OBJECTIVES: To evaluate the adjunctive diagnostic performance of QrayPen C fluorescence-image severity scoring (QS) for identifying same-site secondary caries in posterior composite restorations already selected for repair or replacement. MATERIALS AND METHODS: In this single-centre prospectively conducted observational diagnostic-accuracy study, 102 patients were assessed; 14 declined participation and 5 were excluded because of non-interpretable QLF/clinical images. The final analysis included 83 adults and 120 repair-/replacement-indicated posterior composite restorations. Restorations were assessed using Nyvad criteria, bitewing ICCMS scoring, and QrayPen C imaging. QS was scored on a 0-3 scale and analysed at thresholds > 0, >1, and > 2. The reference standard was same-site dentin status after removal. RESULTS: Secondary caries was confirmed in 80/120 restorations (66.7%). For QS > 0, sensitivity was 85.0%, specificity 90.0%, accuracy 86.7%, LR + 8.50, and LR- 0.17. Patient-level clustered bootstrap analysis gave similar but wider estimates: sensitivity 85.0% (clustered 95% CI 75.9-92.8) and specificity 90.0% (clustered 95% CI 80.0-97.7). Higher QS thresholds increased specificity but reduced sensitivity. CONCLUSIONS: In repair-/replacement-indicated restorations, QS > 0 may help localize suspicious areas and increase diagnostic confidence for same-site secondary caries, but the estimates apply to an enriched clinically problematic cohort. CLINICAL RELEVANCE: QrayPen QS should be interpreted as an adjunctive imaging-derived signal. QS positivity should not justify replacement in isolation, and QS = 0 should not be interpreted as evidence of sound dentin.
Scientific reportsRofida Ragab, Ahmed Abdallah, Rasha Saad, Mona Riad
This prospective clinical investigation evaluated the effects of proximal box elevation using three base materials on periodontal tissues in premolar teeth treated with direct composite restorations. In endodontically treated maxillary premolars, gingival crevicular fluid (GCF) samples were collected after restoring cavities using three base materials: resin-modified glass ionomer (RMGI), flowable composite (Tetric N-Flow), and injectable hybrid composite (Beautifil Flow Plus). Periodontal health was assessed by measuring interleukin-1 (IL-1) and tumor necrosis factor (TNF) concentrations, bleeding on probing (BOP), and pocket depth (PD) immediately and at 3 months postoperatively. Data were statistically analyzed using one-way ANOVA to compare groups, Levene's test to assess homogeneity of variances, and paired t-tests and chi-square tests were used to assess differences within groups. the results revealed that the levels of IL-1, TNF, and PD differed significantly among the three base materials at different time points. The Beautifil Flow Plus group showed the highest TNF levels, the most substantial absolute reduction, and the lowest reduction in IL-1 levels. However, there were no significant differences in BOP among the three materials at any time interval. Within the limitations of this three-month study, all materials were clinically acceptable, though Tetric N-Flow and RM-GI showed a more favorable short-term inflammatory profile than Beautifil Flow Plus. However, due to the limited sample size and short follow-up, no definitive claims regarding long-term periodontal compatibility or clinical superiority can be made.
OBJECTIVES: The aim of this in vitro study was to evaluate the color matching of single-shade and group-shade universal composite resins used in Class V restorations on A3-shade teeth in the presence of different simulated gingival shades using a photometric analysis method. MATERIALS AND METHODS: Class V cavities prepared on 45 extracted human anterior teeth were restored using one group-shade universal composite resin (Neo Spectra ST (NEO)) and two single-shade universal composite resins (Zenchroma (ZC) and Omnichroma (OC)) (n = 15). Standardized digital photographs were obtained under D65 illumination using cross-polarization filters. A commercial gingival shade guide providing three different gingival shades (light, medium, and dark) was used, along with a no-gingiva condition (control). The photographs were calibrated using a gray reference card in Lightroom software. Color differences (ΔE₀₀) were calculated using the CIEDE2000 formula. Data were analyzed using robust mixed ANOVA, with the level of significance set at p < 0.05. RESULTS: Composite resin type had a statistically significant effect on ΔE₀₀ values (p < 0.01). NEO (2.15 ± 0.067) exhibited lower ΔE₀₀ values compared with ZC and OC. Gingival shade alone did not significantly affect ΔE₀₀ values (p = 0.232); however, the interaction between composite resin type and gingival shade was statistically significant (p < 0.01). CONCLUSION: Although the group-shade composite resin demonstrated better color matching than the single-shade composite resins, all ΔE₀₀ values observed in the study exceeded the clinically acceptable threshold (ΔE₀₀ > 1.8). CLINICAL RELEVANCE: When evaluating the color matching of universal composite resins in Class V restorations, the influence of gingival shade may vary depending on the composite resin used.
BACKGROUND: Despite the numerous advantages of using resin-based composite restorations, polymerization shrinkage and the resulting stresses remain significant concerns. These stresses are associated with two critical clinical outcomes: cuspal deflection and microleakage. This study aimed to evaluate the cuspal deflection and microleakage of an incrementally packed nanohybrid and a low-shrinkage bulk-fill resin composite. METHODS: To assess cuspal deflection, 40 maxillary premolars were randomly divided into two groups (n = 20). Standardized mesio-occluso-distal (MOD) cavities were prepared, and one group was restored with incremental Filtek Z250XT and the other with the low-shrinkage bulk-fill resin composite Grandio®SO x-tra. Cuspal deflection was measured after cavity preparation and five minutes post-restoration using a universal horizontal metroscope. For evaluation of microleakage, each group was further subdivided into non-thermocycled and thermocycled subgroups. Microleakage was assessed using a 2% methylene blue dye solution at 37 °C for 24 h, followed by sectioning and examination under magnification. RESULTS: The highest mean cuspal deflection was recorded in the incremental group (12.80 ± 2.57 μm) compared to the bulk-fill group (9.60 ± 2.41 μm). A statistically significant difference in cuspal deflection was observed between the two groups (p = 0.010). No significant difference was found in microleakage scores between the incrementally packed and bulk-fill groups (p = 0.305). The incrementally packed group exhibited the highest mean microleakage score (259.66 ± 20.53 μm), while the bulk-fill group had the lowest mean score (251.10 ± 15.36 μm). Regarding the effect of thermocycling on microleakage, regardless of the type of resin composite used, a statistically significant difference was noted between the non-thermocycled subgroup (241.12 ± 10.17 μm) and the thermocycled subgroup (269.63 ± 11.97 μm) (p < 0.001). CONCLUSION: Low shrinkage bulk-fill composite reduced cuspal deflection in comparison to the incrementally packed materials. Bulk-fill and incrementally packed resin composites both showed comparable vulnerability to microleakage. The thermocycling procedure exerted a deteriorating effect on marginal integrity.
The Cochrane database of systematic reviewsSharon R Lewis, Tanya Walsh, Anne-Marie Glenny, Avijit Banerjee, Dwayne Boyers, Paul V Hatton, Christopher Mackie, Nicolas Martin, William M Palin, Michael W P…
BACKGROUND: Direct-placement dental restorative materials are required to replace the loss of tooth substance and restore the functional structural integrity of damaged posterior teeth. Whilst dental amalgam was traditionally used for these restorations, there are concerns about toxicity to human health and the environment. The Minamata Convention on Mercury recommends a phase-down of amalgam use in dentistry. Alternative mercury-free direct-placement restorative materials are available and have been evaluated in systematic reviews. OBJECTIVES: To summarise the evidence from Cochrane and other systematic reviews evaluating the clinical effectiveness and longevity of restorative materials for direct-placement coronal restoration in the permanent posterior dentition. To summarise the evidence from economic studies for the cost-effectiveness of restorative materials for direct-placement coronal restoration in the permanent posterior dentition. METHODS: In April 2025, we searched the Cochrane Library, MEDLINE, Embase, Epistemonikos and PROSPERO for systematic reviews that compared restorative materials for direct-placement coronal restoration in the permanent posterior dentition in children and adults. We included reviews reporting quantitative syntheses and comparing at least two restorative materials, from: resin-based composite (RBC), resin-modified glass ionomer cement (RMGIC), glass ionomer cement (GIC), compomer, dental amalgam, or other material. For RBC, we also compared bulk-fill with incremental-layered (conventional) RBC. We used Cochrane methodology to conduct an overview of the evidence from eligible reviews, and assessed the methodological quality of reviews using ROBIS. We prioritised data from selected reviews when we found a high degree of overlap of primary studies between reviews. Critical outcomes were: tooth loss (owing to restoration failure), restoration failure, time to failure, and adverse effects. Additionally, we searched for relevant economic evaluations of direct-placement restorative materials and developed a brief economic commentary. MAIN RESULTS: Overall, we found 14 reviews including 57 primary studies; only one was a Cochrane review. Very few primary studies (about 10%) were conducted in general practice. We prioritised data at the longest time point from six reviews, including 23 primary studies. Two reviews were at low risk of bias, and the others were at high risk. However, results across all reviews were largely comparable. RBC compared with dental amalgam. One Cochrane review reported low-certainty evidence that the risk of restoration failure may be 7% less with dental amalgam than RBC (RD 0.07, 95% CI 0.05 to 0.09; 2 studies, 3010 restorations; 5 to 7 years follow-up; class I and II restorations). Studies in this review began recruitment in the late 1990s, which may affect the generalisability of this evidence to contemporary practice, and the failure rate for RBC in these studies was higher than in contemporary evidence of RBC in other reviews (almost 15% compared with approximately 5%). Although there was similar evidence of restoration failure from two other reviews, the certainty of this evidence was very low and, therefore, we had little confidence in the risk reductions reported in these reviews. Only one review reported postoperative pain and discomfort (about 5% in both groups), which reviewers judged to be very low-certainty evidence. RBC compared with GIC. In one review, there may be little or no difference in the risk of restoration failure between RBC or GIC (RD -0.07, 95% CI -0.17 to 0.04, favours RBC; 1 study, 60 restorations; 10 years follow-up), or the risk of postoperative sensitivity (RD 0.03, 95% CI -0.03 to 0.10, favours GIC; 2 studies, 118 restorations); low-certainty evidence in a small sample size. Evidence for postoperative sensitivity in another review was very low certainty (overall events ranging from zero to 10%) and therefore we are uncertain of any benefit for either restorative material. Whilst this evidence included class I and II restorations, most reported were class I restorations (occlusal non-load bearing). Bulk-fill compared with incremental-layered RBC. We found the most reviews for this comparison (n = 8), all reporting similar risk differences, and therefore this evidence was judged to be of moderate certainty. The risk of restoration failure is likely to be low, and no different between groups, at less than 5% (RD 0.00, 95% CI -0.03 to 0.03; 7 studies, 511 restorations; 1 to 10 years follow-up). In one review, there was almost no postoperative sensitivity for either type of RBC (RD 0.00, 95% CI -0.01 to 0.02; 5 studies; 510 restorations; 2 to 3 years follow-up). Overall, more restorations were in class II restorations (multiple-surface load bearing). RMGIC compared with GIC. In one review, RMGIC may be more likely to reduce the risk of restoration failure than GIC in class I restorations (RD -0.19, 95% CI -0.37 to -0.02; 1 study, 50 restorations), and class II restorations (RD -0.71, 95% CI -0.93 to -0.48; 1 study, 38 restorations), both at two years follow-up from low-certainty evidence in a very small sample. GIC compared with dental amalgam, and GIC compared with compomer. No reviews reported critical outcome data for these comparisons. Brief economic commentary: Six economic reports identified no strong conclusions regarding the cost-effectiveness of mercury-free restorative materials. One report, using data from older studies, found that amalgam lasted longer and was less costly than RBC; however, we identified no economic evaluations based on contemporary clinical evidence for amalgam. AUTHORS' CONCLUSIONS: Most evidence compared bulk-fill with incremental-layered RBC; there is probably no difference between these materials in restoration failure. Although we found evidence of fewer restoration failures with dental amalgam than RBC, this may not be comparable to contemporary practice owing to changes in properties of RBC materials and practitioner experience. We identified few economic evaluations to provide strong conclusions to support the clinical effectiveness findings for mercury-free restorative materials. Regarding implications for policy and practice, little evidence in this overview is from general practice. The results of clinical effectiveness should be considered alongside cost, acceptability, clinical presentation, time required for restoration placement (which may be technique-sensitive), and the health and environmental considerations of the materials. These conclusions emphasise that caries prevention is critical to effective and sustainable oral health. FUNDING: Cochrane Oral Health (COH) is supported by a collaborative research agreement between The University of Manchester and the University of Pennsylvania. REGISTRATION: Protocol (2025): https://www.crd.york.ac.uk/PROSPERO/view/CRD420251004182.
OBJECTIVES: This study evaluated the 1-year clinical performance of polyethylene fiber-reinforced direct composite restorations placed in different orientations in endodontically treated premolars and molars. MATERIALS AND METHODS: Eighty-five patients with 90 endodontically treated posterior teeth (32 premolars, 58 molars) received direct composite restorations using Clearfil SE Bond (Kuraray Noritake Dental Inc., Japan), G-aenial Universal Injectable and G-aenial A'CHORD (GC Corp., Japan), and polyethylene fiber (Ribbond, Ribbond Inc., USA). According to cavity configuration, fibers were placed in circumferential (O), mesiodistal (MD), or buccolingual (BL) orientations. Clinical performance was assessed using modified USPHS criteria at 7 days, 6 months, and 12 months. RESULTS: All restorations maintained Alpha scores for color match and secondary caries throughout the study period. At 12 months, limited Bravo scores were observed for retention, marginal discoloration, marginal adaptation, anatomical form, and surface texture. One restoration in the MD group received a Charlie score for retention and required replacement. No statistically significant differences were detected among the three fiber-orientation groups for any evaluated parameter (p > 0.05). CONCLUSIONS: Polyethylene fiber-reinforced direct composite restorations demonstrated favorable short-term clinical performance in endodontically treated posterior teeth. Fiber orientation did not significantly influence clinical outcomes.
Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatologyJ R Zhai, J W Guo, W Y Su, T M Sha, P Ding, Y Wang
Objective: To develop and evaluate Clinical Decision Surpport System-augmented by retrieval-augmented generation (RAG)-Professional (CDSS-RAG-Pro), a RAG-based clinical decision support system, through multi-level comparison of multiple large language models (LLM), and to provide an objective decision-making aid for the clinical restoration of endodontically treated teeth. Methods: A structured knowledge base was constructed by systematically retrieving and incorporating authoritative prosthodontic sources, including the Guideline for the Restoration of Tooth Defects, Dentition Defects and Edentulism (2022 Edition). A RAG module was developed accordingly and integrated into three LLM (DeepSeek-V3, Qwen 2.5-72B-Instruct, and GPT-3.5-turbo) to form the CDSS-RAG-Pro clinical decision support system for post-endodontic restoration. To evaluate the decision-making capability of this system, an expert panel was established. Thirty typical clinical cases were selected from the Department of Prosthodontics, Hospital of Stomatology, Sun Yat-sen University, from May 2024 to December 2025. The three LLM generated restorative plans under both RAG and non-RAG modes. Using a Likert scale, the expert panel scored the restorative plans across three dimensions: decision accuracy, logical coherence, and professional readability. Meanwhile, the expert panel drafted standard restorative reports. Two objective metrics, F1 score of the recall-oriented understudy for gisting evaluation based on longest common subsequence (ROUGE-L F1) and F1 score of the bidirectional encoder representations from Transformer-based semantic similarity score (BERTScore F1), were used to evaluate the semantic similarity between the generated restorative plans and the standard restorative reports. ROUGE-L F1 focused on assessing the model' s mastery of textual knowledge such as restorative guidelines, while BERTScore F1 focused on semantic consistency in reasoning patterns and decision-making logic. Generalized estimating equations were used to analyze differences in decision performance across LLM and between RAG and non-RAG modes. Results: Compared with the non-RAG mode, all models showed improved performance across all evaluation metrics in the RAG mode, with statistically significant differences (all P0.05). The highest BERTScore F1 in the RAG mode was 0.91 (DeepSeek-V3). Significant differences were observed among the three LLM across all evaluation metrics (all P0.05). Significant interaction effects were found between model type and RAG mode for decision accuracy score (interaction χ2=10.11, P0.001) and ROUGE-L F1 (interaction χ2=8.57, P0.05). Conclusions: The RAG-based CDSS-RAG-Pro improves the accuracy and interpretability of general-purpose LLM in decision-making for post-endodontic tooth restoration. This study demonstrates the unique clinical safety and scalability advantages of RAG as a lightweight, small-sample-oriented LLM configuration strategy to empower prosthodontic clinical decision-making.
Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatologyM Wan, X Xu, X D Bao, L W Zheng
Restoration of extensive defects in young permanent molars is more complex than that in mature permanent teeth. Young permanent teeth are characterized by insufficient enamel mineralization, large pulp chambers, short occlusogingival distance, and unstable gingival margins, limiting both mechanical retention and bonding conditions. In addition, individual factors such as patient cooperation, caries risk, and orthodontic needs further complicate treatment planning. Based on current clinical evidence, this review summarizes the indications, advantages, and limitations of direct adhesive restorations, preformed crowns, provisional crowns, inlays/onlays/overlays, endocrowns, and computer-aided design and computer-aided manufacturing (CAD/CAM) indirect restorations, proposing a clinical decision-making framework for extensive defects in young permanent molars. The proposed pathway follows a "three-level assessment and integrated decision-making" approach, in which the physiological characteristics of young permanent teeth, the objective condition of the affected tooth, and patient-and treatment-related factors are comprehensively evaluated to develop an individualized restorative plan. When moisture control is achievable and tooth conditions are favorable, adhesive restorations with cusp coverage can be selected. When moisture control is difficult or rapid restoration of coronal integrity is required, preformed metal crowns may serve as interim restorations. For non-vital teeth with short occlusogingival distance and insufficient retention, endocrowns may be considered. At present, CAD/CAM resin-ceramic indirect adhesive restorations have shown favorable short-to medium-term outcomes over 18-24 months; however, the long-term performance still requires further validation through multicenter studies with larger sample sizes.
PeerJAzhar Iqbal, Kiran Kumar Ganji, Saeed Alqahtani, Muhammad Sohail Zafar, Osama Khattak, Yasir Dilshad Siddiqui, Muhammad Rizwan Memon, Afaf A Almabadi, Mohmed I…
BACKGROUND: Clinical teaching of dentistry often takes place in busy patient-care environments, where there may not be sufficient time for real-time supervision or feedback, compromising student learning during clinical encounters. The One-Minute Preceptor (OMP) is a structure microskills model of teaching which has been developed for efficient clinical teaching in brief encounters. Accordingly, this study aimed to evaluate the OMP model as a microskills teaching and learning approach in operative dentistry clinical settings, with particular emphasis on student learning, reasoning, clinical performance, and perceptions of its usefulness in busy clinical environments. METHODS: A randomized controlled educational intervention with a two-group pretest-posttest design was conducted among third-year Bachelor of Dental and Oral Surgery students. Fifty students who provided written informed consent were included in the study. Using simple randomization with a random number table, participants were allocated to either a control group (n = 26) receiving traditional clinical teaching or an intervention group (n = 24) receiving teaching based on the One-Minute Preceptor model. Student perceptions of the OMP model were collected using a structured 5-point Likert-scale questionnaire. RESULTS: Following the intervention, students in the OMP group exhibited significant improvement across nearly all assessed domains, whereas the control group showed either minimal gains or slight declines in several areas. Post-intervention ratings showed statistically significant improvements (p < 0.01) across most items, particularly within the domains of Commitment, Probe, Feedback, and Overall Competence. Students in the intervention group reported high satisfaction with the OMP model, with most rating it as beneficial for learning in restorative dentistry clinical sessions. CONCLUSION: The findings of this study suggest that the OMP model may be a useful teaching and learning approach for operative dentistry clinical settings, with improvement observed in several assessed student performance domains and positive student perceptions regarding its applicability in busy clinical environments. Further studies with larger samples and more robust statistical analyses are warranted.
Oral health & preventive dentistryAzhar Iqbal, Farooq Ahmad Chaudhary, Saeed Alqahtani, Hmoud Ali Algarni, Meshal Aber Alonazi, Yasir Alyahya, Bilal Arjumand, Yasir Dilshad Siddiqui, Kumar Chan…
PURPOSE: The effect of restorative dental treatment on oral health-related quality of life (OHRQoL) and general well-being in Saudi adults is not well-documented. This study therefore evaluated the sensitivity of the OHIP-14, OIDP, and WHOQOL-BREF instruments in capturing changes in OHRQoL and health-related quality of life (HRQoL) after restorative care for caries. MATERIALS AND METHODS: Between September 2024 and March 2025, a prospective longitudinal cohort of 269 adult patients with untreated caries was recruited from Jouf University Dental Clinics in Saudi Arabia. Standardized restorative protocols were followed for all treatments. The three validated Arabic version of OHIP-14, OIDP, and WHOQOL-BREF instruments were used to assess the quality of life at baseline and at a one-month follow-up. To examine discriminant validity, responsiveness of the instruments, and factors predicting therapeutic change, statistical analysis involved paired and independent t-tests, effect size calculation (Cohen's d), and multiple linear regression. RESULTS: Statistically significant post-treatment improvements were observed across all subdomians of the three instruments. Mean OHIP-14 and OIDP scores decreased markedly (20.64 to 6.81 and 7.17 to 0.27, respectively; p 0.001), while WHOQOL-BREF scores increased statistically significantly (32.53 to 43.03; p 0.001). The degree of improvement was linked to initial caries severity. Therefore, the participants having more advanced caries at the start of the study demonstrated greater responsiveness, particularly in their scores on the OHIP-14 and WHOQOL-BREF. CONCLUSION: The restorative dental treatment of dental caries statistically significantly improves the oral health-related and general quality of life of adult patients. The responsiveness of the OHIP-14, OIDP, and WHOQOL-BREF instruments, as demonstrated by the current study findings, supports their application as robust patient-reported outcome measures (PROMs) in clinical dentistry. It is recommended that these PROMs should be integrated into practice to advance a more holistic and patient-centered approach to the provision of oral healthcare.
This study reports a case of complicated crown-root fractures of the maxillary central incisors (teeth 8 and 9) in a 10-year-old boy. Vital pulpotomy and iRoot BP Plus capping were performed to protect the pulp. The fractured crown fragments were used to restore the tooth morphology, and the esthetics and function of both central incisors were restored. The roots of the affected teeth continued to develop normally. Twenty-five months after the initial treatment, the patient suffered another trauma, resulting in a second dislodgement of the fractured crown of the left maxillary central incisor. Given the structural integrity of the fractured crown, reattachment was performed again to reshape the tooth, thereby restoring its appearance to the greatest extent possible. After a 40-month follow-up, the esthetics and function of teeth 8 and 9 remained satisfactory. Normal anterior occlusion was established, and the treatment outcome was highly appreciated by the patient and his parents. This case provides clinical detail useful for managing complex crown and root fractures caused by multiple traumas in young permanent teeth, emphasizing the importance of pulp preservation, conservative restoration, and preventive measures.
BACKGROUND: Computer aided designed/ computer aided manufactured (CAD/CAM) materials offer diverse options for prosthetic rehabilitations, yet correlation between materials' surface properties and aging through chewing simulation needs characterization. The aim of this study is to measure and evaluate the effect of three body wear on three CAD/CAM materials (poly methylmethacrylate (PMMA), composite resin and polyether ether ketone (PEEK)) regarding their microhardness and surface roughness. METHODS: Seventy-two disc-shaped specimens (20 × 6 mm) were fabricated (n = 24/ group) from PMMA (Yamahachi PMMA Disk), Nano-ceramic Composite (Grandio Blocs, VOCO), and PEEK (BioHPP, Bredent). Specimens were subjected to 120,000 chewing cycles in a chewing simulator using a 3-body wear protocol with a pumice slurry. Wear volume (mm3) was measured digitally. Surface roughness (µm) and Vickers hardness (VHN) were evaluated twice: at baseline and within the wear facets post-simulation. Data were analyzed using Two-way and One-way ANOVA (P-value < 0.05), and Pearson correlation was used to measure the relationship between properties. RESULTS: One-way ANOVA revealed a significant difference between material types (P = 0.000*), with composite exhibiting the lowest mean volume loss (0.08 mm3), significantly outperforming PEEK (0.23mm3) and PMMA (0.55 mm3). For surface roughness, a significant interaction was observed between material type and wear simulation (P = 0.000*), while there was no significant interaction between them on surface hardness (P = 0.89). Composite significantly outperformed PEEK and PMMA regarding all tested properties. CONCLUSION: The 3-body wear simulation induced significantly different volumetric loss across all groups, with the magnitude of loss largely dependent on the material's specific composition and baseline hardness. In addition, the surface roughness and microhardness of three investigated materials were considerably impacted by three-body wear. PMMA have the lowest wear resistance, lowest microhardness, and the greatest surface roughness both before and after wear, while composites with high filler loading and high microhardness have the highest wear resistance followed by PEEK. After wear, the surface roughness of the composite is acceptable.
Acta odontologica ScandinavicaViktorija Ašmankevičiūtė-Lemisnkė, Gediminas Žekonis
OBJECTIVE: The objective of this study was to compare self-reported treatment preferences related to pulpectomy prior to prosthetic treatment, restoration selection for vital teeth, and impression-taking methods between Lithuanian general dentists (GDs) and prosthodontists (Ps). MATERIAL AND METHODS: A questionnaire-based survey was conducted among 386 dentists in Lithuania, including GDs (62.4%) and Ps (37.6%). Data were analyzed using descriptive statistics and inferential tests (Chi-square and Fisher's exact test), with a significance level of p < 0.05. RESULTS: Most indications for pulpectomy were reported similarly by both groups; however, significant differences were observed for extensive coronal structure loss (> 50%) and deep caries, cervical lesions, gingival recession, short clinical crown, insufficient retention, enamel hypoplasia, and external root resorption (p < 0.05). Ps also more frequently reported using indirect restorations, including porcelain-fused-to-metal crowns, lithium disilicate ceramic inlays and onlays, and polymethyl methacrylate crowns. Conventional impressions were more common among GDs, whereas digital or combined workflows were more common among Ps. CONCLUSIONS: Lithuanian GDs and Ps reported broadly similar preferences regarding preservation of tooth vitality, but differed in selected pulpectomy indications, restorative options, and impression-taking methods. These differences may reflect variation in specialist training, clinical experience, and access to prosthetic workflows.
Journal of the Indian Society of Pedodontics and Preventive DentistryAnushka Choche, Jyothsna V Setty, S Arunkumar, Dipali Vetal, Utkarsh Patil, Pratiksha Patil
BACKGROUND: Effective moisture control is essential in pediatric dentistry. Cotton rolls provide limited isolation, while a rubber dam offers better control but may cause discomfort in children. Saliva absorbers have been introduced as an alternative. This study compares saliva absorbers with cotton rolls and a rubber dam for isolation in children. AIM: To evaluate and compare the effectiveness of cotton rolls, rubber dam, and parotid and sublingual saliva absorbers during class ii restorations in primary molars among children aged 4-9 years. METHODOLOGY: This randomized clinical trial included 36 children aged 4-9 years requiring class ii restorations in primary molars. Participants were randomly allocated into three groups ( n = 12 each): cotton roll isolation, rubber dam isolation, and parotid and sublingual saliva absorbers. Standardized cavity preparation and restoration with high-strength glass ionomer cement were performed. Patient anxiety was assessed using pulse rate, face, legs, cry, consolability score scale, and animated emoji scale. Operator ease was evaluated using a questionnaire. Statistical significance was set at P < 0.05. RESULTS: Saliva absorbers showed better patient acceptance and satisfactory moisture control compared to cotton rolls and rubber dams. Rubber dam provided superior isolation but was associated with higher anxiety scores and longer placement time. Operator ease was the highest with saliva absorbers. CONCLUSION: Saliva absorbers were an effective isolation method, providing adequate moisture control with ease of handling.
Journal of dentistryMark-Steven Howe, Derek Richards
OBJECTIVE: Restorative dentistry lacks an integrated prognostic framework linking restorability assessment to long-term survival evidence. This study evaluates whether published 10-year survival data can be systematically anchored to an existing multi-domain restorability index to develop a structured Restorative Dental Prognosis Index (RDPI). METHODS: A theory-driven, five-stage conceptual methodology was applied. A structured literature search identified validated restorability or risk indices as a conceptual anchor. Prognostic features were classified by relevance to restorative outcomes. Published 10-year survival estimates and uncertainty intervals were extracted from systematic reviews and re-analysed to characterise dispersion. Estimates were mapped onto an ordinal prognostic structure to minimise overfitting in heterogeneous evidence. Scenario modelling explored internal coherence, recognising differences between whole-mouth and tooth-level risk. No empirical validation was undertaken. RESULTS: A single multidomain index met eligibility criteria. Across 13 domains, 10-year survival estimates showed wide variation (74-93%), very broad prediction intervals, and high heterogeneity (I²=74.8-99.8%). Despite this, survival data aligned with a three-category ordinal structure, generating a coherent prognostic scaffold. Scenario modelling demonstrated non-linear increases in whole-mouth risk and integration of biological risk with financial exposure. CONCLUSIONS: By mapping long-term survival evidence onto a validated multidomain restorability framework, this proof-of-concept framework provides a structurally consistent prognostic scaffold. While not a predictive model, it offers a foundation for future empirical parameterisation, validation, and integration into restorative treatment planning, teaching, and practice. CLINICAL SIGNIFICANCE: This framework integrates multi-domain restorability assessment with long-term survival evidence to support whole-mouth prognostic reasoning. By simplifying heterogeneous data into ordinal risk states and enabling aggregation, it may help clinicians compare strategies, anticipate failure risk, and align decisions with proportionality, cost exposure, and patient-centred outcomes.
Background and Objectives: Professional ballet dancers endure high occlusal loads, increasing cervical defect prevalence. Conventional composites fail frequently under such conditions. This randomized clinical trial (RCT) compared 24-month performance of a polymer-infiltrated ceramic network (PICN, VITA Enamic) versus a self-curing bioactive composite (Stela) for cervical restorations. Materials and Methods: Twenty professional ballet dancers (40 cervical defects: 21 carious, 19 abfraction) were enrolled in a paired split-mouth RCT. Each received one PICN inlay and one self-curing composite restoration on two non-adjacent defects. Restorations were assessed at 6, 12, and 24 months using United States Public Health Service (USPHS) criteria (primary: marginal integrity) and a dye penetration test. Secondary outcomes included secondary caries, hypersensitivity, and Oral Health Impact Profile-14 (OHIP-14). Statistical tests: McNemar, Fisher's exact, Kaplan-Meier, log-rank (α = 0.05). Results: At 24 months, marginal integrity (USPHS Alpha) was maintained in 91% of PICN restorations for carious defects and 89% for abfraction defects, compared to 70% and 50% for self-curing composite, respectively. No PICN restoration failed (0%). Self-curing composite failures were 20% (carious) and 30% (abfraction) (exploratory uncorrected p = 0.031; non-significant after correction). Dye penetration was lower for PICN in abfraction defects (11% vs. 60%, adjusted p = 0.048) but not in carious defects (9% vs. 30%, adjusted p = 0.317). Kaplan-Meier survival favoured PICN (log-rank p = 0.001); 24-month survival probability: PICN 100% (95% CI: 83-100%), self-curing composite 75% (95% CI: 55-95%). No secondary caries or serious adverse events occurred. Conclusions: PICN hybrid ceramic provided superior marginal integrity and zero failures over 24 months in cervical restorations of professional ballet dancers, outperforming the self curing composite. Within this high-risk population, PICN inlays are recommended for abfraction defects. However, because the study was conducted exclusively in professional ballet dancers, direct extrapolation to the general population should be made with caution. The self-curing composite may be considered for carious defects when light curing is problematic, but patients should be informed of higher failure risk. Longer studies are needed.
Canadian journal of dental hygiene : CJDH = Journal canadien de l'hygiene dentaire : JCHDRyan Lichtblau, Greg Anderson, Aviv Ouanounou
BACKGROUND: Dental caries is a multifactorial, dynamic disease leading to the demineralization and loss of tooth structure. Traditionally, it is treated with mechanical removal of the carious tooth structure and restoration with a restorative material, requiring specialized skills and equipment. Young children, patients with physical or intellectual disabilities, elderly patients, and patients living in remote communities are disproportionately affected because of greater difficulty accessing and undergoing operative dental procedures. The purpose of this narrative review is to explore the use of silver diamine fluoride as an alternative or adjunct tool in clinical practice for treating and preventing dental caries. METHODS: This review was conducted from July 2022 to May 2025. Three electronic databases-PubMed, Cochrane Library, and Ovid Medline-were searched using the keywords silver diamine fluoride, SDF, fluoride, access to care, caries risk, restorative material, and caries prevention. Opinion articles and those not published in English were excluded from consideration. RESULTS: The literature search returned 74 articles, including qualitative studies, case studies, randomized clinical trials, systematic reviews, and meta-analyses. Silver diamine fluoride was found to be effective in treating cavitated and non cavitated lesions caused by dental caries. DISCUSSION AND CONCLUSION: With proper case selection and follow up, silver diamine fluoride is an effective agent for arresting dental caries. Its use by more clinicians because of its effectiveness, safety, low cost, and ease of use can help alleviate some of the challenges faced by certain patient populations. Further research should be undertaken to assess the effectiveness of silver diamine fluoride on adult teeth as well as for dental caries prevention.
Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric DentistryPranitha Vallala, Anurag Negi, Sakshi Katyal, Parimala Ambati, Vijay Yadav
Moyamoya disease (MMD) is a rare cerebrovascular occlusive disorder involving Internal carotid arteries, which may present in association with Down syndrome (Trisomy 21). These patients are at increased risk of intraoperative complications such as hyperventilation, transient ischemia, stroke and cerebral haemorrhage. This case report describes the dental management of an 8-year-old female patient with MMD and associated Down syndrome (DS) receiving antiplatelet therapy, along with a comprehensive literature review. The patient presented with dental pain in the upper right quadrant and multiple carious teeth. The child was cognitively impaired but potentially cooperative, and behavior management was achieved through desensitization and audiovisual distraction techniques. Dental treatment was performed in staged, short appointments and included selective caries excavation and restoration of teeth (#11, #21, #53, #55, #63, #65, #83, #85) using glass ionomer cement. Extraction of decayed teeth (#54, #64, #75 root stumps) was carried out under local anaesthesia (LA) without discontinuation of aspirin therapy. Patient was monitored intraoperatively for SpO2 and postoperatively for extraction-site bleeding, which was effectively controlled using cold application and local pressure. Acetaminophen was prescribed for analgesia. Over a one-year follow-up period, the patient demonstrated significant improvement in oral health, pain reduction, and overall quality of life. This case highlights that the choice of anaesthesia and management protocol should be individualized based on the patient's level of cooperation, extent of dental treatment needs, and associated comorbidities, including bleeding risk and airway considerations.