Journal of Esthetic and Restorative Dentistry最新文献

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.

Objective: To highlight the application of digitally fabricated Snap-On PMMA provisional restorations as a minimally invasive and adaptable methodology for assessing the vertical dimension of occlusion and occlusal stability during the comprehensive rehabilitation of worn dentition.

Clinical considerations: A clinical case is presented involving a 58-year-old male with severe anterior tooth wear, multiple edentulous spaces, and occlusal dysfunction. The patient underwent full-arch digital rehabilitation through a workflow incorporating intraoral scanning, facial scanning, cone-beam computed tomography (CBCT), and virtual smile design. Snap-On PMMA milled provisional restorations enabled real-time evaluation of the proposed VDO, phonetics, esthetics, and centric occlusion in a reversible, non-invasive manner. Their use also enabled immediate implant loading at site #22 and facilitated the digital transfer of the validated occlusal scheme from the provisional stage to the definitive CAD/CAM restorations. Definitive restorations were fabricated using monolithic zirconia and lithium disilicate, selected for their superior mechanical strength, longevity, and esthetic potential.

Conclusion: Snap-On PMMA provisional restorations represent an effective diagnostic and transitional tool in the management of worn dentition. Integrated into a fully digital workflow, they enhance treatment predictability by allowing reversible clinical validation and direct digital transfer of occlusal parameters to the final prostheses. Combined with advanced restorative materials, this approach improves treatment predictability, patient satisfaction, and the long-term clinical success of managing complex cases of worn dentition.

Clinical significance: Snap-On PMMA provisionals offer a minimally invasive, reversible way to assess occlusion, function, and esthetics before final restoration. This technique enhances accuracy and predictability in full-mouth rehabilitations, making it highly valuable in esthetic dentistry.

Introduction: Cervical lesions often demand specialized approaches due to their anatomical position, and the effectiveness of these techniques may vary among clinicians.

Objectives: To assess the clinical effectiveness of various adhesive strategies combined with different restorative materials for managing cavitated cervical carious lesions in adults, with a specific focus on restoration retention. The study also aimed to rank these combinations through network meta-analysis.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Randomized controlled trials comparing at least two restorative protocols in adult populations were included. Pairwise and network meta-analyses were performed using random-effects models. The certainty of the evidence was evaluated using the CINeMA framework.

Results: Seventeen RCTs met the inclusion criteria. Conventional composites applied with two-step etch and rinse adhesives and compomers demonstrated the highest retention rates in pairwise comparisons. Glass ionomer cement showed the most stable long-term performance. However, the network meta-analysis revealed no statistically significant differences among treatments. Notably, compomers ranked highest in overall performance but were supported by studies with substantial heterogeneity and a high risk of bias.

Conclusions: Although compomers achieved the highest retention rates in direct comparisons, the underlying evidence is limited by methodological concerns, reducing confidence in their clinical reliability. In contrast, conventional composites bonded with two-step etch-and-rinse adhesives emerged as the most robust and evidence-based option for restoring cervical carious lesions. The optimization of adhesive protocols, particularly the incorporation of selective enamel etching, remains a key determinant for long-term restoration success.

Clinical significance: This systematic review and network meta-analysis provides robust, evidence-based guidance for the restoration of cavitated cervical carious lesions in adults. Optimizing adhesive protocols, especially with selective enamel etching, significantly enhances the longevity of cervical carious lesion restorations. Evidence supports two-step etch-and-rinse adhesives with conventional composites as a dependable choice, ensuring durable retention, favorable esthetic integration, and long-term performance in this highly visible and esthetically sensitive region of the dentition.

Prospero: Registration number: CRD420251083691.

Objective: To determine whether a bone-flattening drill improves implant placement accuracy in static, computer-assisted implant surgery across different ridge morphologies.

Materials and methods: Thirty 3-D printed maxillary models, each featuring a flat and a 20° sloped healed ridge, were randomly allocated to three drilling protocol groups (n = 10 models per group, 60 total implants). In the flattening-drill group (FL), bone preparation was performed with a flattening drill followed by the manufacturer's drilling sequence. The initial drill group (IN) began directly with the initial drill and subsequent drilling sequence, while the final drill group (FN) commenced from the final drill. Fully guided surgical templates with resin sleeves were used. Positional accuracy-platform, apex, angular, and depth deviation-was assessed by digital superimposition of planned versus actual implant positions. Statistical analyses were performed using two-way analysis of variance with post hoc comparisons.

Results: The FL group demonstrated significantly superior accuracy over the conventional drilling protocols across all parameters. The platform deviation in the FL group (0.36 ± 0.17 mm) was lower than the IN group (0.57 ± 0.21 mm) and FN group (0.99 ± 0.43 mm) (p < 0.001). The angular deviation showed a similar pattern, being 2.92° ± 1.13°, 4.17° ± 1.48°, and 5.95° ± 2.84° in the FL, IN, and FN groups, respectively (p < 0.001). The ridge inclination significantly affected accuracy in the FL and IN groups, while the FN group showed consistently poor accuracy regardless of the ridge morphology. The 95% confidence intervals in the FL group remained within clinically acceptable ranges for both flat and sloped healed ridges.

Conclusions: The use of a bone-flattening drill as an initial drilling step significantly improved the guided implant surgery accuracy compared with conventional protocols. This modification offers a practical solution for achieving predictable implant positioning, especially on sloped ridges, thereby supporting optimal prosthetic outcomes.

Clinical significance: The bone-flattening-drill protocol might provide clinicians with a reliable method for increasing implant placement accuracy to within clinically acceptable ranges and reducing the risks of prosthetic complications and revision procedures. Further in vivo validation is required.

Background: This study investigated the influence of repeated preheating of bulk-fill resin composites on post-gel shrinkage strain (PGSS) and marginal gap formation.

Methods: Eighty Samples (A) were prepared and assigned to two groups (n = 40) based on material type: thermoviscous composite containing Bis-GMA (A1) and matrix-modifying bulk-fill composite free of Bis-GMA (A2). Each group was further divided into four subgroups according to the number of preheating cycles at 54°C: C1 (no preheating, room temperature control), C2 (preheated once), C3 (preheated five times), and C4 (preheated 10 times) for the PGSS test. Additionally, 80 human premolars with standardized Class II (MOD) cavities were restored using the same group allocations to assess marginal gap surface area. PGSS and gap formation were measured and analyzed using independent t-tests and two-way ANOVA (p < 0.001).

Results: PGSS increased with repeated preheating cycles. All preheated groups showed lower PGSS values in the Viscalor Bulk (Bis-GMA-based) composite. The marginal gap surface area significantly decreased in all preheated groups versus controls. BisGMA-containing composites exhibited greater gap formation compared to BisGMA-free materials.

Conclusions: Repeated preheating increases PGSS but enhances marginal adaptation. BisGMA-free composites show superior performance in minimizing marginal gaps.

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.

Objective: Dental implants are at a biological disadvantage compared to natural teeth due to differences in the peri-implant mucosal architecture. Proper design of the prosthetic implant components plays an essential role in maintaining stable hard and soft tissues around implants. The Esthetic Biological Contour (EBC) zones have been described as a structured framework for understanding and managing the peri-implant emergence profile. Appropriate morphology, material selection, and surface treatment within each zone can enhance both esthetic and biological outcomes. This article illustrates a zone-by-zone guide for the design and management of the emergence profile of implant restorations, integrating esthetic, mechanical, and biological principles.

Clinical considerations: Emergence profile design depends on multiple factors, including the three-dimensional position of the implant and the volume and quality of peri-implant soft tissues. A comprehensive understanding of how prosthetic decisions influence peri-implant health is essential for minimizing the risk of biological and esthetic complications.

Clinical significance: A well-designed emergence profile promotes the long-term stability of the peri-implant tissues and directly influences the esthetic and biological success of implant therapy.

Objective: This randomized, parallel, double-blind clinical trial aimed to evaluate the equivalence in bleaching efficacy (BE), as well as the risk and intensity of tooth sensitivity (TS), in participants undergoing in-office dental bleaching with low (6%) versus high-concentration (35%) hydrogen peroxide.

Material and methods: A total of 140 participants were randomly assigned to one of the two groups according to the bleaching gel concentration used: 6% hydrogen peroxide (Automixx 6%, FGM) or 35% hydrogen peroxide (Automixx Plus 35%, FGM), the bleaching procedure was performed for 50 min in three sessions, with 1-week interval. The bleaching procedure was performed for 50 min in three sessions, with a 1-week interval. BE was evaluated using a Vita Easyshade spectrophotometer (ΔE₀₀, ΔE_ab, and ΔWI_D) and both Vita Classical and Vita Bleachedguide shade guides (ΔSGU) at days 7, 14, and 21, and 1 month after completion treatment. The risk and intensity of TS were recorded using a visual analog scale (VAS; 0 to 10), assessed immediately after each of the three bleaching sessions, and at 1, 24, and 48 h posttreatment. BE was assessed with a paired Student's t test. The absolute risk of TS was evaluated using the Fisher's exact test, and the TS intensity was assessed using a paired Student's t test (α = 0.05).

Results: Nonequivalent bleaching outcomes were observed between the groups across all instruments and time points (p > 0.05). The 35% hydrogen peroxide group showed significantly greater efficacy than the 6% group (MD in ΔE₀₀ = 6.3; 90% CI 4.8-7.7; p < 0.05). The risk of TS was lower in the 6% group (44%) compared with the 35% group (74%; p = 0.0005). Sensitivity intensity was also significantly lower in the 6% group up to 24 h posttreatment (p < 0.01).

Conclusions: In-office dental bleaching with 6% and 35% hydrogen peroxide resulted in significant tooth whitening; however, the outcomes were not equivalent across all evaluation time points, with the 35% concentration demonstrating superior efficacy throughout the study. In contrast, TS was significantly higher in the 35% group compared with the 6% group.

Clinical relevance: While 35% hydrogen peroxide delivers more effective tooth whitening in-office, it is also associated with a higher risk and intensity of TS. Lower concentrations like 6% offer a safer alternative with reduced sensitivity but less whitening efficacy.