Journal of Esthetic and Restorative Dentistry最新文献

Objective: To present a digital workflow for rehabilitating terminal dentition patients with complete arch maxillary (FP-2) and mandibular (FP-3) implant-supported restorations through a staged approach.

Clinical considerations: Staging extractions in these patients offers a valuable treatment option, allowing patients to retain fixed prostheses throughout the treatment. In this way, both function and esthetics can be evaluated, without relying on transitional complete dentures or the need for immediate implant placement and loading. Interim fixed restorations, such as tripod prostheses, can assist in the preservation of soft tissue anatomy and increase patient comfort, compared to removable prostheses. Prosthetic-driven implant placement and loading can be facilitated by implementing a stackable surgical template system.

Conclusions: To overcome the challenges of digital implant position acquisition in edentulous areas, a dual-purpose implant scan body system can be implemented. Finally, monolithic zirconia titanium-supported prostheses are delivered to meet both esthetic and mechanical requirements.

Objective: To investigate the effect of deep margin elevation (DME) on the fracture resistance and fracture patterns of various indirect resin-based composite materials.

Materials and methods: A total of 120 extracted maxillary premolars were prepared with standardized MOD onlay cavities extending 2 mm below the cementoenamel junction. Teeth were embedded in acrylic resin and randomly allocated into 10 groups (n = 12), including two controls (positive and negative) and two experimental groups with or without DME. Onlays were fabricated using four materials: Gradia Plus, Signum Ceramis, Tescera ATL, and Grandio Bloc. All restorations were cemented using adhesive protocols and subjected to thermocycling (5000 cycles, 5°C-55°C). Fracture resistance was tested using a universal testing machine. Fracture types were assessed under a stereomicroscope. Selected samples underwent scanning electron microscopy analysis. Data were statistically analyzed using Shapiro-Wilk, ANOVA, Tukey HSD, t tests, and Chi-square tests.

Results: The highest fracture resistance was found in the intact control group and the lowest in the non-restored group. Among experimental groups, Grandio Bloc without DME showed the highest resistance, while Signum Ceramis with DME showed the lowest. DME did not significantly alter fracture resistance but significantly increased the proportion of restorable fracture types.

Conclusions: DME does not compromise fracture resistance but positively affects fracture patterns, promoting more repairable outcomes. Proper material and adhesive system selection remain crucial for long-term success.

Clinical significance: Deep margin elevation enhances the restorable nature of fractures without reducing fracture resistance, offering a viable option in subgingival margin management for indirect composite restorations.

Objectives: This systematic review examines changes in optical properties of sculptable bulk-fill resin composites in staining media, highlighting the potential impact on the long-term aesthetic performance.

Materials and methods: Electronic searches across MEDLINE, Embase, Web of Science, and SCOPUS were conducted in January 2025 and updated on 27/05/2025. The RoBDEMAT framework (Risk of Bias tool for Pre-Clinical Dental Material Research) was utilized for risk of bias assessment. Inclusion criteria were primary studies in English, in vitro studies with a control group, and spectroscopic measurement of optical properties. Studies with visual color determination, no control group, materials other than sculptable bulk-fills, and no full text available were excluded.

Results: Twelve studies were selected for analysis. Coffee, tea, wine, and tomato-based products generally caused greater staining than lighter-colored or acidic beverages, while non-pigment control media caused minimal but measurable changes. Compared to other restorative materials, some bulk-fills (SonicFill, Fill-up) performed better, whereas fiber-reinforced everX exhibited greater susceptibility to color change and whitening index variation, particularly after bleaching.

Conclusions: Sculptable bulk-fills showed variable color stability, with performance influenced by material type, polishing, staining medium, and duration of exposure. Wide methodological variability hindered meta-analytical comparisons, highlighting the need for standardized research protocols.

Clinical significance: This systematic review highlights that the color stability of bulk-fill composites is highly material-dependent, with certain products more resistant to staining and bleaching-induced changes than others. Clinically, this underscores the importance of material selection in achieving long-term aesthetic outcomes, particularly for restorations in patients with high consumption of staining beverages or undergoing bleaching treatments.

Registration: PROSPERO CRD42024603712.

Objectives: To evaluate the impact of non-thermal atmospheric plasma (NTAP) treatment on the bonding performance of different digital methods (full-digital vs. semi-digital) fabricated customized ceramic post-and-core.

Methods: Ceramic blocks treated with NTAP in different configurations were bonded with resin cement and tested by shear bond strength (SBS) and tensile bond strength (TBS) tests: on the ceramic surfaces (X-Pl-Pr-C), on primer-applied surfaces (X-Pr-Pl-C), on cement-applied surfaces (X-Pr-C-Pl), and on both ceramic and cement-applied surfaces (X-Pl-Pr-C-Pl). Contact angle and FTIR-ATR analyses were performed to examine the effects of NTAP on the selected zirconia-resin interface. The precision of full-digital and semi-digital fabrication methods was evaluated by comparing the linear discrepancy during the fabrication of zirconia post-and-cores. Push-out bond strength (PBS) testing was then used to assess the influence of NTAP treatment on zirconia post-and-cores bonded to extracted single root canals.

Results: Appropriate NTAP treatment parameters/procedures significantly improved the immediate TBS and SBS of all ceramic samples, except for the primer-treated group (X-Pr-Pl-C), with the most pronounced enhancement observed for zirconia. Semi-digital fabrication exhibited a smaller linear discrepancy at the apical third of the root compared to the full-digital method. NTAP treatment increased the PBS to both immediate and aged zirconia post-and-cores fabricated via semi-digital or full-digital bonded to root canals.

Conclusion: NTAP treatment enhanced ceramic's wettability and resin polymerization, thereby improving surface bonding. Semi-digital fabrication demonstrated better precision at the apical third of the root. Overall, appropriate NTAP treatment significantly improved the bonding performance of customized ceramic post-and-cores with root canals, with optimal efficacy achieved through concurrent application on both ceramic surfaces and cement-applied surfaces.

Clinical significance: NTAP treatment improves customized ceramic post-and-core bonding, overcoming its surface inertness and reducing debonding risks, ensuring long-term stability.

Objetive: To evaluate the influence of titanium and gold-shaded titanium as well as peri-implant soft tissue thickness on the optical outcome of implant-supported lithium disilicate single crowns.

Methods: Eighteen patients received an anterosuperior implant (Astra Tech Implant System EV). Two customized titanium abutments (gold and conventional) were fabricated, and a lithium disilicate crown was placed. Color measurements were taken at the free gingival margin and in the mid buccal region of both the crown and the contralateral tooth using a spectrophotometer for both abutments. The CIE Lab* color scale was used, and values were calculated as ∆E. Data were analyzed using the Wilcoxon signed ranks test (α = 0.05).

Results: The type of abutment did not significantly influence ∆E values at either the peri-implant soft tissue (p = 0.711) or coronal level (p = 0.094). Lower ∆E values were observed with gold-shaded titanium abutments at both soft-tissue (11.77 ± 6.9) and coronal level (10.42 ± 7.8) compared to titanium abutments (12.85 ± 4.5 and 10.53 ± 7.1, respectively). The mean peri-implant soft tissue thickness was 2.91 ± 0.89 mm.

Conclusions: Both titanium and gold-shaded titanium abutments resulted in perceptible color differences at soft tissue and coronal levels. Gold-shaded abutments yielded the lowest ∆E values. Peri-implant soft tissue thickness did not significantly affect the ∆E at the gingival level.

Clinical significance: Gold-shaded titanium abutments demonstrated a tendency toward improved esthetic outcomes compared to conventional titanium abutments, suggesting their potential usefulness in anterior implant restorations.

Purpose: To evaluate the effect of erosive-abrasive challenge on the optical properties, microhardness, and surface morphology of CAD-CAM ceramics with different surface finishing protocols.

Methods: CAD-CAM ceramics used were: IPS e.max CAD (DIS), IPS Empress CAD (LEU), Cerec Blocs (FEL), and Celtra Duo (CEL). Specimens were divided into five groups (n = 10): Polishing (P), Conventional Glaze (CG-control), Conventional Glaze with 2 firings (CG₂), Extended Glaze firing (EG), and Extended Glaze with 2 firings (EG₂). An erosive-abrasive challenge was performed with citric acid and simulated toothbrushing. Color change (ΔE₀₀), translucency, contrast ratio, gloss, Vickers microhardness, and surface morphology were evaluated. The evaluations were performed before and after the erosive-abrasive challenge. ΔE₀₀ was analyzed with one-way ANOVA with Welch correction and Games-Howell, while the other data were evaluated with two-way repeated measures ANOVA and Bonferroni post-test (α = 0.05%).

Results: After the challenge, CG groups showed clinically unacceptable color changes. Translucency decreased in LEU-P, FEL-P, FEL-EG, and CEL-EG groups, but increased in DIS-CG₂, DIS-EG₂, and CEL-EG groups. The contrast ratio was close to 1. No gloss reduction was observed in CG groups. Microhardness decreased in DIS-EG, DIS-EG₂, LEU, FEL, and CEL groups, but remained unchanged in LEU-CG, FEL-CG₂, and CEL-EG₂ groups.

Conclusion: Erosive-abrasive challenge affected the properties of CAD-CAM ceramics with different behaviors depending on the surface finishing protocol used.

Clinical significance: The optical properties and microhardness of CAD-CAM ceramics are negatively affected by erosive-abrasive conditions. Manual polishing showed similar performance in maintaining these properties and may represent a viable and effective alternative to glaze application.

Objective: To assess clinical outcomes of the surgery-early approach in managing skeletal Class II malocclusion and mandibular deviation.

Materials and methods: A 21-year-old female underwent staged treatment: (1) limited presurgical orthodontics for dental alignment, (2) bimaxillary surgery (LeFort I impaction, BSSRO, and genioplasty) to correct skeletal discrepancies, and (3) postoperative orthodontic refinement using miniscrews and progressive archwires. Progress was monitored through clinical examinations, cephalometric analysis, and CBCT imaging.

Results: Skeletal Class I relationship, reduced mandibular plane angle, and stable TMJ function were achieved. Total retreatment duration was 24 months.

Conclusion: The surgery-early approach effectively addresses complex skeletal discrepancies with reduced retreatment time, contingent upon meticulous preoperative 3D assessment to define the safe anatomic range for tooth movement, ensuring periodontal integrity and stable outcomes. This necessitates interdisciplinary collaboration to achieve optimal outcomes.

Objective: To assess the influence of dentin airborne-particle abrasion techniques on the microtensile bond strength, using two adhesive strategies (self-etch and etch&rinse).

Materials and methods: Twenty molars were assigned to two groups (n = 10) according to the bonding system (Clearfil SE Bond or Optibond FL), divided into four parts and submitted to different surface treatments: no pretreatment (control), airborne-particle abrasion with aluminum oxide without irrigation (Al₂O₃), airborne-particle abrasion with aluminum oxide with irrigation (Al₂O₃/Aquasol), and airborne-particle abrasion with bioactive glass 45S5 (BG45S5). Specimens underwent microtensile bond strength (μTBS) testing and scanning electron microscopy (SEM) analysis. Statistical analysis employed a linear mixed regression model, with a 5% significance level.

Results: Statistically significant differences were found for both adhesive strategy (p < 0.001) and pretreatment (p < 0.001). Al₂O₃/Aquasol and Al₂O₃ exhibit statistically significant differences compared to the control (p < 0.001 and p = 0.006, respectively), while BG45S5 did not differ significantly (p = 0.080). SEM images reveal a smear layer with distinct density across groups, and diminished compactation whenever irrigation was used.

Conclusions: Aluminum oxide with simultaneous irrigation resulted in the highest bond strength values, while without irrigation bond strength outcomes depend on the adhesive strategy. Bioactive glass did not interfere with bonding performance.

Clinical significance: Aluminum oxide airborne-particle abrasion with concomitant irrigation presents the preferable surface pretreatment strategy when bonding to sound dentin.

Objective: To evaluate the impact of occlusion type and artificial intelligence-based computer-aided design (CAD) software on the geometric accuracy and clinical quality of auto-generated anterior and posterior crown designs.

Methods: Five typodont models representing various occlusion types (normal, Class I anterior diastema, Class II division 1, Class II division 2, and Class III anterior crossbite occlusion) underwent crown preparation for the maxillary right central incisor and first molar. Ten sets of intraoral scans were obtained from each prepared model, and crown designs were automatically generated using two software programs: deep learning-based (DL; Dentbird) and conventional automated (CA; Auto Workflow, 3Shape) (n = 10). Surface deviations between the crown designs and preoperative tooth morphology were quantified using root mean square (RMS) values. Clinical crown quality was assessed using World Dental Federation (FDI) criteria. Scheirer-Ray-Hare and Fisher's exact tests were conducted (α = 0.05).

Results: Significant differences in surface deviation and clinical quality were observed between the various occlusion and software types. The DL group demonstrated higher RMS values than the CA group (p < 0.001). However, DL-generated crowns were of significantly better clinical quality (FDI scores) than CA-generated crowns, particularly for posterior teeth, in terms of marginal adaptation, proximal contacts, and anatomical form and contour (p < 0.05). The DL group demonstrated generally favorable outcomes when designing crowns for normal occlusion, but outcomes were less satisfactory when designing anterior crowns with diastemas.

Conclusions: Occlusal scenarios influenced the surface deviation and quality of auto-generated anterior and posterior crown designs. DL software produced higher-quality molar designs than CA software.

Clinical significance: Automated crown design outcomes depend on occlusal scenarios and CAD software selection. DL-based CAD software demonstrated superior clinical quality, particularly for posterior crowns, indicating higher clinical suitability. However, further software refinement is needed to consistently produce clinically acceptable crowns under diverse occlusal conditions, such as anterior diastemas.

Objective: Multimodal large language models (LLMs) have the potential to transform dental learning and decision-making by addressing multimodal dental inquiries that integrate text, images, and analytical data. The purpose of this study was to evaluate the performance of various multimodal LLMs in responding to multimodal dental queries and to identify factors influencing their performance.

Materials and methods: Four multimodal LLMs (ChatGPT-4V, Claude 3 Sonnet, Microsoft 365 Copilot 2024, and Google Gemini 1.5 Pro) were evaluated based on their correct answers and passing margin for the Integrated National Board Dental Examination (INBDE) and the Advanced Dental Admission Test (ADAT). Descriptive statistics, χ ² tests, Cohen's κ, Kruskal-Wallis tests, and Mann-Whitney U tests were used to analyze the performance across different question types, independent inputs, and picture types (α = 0.05).

Results: Claude 3 Sonnet outperformed the other models in both INBDE and ADAT exams, achieving the highest accuracy, followed by ChatGPT-4V, Microsoft 365 Copilot 2024, and Google Gemini 1.5 Pro. χ ² tests revealed significant differences between chatbots in the ADAT exam, but not in the INBDE. Cohen's κ showed weak to moderate model agreement for INBDE and stronger agreement for ADAT, with the highest agreement between Claude 3 Sonnet and ChatGPT-4V (κ = 0.757) and the lowest between Google Gemini 1.5 Pro and Microsoft 365 Copilot 2024 (κ = 0.059). Model performance was influenced by question type (theoretical and clinical), with common errors including misinterpreting clinical scenarios, visual data difficulties, and dental terminology ambiguities.

Conclusion: Multimodal LLMs show potential in answering multimodal dental inquiries, though performance varies across models, with challenges in interpreting clinical scenarios, visual data, and terminology ambiguity.

Clinical significance: Large language models canbe applied not only to memorization-type but also interpretation andproblem-solving cognitive questions in dentistry. Tomaximize the utility of these artificial intelligence models, users need bothan understanding of their differences and the ability to manage complexclinical data.