Journal of Esthetic and Restorative Dentistry最新文献

Objective: This study investigated the influence of restoration type (partial-coverage versus crown) and ceramic-layer thickness on the fatigue behavior and failure load of monolithic composition-gradient multilayer zirconia (4Y-PSZ/5Y-PSZ) molar restorations.

Material and methods: Seventy-two CAD/CAM-fabricated monolithic zirconia restorations (IPS e.max ZirCAD-Prime-Esthetic, Ivoclar-Vivadent) were assigned to six groups (n = 12), based on restoration type-partial-coverage restoration (PCR) or crown (C)-and ceramic thickness (occlusal/buccal: 0.5/0.4, 1.0/0.6, or 1.5/0.8 mm). All restorations were adhesively bonded to standardized dentin-analogue dies. Specimens underwent thermomechanical fatigue (1.2 million cycles, 49 N, 1.6 Hz, 5°C-55°C), followed by single load to failure testing. Data were analyzed using ANOVA, Tukey's post hoc test, and independent t-tests (α = 0.05).

Results: All specimens survived fatigue. Evident cracks were observed post-fatigue; one each in PCR-0.5 and C-0.5 groups, resulting in an overall success rate of 97.22%. Mean failure loads (N) were: PCR-0.5: 2047, PCR-1.0: 2018, PCR-1.5: 2777, C-0.5: 695, C-1.0: 1957, C-1.5: 3503. Ultrathin (0.5 mm) PCRs demonstrated significantly higher failure loads than ultrathin crowns (p < 0.001), whereas crowns at 1.5 mm thickness outperformed PCRs (p = 0.005). No significant difference was observed at 1.0 mm thickness (p = 0.634).

Conclusion: At ultrathin thicknesses (0.5 mm), partial-coverage designs showed superior failure loads over crowns. Both restoration types are mechanically viable at 1.0 mm and 1.5 mm thicknesses.

Clinical significance: Composition-gradient multilayer-zirconia demonstrates high fatigue resistance and is well-suited for minimally invasive, non-retentive PCR molar restorations. However, a minimum thickness of 1.0 mm should be maintained for single crowns.

Objective: To assess whether root surface coverage after periodontal plastic surgery is associated with significant dentin hypersensitivity suppression.

Materials and methods: Included patients presented a significant dentin hypersensitivity (Schiff score ≥ 2) and gingival recession. Treatment consisted of periodontal plastic surgery for root coverage. At 6 months, significant dentin hypersensitivity prevalence was assessed. Surgical outcomes were evaluated by measuring the percentage of root surface coverage and the height of root coverage, both in pixels and millimeters, in two groups: teeth without significant dentin hypersensitivity and those with persistent significant dentin hypersensitivity.

Results: Significant dentin hypersensitivity prevalence was 6.8% (95% CI [1.0%-12.5%]), with suppression in 93.2% of treated teeth 6 months postoperatively. Complete root surface coverage (CRSCpix) was achieved in 69.6% without dentin hypersensitivity, significantly higher than 0.0% in teeth with dentin hypersensitivity (p = 0.0041). Complete root height coverage in pix (CRHCpix) was 63.8% without dentin hypersensitivity versus (vs) 20.0% with DH (p = 0.0737), while complete root height coverage in mm (CRHCmm) was 76.8% without DH vs. 40.0% with dentin hypersensitivity (p = 0.1033). Mean root surface coverage in pixels (RSCpix) was 88.3% ± 19.7% without DH, significantly higher than 62.6% ± 28.2% with dentin hypersensitivity (p = 0.0031). Mean root height coverage in pixels (RHCpix) was 83.2% ± 28.3% without DH versus 68.8% ± 35.1% with dentin hypersensitivity (p = 0.0573), while mean root height coverage in millimeters (RHCmm) was 88.2% ± 24.7% without dentin hypersensitivity versus 73.3% ± 30.8% with dentin hypersensitivity (p = 0.0503). No significant differences were found for height-based root coverage in pixels (RHCpix) and millimeters (RHCmm).

Conclusion: Success of surgical root coverage, particularly the amount of root surface covered, could be a key factor in dentin hypersensitivity suppression.

Objective: This case report presents the retreatment of a patient who experienced iatrogenic complications resulting from inadequate orthodontic diagnosis and treatment. The objective was to mitigate further risks and correct the underlying clinical issues.

Clinical considerations: A 23-year-old female patient presented with iatrogenic uprighting, apical root resorption, and gingival recession of the maxillary incisors following inappropriate orthodontic treatment. She also exhibited a transverse maxillary deficiency, which contributed to an unstable posterior occlusion and an anterior open bite. Orthodontic retreatment involved microimplant-assisted rapid palatal expansion (MARPE) to address the transverse discrepancy, resulting in improved posterior occlusion and successful closure of the anterior open bite.

Conclusion: Consequently, root angulation of the maxillary canines was corrected using a box loop wire, while torque control of the maxillary incisor roots was carefully managed to ensure their alignment within the alveolar bone housing.

Clinical significance: In young adults, a transverse maxillary deficiency can be effectively managed using MARPE, which also contributes to improvements in vertical skeletal relationships. When iatrogenic root resorption and gingival recession result from improper root positioning, repositioning the affected roots may help prevent further resorption and enhance periodontal stability. Such orthodontic complications are frequently associated with excessive space closure following tooth extraction, inappropriate biomechanical strategies, prolonged treatment duration, and extensive tooth movement.

Objective: To describe a tooth-supported, 3D-printed surgical guide designed to enable accurate intraoperative placement of titanium mesh for bone augmentation in the esthetic zone, in accordance with the preoperative design.

Clinical consideration: Titanium mesh supported guided bone regeneration (GBR) is a widely accepted technique for bone augmentation due to its strong spatial support and predictable osteogenesis. However, intraoperative deviations in titanium mesh placement may affect the final outcome of bone augmentation. This case series presents a tooth-supported titanium mesh positioning guide, fabricated through personalized 3D printing, which allows in situ fixation of the mesh during the augmentation procedure.

Conclusion: The guide enabled precise intraoperative positioning of the titanium mesh in accordance with the preoperative design. The maximum intraoperative titanium mesh displacement was 1.59 mm, with an average deviation of 0.42 mm. The average overall bone augmentation volume deviation was 0.057 ± 0.031 cm³(SD), 95% CI: (0.025 cm³, 0.089cm³), corresponding to a bone augmentation accuracy of 91.67%.

Clinical significance: This tooth-supported positioning guide accurately transfers the preoperative design to titanium mesh-supported guided bone regeneration surgery, thereby improving the accuracy of titanium mesh placement. It facilitates a standardized and controlled workflow for bone augmentation, enhancing the predictability of outcomes in the esthetic zone.

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 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.

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.