not only on surgical accuracy but also on biologically driven prosthetic design. Contours that respect the dimensions of the soft tissue complex, particularly concave, polished emergence profiles supported by adequately tall abutments, promote soft tissue stability, facilitate hygiene, and minimize the risk of inflammation or recession. While digital workflows offer precision in prosthetic design, clinicians must still apply sound biological principles and clinical judgment when planning and executing implant-supported restorations. A biologically driven approach, based on a clear understanding of peri-implant anatomy and guided by common sense, is essential for achieving predictable and esthetically successful outcomes.

Objective: To present a novel difficulty classification for horizontal bone augmentation (HBA) grounded in site-specific morphometric characteristics, aiming to assist clinicians in achieving predictable guided bone regeneration (GBR).

Overview: HBA is often needed after tooth loss for proper implant placement. GBR is reliable, but success and complexity depend on defect shape. The new Simple-Challenging-Difficult (SCD) classification sorts HBA by defect type and existing bone support: intraosseous defects are within native bone, while extraosseous require regeneration beyond it. Simple cases have horizontal and vertical support; Challenging ones lack horizontal but keep vertical support and need ≤ 4 mm extraosseous augmentation; Difficult defects lack both supports or require > 4 mm extraosseous augmentation.

Conclusions: The SCD classification provides clinicians with a structured approach to assess defect morphology, enabling more accurate treatment planning, better anticipation of potential complications, and improved patient outcomes in horizontal bone regeneration procedures. Clinicians are encouraged to incorporate this classification into their routine assessment protocols to support informed decision-making and to maximize treatment safety and efficacy.

Clinical significance: Precise evaluation of defect morphology and quantification of residual osseous support are essential for planning the optimal regenerative technique. The proposed classification system provides a systematic framework to facilitate a more consistent and predictable management of horizontal alveolar ridge augmentation.

Objective: To propose buccal dehiscence morphotypes and discuss their impact on the regenerative potential and strategy in immediate implant placement (IIP).

Clinical considerations: Eleven buccal dehiscence morphotypes could be identified based on vertical and lateral extent, and facial soft tissue support. Two morphotypes should not be treated with IIP given a high risk of esthetic failure. These include a buccal dehiscence combined with facial recession and extended defects. Nine morphotypes may be amenable to IIP and appropriate regenerative strategy. Sockets with a relatively high regenerative potential can be treated by slightly modifying the trimodal approach for intact sockets. Sockets with a moderate regenerative potential require the additional use of a non-supportive barrier, whereas those with a low regenerative potential require a supportive barrier and composite bone graft. Comprehensive diagnosis, expertise, and surgical skills are key to identify the correct morphotype, to select the appropriate regenerative strategy and to put it into practice.

Conclusions: The identification of two morphotypes that contraindicate IIP is the first and most crucial step in the clinical decision-making process. Other morphotypes may be amenable to IIP, yet require comprehensive diagnosis, expertise, and surgical skills. Clinical studies are needed to validate the concepts presented in this article.