Journal of Esthetic and Restorative Dentistry最新文献

Objective: Comprehensive rehabilitation for multifactorial dental disease requires coordinated planning across restorative/prosthodontic, periodontal, endodontic, and orthodontic disciplines. Existing tooth-level prognostic tools typically focus on single domains and therefore offer limited guidance for interdisciplinary decision-making or for communicating expected effort and cost.

Overview: This paper proposes the Restorative Value Score (RVS), an objective 0-5 tooth-level index that summarizes, in one number, the amount and complexity of care needed to return a tooth to predictable function and esthetics within a comprehensive plan (with 0 indicating no treatment and 5 indicating extraction). The intermediate categories reflect the breadth of disciplinary involvement and the requirement for more advanced interventions. These interventions are linked to greater time, cost and procedural risk. The RVS is intended to complement-rather than replace-patient-level risk assessment, and should be interpreted in light of systemic, behavioral, and socioeconomic determinants, clinician expertise, and adherence to supportive care. This paper outline the construct and scoring logic, offer guidance for implementation, and propose prospective validation to assess discrimination, calibration, and clinical utility relative to existing tooth- and implant-based alternatives.

Conclusion: By making effort and complexity explicit at the tooth level, the RVS seeks to reduce unwarranted variability, improve predictability and cost-effectiveness, and furnish a common language for clinicians, educators, and patients engaged in multidisciplinary dental care.

Objective: This article aims to describe the clinical execution and management of a full-mouth rehabilitation in a patient with severe tooth wear, utilizing partial and full-contour lithium disilicate restorations, with a long-term follow-up of 11 years and 6 months.

Clinical considerations: Over a follow-up of more than 11 years, this case provides in-depth clinical insight into identifying etiological factors, reestablishing the vertical dimension of occlusion, and implementing lithium disilicate restorations in both partial- and full-contour designs. It also addresses the management of underlying conditions and outlines the challenges encountered during long-term follow-up of a full-mouth rehabilitation for severe tooth wear.

Conclusions: The full-mouth rehabilitation using partial and full-contour lithium disilicate restorations for severe tooth wear demonstrated a favorable outcome. At 11+-year follow-up, the case exhibited appropriate mechanical behavior, preserved esthetic outcomes, and functional integrity, addressing the complex multifactorial etiological factors associated with tooth wear.

Clinical significance: Long-term success in rehabilitating patients with severe tooth wear relies not only on appropriately indicated and executed restorative treatment but also on an interdisciplinary approach that includes effective management of underlying etiological factors and parafunctional habits.

The cover image is based on the article From Virtual Maxillomandibular Relationship Determination to Clinical Implementation for Digital Functional-Esthetic Rehabilitation in Severe Generalised Tooth Surface Loss by Yiqiao Wang et al., https://doi.org/10.1111/jerd.70014.

Objectives: The masking ability of printed zirconia over discolored backgrounds is unknown. This study assessed the impact of method of manufacturing, thickness, and the method of surface treatment on the color masking ability of zirconia.

Materials and methods: Forty 0.5 mm × 10 mm and 40 1 mm × 10 mm zirconia disks (Dental Direct Medical Zirconia, Germany) were designed, fabricated using a milling machine (DWX-51D, Roland DGA, Irvine, CA) and a 3D printer (AON 3D printer; ZIPRO dentistry; South Korea), and divided into eight groups: (1) printed-polished, (2) printed-glazed, (3) milled-polished, and (4) milled-glazed. ΔE₀₀ values between each group and substrates made of natural die composite resin (IPS, IvoclarVivadent, Schaan, Liechtenstein) in shades of ND₁ (control), ND₃, ND₅, and ND₉ were measured. Data were analyzed using three-way ANOVA and Games-Howell tests (α = 0.05).

Results: Printed zirconia with either thickness showed a better masking ability as compared to their milled zirconia. Milled zirconia (0.5 mm) showed the highest ΔE₀₀ values (ND_3-1: 1.70, ND_5-1: 3.62, ND_9-1: 6.46), while 1 mm printed zirconia had the lowest ΔE₀₀ values (ND_3-1: 0.73, ND_5-1: 1.71, ND_9-1: 3.04). Moreover, ΔE₀₀ values of printed zirconia were below the acceptability threshold (< 1.8) for ND₃ and ND₅ substrates, except for 0.5 mm zirconia against the ND₅ substrate.

Conclusion: All zirconia specimens showed clinically acceptable masking ability against a normal dentin shade (ND₃) (< 1.8). Also, printed zirconia (1 mm) against ND₃ substrate showed the highest masking ability. Moreover, only 1 mm printed zirconia over a darker shade of dentin (ND₅) showed a clinically acceptable color difference. However, no zirconia specimen could mask severely discolored dentin (ND₉).

Objective: This review summarizes recent advances in three-dimensional (3D) printing for removable prosthodontics, including complete dentures, removable partial dentures, implant-retained overdentures, and occlusal splints. The aim is to provide clinicians with an overview of current technologies, clinical performance, and future perspectives.

Overview: While subtractive methods are well established, additive manufacturing has recently gained exponential importance, especially in removable restorations. Vat-photopolymerization resins are widely applied for denture bases, teeth, and occlusal splints, while laser sintering enables fabrication of metal frameworks and implant attachments with high accuracy. Clinical studies indicate that printed complete dentures achieve outcomes in adaptation and patient satisfaction comparable to conventional or milled prostheses, with reduced appointment numbers and digital reproducibility. Removable partial denture frameworks and implant-overdenture attachments fabricated by selective laser melting demonstrate promising accuracy and mechanical properties, though process variability and post-processing remain critical aspects. Printed occlusal splints are widely adopted and offer adequate fit and comfort, though material-related challenges and limited long-term data are concerns.

Conclusions: 3D printing emerges as a reliable option for removable dentures, frameworks, and occlusal devices. Future developments in multi-material printing, durable and bioactive resins, and standardized clinical protocols will further define its role in prosthodontics.

Clinical significance: 3D printing is transforming removable prosthodontics. Clinicians can already benefit from streamlined workflows, a standardized process chain, reduced treatment time, and the ability to reproduce dentures, while patients gain from improved comfort and fewer visits. Awareness of material limitations and processing-related specifics remains essential for long-term success. Looking ahead, multi-material printing-allowing simultaneous fabrication of denture bases, teeth, and maybe frameworks-holds promise for improving structural integrity, esthetics, and overall clinical efficiency.

Background: Artificial intelligence (AI) technologies are increasingly incorporated into restorative and esthetic dentistry; however, their reliability across the complete laminate-veneer workflow remains uncertain.

Objectives: To systematically evaluate the accuracy, efficiency, and esthetic predictability of AI-based systems applied to color prediction, margin-line detection, computer-aided design (CAD) automation, and esthetic simulation in laminate-veneer procedures.

Materials and methods: Five electronic databases (PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar) were searched from inception to May 2025 in accordance with PRISMA 2020 guidelines. In vitro, in silico, and clinical studies applying AI or machine-learning models to any step of the laminate-veneer workflow and reporting quantitative outcomes were included. Random-effects meta-analyses were performed for compatible outcomes. Risk of bias was assessed using PROBAST-AI, QUADAS-AI, and ROBINS-I, and the certainty of evidence was graded using the GRADE framework.

Results: Ten studies met the inclusion criteria. AI-based color-prediction models demonstrated a pooled mean color deviation (ΔE₀₀) of 1.85 (95% CI, 1.70-2.00), remaining below the clinical perceptibility threshold, with shade-classification accuracy reaching 97.9% (96.3%-99.0%). Automated margin-line detection achieved a pooled Dice similarity coefficient of 0.947 (0.931-0.963) and a mean deviation of 72 μm (55-89 μm), values within accepted laboratory tolerance. AI-assisted CAD systems significantly reduced design time (Hedges g = -2.10 [-2.90 to -1.30]; p < 0.001) without compromising morphological accuracy. Clinical and perceptual studies showed moderate-to-high concordance between AI-predicted and actual esthetic outcomes, although patient preference varied. The certainty of evidence was moderate for margin-line accuracy and design-time efficiency and low for color and esthetic prediction.

Conclusions: AI applications enhance efficiency and maintain clinically acceptable accuracy throughout the laminate-veneer workflow. Despite promising results, larger clinical datasets, external validation, and standardized reporting are required before routine clinical implementation.

Objective: To evaluate the effect of modeling liquids on Vickers microhardness (VHN), degree of conversion (DC), and light transmittance in bulk-fill resin composites (BFRC).

Materials and methods: One hundred and thirty-two specimens were prepared using three BFRC (TNBF: Tetric N-Ceram Bulk-fill; OBF: Opus Bulk-Fill; and FBF: Filtek One Bulk-Fill) and three modeling liquids (AM: Ambar Universal; MR: Modeling Resin, and WR: Wetting Resin). VHN and DC were evaluated at 1-, 2-, 3-, and 4-mm depths. Light attenuation was assessed using a calibrated integrated sphere. Confocal laser scanning microscopy (CLSM) was used to assess the presence and thickness of the modeling liquid layer on the specimen surface. VHN data were analyzed with 2-way repeated measures ANOVA, followed by Bonferroni post hoc test; light transmittance and DC data were analyzed using Kruskall-Wallis followed by Bonferroni post hoc test and Spearman test followed by Dwass-Steel-Critchlow-Finger post hoc test.

Results: FBF-AM presented lower VHN values at 1-mm (p < 0.05). All experimental groups increased DC, with WR in all BFRC (p < 0.016), AM in the TNBF and FBF (p < 0.0016; p < 0.001), and MR exclusively in OBF (p < 0.001). MR increased light transmittance in all BFRC; WR in FBF and TNBF; and AM in FBF (p < 0.05). CLSM images showed the presence of modeling liquids post-polishing.

Conclusion: Modeling liquids may enhance VHN, DC, or light transmittance when used in BFRC, depending on the modeling liquid and BFRC type.

Clinical significance: The choice of modeling liquid can influence the physical and chemical properties of bulk-fill resin composites. Proper selection may enhance the degree of conversion and hardness without compromising material performance.

Objective: Vertical bone augmentation (VBA) presents variable levels of difficulty depending on the defect morphology and soft-tissue conditions. We propose the FACE scale as a preoperative tool to guide clinicians in evaluating the anticipated surgical complexity of VBA procedures.

Clinical considerations: The FACE scale evaluates the following four dimensions, each scored from 1 to 3: flap configuration (F1-3), apical mucosa position (A1-3), crestal bone peak alignment (C1-3), and defect extent (E1-3). The total score ranges from 4 to 12 points (maximum difficulty). The scale was retrospectively applied to 43 VBA procedures, performing bilateral analyses to assess the association between FACE scores and complications. Complications were recorded in 23.3% of cases and overall success in 76.7%. A tendency toward higher complication rates was observed in cases with extensive defects (E3) and apical dehiscence (A3), although statistical significance was not reached.

Conclusions: The FACE scale provides a structured framework for anticipating surgical complexity in VBA by integrating defect-related and soft-tissue factors. Preliminary results suggest a trend toward increased complication rates with higher FACE scores. These findings should be interpreted as exploratory, offering a preliminary framework to guide future validation of the FACE scale in larger prospective studies.

Clinical significance: The FACE scale offers clinicians a practical tool to anticipate the complexity of VBA procedures by incorporating both defect-related and soft-tissue factors. Its application may be useful for surgical planning, risk assessment, and patient counseling.

Objective: This scoping review aims to assess the effect of different protocols on the outcome of ceramic restoration repairs.

Materials and methods: An electronic search was conducted in three databases (PubMed, Cochrane Library, and Embase), up to July 31st 2025, with previously identified MeSH terms.

Results: Out of the 2423 records, title and abstract screening resulted in the exclusion of 2136 and 136 studies, respectively, while full-text analysis excluded another 37 articles. In addition, 10 records were not included, as full texts could not be obtained after requesting the authors. Twenty-two cross-references were added. Thus, 126 studies were included in this review. It is important to emphasize the methodological heterogeneity among studies. Bond strength was the most frequently evaluated outcome, followed by ultrastructural analysis, chemical analysis, color evaluation and mechanical properties.

Conclusions: In ceramic repair procedures, glass ceramics should be treated with a combination of hydrofluoric acid etching and silanization, while metal oxide ceramics demonstrate superior outcomes when air abrasion and an MDP-containing primer are employed.

Objective: To evaluate the effect of adding zinc oxide and copper nanoparticles (ZnO/CuNp) into universal adhesives (UAs) on resin-dentin microtensile bond strength (μTBS), nanoleakage (NL), and presence of ZnO/Cu within the hybrid layer on caries-affected dentin, both at baseline (T0) and after 2 years of water storage (T2).

Materials and methods: ZnO/CuNp (0% [control]; 5/0.1 and 5/0.2 wt%) were added into Prime&Bond Active (PBA) and Ambar Universal (AMB). Ninety-six extracted human third molars were used. After microbiological induction of caries-affected dentin, UAs were applied in both etch-and-rinse and self-etch modes, followed by composite build-up. Specimens were sectioned to obtain resin-caries-affected dentin bonded sticks for μTBS, NL, and chemical characterization of the hybrid layer for Cu and Zn detection at T0 and T2. Data were statistically analyzed (α = 0.05).

Results: ZnO/CuNp had no effect on μTBS at T0 (p > 0.05) but improved μTBS at T2, compared to control (p < 0.05). Both UAs showed a significant decrease in μTBS over time (p < 0.05), except PBA with ZnO/CuNp in etch-and-rinse mode. NL was significantly lower in ZnO/CuNp-containing UAs at both time points (p < 0.05), though all groups showed increased NL over time. ZnO/CuNp remained detectable in the hybrid layer at T2.

Conclusions: Adding ZnO/CuNp to UAs decreased adhesive interface degradation on caries-affected dentin, likely due to their presence within the hybrid layer even after 2 years.

Clinical significance: ZnO/Cu nanoparticles into UAs could enhance the stability of adhesive restorations on caries-affected dentin by reducing interface degradation.