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.
Lasers in medical scienceIoana Duncea, Cristina Muresan, Oana Almasan, Smaranda Buduru, Cecilia Bacali
This literature review examines the advancements in laser technology that have enhanced the veneer debonding process, offering insights into the proper implementation of these techniques in clinical practice with emphasis on laser parameters, debonding efficiency, thermal effects, and preservation of tooth structure. A systematic literature search was conducted on PubMed,Web of Science, Scopus and Cochrane Library. The review was structured according to the PICO framework. The search was performed independently by two reviewers on laser-assisted debonding of ceramic veneers using Er:YAG or Er,Cr:YSGG lasers.Based on a comprehensive evaluation of existing studies, the review presents different types of prosthetic restorations, materials, and laser parameters, and how they interact with each other. The benefits of laser precision, including improved control, workflow efficiency, fewer procedural steps, and reduced tissue impact, are emphasised to help dental practitioners enhance the standard of care in veneer debonding. Across the twenty nine studies that were obtained, laser debonding facilitated removal while pulpal temperature increases remained below commonly cited critical values. Both Er:YAG and Er,Cr:YSGG systems demonstrated effective veneer removal. Thinner veneers nedeed less irradiation time and lower energy. Limited enamel alterations occured when appropriate parameters were used. Current studies suggest that Er:YAG and Er, Cr: YSGG lasers offer clinical advantages in terms of efficiency, safety, and patient comfort. Studies demonstrate that optimized laser settings reduce debonding time and minimize the risk of thermal damage to underlying tooth structure and surrounding tissues. Debonding efficiency was influenced by veneer thickness, ceramic type, cement composition, laser power, pulse duration and cooling protocols Er:YAG and Er,Cr:YSGG lasers are promising tools for ceramic veneer debonding. However, results obtained in these studies cannot be directly associated to patient-centered issuses, further standardized clinical studies are required before definitive clinical recommendations can be made.
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 and experimental dental researchAspasia Pachiou, Viviane Laura Humm, Nadja Naenni, Eleana Kontonasaki, Ronald E Jung, Daniel S Thoma
OBJECTIVES: To evaluate the association between patient behavior and clinician emotional burden, perceived clinical performance, interaction difficulty, and decision-making in implant dentistry. MATERIAL AND METHODS: A cross-sectional online questionnaire was distributed via individual invitations to 150 dental professionals involved in implant dentistry. A total of 127 clinicians completed the survey (response rate: 84.7%). The questionnaire assessed demographic and professional characteristics, clinicians' perceptions of patient behavior, emotional responses, and the perceived impact of patient-related factors on clinical performance and decision-making. Composite domains for emotional burden and interaction difficulty were developed, and their internal consistency was assessed using Cronbach's α. Associations were evaluated using Spearman's correlation and linear regression analyses. RESULTS: More challenging patient behavior was significantly associated with increased emotional burden (ρ = 0.50, p < 0.001) and interaction difficulty (ρ = 0.46, p < 0.001). Similar findings were observed when patient behavior was compared with usual clinical cases (both p < 0.001). Procedural difficulty showed only weak or non-significant associations with emotional burden and interaction difficulty. Emotional burden was strongly associated with interaction difficulty (ρ = 0.84, p < 0.001), avoidance of scheduling similar patients (ρ = 0.47, p < 0.001), and lower perceived clinical performance (ρ = 0.27, p = 0.002). Regression analyses confirmed that patient behavior was significantly associated with emotional burden (p < 0.001). CONCLUSIONS: Patient behavior appears to be associated with clinician emotional burden and perceived clinical performance more strongly than case difficulty in implant dentistry.
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.
Journal of Indian Prosthodontic SocietyChaimongkon Peampring, Phatootip Henprasert
AIM: Conventional complete denture (CD) fabrication requires multiple appointments, posing barriers for remote elderly patients.This study compared oral health-related quality of life (OHRQoL) and patient satisfaction between digitally fabricated dentures (DD) and conventional methods within the Royal Mobile Dental Services in Thailand. SETTINGS AND DESIGNS: In this prospective randomized trial, 30 edentulous participants (aged 50-80 years) were allocated to CD ( n = 15) or DD ( n = 15) groups; 25 participants (CD: n = 15, DD: n = 10) completed the 1.5-month evaluation. MATERIALS AND METHODS: The CD protocol used a four-visit, heat-polymerized workflow. The DD protocol used a three-visit workflow with mucostatic intraoral scanning and three-dimensional (3D) printing dentures. Participants and outcome assessors were blinded. STATISTICAL ANALYSIS USED: Outcomes were assessed after the first meal, at 24 h, and at 1.5 months using a Visual Analog Scale (VAS) for satisfaction and the Oral Health Impact Profile-14 for OHRQoL. Data were analyzed using Mann-Whitney U -tests. RESULTS: Overall VAS satisfaction showed no significant intergroup differences ( P > 0.05). At 24 h, the DD group reported significantly higher negative impacts ( P < 0.05) on phonetics, taste perception, and food avoidance. By 1.5 months, most OHRQoL dimensions in the DD group normalized to match the CD group, but phonetic difficulties remained significantly higher ( P < 0.05). CONCLUSION: 3D-printed dentures offer satisfaction comparable to conventional methods while reducing clinical visits. Early functional limitations resolve rapidly, but persistent phonetic issues suggest that standardized computer-aided design protocols may benefit from patient-specific customization to optimize speech outcomes in mobile dental settings.
Journal of Indian Prosthodontic SocietyUnnati Gedam, Uday Kiran Uppada
This study aimed to evaluate the contribution of the Journal of Indian Prosthodontic Society (JIPS) toward enhancing global prosthodontic research visibility through a comprehensive evaluation of publication trends, citation dynamics, thematic distribution, and international authorship patterns over 21 years. A cross-sectional study was undertaken evaluating all articles published in JIPS from January 2005 to December 2025. Data were retrieved from the journal's official archives. The key variables assessed included annual publication volume, study design, thematic domains, citation metrics, geographic distribution of authorship, and journal impact indicators. Data were analyzed using descriptive statistics and temporal trend evaluation. A total of 1238 articles were published during the study period. Original articles accounted for the largest number of publications (54.4%), followed by case reports/series (22%) and review articles (15%). The early publication trends (2005-2015) were focused on research related to complete denture and fixed partial denture, whereas the recent research (2016-2025) showed a substantial inclination toward implantology, digital prosthodontics, and biomaterial innovations. International authorship contributions increased progressively over the study period, particularly from America, Asia, Africa, and some European countries, reflecting the journal's expanding global reach. Citation performance improved substantially following key indexations in PubMed, Scopus, and Web of Science. The journal demonstrated a steady growth in the impact metrics, including impact factor, SCImago Journal Rank, and quartile rankings. National specialty journals like JIPS play a pivotal role in enhancing global research visibility by promoting region-specific research dissemination, improving accessibility through indexations, and aligning with contemporary and emerging scientific advancements in prosthodontics.
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 SocietyMansi Dhiran, Ajay Sabane, Abhijit Ashok Patil, Arti Gachake, Darshana Mundhe, Rupali Patil
AIM: This study aims to evaluate and compare the scanning accuracy of three IOSs and measuring the vertical marginal fit of three-dimensional (3D) printed resin retainers for single crown, three-unit, and cross-arch fixed partial denture situations. SETTINGS AND DESIGN: Comparative In Vitro Study. MATERIALS AND METHODS: A maxillary Nissin typodont with prepared abutments at #13, #23, #25, #27, and #16 served as the master model. A calibrated Shining 3D laboratory scanner provided the reference standard tessellation language (control). Each IOS generated six scans ( n = 6/scanner; 18 test scans). Trueness and precision were derived by best-fit superimposition in Geomagic Design X. Fifty-four single-unit, three-unit, and cross-arch retainers were 3D-printed. Vertical marginal discrepancy was measured at mid-buccal and mid-lingual sites using a digital stereomicroscope (×20). STATISTICAL ANALYSIS USED: One-way ANOVA with Tukey's post-hoc test was used for comparisons among scanners and prosthesis spans. Pearson's correlation was used to assess the relationship between trueness and marginal fit, and Chi-square test was used to assess clinical acceptability. A P value ≤0.05 was considered statistically significant. RESULTS: 3Shape TRIOS 3 showed the highest trueness (28.5 ± 5.2 µm) and precision (18.2 ± 3.1 µm), followed by Medit i700 and Shining 3D Aoralscan 3 ( P < 0.001). Marginal discrepancy was lowest with 3Shape TRIOS 3 (52.4 ± 6.5 µm) and increased with span. A positive correlation was found between trueness and marginal fit ( r = 0.82; P < 0.001). Clinical acceptability was 100%, 94.4%, and 77.8% for 3Shape TRIOS 3, Medit i700, and Shining 3D Aoralscan 3, respectively ( P = 0.041). CONCLUSION: All three scanners delivered clinically acceptable results; 3Shape TRIOS 3 yielded the highest accuracy and best marginal adaptation. Accuracy and marginal fit deteriorated as prosthesis span increased.
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.
Journal of Indian Prosthodontic SocietyP S Prakhyath, Bharath Prabhu, Shijal Narayan Suvarna
AIM: This study aimed to evaluate and compare the vertical marginal discrepancy of DMLS copings fabricated from stone dies scanned using an intraoral scanner (IOS) and a laboratory scanner. SETTINGS AND DESIGN: An in vitro comparative study was conducted to evaluate the influence of intraoral and laboratory scanning systems on the vertical marginal discrepancy of DMLS copings. MATERIALS AND METHODS: A customised stainless-steel model simulating a prepared tooth with a shoulder finish line was fabricated. Impressions of the model were made using elastomeric impression material. Forty dies ( n =40) were poured using type IV dental stone and divided into two groups ( n =20). Group 1 dies were scanned using a 3Shape TRIOS IOS and Group 2 dies were scanned using a 3Shape extraoral laboratory scanner. Copings were fabricated using CAD/CAM software. Marginal gap between the die and the coping was measured at 4 predetermined points (buccal, lingual, mesial, and distal) using a stereomicroscope at ×40 magnification. STATISTICAL ANALYSIS USED: Data were analysed using SPSS (version 21, IBM Corp., Armonk, NY, USA). Student's unpaired t-test was used to compare the tested groups. The collected data were analysed at a significance level set at P < 0.05. RESULTS: The mean marginal gap between the die and coping was 11.44 μm for Group 1 and 29.62 μm for Group 2. The difference between the groups was statistically significant ( P < 0.001). CONCLUSION: Copings fabricated from dies scanned using IOS demonstrated significantly lower vertical marginal discrepancies compared to those scanned using the laboratory scanner. However, the marginal gaps observed in both groups were within clinically acceptable limits.
Journal of Indian Prosthodontic SocietyShady M El Naggar, Ahmed M Esmat, Eman G Helal, Maie F Khalil, Ayman M Gouda
AIMS: This study aimed to investigate the consistency of ratings, the quality of chatbot-generated removable partial denture (RPD) designs, and the repeatability of chatbot outputs over time through standardized Kennedy classification-based RPD design prompts. SETTINGS AND DESIGN: This study used a cross-sectional design to test the consistency of four AI chatbots among raters (ChatGPT; GPT-4; OpenAI, Copilot 1.25062.106.0; Microsoft, AI Chat-AI language model; DeepAI, Claude AI; Claude 3 Opus; Anthropic) on RPD design for 80 virtual Kennedy-classified cases (40 maxillary/40 mandibular). MATERIALS AND METHODS: Eighty partially edentulous virtual cases (Class I, I Mod 2, II, II Mod 1, II Mod 2, III Mod 1, III Mod 2, and IV) were assigned to AI chatbots. Each case was randomly assessed three times daily, resulting in 960 responses evaluated. Four removable prosthodontists scored responses using a modified global quality score based on a five-point Likert scale. STATISTICAL ANALYSIS USED: Statistical analyses used the intraclass correlation coefficient (ICC) and two-way Analysis of variance ANOVA ( P ≤ 0.05). Interobserver reliability was measured using the ICC, technical quality was compared with an expert consensus reference standard, and repeated-measures ANOVA demonstrated significant temporal variation in chatbot outputs. RESULTS: All chatbots showed excellent interobserver reliability (ICC >0.90), but the resulting RPD designs had lower scores compared with the expert gold reference standards. Repeated-measures analysis indicated significant intra-rater variability across all chatbots ( P < 0.001), suggesting lower repeatability. CONCLUSIONS: AI chatbots showed excellent interobserver reliability but limited technical quality and temporal stability in the RPD framework design. ChatGPT (GPT-4; OpenAI) performed best, but all models still need expert supervision and further optimisation before use.
Journal of Indian Prosthodontic SocietySmruti Nanda, Mirna Garhnayak, Abhijita Mohapatra, Sangram Panda, Abhilash Mohapatra, Gopal Krishna Choudhury
AIM: This study aimed to compare the marginal and internal adaptation of monolithic computer-aided design and computer-aided manufacturing (CAD/CAM) zirconia crowns and heat-pressed ceramic-veneered zirconia crowns fabricated using a standardized digital workflow. SETTINGS AND DESIGN: An in vitro laboratory study was conducted using standardized epoxy resin dies and zirconia crowns fabricated by two different laboratory workflows. MATERIALS AND METHODS: Twenty zirconia crowns were fabricated from a single STL dataset with a 50-µm cement space and divided into two groups ( n = 10): monolithic CAD/CAM zirconia (MZ) and bilayer heat-pressed ceramic-on-zirconia (PVZ). All crowns were fabricated on epoxy resin dies replicated from a CAD/CAM-milled stainless-steel master die. After cementation with glass ionomer cement under a controlled seating load of 50 N, the specimens were sectioned buccolingually. Marginal and internal gaps were measured using scanning electron microscopy at eight predetermined sites. STATISTICAL ANALYSIS USED: Data were evaluated for normality using the Shapiro-Wilk test. Intergroup comparisons were performed using the Mann-Whitney U-test, with statistical significance set at P < 0.05. Bonferroni adjustment was applied for exploratory multiple comparisons. RESULTS: For the primary outcome, composite internal adaptation was lower in the monolithic CAD/CAM zirconia crown group than in the heat-pressed ceramic-veneered zirconia crown group (103.07 vs. 111.38 µm; P = 0.019), with a moderate effect size ( r = 0.53). Composite marginal adaptation did not differ significantly between the groups (88.90 vs. 95.73 µm; P = 0.226). CONCLUSION: Both fabrication workflows produced zirconia crowns with marginal and internal adaptations within clinically acceptable limits. Monolithic CAD/CAM zirconia crowns showed slightly smaller internal discrepancies than heat-pressed ceramic-veneered zirconia crowns; however, the magnitude of this difference is unlikely to affect clinical seating or cementation.
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.
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.
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.
Clinical oral investigationsEngin Sacu, Neslihan Tekce, Ahmet Erdem, Duygu Cetin, Safa Tuncer, Mustafa Demirci
OBJECTIVES: This in vitro study evaluated the effects of 2 wt% 2-methacryloyloxyethyl phosphorylcholine (MPC) and post-curing level on degree of conversion, water sorption, and Bis-EMA release from a 3D-printable resin for definitive crowns. MATERIALS AND METHODS: VarseoSmile Crown plus and its 2 wt% MPC-modified formulation were fabricated by digital light processing and post-cured with 2 × 2000, 4 × 2000, or 8 × 2000 flashes. Degree of conversion and water sorption were evaluated in 10 specimens per group, and Bis-EMA release in 5. Degree of conversion was measured before and after 10,000 thermocycles by FTIR-ATR, water sorption after thermocycling, and Bis-EMA release at 24 h and 14 days by HPLC-UV. Statistical significance was set at α = 0.05. RESULTS: Higher post-curing levels increased degree of conversion and reduced Bis-EMA release (P < 0.05), but did not affect water sorption (P = 0.294). MPC reduced degree of conversion and increased water sorption (P < 0.05), but did not affect 24-hour or cumulative 14-day Bis-EMA release (P = 0.130 and P = 0.083, respectively). Bis-EMA release from Lava Ultimate remained below the detection limit. CONCLUSIONS: Increasing post-curing improved polymerization and reduced Bis-EMA release. MPC reduced degree of conversion and increased water sorption without significantly affecting Bis-EMA release. After thermocycling, degree of conversion increased only at the lowest post-curing level. CLINICAL RELEVANCE: Appropriate post-curing may limit Bis-EMA release from definitive 3D-printed crowns. Although MPC modification was associated with lower degree of conversion and greater water sorption, the magnitude of the observed difference in degree of conversion may be of limited clinical relevance.
Journal of applied oral science : revista FOBMaria Pavli, Maria Georgaki, Nadia Theologie-Lygidakis, Nikolaos Nikitakis, Christos Perisanidis
INTRODUCTION: Leukocyte- and platelet-rich fibrin (L-PRF) has gained considerable attention due to its regenerative potential and biocompatibility in alveolar ridge preservation (ARP). OBJECTIVE: To evaluate the histological findings in post-extraction sockets after ARP with L-PRF (experimental group) and compare them with those obtained using allograft plus a collagen membrane (control group). Histological findings may contribute to the evaluation of bone quality and the rate of bone remodelling. METHODOLOGY: Twenty-six sites in 26 patients requiring extraction of a single-rooted maxillary or mandibular tooth were included in this study. Treatment options were randomly assigned. Post-extraction sockets were filled with either an L-PRF matrix or an allograft covered with a collagen membrane. Dental implant placement was performed subsequently. After 12 weeks, bone biopsies were obtained from the sites at the time of implant placement. Histological evaluation of the bone specimens assessed the area of new bone formation and the presence of osteoblasts, osteoclasts, osteolytic lacunae, osteocytes, and blood vessels. RESULTS: Histological evaluation showed that: a) the proportion of cases with >50% new bone formation was higher in the experimental group compared to the control group (53.8% [7/13] versus 30.8% [4/13]) (p=0.033) b) the presence of osteoblasts was higher (p=0.066) in the experimental group (100% versus 76.9%); c) the presence of osteoclasts was higher (p=0.004) in the experimental group (92.3% versus 38.5%); d) the presence of osteolytic lacunae was higher (p=0.063) in the experimental group (92.3% versus 61.5%); e) the presence of osteocytes was higher (p=0.03) in the experimental group (100% versus 69.2%); and f) the presence of blood vessels was higher (p=0.016) in the experimental group (84.6% versus 38.5%). The presence of osteoblasts and osteolytic lacunae were higher but were not statistically significant. CONCLUSIONS: Within the limitations of this study, ARP with L-PRF may result in accelerated healing, improved bone quality, and a higher rate of bone remodelling. These results reflect the exploratory nature of this study and support the need of additional research, preferably with a larger sample size.
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.
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 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.
The Chinese journal of dental researchYou Sheng Jiang, Lin Feng, Jun Xin Zhu, Xiao Yan Wang, Xue Jun Gao
OBJECTIVE: To explore how central retainer depth affects stress distribution and fracture resistance in endocrown-restored premolars. METHODS: A 3D finite element (FE) model of an intact maxillary premolar was established as a negative control. Five endocrown-restored FE models were established, differing in the extension of the central retainer inside the pulp chamber: 0, 2, 3, 4 and 5 mm. The remaining pulp cavity was filled with composite resin. Stress distributions were analysed under oblique loads. Thirty freshly extracted human maxillary premolars were randomly divided into three groups after endodontic treatment. The extension of the central retainer was set to 0 (G0), 2 (G2) or 4 mm (G4). After endocrown manufacturing and cementation, all specimens were subjected to oblique loads in a universal testing machine until fracture occurred. Fracture resistance was analysed by one-way analysis of variance (ANOVA). Fracture patterns were analysed using a Fisher exact test (α = 0.05). RESULTS: The FE analysis showed that within a range of 0 to 4 mm, increasing retainer depth led to decreased peak von Mises Stress (VMS) values in the cement layer and tooth cervix. At a retainer depth of 5 mm (without base material), peak VMS values were higher than those parameters at a depth of 4 mm. The mean fracture resistance values increased with the increasing retainer depth. G4 exhibited significantly higher fracture resistance than G0. The proportion of irreparable fractures increased with retainer depth. CONCLUSION: A central retainer with composite resin used as base material and extending approximately 1 mm apical to the cementoenamel junction is recommended for endocrown-restored premolars.
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.
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.
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.
AIM: This study investigated the effects of various radicular dentin conditioning agents, maleic acid, citric acid, phosphoric acid, and EDTA, on dentin-derived biomarker release and radicular dentin microhardness for regenerative endodontic applications. MATERIALS AND METHODS: Sixty single-rooted teeth were processed into dentin cylinders and discs and randomly assigned to five groups (n = 12): 7% maleic acid, 10% citric acid, 37% phosphoric acid, 17% EDTA, and phosphate-buffered saline (PBS) as a negative control. Growth factor release (TGF-β, VEGF, BMP-2) was quantified using ELISA after 24 h incubation. Microhardness changes were evaluated in corresponding dentin cylinders sectioned longitudinally. RESULTS: Maleic acid produced the highest release of TGF-β, VEGF, and BMP-2 (p < 0.001), followed by EDTA, citric acid, and phosphoric acid in a biomarker-dependent hierarchy. Microhardness was significantly affected by the conditioning agent (p = 0.004), with EDTA and maleic acid reducing dentin hardness compared with the control, while citric acid and phosphoric acid showed no significant effect. No significant differences were observed among root thirds (p = 0.169). CONCLUSION: Dentin conditioning in regenerative endodontics involves a trade-off between biological activation and preservation of structural integrity. Stronger conditioning agents enhance growth factor release but may compromise dentin hardness. Among the tested agents, citric acid demonstrated the most balanced performance, combining effective biomarker release with minimal effects on dentin microhardness. In contrast, phosphoric acid preserved dentin structure but showed limited biological activity, making it less suitable when regenerative signaling is the primary objective. CLINICAL RELEVANCE: The selection of dentin conditioning agents should not be based solely on their biological signaling potential, as it directly influences the mechanical properties of radicular dentin and may impact regenerative outcomes.
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.
Journal of applied oral science : revista FOBMarina de Brito Teixeira, Marcelo Pereira Brod, Douver Michelon, Adriana Fernandes da Silva, Evandro Piva, Rafael Guerra Lund, Wellington Luiz de Oliveira da R…
INTRODUCTION: Digital technologies and additive manufacturing are transforming restorative dentistry by enabling the production of highly customized provisional crowns using cost-effective methods. OBJECTIVE: This study evaluated the physicomechanical and biological properties of photosensitive resins designed for Digital Light Processing (DLP) printers when used to fabricate provisional restorations with an affordable Liquid Crystal Display (LCD) printer. METHODOLOGY: Three resins - NextDent C&B (ND), Cosmos Temp (CT), and Prizma BioProv (PB) - were tested and compared against bis-acryl (BR) and self-cure PMMA (SA) controls. Evaluated properties included flexural strength, elastic modulus (immediate, 30, and 90 days), Knoop microhardness, radiopacity, surface roughness, water sorption, solubility, and dimensional accuracy. Biological assessment employed L929 fibroblast cell viability at 1, 7, and 14 days. Data were analyzed using One-way or Two-way ANOVA and Tukey's test (p<0.05). RESULTS: CT exhibited the highest flexural strength, elastic modulus, and Knoop microhardness, alongside the lowest surface roughness, water sorption, and solubility compared to all other materials. ND showed lower surface roughness than controls but higher water sorption. PB presented mechanical properties comparable to those of the controls, but with higher roughness and solubility. All 3D-printed resins exhibited low radiopacity, and, with the exception of BR, cell viability decreased significantly for all materials up to day 14. CONCLUSION: Selected photosensitive resins processed via an affordable LCD printer showed physicomechanical performance comparable to traditional bis-acryl and PMMA resins in fabricating provisional crowns. However, the low radiopacity observed for all 3D-printed materials and the time-dependent decrease in cell viability represent limitations that warrant further investigation.
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.
International journal of implant dentistryThomas Mehnert, Michael Noack, Philip Simon, Florian Beuer, Stefano Pieralli
BACKGROUND: Data on market-available two-piece zirconia (ZrO₂) dental implants are limited. Therefore, the aim of this retrospective study was to evaluate the clinical performance of a commercially available ZrO₂ implant system over a 24-month period. MATERIALS AND METHODS: In a single private dental office, 35 patients received 63 two-piece ZrO₂ implants for the support of single crowns (SC), fixed dental prostheses (FDP), and overdentures between September 2017 and October 2021. To ensure cohort homogeneity, 31 patients, which received 44 implants to support SCs, were selected for statistical analysis. An anonymized database was used to examine survival and complication rates, marginal bone loss (MBL), and soft tissue parameters. Patients were followed within a defined recall period of at least two years. Descriptive statistics (95% CI) were calculated for MBL, with paired t-tests and one-way ANOVA for comparisons. Associations and clinical parameters were analyzed using Chi-square/Fisher's exact, paired t-test, and Wilcoxon tests (p ≤ 0.05). RESULTS: During the observation period, no implant losses or implant fractures occurred. The mean MBL was 0.24 ± 0.58 mm at 6 months, 0.18 ± 0.62 mm at 12 months, and 0.20 ± 0.66 mm at 24 months. These values were statistically within the range of random variation. MBL differed between the maxilla and mandible, but not significantly. Probing depths increased significantly over time but did not exceed 2.78 ± 0.26 mm. Bleeding on probing mean values showed a continuous decrease from 9.1 ± 13.7% at baseline to 1.1 ± 4.3% after 24 months, with significant differences between baseline and 24 months, as well from 6 to 24 months (p = 0.002 and p = 0.003 respectively). CONCLUSION: Over 24 months, two-piece ZrO₂ implants exhibited a 100% survival rate with no observed fractures. MBL was reduced, especially in augmented sites. The presented data support the short-term suitability of this implant system for single-unit restorations. CLINICAL TRIAL NUMBER: Not applicable.
Brazilian oral researchTiago Schaffer Ramos, Diógenes Dias Oliveira, Caren Serra Bavaresco, Flávio Renato Reis de Moura
The aim of the present study was to investigate factors associated with the municipal provision of dental prostheses via the Brazilian Unified Health System (UHS). This cross-sectional study covered 5,565 Brazilian municipalities, utilizing data from a secondary database. The dependent variable was the municipal provision of dental prostheses. The independent variables were demographic and socioeconomic characteristics (regions of Brazil, number of residents in the municipality, health budget, gross domestic product [GDP] per capita, municipal human development index [MHDI], and Gini coefficient) and municipal structure of primary oral care (family health team [FHT] coverage, oral health team [OHT] coverage, OHT/FHT proportion) and secondary oral care (presence of dental specialties center [DSC], types of DSC, municipality employing at least one dentist specialized in dental prosthetics [DSDP], presence of regional dental prosthesis laboratory [RDPL]). Poisson regression with robust variance (p ≤ 0.05) was used for multivariate analysis. A total of 57% of Brazilian municipalities provided dental prostheses via the UHS. Municipalities in the Northeast region were 16% (PR = 1.16; 95%CI: 1.12-1.20) more likely to provide dental prosthetics via the UHS. Municipalities with a low GDP per capita (PR = 1.10; 95%CI: 1.08-1.11), the presence of a DSC (PR = 1.17; 95% CI: 1.15-1.19), the presence of a type III DSC [containing 7 or more dental offices] (PR = 1.06; 95%CI: 1.03-1.10), an employed DSDP (PR = 1.15; 95%CI: 1.12-1.18) and an RDPL (PR = 1.25; 95%CI: 1.23-1.27) were more likely to provide dental prostheses via the UHS. Demographic and socioeconomic factors and the available primary and secondary oral care structure influenced the municipal provision of dental prostheses via the UHS.
PURPOSE OF REVIEW: This study aims to identify complications and difficulties in oncology patients undergoing dental implant osseointegration, considering the impact of treatment on the microarchitecture of the craniofacial region, the oral cavity microbiome, and oral cavity inflammation. RECENT FINDINGS: Surgical resection, radiotherapy, chemotherapy, and targeted therapies significantly affect the condition of bones, mucous membranes, and soft tissues, and consequently the possibilities and limitations of prosthetic rehabilitation. Chemotherapy significantly affects calcium and phosphorus metabolism. It has been observed that there is an increased risk of fractures, as well as changes in their microarchitecture, and a reduction in the resorption of biomaterials after transplantation has been observed, impairing bone repair in critical defects. These changes may also affect the processes of osteogenesis and osteoclastogenesis and lead to osteoblast cell apoptosis. The impact of therapy on the oral microbiota, as well as on increased inflammation and oxidative stress in the oral cavity, is also significant. These changes can lead to difficulties in implant osteointegration, as well as opportunistic infections, which reduce the patient's prognosis for implant acceptance. Complications after implantation in oncology patients may include inflammation of the mucosa around the implant and inflammation of the tissues around the implant, soft tissue ulceration, marginal bone loss, and partial loss of osseointegration. Due to the complexity of the processes occurring in the oral cavity of oncology patients, prosthetic treatment planning should be interdisciplinary and involve an oncologist, surgeon, prosthodontist, and conservative dentist.
International journal of oral implantology (Berlin, Germany)Priyanshu Priyam, Neha Jain, Vidushi Saxena
PURPOSE: This systematic review and meta-analysis evaluated the accuracy of dental implant placement using digital surgical guides in the anterior maxilla. The anterior maxilla was assessed as a region-specific subgroup due to its unique anatomical constraints, high aesthetic demands and increased sensitivity to positional deviations compared to other arch regions. MATERIALS AND METHODS: A comprehensive literature search was conducted across the PubMed, Google Scholar, and EBSCOhost databases. The search followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and included studies reporting the accuracy of digital surgical guides used for implant placement in the anterior maxilla. Six studies met the inclusion criteria for qualitative synthesis, of which five were eligible for quantitative meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute checklists tool for clinical studies and the Quality Assessment Tool for In Vitro Studies for in vitro designs. Meta-analysis was performed using a random-effects model and certainty of evidence was further evaluated using the Grading of Recommendations Assessment, Development and Evaluation analysis. RESULTS: All included studies reported deviation metrics between the virtually planned and postoperative implant positions. The pooled meta-analysis demonstrated mean apical deviation of 0.89 mm (P 0.00001), depth deviation of 0.43 mm (P 0.00001) and angular deviation of 2.47° (P 0.00001). Substantial heterogeneity (I2 > 90%) was observed among the included studies; therefore, a random-effects model was used. According to the the Grading of Recommendations Assessment, Development and Evaluation assessment, the certainty of evidence was moderate for apical deviation but low for depth and angular deviation. CONCLUSION: Digital surgical guides demonstrated implant placement deviations within commonly reported clinical thresholds in the anterior maxilla, suggesting acceptable accuracy in appropriately selected clinical scenarios. However, due to substantial heterogeneity among studies and low-to-moderate certainty of evidence, these findings should be interpreted with caution. CONFLICT-OF-INTEREST STATEMENT: The authors declare that there are no conflicts of interest relating to this study.
International journal of oral implantology (Berlin, Germany)Renzo Guarnieri, Tiziano Testori, Richard Lazzara, Massimo Del Fabbro, Luca Testarelli
PURPOSE: To evaluate the long-term prognostic value of a biomarker-guided implant risk tool in predicting the occurrence of peri-implantitis. MATERIALS AND METHODS: From a pool of private implant patients enrolled in a supportive care programme for at least 10 years, 80 partially edentulous subjects were recruited and evaluated retrospectively. A prognostic score was estimated based on the area under the curve for receiver operating characteristic including 95% confidence intervals. Analyses were performed at the patient level. RESULTS: The mean implant follow-up period was 10.5 years. Incidence of peri-implantitis was 17.5%. The percentage of cases at high risk of peri-implantitis according to the biomarker-guided implant risk tool was 27.6%. The area under the receiver operating characteristic curve for the biomarker-guided implant risk tool was 0.836 for peri-implantitis events. A high biomarker-guided implant risk score was significantly associated with incidence of peri-implantitis, with a hazard ratio of 4.8. CONCLUSION: The biomarker-guided implant risk tool might represent a promising means to assess patients at high risk of developing peri-implantitis. CONFLICT-OF-INTEREST STATEMENT: The authors declare there are no conflicts of interest relating to this study.