Journal of Esthetic and Restorative Dentistry最新文献

Objective: Due to the fluid and changing nature of oral soft tissue, creating an ovate pontic in both the provisional and final phases can be challenging. This article will explain the advantages of a digital workflow to streamline ovate pontic design, approval, and fabrication of the final prosthesis.

Clinical considerations: The factors influencing the design of an ovate pontic will be presented for both an existing edentulous site and an immediate extraction site. Digital tools can simulate an extraction, allowing precise measurement of the proposed pontic position and dimensions. The development of idealized contours and esthetics in the provisional restoration facilitates soft tissue scaffolding during the healing phase. Additionally, digital tools enable the approved design to be more easily duplicated in the definitive restoration.

Conclusions: Digital technologies can be useful in providing efficient and effective solutions for designing and communicating idealized subgingival contours of ovate pontics, thereby streamlining design and fabrication in both the provisional and final stages.

Clinical significance: The digital protocol described offers a predictable and practical workflow for efficiently and effectively designing and finalizing an ovate pontic.

Objective: This technical report describes a fully digital workflow for the manufacturing of a functional removable esthetic device (FRED) that addresses multiple clinical scenarios before prosthetic rehabilitation. The proposed method integrates advanced digital tools to achieve functional and esthetic outcomes while ensuring reversibility and patient comfort.

Clinical considerations: The workflow includes intraoral and facial scanning, jaw motion tracking, and CAD/CAM technology to create a 4D virtual patient. This allows for a precise recording of the maxillomandibular relationship and facilitates the determination of the comfort position to establish a new occlusal vertical dimension (OVD). FRED is a custom-designed, removable, tooth-colored device manufactured to provide temporary functional support, esthetic preview, catering to different clinical scenarios, including tooth wear, occlusal trauma, and periodontal conditions.

Conclusions: This technique combines digital and traditional prosthetic principles into a patient-centered, adaptable workflow, allowing precise, non-invasive, and dynamic evaluation of OVD modifications. By integrating digital recording, facial scanning, and CAD/CAM fabrication, it enhances function, esthetics, and patient comfort.

Clinical significance: This technique highlights the synergy of digital innovation and prosthetic principles, enhancing diagnostic capabilities and treatment predictability. The patient-centered design supports functional stability and esthetic outcomes, making it a valuable tool in modern prosthetic dentistry.

Objective: This study aims to evaluate the influence of different preparation designs on the marginal and internal fit of 3D-printed permanent endocrowns using circumferential 3D analysis.

Materials and methods: Maxillary right first molar typodont teeth were prepared with four designs (n = 12); Group 1-butt joint & 2 mm pulp chamber, Group 2-butt joint & 4 mm pulp chamber, Group 3-shoulder & 2 mm pulp chamber, and Group 4-shoulder & 4 mm pulp chamber. Teeth were scanned, replicated as 3D-printed master dies, and restored with 3D-printed ceramic-filled hybrid endocrowns. After seating with Fit Checker, superimposed scans were analyzed circumferentially at standard points. Marginal, internal, pulp chamber, and overall gap values were measured from mesiodistal, buccolingual, and oblique sections. Statistical analysis was performed using two-way anova and post hoc Tukey tests (α = 0.05).

Results: Margin design and pulp chamber depth interactions revealed significant differences (p < 0.05). The least marginal fit was in Group 2, while the best internal and overall fit was in Group 3 (p < 0.05).

Conclusion: Different preparation designs have an impact on the fit of endocrowns. A shoulder margin design and a 2-mm pulp chamber depth exhibited a better internal fit of 3D-printed ceramic-filled hybrid endocrowns through circumferential 3D analysis.

Clinical significance: Circumferential 3D analysis reveals that variable preparation designs significantly influence the fit of endocrowns, guiding clinicians in selecting optimal designs for improved clinical outcomes.

Objective: This study aimed to evaluate the reliability, consistency, and readability of responses provided by various artificial intelligence (AI) programs to questions related to Restorative Dentistry.

Materials and methods: Forty-five knowledge-based information and 20 questions (10 patient-related and 10 dentistry-specific) were posed to ChatGPT-3.5, ChatGPT-4, ChatGPT-4o, Chatsonic, Copilot, and Gemini Advanced chatbots. The DISCERN questionnaire was used to assess the reliability; Flesch Reading Ease and Flesch-Kincaid Grade Level scores were utilized to evaluate readability. Accuracy and consistency were determined based on the chatbots' responses to the knowledge-based questions.

Results: ChatGPT-4, ChatGPT-4o, Chatsonic, and Copilot demonstrated "good" reliability, while ChatGPT-3.5 and Gemini Advanced showed "fair" reliability. Chatsonic exhibited the highest "DISCERN total score" for patient-related questions, while ChatGPT-4o performed best for dentistry-specific questions. No significant differences were found in readability among the chatbots (p > 0.05). ChatGPT-4o showed the highest accuracy (93.3%) for knowledge-based questions, while Copilot had the lowest (68.9%). ChatGPT-4 demonstrated the highest consistency between repetitions.

Conclusion: Performance of AIs varied in terms of accuracy, reliability, consistency, and readability when responding to Restorative Dentistry questions. ChatGPT-4o and Chatsonic showed promising results for academic and patient education applications. However, the readability of responses was generally above recommended levels for patient education materials.

Clinical significance: The utilization of AI has an increasing impact on various aspects of dentistry. Moreover, if the responses to patient-related and dentistry-specific questions in restorative dentistry prove to be reliable and comprehensible, this may yield promising outcomes for the future.

Objective: This clinical report seeks to elucidate the versatility and mid-term outcomes of the direct-indirect technique. It presents a comprehensive step-by-step protocol for restoring anterior dentition across various clinical scenarios in accordance with the principles of the polychromatic layering technique.

Clinical considerations: This clinical report was divided into two phases. First, an urgent procedure due to the debonding of an interim restoration in tooth #10 was followed by crafting a direct-indirect veneer. Then, in the six-month follow-up appointment, a complete esthetic improvement in the anterior dentition (teeth #8, #9) with two techniques and different materials for each tooth was observed: In tooth #8, a direct incisal edge augmentation was performed, while in tooth #9, a thin contact lens-type direct-indirect fragment was created to improve the form of the tooth. The restorations were followed up for a 24-month mean, with the following criteria: Color, wear, adaptation, marginal discoloration, and integrity.

Conclusions: The direct-indirect technique showed optimal clinical outcomes after a mid-term follow-up, making it an option to traditional direct veneering, ceramics, and CAD-CAM materials.

Clinical significance: The direct-indirect technique amplifies the scope of resin composite restorations, providing optimal esthetic performance, broad indications, and mid-term longevity regardless of the selected restorative composite material or veneer type.

Objectives: To demonstrate the implementation of a digital workflow for the rehabilitation of a terminal dentition patient with complete-arch implant-supported prostheses.

Clinical considerations: A virtual patient-oriented workflow can facilitate interdisciplinary treatment planning, improving the synergism between surgical and prosthetic procedures. Digital technologies assisted the acquisition of prosthetic information and optimized dental implant placement, provisional restoration fabrication, and delivery of definitive prostheses.

Conclusions: Digital processing methods enable the integration of cutting-edge technological innovations, with fundamental prosthetic and surgical principles, to build individualized workflows for immediate implant placement and loading, aiming to provide improved patient care in comprehensive rehabilitation. To ensure predictable outcomes, a thorough diagnosis and data collection are needed for selecting the appropriate digital workflow, based on the latest scientific evidence.

Clinical significance: For patients with terminal dentition, clinicians can integrate artificial intelligence (AI) driven applications to form a comprehensive treatment plan. The virtual treatment plan can then be transferred to clinical practice, enabling surgical and prosthetic interventions for complete-arch, immediate implant placement and loading through a digital workflow.

Objective: This study aimed to evaluate the effect of limonene (LIM) on the bond strength of a universal adhesive system in self-etch mode to caries-affected dentin (CAD).

Materials and methods: Class I cavities were prepared in eighty sound human molars and divided into four groups (n = 20): Sound dentin (SD), SD + LIM (SD treated with LIM), CAD, and CAD + LIM (CAD treated with LIM). Following pH cycling, two layers of a universal adhesive system (Single Bond Universal, 3MESPE) were applied. After restoration (Filtek Z350, 3MESPE), samples were sectioned into 0.9 mm² sticks and stored in distilled water at 37°C for 24 h and 6 months. Subsequently, sticks were subjected to microtensile bond strength testing. Data were analyzed using 2-way ANOVA and Bonferroni's test (p < 0.05). Fracture patterns were examined under optical and scanning electron microscopes.

Results: After 24 h, SD + LIM showed lower bond strength than CAD but remained higher than CAD + LIM. CAD + LIM exhibited the lowest bond strength, regardless of aging. In SD + LIM, widened dentinal tubules were observed, accompanied by resin tags. In CAD + LIM, disorganized and unprotected collagen fibrils were identified, with fewer resin tags.

Conclusions: Limonene decreased the bond strength of the universal adhesive system in self-etch mode to caries-affected dentin.

Clinical significance: Limonene as a pretreatment in self-etch adhesive protocols shows potential for enhancing the durability of adhesive restorations on sound dentin. However, its use on caries-affected dentin could compromise adhesion, highlighting the need for careful consideration when applying it to compromised substrates.

Objectives: To evaluate the feasibility of esthetic assessments based on intraoral scanning data using pink and white esthetic scores (PES/WES).

Materials and methods: Thirty samples with both intraoral photographs and scanning data were collected and rated by two observers with excellent consistency independently. PES includes seven variables, and WES includes five. The maximum scores were 14 and 10, respectively.

Results: The mean PES/WES was 10.60 ± 1.69 and 8.50 ± 1.28 for photographs and 10.97 ± 1.69 and 8.40 ± 1.25 for scanning data. No significant difference was observed between the two sample types. The alveolar process variable had significantly higher scores, while the soft-tissue color variable had significantly lower scores based on intraoral photographs compared to scanning.

Conclusions: Intraoral scanning could be a method for the esthetic evaluation of single implant-supported restorations using PES/WES. The use of three-dimensional imaging enables the precise assessment of esthetic outcomes, paving the way for improvements in the digital workflow of implant dentistry. However, the limitations of color and texture reproducibility should be noted.

Clinical significance: Intraoral scanning data can be used for esthetic evaluation, and reliable results could be achieved with the application of scanning.

Objective: To address the following PICOS question: Can single-shade resin composites achieve a color match comparable to multi-shade composites in tooth restoration?

Materials and methods: A comprehensive search was conducted across multiple electronic databases to identify in vitro and clinical studies evaluating the color match in tooth restoration, in terms of CIELAB (ΔE_ab) and/or CIEDE2000 (ΔE₀₀) color differences metrics, using single-shade and multi-shade composites. The risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool), while the revised Cochrane Collaboration's tool (RoB 2) was employed for randomized controlled clinical trials (RCTs). Meta-analyses were performed using RevMan to compare ΔE_ab and ΔE₀₀ values between single-shade and multi-shade composites (p < 0.05).

Results: After initial screening, 15 in vitro studies and 4 RCTs met the inclusion criteria for qualitative synthesis, with 8 in vitro studies selected for quantitative analysis. The majority of in vitro studies were classified as medium risk of bias, while RCTs were ranked as low risk of bias. Meta-analyses performed on in vitro studies revealed that single-shade composites exhibited statistically significant higher color differences with the surrounding tooth structure compared to multi-shade composites, for both ΔE_ab and ΔE₀₀ (p < 0.05). However, RCTs usually reported promising outcomes for single-shade materials.

Conclusions: This systematic review concluded that multi-shade composites provide a more accurate color match between tooth and direct restoration than single-shade materials when evaluated by instrumental analysis in laboratory settings.

Clinical significance: Multi-shade composites exhibit superior color match properties in laboratory studies. However, single-shade composites are a promising alternative when observed visually in clinical settings.