Journal of Esthetic and Restorative Dentistry最新文献

Objective: The aim of this retrospective case report was to evaluate the long-term effect of a customized connective tissue graft technique (c-CTG) aimed at preserving or enhancing buccal and interproximal soft tissues in the context of regenerative treatment of infrabony defects in the esthetic zone.

Clinical considerations: Three patients presenting with a single, deep periodontal infrabony defect between the maxillary central incisors were treated using the c-CTG. All sites demonstrated regenerative success, defined as a clinical attachment gain of ≥ 3 mm and probing depth ≤ 4 mm, maintained over a 3- to 5-year follow-up period. In Case 1, complete resolution of pre-existing buccal recession was observed, along with a 2 mm increase in papilla height. Case 2 showed partial closure of a postoperative black triangle, with progressive papilla gain between 6 and 24 months. In Case 3, the initial interproximal gingival crater evolved into a positive soft tissue architecture that was maintained over the long term.

Conclusion: Based on the findings, the c-CTG appears to be a feasible approach for achieving both predictable regenerative outcomes and long-term enhancements in both buccal and interdental soft tissue contours.

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 perceptions of scan-free virtual video mock-ups using the Orofacial Esthetic Scale (OES), comparing self-assessments and evaluations of anonymized individuals by dental professionals and laypeople.

Materials and methods: This study was conducted at the Clinic of Reconstructive Dentistry, University of Zurich. Fifty participants (25 dental professionals and 25 laypeople) were video recorded under standardized conditions while smiling, turning from en face to profile, and speaking to simulate dynamic facial movements. Recordings were obtained using a clinical capture application linked to the device's native rear camera, and AI-generated scan-free virtual video mock-ups were returned within minutes. Each participant rated their own mock-up using the Orofacial Esthetic Scale (OES) and, in randomized order, evaluated five anonymized virtual mock-ups generated from the software library (based on real patient recordings but fully de-identified for privacy protection). Median OES scores were compared using Wilcoxon signed-rank and Mann-Whitney U tests (α = 0.05).

Results: Fifty participants (25 dentists and 25 laypeople) were included. Overall, ratings improved from baseline to the scan-free virtual video mock-up for tooth color and alignment (p = 0.003 and p = 0.014), while no significant changes were observed for the remaining items. In subgroup analyses, laypeople reported significant improvements in tooth color, alignment, form, and overall esthetics after Holm correction, whereas no differences were found among dentists. For mock-up ratings, laypeople assigned higher scores than dentists across all OES items (all p < 0.05), except for tooth alignment and facial profile. When assessing anonymized mock-ups of other individuals, laypeople consistently rated all eight items significantly higher than dentists.

Conclusions: Within the limitations of this study, it was concluded that lay participants assigned higher esthetic ratings than dental professionals for virtual video mock-ups of themselves and of unknown individuals. Comparisons between self-evaluation and evaluation of anonymized individuals showed no consistent differences among dentists, while several item-level differences were observed among lay participants. Compared with natural dentition, ratings for tooth color and tooth alignment increased after viewing the virtual mock-up, while other items did not change significantly.

Clinical significance: These findings suggest that integrating simplified digital simulations with patient-reported outcome measures enhances communication, aligns expectations, and supports patient-centered shared decision-making in prosthodontic and implant treatment planning.

Objective: The optimal duration of phosphoric acid etching (PAE) for enamel bonding remains uncertain, particularly in the context of universal adhesives. The aim of this systematic review was to determine whether shortened etching times (< 15 s) provide comparable bond strength to conventional protocols.

Materials and methods: Searches were conducted across four databases, including Embase, OpenGrey through DANS, PubMed, and Scopus. Laboratory studies on human or bovine enamel specimens, treated with varying PAE durations prior to the application of universal adhesives, were included. Data regarding etching protocols, adhesive types, substrate preparation (ground vs. unground enamel), and bond strength outcomes were analyzed. Risk of bias was evaluated using the RoBDEMAT tool.

Results: Of 762 records screened, eight laboratory studies met inclusion criteria. Etching times of 3-15 s achieved bond strengths that were statistically non-inferior to conventional durations, with no added benefit from prolonged etching. Ground enamel consistently showed enhanced bond strength with PAE, whereas unground enamel exhibited similar bonding trends. The risk of bias was most often due to inadequate sample size justification, deficiencies in randomization, and absence of blinding.

Conclusions: Short-duration PAE (3-15 s) appears sufficient for effective bonding of universal adhesives to enamel, while minimizing potential risk of over-etching of adjacent dentin. Future research should focus on tailoring etching protocols based on cavity-specific characteristics and exploring alternative pretreatment methods to enhance bonding performance.

Clinical significance: This review suggests that abbreviated phosphoric acid etching (3-15 s) provides enamel bond strengths equivalent to conventional durations when universal adhesives are used. This approach may reduce the risk of inadvertent dentin over-etching in mixed-substrate cavities while maintaining optimal adhesive performance.

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, χ² 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. χ² 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.

Introduction: The promise of faster, simpler restorations has driven the rise of bulk-fill composites, but do speed and simplicity come at the cost of longevity and marginal integrity?

Objective: To compare and rank the clinical performance of bulk-fill and conventional incremental layering restoration techniques in Class II posterior restorations through a network meta-analysis (NMA).

Methods: Following PRISMA 2020 guidelines, a comprehensive electronic search was conducted across five databases. Twelve randomized clinical trials met the eligibility criteria. Risk of bias was assessed using RoB2, and confidence in evidence was evaluated through CINeMA. Network meta-analyses at 6, 12, and 24 months estimated relative risks for marginal adaptation, fractures, and retention using random-effects models.

Results: Across all follow-ups, no statistically significant differences were observed between bulk-fill and incremental techniques. Risk ratios clustered around unity, and P-scores indicated minimal ranking variability, confirming comparable outcomes among bulk-fill subtypes regardless of viscosity or curing mode. Most evidence was rated as low risk of bias with acceptable indirectness. CINeMA indicated predominantly low concerns for indirectness and risk of bias, supporting the robustness and transitivity of the network. The ormocer-based and overlay bulk-fill composites showed the highest, though not statistically superior, ranking probabilities at 12 and 24 months.

Conclusion: Across 6-, 12-, and 24-month follow-ups, no statistically significant differences were detected between bulk-fill techniques and incremental placement for the primary outcomes (marginal adaptation, fractures, and retention). Treatment rankings (P-scores) showed minimal separation overall; ormocer-based and overlay bulk-fill configurations tended to occupy higher ranks at 12-24 months, but without statistically confirmed superiority.

Clinical significance: This systematic review and network meta-analysis provides robust, evidence-based guidance to support clinical decision-making in the restoration of posterior Class II cavities. The findings indicate that bulk-fill resin composites regardless of viscosity or formulation demonstrate clinical performance comparable to conventional incremental layering techniques, while markedly simplifying placement procedures and enhancing operative efficiency.

Trial registration: This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251170292).

Objective: To present a structured, stepwise approach for the esthetic management of demarcated anterior opacities associated with molar-incisor hypomineralization (MIH), emphasizing the role of bleaching within a minimally invasive treatment workflow.

Clinical considerations: Discoloration of anterior teeth, particularly MIH-related opacities, can significantly affect Psychosocial well-being and overall health. Recommended interventions range from non-invasive and microinvasive techniques, such as bleaching and resin infiltration, to more invasive options like composite restorations. Due to the variability in opacities, a combination of treatment modalities is often necessary. From a clinical workflow perspective, MIH-affected anterior teeth can be categorized into basic, advanced, and complex cases, depending on their appearance and anticipated treatment needs. This clinical report demonstrates the proposed stepwise approach in five cases: two basic, two advanced, and one complex, illustrating how complexity guides treatment selection.

Conclusion: A minimally invasive approach should be prioritized for managing MIH-related anterior discolorations. Bleaching serves as an important first-line option before considering more invasive alternatives, thereby preserving hard tooth structure-an especially critical consideration in pediatric patients.

Clinical significance: Implementing a systematic, minimally invasive treatment protocol for MIH-affected anterior teeth can enhance esthetic outcomes while maintaining tooth integrity, thereby improving patient confidence, identity and quality of life.

Objective: This clinical trial aimed to evaluate the influence of a purple repositioning silicone guide on color assessment before and after at-home tooth bleaching.

Materials and methods: Forty-five individuals received 10% carbamide peroxide at-home tooth bleaching using custom trays on both arches, 3 h per day for 2 weeks. Upper canines were evaluated with a spectrophotometer in two different ways: with and without (control) a purple silicone guide. Tooth color was assessed using the CIELab (ΔE*_ab), CIEDE2000 (ΔE₀₀), and the whitening index for dentistry (ΔWI_D) at baseline, 2 and 4 weeks after the beginning of treatment. Data were analyzed using paired t tests for dependent samples (p < 0.05).

Results: At all evaluation periods, the use of the purple silicone guide resulted in lower b* values and higher WI_D values (p < 0.001) compared with the control group. At 2 and 4 weeks, the repositioning guide resulted in lighter teeth (higher values of ΔE*_ab, ΔE₀₀, and ΔWI_D) than the group that did not use the guide (p < 0.04).

Conclusions: The use of a purple repositioning guide with a spectrophotometer influenced the color measurement of upper canines before and after at-home tooth bleaching.

Purpose: To assess the influence of the color and diameter of retraction cords or Teflon tape and intraoral scanner (IOS) technology/system on the accuracy of crown preparations digitized using three IOSs.

Materials and methods: A typodont with a crown preparation with an equigingival finish line was digitized using a laboratory scanner (control). Three groups were created: i700, TRIOS 5, and Aoralscan3. Six subgroups were developed depending on the retraction method: no cord (NC subgroup), purple 00 cord (Knittrax 00; Pascal Dental) (00-K subgroup), yellow-black 00 cord (Ultrapack 00; Ultradent) (00-U subgroup), yellow 02 cord (Knittrax 02) (02-K subgroup), green 02 cord (Ultrapack 02) (02-U subgroup), and Teflon tape (T subgroup) (n = 10). The control scan was used as a reference to measure the root mean square (RMS) error discrepancies with each experimental scan on the preparation and margin areas. Two-way ANOVA and pairwise multiple comparisons tests were used to analyze trueness. Levene and pairwise comparisons tests were used to analyze precision (α = 0.05).

Results: In the preparation area, trueness differences were found among groups (p < 0.001) and subgroups (p < 0.001), with a significant group×subgroup interaction (p < 0.001). The i700 and Aoralscan3 and the 00-U, 02-U, and T subgroups had the best trueness. In the margin area, trueness discrepancies were found among groups (p < 0.001) and subgroups (p < 0.001). The Aoralscan3 and 02-U and T subgroups demonstrated the best trueness. Finally, precision discrepancies were found only in the preparation area among groups (p < 0.001) and subgroups (p < 0.001). The i700 and Aoralscan 3 groups and 02-U and T subgroups had the best precision.

Conclusions: The IOS and retraction technique tested influenced the trueness and precision of the single tooth preparation cast.

Clinical significance: The color and diameter of the retraction cord or Teflon tape used as the first cord in the double cord technique for digitizing a crown preparation with equigingival finish line did impact the scanning accuracy of the IOSs tested. However, the scanning discrepancies measured are not clinically relevant.

Objective: This umbrella review synthesized high-level evidence on the clinical longevity and failure patterns of direct restorative materials, including conventional composites, bulk-fill resins, ormocer-based composites, and glass ionomer cements (GIC/RMGIC) used in posterior restorations and non-carious cervical lesions (NCCLs).

Materials and methods: Sixteen systematic reviews and meta-analyses published between 2012 and 2025 were included, representing over 15,000 restorations with follow-up periods ranging from 6 to 120 months. Methodological quality was assessed using AMSTAR 2, and evidence certainty was graded with the GRADE framework. Outcomes included survival rates, failure types, and comparative risk estimates (RR, OR).

Results: Conventional composites demonstrated > 90% 5-year survival, especially with multi-step adhesives. Bulk-fill resins showed similar short-medium-term outcomes (failure rates < 7%), but long-term data remain limited. Ormocer-based composites had significantly higher failure rates (12.1%), primarily due to marginal degradation. GICs exhibited lower survival but remain useful in high caries risk or moisture challenged conditions. The sandwich technique with RMGIC bases improved retention in NCCLs. Adhesive protocol emerged as a key prognostic factor across all materials.

Conclusions: Clinical longevity is influenced by material class, bonding strategy, and patient risk profile. Conventional and bulk-fill composites remain the most reliable options. RMGICs and sandwich approaches are effective in specific indications.

Clinical significance: This umbrella review provides clinicians with consolidated, high-level evidence to optimize restorative decisions. The integration of AMSTAR 2 and GRADE strengthens the clinical applicability of findings.