Clinical oral investigationsBeyza Arslandaş Dinçtürk, Ceren Başerdem, Cemile Kedici Alp, Pekka K Vallittu, Mine Betül Üçtaşli, Sufyan Garoushi, Lippo Lassila
OBJECTIVES: Minimally invasive occlusal veneers fabricated from ceramic and resin-based materials have gained increasing popularity in recent years. The aim of this study was to evaluate the effect of different CAD/CAM materials and restoration thicknesses on the immediate load-bearing capacity of occlusal veneers. MATERIALS AND METHODS: A total of 100 human mandibular molars were prepared for occlusal veneers with a 1-mm circumferential rounded chamfer finish line. A preparation height of 1.5 mm extending from the preparation margin to the occlusal plane was created. The teeth were divided into 10 groups (n = 10), and occlusal veneers were fabricated in two different thicknesses (0.6 and 1.5 mm) using four CAD/CAM block materials: lithium disilicate glass ceramic (IPS e.max), nanoceramic composite (Lava Ultimate and Cerasmart 270), hybrid ceramic (Enamic), and an experimental short fiber-reinforced composite (SFRC CAD). The tested thickness of 0.6 mm is below the minimum thickness recommended by all manufacturers. Restorations were designed using Cerec software. After adhesive cementation, all specimens were stored in water at 37 °C for 2 days, followed by quasi-static loading testing. Data were analyzed using 2-way ANOVA (´restorative material´ and ´restoration thickness`) and Tukey's post hoc test (α <0.05). RESULTS: The two-way ANOVA demonstrated significant main effects of both restorative material and restoration thickness on fracture load (p < 0.001), whereas the material-thickness interaction was not significant (p = 0.200). SFRC CAD exhibited the highest fracture load (SFRC 0.6 mm = 2560.2 ± 424.5N and SFRC 1.5 mm = 2799.0 ± 655.9N) while IPS e.max (IPS e.max 0.6 mm = 1224.2 ± 363.4N and IPS e.max 1.5 mm = 1799.9 ± 436.8N) showed the lowest. Increasing restoration thickness from 0.6 mm to 1.5 mm significantly resulted in higher fracture load regardless of the restorative material. CONCLUSION: Both restorative material and restoration thickness play important roles in the mechanical performance of occlusal veneers. Among the evaluated CAD/CAM materials, the experimental short fiber-reinforced composite demonstrated the highest load-bearing capacity, whereas ceramic and resin-based CAD/CAM materials showed lower values. However, the higher incidence of catastrophic failures involving both restoration and tooth structure in the SFRC CAD groups indicates that fracture load alone should not be considered the only factor for material selection. These findings suggest that ultrathin occlusal veneers may have potential for minimally invasive restorative applications; however, their long-term clinical performance and failure behavior should be further investigated before clinical recommendations can be established. CLINICAL RELEVANCE: Occlusal veneers with a thickness of 0.6 mm, minimum thickness recommended by manufacturers, exhibited promising immediate load-bearing capacity, supporting their potential use in minimally invasive restorative. Furthermore, the experimental short fiber-reinforced composite CAD/CAM material demonstrated superior load-bearing capacity compared with the other CAD/CAM materials evaluated in this study.
Clinical oral investigationsElmira Boloori, Dagmar E Slot, Bruno G Loos, Teun J de Vries, Fridus G A van der Weijden
OBJECTIVE: This systematic review summarized and synthesized the in vitro biological effects of resin composites (RCs) on human gingival fibroblasts (HGFs) to clarify their isolated cellular biocompatibility. MATERIALS AND METHODS: A systematic search was conducted in the MEDLINE/PubMed database using a PECOS framework to identify in vitro studies evaluating HGF responses to RCs. Two independent reviewers screened literature, extracted data, and assessed methodological quality (QUIN tool) and certainty of the evidence (GRADE framework). RESULTS: Thirty-eight studies comprising 185 distinct experiments across eight outcome measures were included. Marked heterogeneity was observed regarding RC composition (7 categories), specimen geometry, cell lines, and experimental durations. When evaluating cellular survival and damage independently, 27% of cytotoxicity experiments reported significant cell damage/death, while 45% of cell viability assays demonstrated a decreased metabolic activity. DNA damage was prominent, with 50% of 18 experiments reporting significant alterations. Significant increases occurred in reactive oxygen species production (71%) and inflammatory mediator release (62%). Conversely, 85% of morphology experiments showed no significant alterations. The overall certainty of evidence was graded as low to moderate. CONCLUSION: Dental resin composites can induce notable, independent adverse biological responses in human gingival fibroblasts in vitro, characterized by oxidative stress, inflammatory mediator release, DNA damage, and compromised viability. While highlighting a clear potential for toxicity, the low-to-moderate certainty and lack of physiological simulations leave their direct clinical significance open to further investigation. CLINICAL RELEVANCE: Synthesized evidence indicates that dental RCs exert moderate in vitro biological effects on gingival fibroblasts, including DNA-damage and inflammatory responses.
Clinical oral investigationsElias Daniel Covas Rodrigues, Victor Miguel Polizeli, Júlia Tavares de Sousa, Larissa Fernanda Pereira, Regina Guenka Palma-Dibb, Larissa Moreira Spinola de Ca…
OBJECTIVES: This study evaluated the effects of aspartic acid modification on the physicochemical properties and phosphate-associated surface response of a hydraulic calcium silicate cement. MATERIALS AND METHODS: White mineral trioxide aggregate (MTA) was mixed using 0%, 25%, 50%, 75%, or 100% (v/v) of a 4 g/L aspartic acid stock solution. Final setting time, solubility, pH, and Ca²⁺ concentration in the immersion solution were evaluated after seven days in deionized water (n = 10). Surface roughness, morphology, elemental composition, and phosphate- and carbonate-associated spectral features were assessed after 30 days of storage in deionized water or phosphate-buffered saline (PBS). The Ap/C spectral ratio was calculated from the integrated ATR-FTIR band areas. Data were analyzed using one- or two-way ANOVA followed by Tukey's test (α = 0.05). RESULTS: The 25% formulation showed the shortest setting time, whereas the 100% formulation showed the longest (p < 0.001). All aspartic acid-containing formulations exhibited greater solubility and lower Ca²⁺ concentrations than the control (p < 0.05), and the 50%, 75%, and 100% formulations exceeded the recommended solubility limit. The 25% formulation had the lowest pH, whereas the control, 75%, and 100% formulations maintained similar alkaline values. Surface roughness was lowest for the 25% formulation and highest for the 100% formulation, with no significant effect of storage medium. EDS detected negligible surface phosphorus after storage in deionized water but marked phosphorus content after PBS storage. Ap/C analysis showed significant main effects of cement formulation and storage medium, without a significant interaction. The 25%, 50%, and 75% formulations exhibited higher marginal Ap/C ratios than the 0% and 100% formulations. CONCLUSIONS: Aspartic acid produced non-linear and formulation-dependent changes in the evaluated properties. Higher Ap/C ratios reflected differences in relative spectral composition but did not confirm increased apatite formation or a crystalline apatite phase. Ca-P-rich surface deposition depended on phosphate supplied by the storage medium, and no formulation improved all evaluated outcomes.
BMC oral healthMaged Mohamed, Hager Fawzy, Shahd Mahmoud, Mohamed Hani, Mohamed Abd El-Aal, Mohammad Asharf, Enas Elwakeel, Amr Azab, Dina Abozaid
AIMS: This systematic review critically evaluates the antimicrobial performance, mechanical properties, and fluoride release of glass ionomer cements (GICs) modified exclusively with green-synthesized nanoparticles. The review highlights how eco-friendly nanoparticle production influences material behavior and clinical applicability. METHODS: A comprehensive literature search was conducted across multiple electronic databases to identify in vitro, in vivo, and clinical studies reporting on GICs incorporated with green synthesized nanoparticles. Inclusion criteria were based on nanoparticle synthesis method, outcomes, and material characterization. Data extraction, quality assessment, and synthesis followed PRISMA guidelines. RESULTS: Twenty-five studies met the inclusion criteria. Green-synthesized nanoparticles derived from plant and biological extracts consistently enhanced antibacterial activity through reactive oxygen species (ROS) generation, membrane disruption, ion release, and biofilm inhibition. Improvements in compressive strength, microhardness, and fluoride release were observed for several nanoparticle formulations, particularly chitosan-titania-zirconia-hydroxyapatite and plant-mediated hydroxyapatite. However, variability in synthesis routes, nanoparticle concentrations, and characterization protocols limited direct comparison across studies. CONCLUSIONS: Green-synthesized nanoparticles significantly improve the antimicrobial and mechanical properties of GICs while offering enhanced biocompatibility and sustainability compared to chemically synthesized nanomaterials. Standardized synthesis, precise nanoparticle characterization, and clinical validation are essential to advance the integration of green nanotechnology in restorative dentistry.
BMC oral healthMohamed Gamal Hassanin Atia, Mohamed Said Hamed, Asmaa Yousri Abdallah, Ahmed Abdelmohsen Younis
BACKGROUND: Immediate loading significantly improves oral health related quality of life (OHRQoL) as well as satisfaction of patients. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in partially edentulous maxilla. The aim of this study is to evaluate and compare the clinical stability and radiographic difference of osteointegration between immediate and delayed loaded dental implants in the anterior and premolar regions of the maxilla. METHODS: Sixteen patients aged from 20 to 55 were divided into two equal groups. Group 1 consisted of 8 implants that were placed and loaded 6 months after placement, while group 2 consisted of 8 implants that were placed and immediately loaded with a provisional PMMA restoration; after 6 months, the provisional restoration was replaced by a fixed restoration. Each implant was clinically evaluated for implant stability using the Osstell device and radiographically evaluated for bone density around the implant using postoperative indirect standardized digital radiographs taken immediately after implant placement and after 3 and 6 months. RESULTS: Both groups had a significant decrease in pain and swelling after surgery over time, but the immediate loading group had consistently lower values on day 1 (p = 0.001), day 3 (p = 0.023), and day 7 (p < 0.001). Moreover, the immediate loading group also had a significantly lower edema at all-time points (day 1: p = 0.005; day 3 and day 7: p < 0.001). Implant stability (ISQ) increased over time in both groups, while no statistically significant between-group difference was observed at baseline or at 6 months. Peri-implant bone density showed no significant differences between groups at any time point. CONCLUSIONS: Immediate implant loading was found to be a better alternative than delayed loading, as it provides comparable bone density and implant stability while significantly reducing postoperative pain and edema, consequently enhancing quality of life, aesthetic results, and early patient comfort without compromising radiographic performance. TRIAL REGISTRATION: NCT07381283 (registration date: February 2, 2026).
The journal of adhesive dentistryOliver Bailey, Frank Pfefferkorn, Thomas Attin, Roland Frankenberger, Bas Loomans, Anne-Katrin Lührs, Nicola Scotti, Diana Wolff, Reinhard Hickel, Niek Opdam
PURPOSE: There is confusion over the indications, techniques, and material choices for placing direct class II composite restorations among general dentists. This paper synthesizes new data on the general frequency of use of materials and techniques by experts, with a previous related paper that explored if and how experts restored specific class II cavities with varying complexities. It aimed to see if consensus on technique and material use when restoring class II cavities with composite could be pursued. These findings are used to inform an overview of various techniques and provide guidance on the management of more complex class II cavities. METHODS: An international expert group (n = 9) developed an e-questionnaire. The first part of the questionnaire, reported here, covered the general frequency of material and technique use during cavity preparation, control of the operating field, soft tissue management, matrix selection, stabilization and peripheral seal, tooth separation, composite materials, application techniques, light curing, finishing, and polishing. It was distributed to 67 international clinicians with expertise in placing direct composite restorations (September 2024). RESULTS: Response rate was 82%, with 95% of responders completing the first part of the survey. There was a wide variation in frequency of use of a broad variety of materials and techniques. CONCLUSIONS: International experts used a wide variety of materials and techniques for restoration of class II cavities with direct composite. Consensus was therefore not pursued. There are many potential techniques which can offer pragmatic solutions to directly restore complex class II cavities that are not beyond general practitioners.
Clinical oral investigationsAndrea Spinelli, Valentina Pergola, Carlo Prati, Maria Giovanna Gandolfi, Fausto Zamparini
OBJECTIVES: To radiographically evaluate short-term changes in NeoSealer Flo extruded beyond enlarged apical preparations under different moisture and apical-support conditions. MATERIALS AND METHODS: Thirty-two extracted single-rooted human teeth were randomly allocated to four experimental conditions (n = 8 per group). Teeth were prepared with reciprocating NiTi instruments to size 50/0.05 and filled with a matched gutta-percha cone and a premixed bioceramic sealer. The conditions combined the presence or absence of sponge support around the apex with dry or phosphate-buffered saline PBS-moistened canals. Standardized radiographs were acquired immediately after filling (T0), at 7 days (T1), and at 28 days (T2). Intracanal radiopaque area (Area of the canal, AOC) and apically extruded radiopaque area (Area of Extrusion, AE) were traced within a calibrated 6 × 10-mm region of interest. Separate random-intercept linear mixed models included group, time, and their interaction; pairwise comparisons used Sidak adjustment. RESULTS: Mean AOC changed by no more than 0.56 mm² within groups. The group-by-time interaction was not significant for AOC (Wald χ²(6) = 5.31, p = 0.505) but was significant for AE (Wald χ²(6) = 21.72, p = 0.001). From T0 to T2, mean AE changed by + 3.38 mm² (Group 1; dry/sponge), + 0.25 mm² (Group 2; moist/sponge), + 1.50 mm² (Group 3; dry/no sponge), and + 0.41 mm² (Group 4; moist/no sponge). CONCLUSIONS: Intracanal radiopaque area remained relatively stable over 28 days, whereas the extruded radiopaque area differed among experimental conditions. The largest mean increase occurred in the dry, sponge-supported group. CLINICAL RELEVANCE: Local moisture and periapical status may influence the radiopaque area of extruded NeoSealer Flo. However, the radiographic changes do not directly demonstrate material expansion, dissolution, resorption, or biological integration. Apical extrusion should be minimized in clinical practice.
Clinical and experimental dental researchAna Catarina Rios Castro Alves, Adonias Antonio da Silva, Roberta Bruno da Silva, Rayan de Lima França, Dayse Andrade Romão, de Fragoso, Natanael Barbosa Dos S…
INTRODUCTION: Polyphenols have been investigated in dental materials and restorative techniques due to their interactions with metal cations, antioxidant activity, and collagen crosslinking ability, which make them a promise for reinforcing the dental substrate and improving material adhesion. However, more studies are necessary before to support their use in clinical procedures. OBJECTIVES: This study evaluated the effects of quercetin and resveratrol on bond strength and the protection of dentin collagen fibrils against enzymatic degradation. MATERIALS AND METHODS: Demineralized human dentin specimens were immersed for 1 min in solutions of quercetin or resveratrol (100, 250, and 500 µg/mL), 2% chlorhexidine (CHX), or 0.9% saline (control). The specimens were then incubated in collagenase for 24 h at 37°C, and changes in dry mass were measured. For microtensile bond strength testing, quercetin, resveratrol, CHX, or distilled water (DW) were applied to phosphoric acid-conditioned dentin, followed by application of Single Bond 2 (3 M/ESPE) adhesive and Z350XT resin (3 M/ESPE). Adhesive strength was measured after 24 h and after 1 year in distilled water. Data were analyzed using the Kruskal-Wallis and Dunn tests or ANOVA followed by Tukey's test (p < 0.05). RESULTS: Quercetin-treated specimens showed a significant weight increase compared with CHX (p < 0.05). Both quercetin- and resveratrol-treated groups exhibited resistance to collagenase similar to CHX (p > 0.05). After 1 year, only the DW group showed a significant decrease in bond strength (p = 0.001). CONCLUSIONS: Dentin treatment with quercetin or resveratrol effectively preserved adhesive strength and protected collagen against enzymatic degradation, suggesting their potential as agents to improve the longevity of adhesive restorations.
Clinical and experimental dental researchJoão Daniel Paganella Chaves, Elisa Souza Camargo, Rodrigo Nunes Rached, Evelise Machado de Souza
OBJECTIVE: The effectiveness of enamel acid etching may be enhanced when combined with additional surface treatments, such as diamond bur grinding. However, there are no reports of the effect of enamel grinding and bonding strategies when a universal adhesive and highly filled flowable composites are used. The aim was to evaluate the effect of enamel grinding and adhesive strategy on the microshear bond strength (micro-SBS) of injectable composite resins. MATERIALS AND METHODS: One hundred sixty enamel specimens were randomly allocated into 16 groups according to enamel preparation (diamond bur grinding or no grinding), adhesive strategy (self-etch or etch-and-rinse), and composite type (three injectable composites and one conventional composite). After 48 h of water storage, the specimens were tested for micro-SBS in a universal testing machine (0.5 mm/min). Data were analyzed using three-way ANOVA and Tukey's test for micro-SBS data, and Fisher's exact test and Chi-square test for failure mode (α = 0.05). RESULTS: A significant main effect was observed for bonding strategy (p < 0.001), but not for enamel preparation (p = 0.042) and composite resin (p = 0.044). The etch-and-rinse strategy resulted in significantly higher bond strength than the self-etch approach, irrespective of the enamel preparation, for all the resin composites (p < 0.05). Adhesive strategy was the most frequent mode of failure (35%), with self-etching yielding a 70% rate of adhesive failures compared to 0% for the etch-and-rinse approach. CONCLUSIONS: The etch-and-rinse strategy improved enamel bond strength and eliminated adhesive failures for all composites tested, regardless of enamel grinding. CLINICAL SIGNIFICANCE: Enamel should be etched before applying a universal adhesive for injectable composite restorations, as this increased bond strength and eliminated adhesive failures regardless of enamel grinding or composite type. Diamond bur grinding only reduced adhesive failures when the self-etch mode was used.
Clinical and experimental dental researchMaría Baus-Domínguez, Paula Hermida-Cabrera, Javier Pascual, Fernando Vivancos-Cuadras, María-Ángeles Serrera-Figallo, José-Luis Gutiérrez-Pérez, Daniel Torres…
OBJECTIVES: Peri-implantitis is a reality that clinicians face in their daily practice. Current evidence discusses the applicability of bacteriostatic or bactericidal methods in order to minimize the colonization of bacteria, which entails controversy. In this scenario there arises a need to develop surfaces that minimize bacteria's appetite for them. METHODS: An in vitro microbiological study was conducted to assess the effect of a chlorhexidine-based bioadhesive gel on the growth and adhesion of a simplified peri-implantitis-associated microbial consortium. Grade IV titanium disks with three surface types (machined, sandblasted, and ContacTi) were incubated with the consortium under anaerobic conditions for 10 days, with and without gel treatment. Microbial viability was evaluated by colony-forming unit (CFU) counts, and biofilm structure was analyzed by scanning electron microscopy. Microbial community composition was assessed using 16S rRNA gene amplicon sequencing. RESULTS: After 10 days, gel-treated implants showed complete inhibition of cultivable microorganisms, with CFU values reduced below the detection limit on all surfaces, compared with untreated implants (p < 0.05). In untreated samples, ContacTi surfaces exhibited higher bacterial viability than machined and sandblasted surfaces. Metataxonomic analysis revealed a marked reduction in peri-implant pathogens, particularly Porphyromonas gingivalis, whose relative abundance decreased from approximately 20% in the initial inoculum to ~1% after incubation. CONCLUSIONS: The bioadhesive gel demonstrated a quantitatively significant antimicrobial effect, preventing biofilm formation on all tested implant surfaces after 10 days.
Clinical and experimental dental researchAlina Paganini, Eva Magni, Wadim Leontiev, Thomas Connert, Anne Géraldine Guex, Andreas Filippi
OBJECTIVES: Endodontic treatment is mandatory after severe dental trauma such as avulsion or intrusion. Initial intracanal dressing with calcium hydroxide should be avoided according to international guidelines due to potential periodontal ligament damage by pH elevation. However, whether an intracanal dressing is able to alter the extraradicular site remains unclear. This in vitro study quantified extraradicular pH changes through dentinal diffusion of calcium hydroxide or Ledermix in a sealed-apex model in human teeth. MATERIAL AND METHODS: Thirty-five cryopreserved human premolars were prepared with or without cemental defects and received UltraCal XS, Ledermix, or saliva as an intracanal dressing. In the test groups, apices were sealed with composite resin material; the positive control remained with open apices. Teeth were stored in NaCl solution. External pH of the solution was measured on days 1, 3, 5, 7, and 14. A mixed model was applied to determine the effect of group, apical plug, cemental defect, and time on pH alterations. RESULTS: Calcium hydroxide in teeth without apical sealing caused a sustained external alkalinisation (± pH 12). In teeth with apical sealing, no significant external rise in pH occurred for any dressing over time compared to day 1; only one sealed specimen with calcium hydroxide dressing reached pH 9.1 transiently. The pH in Ledermix and saliva groups remained roughly neutral irrespective of sealing or cemental defects. Mixed-effects modeling identified the apical plug as the only significant factor (p < 0.05); presence of cemental defects or days after treatment had no significant effect on pH. CONCLUSIONS: In a sealed-apex model, intracanal dressings did not raise the external pH significantly by dentinal diffusion. Therefore, the results do not support the advantage of a certain intracanal dressing in endodontic treatment after severe dislocation injuries of teeth without open apices with respect to maintained physiological pH.
Journal of Indian Prosthodontic SocietyAryan Shivaji Deshmukh, Naveen Gopi Chander, Muthukumar Balasubramanium
AIM: Layer thickness and print orientation are important printing considerations that influence the mechanical performance of additively manufactured denture base resins. However, evidence regarding their combined effects remains limited. The study investigated the influence of print orientation and layer thickness on the flexural strength, fracture toughness, surface roughness, and impact strength of an additively manufactured digital light processing (DLP) denture base resin. STUDY SETTING AND DESIGN: In vitro comparative study. MATERIALS AND METHODS: Using a DLP-based three-dimensional printing system, 384 denture base resin specimens were manufactured with three build orientations (0°, 45°, and 90°) and four printing layer heights (25, 50, 75, and 100 µm). Flexural strength and elastic modulus were assessed using a three point bend test, fracture toughness using a pre-notched three point bending test, and Izod impact tester was used to estimate the impact strength. Surface roughness was evaluated with a stylus profilometer, and fractured surfaces were examined using scanning electron microscopy. STATISTICAL ANALYSIS USED: Two-way analysis of variance and Bonferroni adjusted post hoc comparisons. RESULTS: Both layer thickness and print orientation significantly influenced all tested properties ( P < .001). The highest flexural strength (127.71 ± 1.83 MPa), fracture toughness (1.49 ± 0.02 MPa·m 0 · 5 ), and impact strength (10.58 ± 0.15 kJ/m 2 ) were observed at 25 µm and 45° orientation, whereas the lowest values were recorded at 100 µm and 90°. Surface roughness increased with increasing layer thickness, with the smoothest surface at 25 µm and 0° (Ra = 0.33 ± 0.01 µm) and the roughest at 100 µm and 90° (Ra = 0.95 ± 0.02 µm). CONCLUSION: Fabrication at 25 µm layer thickness and 45° print orientation provided the most favorable mechanical performance for the additively manufactured DLP denture base resin.
Journal of Indian Prosthodontic SocietyLalit Kumar, Shefali Singla, Jyoti Yadav, Jyoti Sharma, Surinder K Mehta, Sunint Singh
AIM: Cemented crowns are susceptible to microleakage over time. Incorporation of quaternized polyethyleneimine (QPEI) nanoparticles into glass ionomer cement (GIC) may enhance its antibacterial properties, potentially increasing crown longevity. Insoluble QPEI nanoparticles exhibit strong antibacterial activity against bacteria in vitro, especially in provisional and orthodontic cements. However, their efficacy under oral conditions remains uncertain. Given the limited evidence under oral conditions, the present study evaluated the antibacterial performance of QPEI-modified GIC in vivo . SETTINGS AND DESIGN: This exploratory, prospective split-mouth in vivo study was conducted in 16 participants requiring two full veneer crowns in the same arch. Bacterial evaluation was performed after 1 month. Each subject received both interventions on contralateral teeth, thus minimizing inter-individual variability. MATERIALS AND METHODS: Patients requiring two fixed prosthetic crowns in the same arch were included. QPEI nanoparticles were synthesized and characterized using nuclear magnetic resonance, Fourier transform infrared, and dynamic light scattering techniques. After tooth preparation, one crown was cemented with conventional GIC and the other with 1% QPEI-modified GIC. After 1 month, marginal cement samples were collected, and bacterial growth was quantified by colony-forming unit (CFU/mL) counts on brain heart infusion agar. STATISTICAL ANALYSIS USED: Statistical analysis was performed using SPSS software. Data normality was assessed using the Kolmogorov-Smirnov test, and the Wilcoxon signed-rank test was used for intergroup comparison. RESULTS: Paired analysis revealed a statistically significant reduction in viable bacterial counts in the test group, with the Hodges-Lehmann estimator indicating a median reduction of approximately 7.5 × 10 4 CFU/mL (95% confidence interval: -3.2 × 10 4 to -1.4 × 10 4 CFU/mL). CONCLUSION: Incorporation of 1% QPEI-modified GIC significantly enhanced its antibacterial efficacy in vivo over 1 month, indicating its potential as an antibacterial luting material for fixed prosthodontic restorations.
Clinical implant dentistry and related researchFrancesco Gianfreda, Luca Guarente, Marzia Lommi, Maria Scarpati Cioffari di Castiglione, Alberto Antonio Nativio, Carlo Raffone, Mirko Martelli, Patrizio Boll…
BACKGROUND AND OBJECTIVES: Pterygoid implants represent a graftless option for rehabilitation of patients with posterior maxillary atrophy, engaging the dense cortical bone of the pterygomaxillary complex. Despite clinical growth, a comprehensive synthesis of indications, surgical techniques, and complications is lacking. This review evaluated the prevalence of complications, implant survival rates, and marginal bone loss (MBL) associated with pterygoid implant placement. METHODS: The reporting of this review follows PRISMA 2020 guidelines. Six electronic databases (PubMed, Ovid, Scopus, WoS, CENTRAL, and Dentistry & Oral Sciences Source) were searched from 1 January 2020 to 31 December 2025. Included criteria comprised randomized and non-randomized clinical studies reporting outcomes of pterygoid implants (≥ 13 mm) in adult patients with posterior maxillary atrophy (minimum 10 implants). Risk of bias was assessed using JBI critical appraisal checklists. Proportions were pooled using the Freeman-Tukey double arcsine transformation under a random-effects model. Certainty of evidence was assessed using GRADE. RESULTS: Seventeen studies reporting 846 patients and 1915 pterygoid implants were included. The pooled survival rate was 97.9% (95% CI: 97.1%-98.6%; I2 = 0%; 14 studies) and the overall failure rate was 2.1% (95% CI: 1.4%-3.0%). Early failure rate was 0.9% (95% CI: 0.0%-3.0%; I2 = 59.5%). Late failure and MBL were summarized narratively. Certainty of evidence was low to very low. CONCLUSIONS: Pterygoid implants demonstrate excellent survival (97.9%) and low failure rates (2.1%), primarily early, supporting their reliability as a graftless solution for posterior maxillary atrophy. Complications appear infrequent though heterogeneously reported. Low evidence certainty necessitates prospective studies with standardized outcome reporting.
Pakistan journal of pharmaceutical sciencesChangming Xu, Lei Jiang, Hu Da
BACKGROUND: Periprosthetic osteolysis (PIO) induced by wear particles is a major cause of implant failure, yet the underlying molecular mechanisms remain incompletely understood. Oxidative stress and inflammation are key pathological features, but the role of nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) in this process is unclear. OBJECTIVES: This study aimed to investigate the role and mechanism of NOX4 in wear particle-stimulated inflammation and osteolysis, with a focus on the reactive oxygen species (ROS)/NLRP3 inflammasome signaling pathway. METHODS: In-vivo and in-vitro PIO models were established using mice and Raw264.7 cells stimulated with cobalt-chromium-molybdenum alloy (Co-Cr-Mo) particles. NOX4 expression, inflammatory factor levels (TNF-α, IL-1β, IL-6), ROS production, and NLRP3 inflammasome activation (NLRP3, ASC, Caspase-1) were examined. The effects of NOX4 silencing, along with NLRP3 and ROS inhibition, were assessed. RESULTS: Relative to normal mice and control group, the levels of inflammatory factors and NOX4 expression in PIO mice and cobalt-chromium-molybdenum alloy (Co-Cr-Mo)-stimulated Raw264.7 cells were higher. After NOX4 silencing, the levels of inflammatory factors in Raw264.7 cells were lower under situation of Co-Cr-Mo stimulation. The elevated NLRP3 inflammasome activation and ROS level caused by Co-Cr-Mo stimulation were reversed following NOX4 silencing. Co-Cr-Mo elevated the levels of NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC) and Caspase-1 levels, but this effect was reversed after NOX4 silencing. NLRP3 inflammasome inhibitor or ROS inhibitor could reverse the elevated inflammation in Raw264.7 cells under Co-Cr-Mo stimulation. CONCLUSION: NOX4 promotes wear particle-induced inflammation and osteolysis by activating the ROS-dependent NLRP3 inflammasome, providing new targets for treating periprosthetic osteolysis.
Clinical and experimental dental researchMohammadreza Nakhaei, Hossein Dashti, Arsalan Shahri, Mahsa Rahmani, Ali Kazemian, Saeid Sabzevari, Masih Rezaee
OBJECTIVES: To quantify the occlusal adjustment required for two-unit, implant-supported polymethyl-methacrylate (PMMA) crowns with either digital or conventional impression techniques, using full-arch and half-arch workflows. MATERIAL AND METHODS: An acrylic maxillary-mandibular model carrying two bone-level implant analogs (sites 46-47) was mounted on a semi-adjustable articulator. Twenty impressions were made (n = 5 per group): digital full-arch, digital half-arch, conventional full-arch, and conventional half-arch. PMMA crowns were designed using computer-aided design (CAD) software, milled, and surface-scanned before adjustment. Occlusal contacts were refined on the articulator with 21 µm film while recording adjustment time. Pre- and post-adjustment scans were superimposed and analyzed using three-dimensional surface analysis software to quantify mean material reduction (µm). Data were analyzed with one-way ANOVA and independent-samples t-tests (α = 0.05). RESULTS: Digital workflows required significantly less occlusal reduction (146 ± 35 µm vs. 226 ± 35 µm; p = 0.035) and shorter adjustment times (144 ± 36 s vs. 385 ± 36 s; p < 0.001) than conventional, with no effect of arch span (full vs. half; p > 0.05). Within protocols, the digital half-arch group showed the smallest adjustment (127 ± 37 µm) and fastest finishing (98 ± 33 s), whereas the conventional half-arch group required the longest time (456 ± 21 s). CONCLUSION: Fully digital impressions reduce both the amount of occlusal adjustment and the chairside time needed to seat implant-supported crowns compared with conventional silicone impressions. Reducing the scan to a half-arch does not compromise occlusal precision, making the digital half-arch workflow an efficient alternative for posterior, free-end implant restorations. CLINICAL RELEVANCE: In implant posterior PMMA crowns, the impact of impression/workflow choice on occlusal adjustment is unclear. This in-vitro study measured occlusal reduction and chairside time across digital versus conventional and full- versus half-arch workflows. Digital, especially half-arch, required less adjustment and shorter time. Clinically, a digital half-arch approach may streamline delivery and reduce unnecessary material removal, pending confirmation in patient-based settings.
This acidic ethanol extraction method was adopted to extract total alkaloids from lotus leaves. Single-factor experiments combined with response surface methodology (RSM) were employed to optimite extraction conditions. The optimal extraction parameters were determined as follows: 55 °C, 77% ethanol, 0.66% hydrochloric acid, under which the extraction yield of total alkaloids reached 4.14%. D101 macroporous resin was selected for the purification of crude alkaloid extracts. The resin exhibited an adsorption capacity of 8.60 mg/g and a desorption rate of 43.39%. The optimized purification conditions were as follows: 4 mg/mL sample solution, 50% ethanol eluent, 1.5 BV/h flow rate, 30 mL loading/100 mL elution volume. After purification, total alkaloid purity reached 89.31 ± 1.33%. Adsorption obeyed pseudo-second-order kinetics and Temkin isotherm, being spontaneous and endothermic. This provides improved methods for isolating bioactive alkaloids from lotus leaf.
Journal of Indian Prosthodontic SocietySarah Latreche, Olina Rios, Franck Afota, Charles Savoldelli, Yannick Tillier
AIM: Finite element analysis (FEA) is widely used in implant prosthodontics to assess biomechanical behavior and support treatment planning in complex edentulous cases. This work aimed to evaluate stress distribution patterns associated with three implant configurations (all-on-four, all-on-six, and quad-zygomatic) in the edentulous maxilla using a single patient-specific finite element model under immediate loading conditions. SETTINGS AND DESIGN: Two CBCT scans from a single edentulous patient, acquired before and after full-arch bone grafting, were segmented to generate three digital twin models including the maxilla, implants, abutments, and a full-arch prosthesis. MATERIALS AND METHODS: A unilateral oblique load of 150 N at 45° was applied to the posterior region of the prosthesis using a non-deformable distribution tool to simulate immediate functional loading. Stress distribution and displacement patterns within bone and prosthetic components were evaluated. STATISTICAL ANALYSIS USED: A descriptive biomechanical evaluation based on stress magnitude and distribution patterns was conducted. RESULTS: The simulations demonstrated distinct biomechanical responses among the implant configurations. The all-on-six model showed a more uniform stress distribution with lower peak stress values compared to the other configurations. In this model, the difference between tensile and compressive cortical stress peaks was reduced relative to the all-on-four and quad-zygomatic configurations. In all scenarios, stress values remained within physiological limits reported for bone tissue. CONCLUSION: Within the limitations of a single patient-specific model and the absence of inferential statistical analysis, this single-case biomechanical evaluation suggests that digital twin-based finite element analysis may serve as an exploratory tool for biomechanical assessment and prosthodontic treatment planning in implant-supported rehabilitation of the edentulous maxilla.
Clinical implant dentistry and related researchHee-Sun Choi, Seung-Hyun Park, Seulbin Im, Da-Mi Kim, Eun-Kyoung Pang, Ignacio Sanz-Martin, Jae-Kook Cha
AIM: To characterize longitudinal changes in peri-implant soft tissue phenotype following surgical therapy of peri-implantitis. MATERIALS AND METHODS: Twenty-one patients with superimposable intraoral scan datasets at four timepoints-pre-operative (T0), intra-operative (T1), 3-month (T2), and 12-month (T3) follow-up-were included. Soft tissue parameters including mean mucosal thickness (mMT), supracrestal tissue height (STH), keratinized mucosal area, and volumetric shrinkage were assessed. Clinical parameters, including probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), and gingival index (GI), were recorded at T0, T2, and T3. Treatment success was defined using composite clinical criteria at 12 months. RESULTS: Significant reductions in mMT, STH, and keratinized mucosal area were observed over 12 months in both successful and non-successful treatment groups. mMT decreased from 1.45 mm to 0.36 mm in the successful group and from 2.83 mm to 1.38 mm in the non-successful group. STH converged to approximately 3 mm in both groups at T3. Keratinized mucosal area also decreased over time, with no significant between-group difference (p = 0.721). The most pronounced changes occurred during the first 3 months, with volumetric shrinkage of 30.2 and 31.6 mm3 at T2 in the successful and non-successful groups, respectively (p < 0.001). The magnitude of soft tissue phenotype changes did not differ significantly between groups for most parameters (p = 0.522). STH at T3 showed a negative association with BOP (coefficient = -0.08, p = 0.049), whereas baseline keratinized mucosal area positively predicted residual mMT at T3 (coefficient = 0.024, p < 0.001). CONCLUSIONS: Surgical therapy of peri-implantitis resulted in significant reductions of soft tissue phenotype, and baseline keratinized mucosal area was positively associated with residual mMT at 12 months. No statistically significant association was observed between the magnitude of soft tissue shrinkage and clinical outcomes.
Clinical and experimental dental researchSultan Ainoosah, Redhwan Saleh Al-Gabri, Omar M Alaryani, Ahmad Abdulkareem Alnazzawi, Ahmed E Farghal, Ahmed Yaseen Alqutaibi
BACKGROUND: Robotic computer-assisted implant surgery (r-CAIS) aims to improve implant placement trueness, but existing reviews include heterogeneous designs, and no review has exclusively synthesized RCTs to date. This review aimed to evaluate the positional trueness and clinical outcomes of r-CAIS compared with free-hand implant surgery (FHIS), dynamic computer-assisted implant surgery (d-CAIS), and static computer-assisted implant surgery (s-CAIS), through a systematic review and meta-analysis of RCTs. MATERIALS AND METHODS: This systematic review was conducted according to PRISMA 2020 guidelines. Electronic searches were performed in major biomedical databases from inception to March 2026. Only RCTs were eligible. Risk of bias was assessed using the RoB 2 tool and certainty of evidence was rated using the GRADE framework. Meta-analyses were performed using a random-effects model where feasible. RESULTS: Seven RCTs enrolling 529 implants were included. Moderate-certainty evidence demonstrated significantly improved positional trueness with r-CAIS over FHIS across all deviation parameters, with the largest effect observed for angular deviation (MD = -4.56°; 95% CI -6.25 to -2.86). High certainty evidence showed a significant angular deviation advantage of r-CAIS over d-CAIS (MD = -0.77°; 95% CI: -1.33 to -0.21), while platform and apical deviations did not differ significantly. All comparisons with s-CAIS were non-significant, rated low to very low certainty from a single small trial. Operative time evidence was very low certainty, precluding any directional conclusion. Early implant retention ranged from 93.3% to 100% across all modalities with no meaningful between-group differences. CONCLUSIONS: r-CAIS improves implant positional trueness compared with free-hand surgery, supported by moderate certainty evidence, with a high certainty angular deviation advantage over dynamic navigation. However, improved trueness has not been shown to translate into better clinical or patient-reported outcomes. Wider clinical use should depend on long-term, multicenter RCTs using standardized patient-centered outcomes.
Journal of Indian Prosthodontic SocietyHari Narayan Singla, Reeta Jain, Rupandeep Kaur Samra, Ravudai Singh Jabbal, Sumit Chopra, Sadhvi Gupta
AIM: To evaluate and compare stress distribution patterns in mandibular implant-supported overdenture retained with bar and ball attachment systems at two attachment heights (1 mm and 3 mm) using three-dimensional finite element analysis (FEA). SETTINGS AND DESIGN: An in silico comparative three-dimensional finite element analysis study. MATERIALS AND METHODS: Four three-dimensional finite element models of an edentulous mandible restored with two interforaminal bone-level implants (3.5 × 10 mm) were developed. The models incorporated bar attachments with heights of 1 mm (A1) and 3 mm (A2), and ball attachments with heights of 1 mm (B1) and 3 mm (B2). All materials were assumed to be homogeneous, isotropic, and linearly elastic. Complete osseointegration was simulated using bonded contact conditions. A mesh convergence test was performed, and mesh refinement continued until the change in peak von Mises stress between successive mesh refinements was <5%. A static vertical load of 100 N was applied at the central occlusal fossa of the first molar under unilateral and bilateral loading conditions. Stress distribution was evaluated qualitatively and quantitatively using von Mises stress analysis. STATISTICAL ANALYSIS USED: No statistical analysis was performed. Stress distribution was compared descriptively using qualitative stress distribution patterns and quantitative von Mises stress values generated by the finite element models. RESULTS: Under unilateral loading, stresses were concentrated predominantly on the working side, with the implant neck serving as the principal site of stress concentration. Increasing attachment height increased stress magnitudes in both bar and ball attachment systems under unilateral and bilateral loading conditions. Overall, stress concentrations were greatest at the implant neck, followed by the implant body and apical region. Cortical bone consistently exhibited higher stress values than cancellous bone across all models. CONCLUSION: Within the limitations of this finite element study, attachment height and splinting configuration influenced peri-implant stress distribution. Increased attachment height was associated with greater stress magnitudes in both attachment systems.
OBJECTIVES: The long-term esthetic performance of CAD/CAM ceramic restorations may be influenced by repeated exposure to therapeutic mouthrinses. This study evaluated the effects of chlorhexidine, essential oil-based, and stannous fluoride mouthrinses on the color stability (ΔE) and surface roughness (Ra) of glazed and polished CAD/CAM ceramics. MATERIALS AND METHODS: In this in vitro experimental study, 320 specimens fabricated from four CAD/CAM ceramic materials (Vita Mark II, IPS e.max CAD, CAD, Celtra Duo, and high-translucency zirconia) were randomly assigned to glazed or polished surface treatment groups and immersed daily for 20 min in chlorhexidine, essential oil-based, stannous fluoride mouthrinses, or distilled water (control) for 30 days. Color stability was assessed using spectrophotometry based on the CIE Lab* color system, and surface roughness was measured using laser profilometry. Data were analyzed using one-way ANOVA followed by Tukey's post hoc test (α = 0.05). RESULTS: The effects of therapeutic mouthrinses on color stability and surface roughness varied according to ceramic material and surface finish. The greatest color change was observed in polished IPS e.max CAD immersed in the essential oil-based mouthrinse (ΔE = 3.69), whereas the lowest ΔE was recorded for glazed Celtra Duo immersed in stannous fluoride (ΔE = 1.59). Polished specimens consistently exhibited greater increases in surface roughness than glazed specimens across all ceramic materials. Significant differences in ΔE and/or Ra were identified according to ceramic type, mouthrinse composition, and surface finish (p < 0.05). CONCLUSION: The effects of therapeutic mouthrinses on CAD/CAM ceramics depend on both ceramic composition and surface finish. Essential oil-based mouthrinse produced the greatest color changes in several ceramic materials, whereas glazed surfaces generally demonstrated greater resistance to surface roughness changes than polished surfaces. These findings highlight the importance of considering both material selection and surface finishing when recommending therapeutic mouthrinse use for patients with CAD/CAM ceramic restorations.
BMC oral healthMohammed Ehab Mohammed Ali Saad, Nahla Hamed Mohamed Hamed, Mohammed Nasser Anwar
OBJECTIVE: To evaluate the effect of different intra‑canal restorative techniques on the fracture resistance of endodontically treated anterior teeth and to assess the influence of marginal ridge loss on their mechanical behavior. MATERIALS AND METHODS: Ninety extracted sound maxillary central and lateral incisors were selected and randomly divided into five groups. Ten teeth were left intact to serve as the control group, while the remaining teeth were endodontically treated, obturated, and randomly allocated into four groups according to different intra‑canal restorative techniques; (1) PS: packable short fiber‑reinforced composite, (2) FP: prefabricated glass fiber posts, (3) FS: flowable short fiber‑reinforced composite, (4) DC: dual‑cure composite core material, each group was further subdivided according to marginal ridge integrity into two subgroups (n = 10), intact marginal ridges (I) and removed marginal ridge (R). All specimens were subjected to thermocycling for 10,000 cycles. Fracture resistance testing was carried out using a universal testing machine with a load applied at 135° to the long axis of the tooth until the fracture occurred. Fracture patterns were examined using a stereomicroscope and classified as favorable and unfavorable fractures. The data were statistically analyzed using two-way ANOVA, followed by Tukey's post hoc test and fracture patterns were analyzed using Fisher's exact test, with the significance level set at α = 0.05. RESULTS: Intra-canal restorative technique and marginal ridge integrity significantly affected fracture resistance (p < 0.05), whereas no significant interaction was observed (p = 0.564). Fiber post restorations demonstrated the highest fracture resistance values. No statistically significant differences were observed among fiber posts, packable short fiber-reinforced composite, and flowable short fiber-reinforced composite under either marginal ridge condition (p > 0.05). Loss of one marginal ridge significantly reduced fracture resistance across all restorative techniques. The fracture pattern was significantly associated with the restorative technique (p = 0.014), with flowable short fiber-reinforced composite showing the highest proportion of favorable fractures. CONCLUSIONS: SFRC intra-canal restorations showed fracture resistance values that were not statistically different from those of fiber post restorations. Marginal ridge loss significantly compromised fracture resistance of endodontically treated anterior teeth. CLINICAL SIGNIFICANCE: SFRC may represent a promising post-free restorative option for endodontically treated anterior teeth when sufficient coronal tooth structure remains, particularly in teeth with preserved marginal ridge integrity. However, long-term clinical studies and fatigue-loading investigations are required before definitive clinical recommendations can be made.
BMC research notesLoan-Chi Thi Bui, Son Hoang Le, Hien Thuc Huu Huynh, Bich-Ly Thi Nguyen
OBJECTIVE: To date, limited evidence exists regarding the clinical efficacy of MTA Flow™ Thick as a retrograde filling material in apicoectomy. This study aimed to investigate the clinical and radiographic outcomes over a 6-month follow-up period following apicoectomy with MTA Flow™ Thick as the retrograde filling material. RESULTS: A total of 24 teeth from 16 patients were included in this prospective study. All apicoectomies were performed by a single oral surgeon following a standardised surgical protocol. Clinical and radiographic outcomes were assessed at 3 and 6 months. All clinical symptoms-pain, swelling, and fistulas-showed a statistically significant reduction at both follow-up intervals (p < 0.001 for all). Periapical lesion size decreased at both time points (p < 0.001). Radiographic healing was observed in ≥ 85.5% of cases and demonstrated progressive improvement between the two follow-ups. The overall success rate increased significantly from 83.3% at 3 months to 91.7% at 6 months. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT07254143, date 28 November 2025). This is a retrospectively registered trial.
Clinical oral investigationsGulnaz Aydemir, Jale Gorucu, A Ruya Yazici
OBJECTIVES: To compare the 36-month clinical performance of a no-wait universal adhesive in non-carious cervical lesions (NCCLs) according to etching method and application mode. MATERIALS AND METHODS: Forty-one participants with at least five NCCLs received 215 restorations, which were randomly assigned to five groups according to five surface-conditioning and adhesive application protocols: Enamel and dentin etching with phosphoric acid (ED-A), selective enamel etching with phosphoric acid (SEE-A), self-etch (SE; control group), enamel and dentin etching with laser (ED-L), selective enamel etching with laser (SEE-L). Restorations were placed by a single operator using Clearfil Universal Bond Quick and Clearfil Majesty ES-2 and were evaluated at baseline, 6, 12, 18, 24, and 36 months using modified USPHS criteria. Survival was analyzed using Kaplan-Meier survival analysis with the log-rank test, and categorical outcomes were analyzed using Generalized Estimating Equations (GEE) (p < 0.05). RESULTS: The 36-month recall rate was 97.5% (40 participants; 199 restorations). At 36 months, retention loss was greater in the ED-A group than in the SEE-A and SE groups and in the SEE-L group than in the SEE-A and SE groups (p = 0.036 for all comparisons). Marginal discoloration was greater in the SE group than in the ED-A and SEE-A groups (p = 0.022 and p = 0.004, respectively) and in the SEE-L group than in the SEE-A group (p = 0.014). Marginal adaptation was poorer in the SE group than in the ED-A, SEE-A, and ED-L groups (p = 0.001, p = 0.011, and p = 0.013, respectively). Marginal discoloration increased and marginal adaptation deteriorated significantly over time in all groups (p < 0.05). CONCLUSIONS: Phosphoric acid enamel etching provided the most favorable long-term marginal performance, whereas the SE and selective laser etching protocols showed less favorable marginal behavior.
OBJECTIVES: This study evaluated the effects of surface treatment protocols and thermocycling on the optical, surface, and mechanical properties of additively manufactured resins. MATERIALS AND METHODS: Five materials (saremco print CROWNTEC, VarseoSmile Crownplus, VarseoSmile TriniQ, VarseoSmile TriniQ for Formlabs, and Ceramic Crown) were assigned to six groups: control, silane, sandblasting (SB), SB+silane, hydrofluoric acid (HFA), and HFA+silane. After surface treatments and 5,000 thermocycles, color change (ΔE₀₀), translucency (ΔTP₀₀), gloss, surface roughness (Ra), and microhardness (VHN) were measured. Data were analyzed using robust ANOVA and aligned rank transform (ART) mixed ANOVA with Holm-adjusted multiple comparisons (α = 0.05). RESULTS: Material type, surface treatment, and aging significantly affected all evaluated parameters (p < 0.001). Following surface treatment (T1), SB and SB + S groups exhibited significantly higher surface roughness and microhardness compared with control, silane, HFA, and HFA + S groups (p < 0.001). In terms of ΔE₀₀, SB and SB + S groups exceeded the clinical acceptability threshold (ΔE₀₀ > 1.8), whereas C, S, HFA, and HFA + S groups remained below the perceptibility threshold at T1. After thermocycling (T2), clinically unacceptable color changes were observed in most treatment groups, gloss values decreased significantly, and microhardness increased (p < 0.001). ΔTP₀₀ values were significantly influenced by material type (p < 0.001) but not consistently by surface treatment. Gloss values decreased significantly over time (p < 0.001), with the lowest values observed at T2. Among the materials, Ceramic Crown showed significantly higher microhardness and lower color change compared with the others (p < 0.05). CONCLUSIONS: Surface treatments and thermocycling significantly affect additively manufactured resins; mechanical pretreatments improve hardness but may compromise optical properties. CLINICAL RELEVANCE: Careful selection of surface treatment protocols is required to achieve a balance between mechanical performance and esthetic outcomes in additively manufactured restorations.
OBJECTIVE: To evaluate the fluorescence compatibility of five resin composite materials in cervical restorations using multiple assessment techniques. MATERIALS AND METHODS: Forty extracted A2 shade human molars were selected, and standardized Class V cavities were prepared on the buccal surfaces. The cavities were restored using five resin composite materials (n = 8). Fluorescence images were obtained using three assessment techniques based on fluorescence illumination: Tech-I (QrayPen C, 405 nm), Tech-II (Valo X with DSLR camera, 395-415 nm), and Tech-III (Ashur device with DSLR camera, 405 nm). Fluorescence differences (ΔE) were calculated using the CIEDE2000 formula. Statistical analyses included one-way ANOVA, Tukey post-hoc test, and Pearson correlation (p < 0.05). RESULTS: Significant differences were observed among composite materials in all techniques (p < 0.001). Filtek Z250XT showed the lowest ΔE values (Tech-I: 3.83 ± 1.39, Tech-II: 3.60 ± 1.11, Tech-III: 3.41 ± 0.69), indicating the best fluorescence compatibility. Conversely, Estelite Asteria exhibited the highest ΔE values (Tech-I: 15.53 ± 3.94, Tech-II: 23.79 ± 2.72, Tech-III: 14.15 ± 2.46). Strong positive correlations were found among the techniques (Tech-I vs. Tech-II: r = 0.707; Tech-I vs. Tech-III: r = 0.774; Tech-II vs. Tech-III: r = 0.880; p < 0.001). CONCLUSION: The fluorescence compatibility of resin composite materials varies significantly depending on the material type. The Filtek Z250XT demonstrated the closest fluorescence compatibility to natural tooth structure. The assessment techniques showed strong agreement under standardized conditions. CLINICAL SIGNIFICANCE: Understanding the fluorescence behavior of composite materials may guide clinicians in selecting appropriate materials for improved esthetic outcomes and clinical performance.
Clinical oral investigationsCamilo Pulido, Alessandro Dourado Loguercio, Camila Falconí-Páez, Cesar Augusto Galvão Arrais
OBJECTIVE: To evaluate the influence of operator experience on the bonding performance of four adhesive strategies: three- and two-step etch-and-rinse (ER), and two- and one-step self-etch (SE) systems to dentin. MATERIALS AND METHODS: Ninety-six caries-free molars were divided according to the operator experience (3YG: third-year undergraduate students; 5YG: fifth-year undergraduate students; 1YR: first-year residents in Operative and Restorative Dentistry) and four adhesive systems. The occlusal third of each crown was removed to obtain a flat, mid-coronal dentin surface, which was standardized using 600-grit silicon carbide paper. Adhesives were applied following the manufacturer's recommendations, and a 4-mm-thick composite resin build-up was placed. Specimens were sectioned into resin-dentin beams (cross-sectional area ≈ 0.8mm2) for microtensile bond strength (µTBS) and nanoleakage (NL) evaluation. Data were analyzed using two-way ANOVA and Tukey's post-hoc test (α = 0.05). RESULTS: The less experienced group (3YG) generally showed significantly lower µTBS and higher NL compared to more experienced operators (p < 0.05), with the exception of the 1-step SE strategy, where experience did not influence bond strength. Within the 3YG group, the 1-step SE approach yielded the highest µTBS values, whereas in the 5YG group, 1-step SE and 2-step ER showed the highest values; the 1YR group performed consistently across all adhesive systems. For NL, the 3YG group generally showed higher values than the more experienced groups, although 5YG and 1YR did not differ for the 1-step SE strategy. In the 3YG and 5YG groups, the 3-step ER strategy resulted in the highest NL values, whereas no significant differences among adhesive strategies were observed within the 1YR group. CONCLUSIONS: Two-step etch-and-rinse and one-step self-etch adhesives showed higher µTBS values and demonstrated lower sensitivity to operator experience compared with more technique-dependent multi-step systems. CLINICAL RELEVANCE: Simplified adhesive protocols may provide more predictable bonding outcomes in teaching environments and for clinicians with limited clinical experience.
Clinical oral investigationsÖznur Eraslan, Öznur Küçük Keleş
OBJECTIVES: This study aimed to evaluate the effects of different root canal filling strategies and coronal restoration types on the biomechanical behavior of mandibular premolars with simulated apical external root resorption using three-dimensional finite element analysis (FEA) combined with a two-parameter Weibull-based fracture probability assessment. MATERIALS AND METHODS: MTA plug + gutta-percha + composite core and ceramic crown (MTA/GP/CC), MTA full-canal obturation + composite core and ceramic crown (MTA/CC), MTA plug + gutta-percha + hybrid-ceramic endocrown (MTA/GP/ECR), MTA full-canal obturation + hybrid-ceramic endocrown (MTA/ECR), Biodentine plug + gutta-percha + composite core and ceramic crown (B/GP/CC), Biodentine full-canal obturation + composite core and ceramic crown (B/CC), Biodentine plug + gutta-percha + hybrid-ceramic endocrown (B/GP/ECR), Biodentine full-canal obturation + hybrid-ceramic endocrown (B/ECR), and an intact tooth (IT). A 300 N oblique load was simulated for all models. RESULTS: FEA showed that the highest tensile stress in coronal restorations occurred in the MTA/GP/ECR model, whereas the lowest values were found in the MTA/ECR and B/ECR models. Within root dentin, maximum tensile stress was highest in the B/GP/CC model (0.683 MPa) and lowest in the MTA/ECR configuration (0.534 MPa). At 300 N, Weibull-based system fracture probabilities ranged from 0.0180% to 0.0192% for full-coverage crown (CC) designs and from 0.0157% to 0.0167% for ECR designs. For matched root-filling strategies, ECR configurations showed approximately 13-14% lower relative system fracture probabilities than the corresponding CC configurations. CONCLUSIONS: Complete bioceramic obturation combined with a hybrid-ceramic endocrown (ECR) showed a favorable biomechanical profile and the lowest relative Weibull-based system fracture probabilities among the evaluated configurations. CLINICAL RELEVANCE: Within this idealized FEA-Weibull framework, ECR restorations combined with full-canal bioceramic obturation showed modestly lower relative system fracture probabilities than matched full-coverage crown configurations. The probabilistic response was dominated by root dentin rather than by direct fracture contributions from the restorative materials.
INTRODUCTION: Dental caries remains one of the most prevalent chronic diseases in childhood worldwide. In Brazil, untreated carious lesions continue to affect oral health and quality of life in school-aged children. Minimally invasive approaches for caries management have demonstrated feasibility in community settings and may expand access to preventive and restorative care in socially vulnerable populations. METHODS: This multicentre longitudinal intervention study will recruit 50 000 children aged 6-12 years from public schools in five Brazilian cities (Santos, Ponta Grossa, Brasília, Fortaleza and Belém). All participants will undergo clinical examination using the International Caries Detection and Assessment System (ICDAS) and will receive preventive and educational measures, including oral health counselling, supervised toothbrushing with fluoridated toothpaste (1100 ppm F), toothbrushes, toothpaste and application of Duraphat fluoride varnish to permanent molars and incisors. Among children with active carious lesions, 2500 will enter the longitudinal minimally invasive treatment phase according to lesion severity: fluoride varnish for ICDAS 1-2 lesions; fluoride varnish or atraumatic restorative treatment (ART) sealants for ICDAS 3 lesions; and ART with high-viscosity glass ionomer cement for ICDAS 4-6 lesions. Participants will be re-evaluated every 3 months for up to 24 months. EXPECTED OUTCOMES: The primary outcome will be control of caries activity assessed longitudinally using ICDAS criteria. Secondary outcomes include inactivation of white spot lesions, survival of restorations and sealants and adherence to preventive measures. The study is expected to generate evidence to support public oral health policies and minimally invasive strategies for school-based caries management in Brazil. ETHICS AND DISSEMINATION: This protocol has been approved by the human research ethics committee of Universidade Metropolitana de Santos-UNIMES (protocol number: 7.630.345. Approved on 10 June 2025). Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT06999005 (registered on 14 May 2025).
OBJECTIVES: This study evaluated the load-bearing capacity and reliability of different zirconia materials used for inlay-retained fixed dental prostheses (IRFDPs), considering the influence of substrate type (tooth substrate or resin composite) and thermo-mechanical aging. MATERIALS AND METHODS: IRFDPs (N = 160) were fabricated using four zirconia materials: IPS e.max ZirCAD LT (3Y-TZP), Katana YML (3Y-5Y graded zirconia), Katana HTML Plus, and Katana STML (n = 40 each). Restorations were adhesively cemented onto tooth or resin composite substrates and tested either under dry conditions or after thermo-mechanical aging (1,200,000 cycles, 50 N, 5-55 °C). Fracture load was determined using monotonic load-to-fracture testing. Data were analyzed using two-way ANOVA and Tukey's test (α = 0.05). Reliability of durability was assessed using Weibull analysis. RESULTS: Under dry conditions, material (p = 0.0047), substrate (p = 0.0237), and their interaction (p = 0.0004) significantly influenced fracture load. YML-composite (1406 ± 386 N) and HTML-composite (1142 ± 249 N) showed higher values than STML-composite (553 ± 246 N). No significant differences were observed on tooth. substrate After aging, material and interaction effects remained significant (p < 0.05). HTML-tooth showed the highest fracture load (1727 ± 351 N), while STML-composite showed the lowest (718 ± 292 N). Weibull analysis indicated comparable reliability after aging. CONCLUSIONS: Zirconia type and substrate significantly influenced mechanical performance of IRFDPs. High-translucent and graded zirconia showed substrate-dependent behavior, whereas 3Y zirconia was more stable. CLINICAL RELEVANCE: Zirconia selection and bonding substrate influence fracture resistance of IRFDPs. High-translucent zirconia requires careful substrate selection, while 3Y zirconia provides more consistent performance in posterior applications.
The long-term success of dental implants depends on rapid and stable osseointegration. Numerous surface treatments and biologic adjuncts have been proposed to enhance early bone anchorage, but the strength and consistency of the available preclinical and clinical evidence remain uncertain. To synthesise evidence from preclinical animal models and human clinical studies evaluating the influence of titanium implant surface modifications, biologic adjuncts, and systemic factors on osseointegration-related outcomes. A protocol was established following the PRISMA 2020 guidelines and subsequently registered with PROSPERO (CRD420251153021). A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar from their inception through December 2025. The studies included in this review comprised both in vivo animal research and human clinical trials that examined modified titanium implant surfaces, supplementary biological therapies or systemic modifiers, and provided quantitative outcomes related to osseointegration. The primary outcomes measured were bone-to-implant contact percentage (BIC%), implant stability quotient (ISQ), changes in marginal bone levels, radiographic bone density, and bone volume fraction. The risk of bias was evaluated using the SYRCLE tool, Cochrane RoB 2.0, and the JBI checklist where applicable. Animal and human evidence were synthesized qualitatively, whereas random-effects meta-analysis was performed only for clinically comparable human studies reporting common outcomes. Fourteen studies met the inclusion criteria (eight animal and six human). Roughened, hydrophilic, nanostructured, UV- or plasma-activated surfaces, as well as platelet-derived concentrates and concentrated growth factors, generally demonstrated favourable effects on osseointegration-related outcomes, including higher BIC, bone volume, and earlier implant stability, whereas diabetes and pharmacologic VEGF blockade were associated with impaired osseointegration. Pooled analysis of four human trials showed higher ISQ values for test interventions (SMD 1.37; 95% CI 1.02-1.73; P < 0.00001; I2 = 5%). Two human trials reporting radiographic bone density also favoured the experimental protocols (SMD -1.26; 95% CI -1.74 to -0.78; P < 0.00001; I2 = 4%). However, interpretation of the radiographic bone density analysis is limited because only two studies contributed quantitative data. Human studies generally demonstrated low-to-moderate risk of bias, whereas several animal studies showed unclear randomisation and blinding. The certainty of evidence ranged from low to moderate across the primary outcomes. The available evidence suggests that surface-optimised and biologically augmented titanium implants may improve early osseointegration and implant stability, whereas adverse systemic conditions may compromise these benefits The quality of evidence is not very good because of methodological limitations, clinical heterogeneity, and the limited number of studies available for quantitative synthesis. More robust and mechanistic clinical trials with standardised reporting are needed to improve surface selection and biologic strategies for different patient profiles.
PloS oneXianyu Li, He Liu, Lari Häkkinen, Guoqiao Jiang, Binwen Chen, Markus Haapasalo, Ya Shen
BACKGROUND: Calcium silicate based root canal sealers exhibit diverse physicochemical and biological properties that may influence periapical tissue responses. This study compared three sealers, Grey MTA Plus (MP), BioRoot RCS (BR), and Bio C Sealer (BC), using ProRoot MTA (PM) as a mechanistic reference material. METHODS: Physicochemical properties, including pH, solubility in deionized water (n = 5), and elemental release (Ca, P, Bi, Pb, K, Mg; n = 3), were evaluated. Human periodontal ligament cells were used to assess cytotoxicity by CCK 8 assay, mineralization by Alizarin Red S staining, and gene and protein expression of IL 6 and MMP 1 by qRT PCR, ELISA, and Western blot (n = 3 independent experiments). MAPK pathway activation was analyzed in cells treated with BR. Statistical analysis was performed using one way ANOVA followed by Tukey's post hoc test after verification of assumptions. RESULTS: All materials exhibited alkaline pH values above 11. BC and BR showed higher solubility than PM under the tested conditions, whereas PM and MP released higher levels of calcium and were associated with increased mineralization. BC and BR reduced cell viability at higher concentrations and longer exposure times, particularly under serum free conditions. IL6 mRNA expression was reduced in BC and BR, but IL 6 protein levels were unchanged. In contrast, BR increased MMP 1 protein secretion. BR also induced phosphorylation of p38, JNK, and ERK1 2, and inhibition of these pathways reduced MMP 1 secretion. CONCLUSION: PM and MP showed higher calcium release and were associated with increased mineralization, whereas BC and BR showed higher solubility and concentration dependent cytotoxicity. BR increased MMP-1 secretion and was associated with MAPK activation. These findings are based on in vitro conditions and should be interpreted with caution.
BACKGROUND: The management of acute oral hemorrhage in emergency settings is frequently complicated by saliva, high vascularity, and microbial presence. This scoping review maps the emerging field of multifunctional, dental-inspired biomaterials. The objective is to synthesize evidence on injectable materials providing rapid hemostasis and antimicrobial protection, while acknowledging the current transition from laboratory models to clinical applications. METHODS: Following PRISMA-ScR guidelines and the Population-Concept-Context (PCC) model, we searched Scopus, PubMed, and Web of Science (updated search date: July 10, 2026). No language restrictions were applied. Two authors independently performed screening and data extraction (Cohen's Kappa = 0.88). Review articles provided thematic context, while 13 primary research studies provided data for performance benchmarking. No formal protocol was registered. RESULTS: Analysis of 13 primary studies reveals a shift toward chitosan and gelatin-methacryloyl (GelMA) matrices. Quantitative synthesis showed a 32%-42% reduction in hemostasis time compared with commercial controls [1, 2], primarily in low-pressure models. Antimicrobial zones of inhibition ranged from 10 to 18 mm. Antimicrobial action was primarily validated against planktonic, single-species cultures, with effectiveness against complex oral biofilms yet to be proven. CONCLUSIONS: Current evidence supports the application of these materials for minor-to-moderate hemorrhage. Broad application for major arterial trauma remains a future objective requiring longitudinal safety studies on nanoparticle bioaccumulation and dynamic mechanical validation under arterial pressure.
OBJECTIVES: This study aimed to compare the 60-month clinical performance of glass hybrid (GH) and short fiber-reinforced composite (SFRC)-supported microhybrid composite restorations placed in MIH-affected first permanent molars following selective caries removal (SCR). MATERIALS AND METHODS: Thirty-one children (18 girls, 13 boys; 6-12 years) with MIH and at least two fully erupted first permanent molars exhibiting moderate-to-severe lesions (MIH-TNI scores 2 and 4) were enrolled. Following SCR, 62 molars were restored using a randomized split-mouth design. In each participant, one molar received a GH restoration (Equia Forte® HT), whereas the other selected molar was restored with an SFRC material (EverX Flow™) covered with a microhybrid composite resin (G-Aenial® Posterior). Clinical evaluations were performed at baseline and 6, 12, 24, 36, and 60 months using modified United States Public Health Service (USPHS) criteria. RESULTS: Clinical performance deteriorated significantly over time for both materials (p < 0.001). GEE analysis showed no significant independent effect of material type on any modified USPHS criterion (p > 0.05), while time significantly affected retention, marginal adaptation, postoperative sensitivity, and secondary caries (p < 0.001). Kaplan-Meier analysis demonstrated significantly higher survival rates for SFRC-supported microhybrid composite than for GH restorations at 60-month (75.5% vs. 59.2%; p = 0.002). CONCLUSIONS: Both GH and SFRC-supported microhybrid composite restorations provided clinically acceptable long-term outcomes in MIH-affected molars after SCR. Although clinical performance per modified USPHS criteria was comparable, SFRC-supported microhybrid composite restorations demonstrated superior long-term survival. CLINICAL RELEVANCE: When long-term durability is a primary consideration, SFRC-supported microhybrid composite restorations may be preferred for the restorative management of MIH-affected molars. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT07733804.
The journal of adhesive dentistryInga Vanessa Bordihn, Cita Nottmeier, Henriette Ida Ulrike Stasche, Gina Marie Georgi, Ellen Schulz-Kornas, Tobias Meißner, Rainer Haak, Julian Petersen, Till …
PURPOSE: The aim of this in vitro study was to investigate whether removing fluorescent clear aligner attachments under UV light improves the efficiency of attachment removal and reduces enamel loss and composite residue. METHODS AND MATERIALS: Clear aligner attachments were bonded to bovine teeth using fluorescent-modified composite (AlignerFlow LC, VOCO, Germany); 20 models were prepared. In a split-mouth design, attachments were removed either using a fluorescence-aided identification technique (FIT) under UV light, or with standard white light (non-FIT). Removal time was recorded for each attachment. Intraoral surface and optical coherence tomography (OCT) scans (T0, T1) were analyzed to quantify enamel loss and composite residue using Avizo Software, while OCT scans were assessed using a dichotomous scale for enamel loss and a four-point scale for composite residue. RESULTS: Although there is a trend toward faster attachment removal with FIT, measurements of removal time did not differ significantly between the groups due to high inter-individual variability. Volumetric analysis revealed a significant reduction in composite residue with FIT, while no significant differences in enamel loss were detected between the groups. OCT measurements revealed no significant differences between groups, as composite residue and enamel loss occurred on a microscopic scale in most of the specimens, regardless of the debonding method. CONCLUSION: While neither debonding time nor enamel loss were affected, FIT significantly reduced residual composite after attachment removal, suggesting that FIT may contribute to more standardized clinical outcomes. Future in vivo studies with larger sample sizes, multiple operators, and different adhesive systems are needed to validate these findings.
Clinical oral investigationsRebecca R G Frota, Michael Solomonov, Gustavo De-Deus, Emmanuel J N L Silva, Felipe G Belladonna, Joe Ben-Itzhak, Erick M Souza, Diogo S Oliveira, Marco A Vers…
OBJECTIVES: To compare the push-out bond strength (POBS) of AH Plus and TotalFill BC Sealer in long oval canals prepared with the Self-Adjusting File Infinitum (SAF Infinitum) system. MATERIALS AND METHODS: Thirty mandibular canines with long oval canals, selected by micro-CT analysis and anatomically matched, were assigned to three irrigation-protocol groups (n = 10): 2.5% NaOCl (4 min, 4 mL/min); 2.5% NaOCl/HEDP (4 min, 2 mL/min); and 2.5% NaOCl/HEDP (2 min, 2 mL/min). Each group was subdivided by sealer (AH Plus or TotalFill BC Sealer, n = 5) and filled using the single-cone technique. Roots were sectioned into coronal, middle, and apical slices for POBS testing and failure mode analysis. POBS was analyzed using a Gamma generalized linear mixed-effects model with a log link and tooth as a random intercept, followed by Bonferroni-adjusted pairwise comparisons (α = 0.05). RESULTS: Neither irrigation protocol (P = 0.879) nor sealer (P = 0.769) significantly affected POBS, and no two- or three-way interactions were significant (all P > 0.7). In contrast, POBS differed significantly across root thirds (P < 0.001), with higher values in the apical than in the coronal (P = 0.001) and middle thirds (P < 0.001), and higher in the coronal than in the middle third (P = 0.005). Adhesive failure at the sealer-gutta-percha interface predominated overall (80% AH Plus, 93% TotalFill BC) and was universal in the middle third. CONCLUSIONS: In long oval canals prepared with SAF Infinitum, POBS differed significantly according to root third but not according to sealer type or irrigation protocol. CLINICAL RELEVANCE: When the SAF Infinitum system is used with a single-cone filling technique, short-term POBS does not appear to differ according to the irrigation protocol or sealer type under the conditions tested. Sealer and irrigation choices may therefore be guided by other biological and clinical considerations rather than by short-term push-out bond strength alone.
BACKGROUND: STELA is a newly introduced auto-cured bulk-fill composite proposed as an alternative to amalgam. It does not require light activation and provides an unlimited depth of cure, in addition to acceptable esthetic and mechanical properties. OBJECTIVES: To evaluate cuspal displacement, marginal adaptation, and nanoleakage in mesio-occluso-distal (MOD) Class II preparations of maxillary premolars restored with an auto-cured bulk-fill composite compared with a light-cured bulk-fill composite. MATERIALS AND METHODS: Sixty maxillary human premolars extracted for orthodontic purposes were randomly assigned to two groups (n = 30) according to the bulk-fill composite used. Standardized MOD Class II preparations were made and restored using either Group 1: STELA Capsule (SDI, Australia) or Group 2: Tetric N-Ceram Bulk Fill (Ivoclar Vivadent, Liechtenstein). Each group was subdivided into three subgroups (n = 10) based on the test performed. In Subgroup 1, cuspal displacement was recorded after post-cavity preparation and at (5 min, 24 h) post-restoration using a digital microscope. The remaining restored specimens underwent thermocycling and mechanical loading. Subsequently, marginal adaptation (Subgroup 2) was examined using scanning electron microscopy. Nanoleakage (Subgroup 3) was evaluated using silver nitrate tracing. Statistical analysis was performed using the independent-samples t-test and Fisher's exact test (P ≤ 0.05). RESULTS: STELA Capsule demonstrated significantly lower cuspal displacement at both 5 min and 24 h post-restoration compared with Tetric N-Ceram Bulk Fill (P < 0.001). Following thermocycling and mechanical loading, STELA Capsule also exhibited better marginal adaptation (P = 0.033) and reduced nanoleakage (P < 0.001) compared with the Tetric N-Ceram Bulk Fill. CONCLUSIONS: The STELA composite with its dedicated primer showed favorable laboratory outcomes compared with Tetric N-Ceram Bulk Fill used with Tetric N-Bond. This restorative protocol can serve as a viable clinical alternative to light-cured bulk-fill composites, particularly for restoring MOD Class II preparations in maxillary premolars. CLINICAL RELEVANCE: The novel auto-cured bulk-fill composite with its dedicated primer demonstrated excellent performance in reinforcing weakened premolars. It exhibited superior results in reducing cuspal displacement, improving marginal adaptation, and minimizing nanoleakage compared to a light-cured bulk-fill composite, indicating its potential for clinical use.
BMC oral healthAlaa A Salem, Mohamed S Hammed, Ahmed M ElRawdy, Hesham ElHawary
BACKGROUND: Whether grafting peri-implant jumping gaps exceeding 2 mm during immediate implant placement improves outcomes remains uncertain. This trial evaluated the effect of β-tricalcium phosphate (β-TCP) grafting on implant stability and peri-implant radiodensity in such sites. METHODS: In this prospective, parallel-group randomized controlled trial, 16 patients (8 per group) receiving 39 immediate maxillary anterior/premolar implants at sites with a jumping gap exceeding 2 mm were randomized 1:1 to no grafting (control) or injectable β-TCP (test); the patient was the unit of analysis. The pre-specified primary comparison was implant stability quotient (ISQ) at 6 months. Peri-implant radiodensity was monitored on standardized periapical radiographs (grayscale value) at baseline, 3, and 6 months, and quantified by cone-beam CT (CBCT) at 6 months only (ALARA principle); CBCT values are relative, arbitrary gray-value radiodensity, not true Hounsfield units. Between-group differences were analyzed with independent-samples t tests, within-group changes with repeated-measures ANOVA, and group×time interactions with mixed-design ANOVA (α = 0.05). RESULTS: No statistically significant between-group differences were detected in baseline age or jumping-gap width. No significant between-group difference in ISQ was detected at any time point, and the ISQ group×time interaction was not significant (p = 0.49); ISQ increased significantly over time in both groups. Periapical grayscale value increased significantly faster in the test group on unadjusted analysis (group×time interaction, p = 0.009), but this was no longer significant after adjusting for a small baseline difference (ANCOVA, p = 0.39). On 6-month CBCT, radiodensity was significantly higher in the test group (1224.0 ± 237.0) than control (931.9 ± 100.4 arbitrary units; mean difference 292.1; 95% CI 87.7 to 496.5; p = 0.010), a secondary outcome not included in the a priori sample-size calculation. CONCLUSIONS: β-TCP grafting of jumping gaps exceeding 2 mm did not significantly affect ISQ or baseline-adjusted periapical grayscale value. The test group showed significantly higher 6-month CBCT-derived radiodensity, but this was not prospectively powered and may partly reflect residual graft material, so it should be interpreted cautiously. Larger, adequately powered equivalence trials are needed before conclusions about grafting necessity can be drawn. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07709676. Registered 2026-07-12. Retrospectively registered.
Orvosi hetilapFanni Bolya-Orosz, István Gera, Dániel Palkovics, Péter Windisch
Dental implant therapy has become an increasingly widespread option for rehabilitation worldwide, with a substantial rise in both the number of implants placed and the patients seeking this type of treatment. As a result, the prevalence of biological and mechanical complications has also increased. Peri-implant inflammatory diseases - especially peri-implantitis, which involves progressive bone loss - have emerged as a major clinical challenge, as they can ultimately lead to the loss of the implant and the associated restoration, imposing significant financial and health burdens on patients. The primary etiological factor of peri-implantitis is the accumulation of bacterial biofilm. The condition most commonly occurs in patients with a history of unsuccessfully treated periodontal disease. Nevertheless, several additional risk factors contribute to its development, including insufficient alveolar bone support, weak peri-implant tissue, the lack of supportive periodontal and peri-implant maintenance therapy following implant placement. To ensure long-term treatment success, prevention and regular maintenance are crucial. Comprehensive management includes meticulous preoperative planning, ideal implant positioning, prosthetic designs that facilitate effective oral hygiene, and continuous professional supportive therapy. The following case report demonstrates that even in severe, full-arch peri-implantitis cases, favorable outcomes can be achieved through a multidisciplinary therapeutic approach when followed by strict maintenance. Long-term follow-up highlights that with proper rehabilitation and strong patient compliance, implant function can be preserved even in the presence of compromised peri-implant hard tissue environment. Orv Hetil. 2026; 167(38): 1523-1531.