Journal of Esthetic and Restorative Dentistry最新文献

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.

Objectives: Restoring the anatomical structure of posterior teeth with significant structure loss is challenging and time-consuming due to anatomical variations. This study assesses the efficiency and effectiveness of using ready-made prefabricated plug-in stamps compared to the conventional freehand method for occlusal restorations.

Methods: Following ethical approval, 40 Frasaco typodont teeth and 20 extracted natural teeth were included in the study. Prefabricated plug-in stamps were created using typodont teeth from a different manufacturer. Occlusal cavities were prepared on 40 typodont teeth and restored with resin-based composite (RBC) and glass-ionomer cement (GIC) using two techniques: the conventional freehand and the ready-made prefabricated plug-in stamp. Additionally, extracted teeth were restored with RBC using both techniques. A single clinician prepared all cavities, while 10 volunteer clinicians conducted the restorations, each completing six restorations (two RBCs on typodont teeth, two RBCs on natural teeth, two GICs on typodont teeth) using both techniques. The restoration time was measured for each tooth. Three calibrated examiners assessed the final restorations using a rubric evaluating marginal adaptation, anatomy, contour, surface texture, and occlusion. Restoration times and evaluation scores were analyzed using the Wilcoxon signed-rank test and paired t-test (p = 0.05).

Results: For typodont teeth, the prefabricated plug-in stamp technique with RBC significantly reduced restoration time (p = 0.002), finishing and polishing time (p = 0.010), and total time (p = 0.004) compared to the conventional freehand technique. For natural teeth, the use of prefabricated plug-in stamp also significantly reduced finishing and polishing time (p = 0.002) and total time (p = 0.006). GIC restorations showed significantly shorter evaluation scores and total time with the prefabricated technique (p = 0.002). Restoration evaluation scores were significantly better with the prefabricated plug-in stamp technique than with the conventional freehand technique (p < 0.05).

Conclusions: Utilizing prefabricated plug-in stamp demonstrated superiority in restoring the occlusal part of the tooth and provided more efficient outcomes regarding application, finishing and polishing time, and anatomical accuracy than the conventional freehand technique.

Clinical relevance statement: Using the ready-made prefabricated plug-in occlusal stamps can provide dentists with a standardized and time-efficient method for restoring posterior tooth anatomy with greater precision. Potentially enhancing patient outcomes and improving treatment efficiency in clinical settings.

Objectives: This case report elucidates the application of an integrated digital workflow in which diagnosis, planning, and execution were enhanced by artificial intelligence (AI), enabling an assertive interdisciplinary esthetic-functional rehabilitation. With AI-powered software, the sequence from orthodontic treatment to the final rehabilitation achieved high predictability, addressing patient's chief complaints.

Clinical considerations: A patient presented with a missing maxillary left central incisor (tooth 11) and dissatisfaction with a removable partial denture. Clinical examination revealed a gummy smile, a deviated midline, and a disproportionate mesiodistal space relative to the midline. Initial documentation included photographs, intraoral scanning, and cone-beam computed tomography of the maxilla. These data were integrated into a digital planning software to create an interdisciplinary plan. This workflow included prosthetically guided orthodontic treatment with aligners, a motivational mockup, guided implant surgery, peri-implant soft tissue management, and final prosthetic rehabilitation using a CAD/CAM approach.

Conclusions: This digital workflow enhanced communication among the multidisciplinary team and with the patient, ensuring highly predictable esthetic and functional outcomes.

Clinical significance: Comprehensive digital workflows improve diagnostic accuracy, streamline planning with AI, and facilitate patient understanding. This approach increases patient satisfaction, supports interdisciplinary collaboration, and promotes treatment adherence.

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.

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.

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.

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.

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.