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Dental treatment after endodontic therapy is quite challenging in clinical practice. While multiple post-and-core systems emerged and disappeared in the dental field, the historical process was laborious and still requires several up to date scientific evidence. Furthermore, once considered the gold standard, rigid metallic post-and-cores might be considered a limited option. Moreover, the development of glass-fiber posts and the biomechanical principles for root preparation bring multiple advantages, but also raise concerns over guidelines and indications. This review examined the classic literature so that clinicians may understand the concepts behind post endodontic restorative treatments and the doubts that still remain in the daily practice before performing this restorative modality.

Objectives: This systematic review aimed to determine whether bioactive resin materials can prevent secondary caries or enhance the longevity of direct posterior restorations., Data Sources: The protocol was registered in PROSPERO (CRD42024561179). The review followed PRISMA guidelines, utilizing a PICO framework. Studies were identified through searches in six databases (PubMed, Scopus, Cochrane, Embase, Scielo, Web of Science) up to May 2024., Study Selection: Two independent reviewers applied inclusion criteria, selecting randomized clinical trials evaluating bioactive resin composites in restorative dentistry. Data were extracted into pre-designed forms, and article quality was assessed using the CONSORT, RoB 2, and GRADE tools. Meta-analyses focused on secondary caries incidence and restoration longevity using USPHS and FDI criteria., Results: Of 1,565 articles identified, 10 met the inclusion criteria. These studies, conducted in five countries, included 411 participants with follow-up periods ranging from 1 to 8 years. Materials evaluated included ACTIVA™ BioACTIVE, Giomer, and Cention N. Meta-analysis found no statistically significant differences between bioactive and conventional resin composites in preventing secondary caries or reducing retention loss (p > 0.05), the two primary outcomes considered in this review for assessing restoration longevity. Subgroup analysis showed no differences between follow-up periods., Conclusions: Bioactive materials demonstrated similar clinical performance to conventional composites in preventing secondary caries and retaining restorations, offering no additional benefit in enhancing the longevity of direct posterior restorations., Clinical Significance: This review provides evidence that bioactive resin materials offer no significant clinical advantage over traditional composites, guiding (or informing) clinicians in (or about) material selection for restorative treatments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study investigates longevity of glass ionomer restorations in an older adult population., Methods: This was a retrospective study based on clinical records. Patient records for 3,665 restorations in 1,777 adults 65 or older who had received a restoration between 12th July 2016 and 20th October 2022 were extracted from the electronic dental records system of the University of Iowa College of Dentistry and Dental Clinics. The data were analyzed to determine the influence of patient factors and restorative material on restoration longevity. Single variable and multiple variable survival models were created., Results: Many variables that showed a statistically significant influence on restoration longevity in the single variable survival models and did not show such an influence in the multivariable model, indicating the effect of these variables is explained when other factors are controlled for. In particular, patient age at the time of restoration showed no significant influence in the multivariable model, and no medical factor had a statistically significant influence. The restorative material did show a significant influence in the multivariable model; using the resin-modified glass ionomer restorative (Fuji II LC) as a reference, the conventional glass ionomer restorative (Fuji IX) had a hazard ratio of 2.0 (p = 0.011), and the coated-conventional glass ionomer restorative (Equia) had a hazard ratio of 2.8 (p < 0.001)., Significance: Resin-modified glass ionomer restorations may have superior longevity for older adults than conventional and coated-conventional glass ionomer restorations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was funded by the Nakao Foundation, which in turn was established by GC, the manufacturer of the restorative materials investigated., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: This 24-month, double-blind, split-mouth randomized equivalence clinical trial compared the clinical performance of a bulk-fill thermoviscous composite resin using two different preheating methods for the restoration of non-carious cervical lesions (NCCLs)., Material and Methods: A total of 120 NCCLs were randomized into two groups (n = 60 each). In one group, a bulk-fill thermoviscous composite resin (VisCalor bulk, Voco GmbH) was preheated using a dispenser heater (DH, VisCalor Caps dispenser/warmer), while in the other group, the same resin was preheated with a bench heater (BH, Caps Warmer). In the BH group, the composite underwent preheating at 68 °C using a heating bench for 3 min while in the DH group, the composite was preheated at the same temperature for 30 s using a dispenser heater. Subsequently, the preheated bulk-fill thermoviscous composite resin was directly applied to the NCCLs. The restorations were evaluated at baseline, and after 6, 12, 18, and 24 months of clinical service using the FDI criteria. The total working time was recorded. The study used TOST-P to assess groups equivalence, Kaplan-Meier analysis for retention/fracture rate, log-rank test for secondary outcomes' survival distributions, and paired t-tests for comparing time per clinical step between groups (α = 0.05)., Results: After 24 months, 106 restorations were evaluated. Four restorations were lost-two from the DH group and two from the BH group-resulting in similar retention rates for both groups (96.1%, 95% CI 86.8 - 98.9, p > 0.05). The hazard ratio was 0.83 (95% CI 0.26 to 2.72), indicating no significant difference between the groups (p > 0.05). All other FDI parameters were deemed clinically acceptable. However, the total working time for the BH group was significantly longer than that for the DH group (p < 0.001)., Conclusions: Both preheating protocols employed for the bulk-fill thermoviscous composite resin demonstrated high and equivalent survival rates after 24 months, the other FDI parameters were deemed clinically acceptable over the same period., Clinical Significance: Clinicians can choose either method for heating the thermoviscous composite resin for restoration of non-carious cervical lesions, as they do not impact important clinical outcomes after 24 months. The total working time for the bench heater is higher than that for the dispenser heater due to the need for preheating of the bench heater., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to introduce a novel technique for fabricating provisional crowns integrated as a single unit with aligner attachments., Methods: A total of 60 crowns with attachments were prepared: 20 conventional (Protemp) and 40 3D-printed (20 bonded with attachments; 20 integrated with composite attachments as a single unit) using NextDent resin. Two central incisors were scanned (once without attachments and once with attachments) to create STL files for specimen printing. Half of the specimens (30, n = 10 per group) underwent thermal cycling (5000 cycles). Shear bond strengths (MPa) were evaluated using a universal testing machine. The debonded areas and attachment failures were analyzed to determine the fracture type. Data analyses were performed using ANOVA and post hoc Tukey tests (α = 0.05)., Results: The 3D-printed specimens showed higher strength values than the bonded attachments per group (P < 0.001). The 3D-printed crowns with attachments demonstrated the highest strength (12.39 ± 1.92 MPa). Thermal cycling significantly decreased the bond strength of the attachments (P < 0.001), except in the 3D-printed crowns with composite attachments as a single unit, which showed no significant change after thermal cycling (P = 0.643). In the bonded attachment groups, the adhesive type was the predominant failure mode, while in the 3D-printed groups, attachment fractures were the primary cause of failure., Conclusion: The 3D-printed provisional crowns with attachments have high strength and is clinically appropriate for orthodontic treatment when temporization of teeth is indicated., Clinical Significance: The developed technique for fabricating 3D-printed provisional restorations with orthodontics attachments as a single unit is a promising approach. The technique may be incorporated into the digital orthodontic treatment workflow when temporization is indicated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To compare the clinical efficacy of resin nanoceramic and zirconia-reinforced lithium silicate ceramic endocrowns in the treatment of endodontically treated teeth by assessing the clinical performance of restorations fabricated using a chairside computer-aided design/computer-aided manufacturing (CAD/CAM) system., Materials and Methods: Ninety endocrown restorations were fabricated on endodontically treated teeth using a CAD/CAM system. Fifty-two restorations were fabricated using Lava Ultimate blocks (LU, 3 M Espe, Seefeld, Germany) and 38 restorations were fabricated using Celtra Duo blocks (CD, Dentsply Sirona, York, PA, USA). The performance of the endocrown restorations was evaluated over a 3-year period using the modified United States Public Health Service (USPHS) criteria by two calibrated evaluators. The data were analyzed using Chi-square (x 2 ) and Fisher exact tests (p < 0.05)., Results: The restoration survival rates in the two groups were 82.7 % (LU) and 86.8 % (CD) (p = 0.6). Twelve restorations failed (8 LU, 4 CD) due to debonding (n = 4, 2 LU, 2 CD), ceramic fracture (n = 2, 1 LU, 1 CD), tooth fracture (n = 5, 4 LU, 1 CD), and secondary caries (n = 1, 1 LU) during the follow-up period. There was no statistically significant difference between the two materials according to the modified USPHS criteria (p > 0.05)., Conclusion: Resin nanoceramic and zirconia-reinforced lithium silicate ceramic endocrown restorations fabricated using a chairside CAD/CAM system demonstrated acceptable clinical performance in the treatment of endodontically treated teeth., Clinical Significance: Resin nanoceramic and zirconia-reinforced lithium silicate ceramics are potential alternative materials for the chairside fabrication of endodontically treated teeth., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To assess the association between smoking and early dental implant failure by conducting a systematic review and meta-analysis of observational studies., Data Sources: PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched for reports of relevant studies addressing the relationship between smoking and early dental implant failure published between database inception and June 2024., Study Selection: Thirty-two observational clinical studies published between 1994 and 2024 were included, with a total of 59,246 implants at implant level and 14,115 patients at individual level. At implant level, a meta-analysis of 21 included cohort studies showed that smoking was associated with increased risk of early dental implant failure compared with non-smoking (odds ratio [OR], 2.59; 95 % confidence interval [CI], 2.08-3.23). Three included studies reported that smoking was associated with higher maxillary early dental implant failure risk (OR, 5.90; 95 %CI, 2.38-14.66) than that of mandible (OR, 3.76; 95 %CI, 1.19-11.87). At individual level, meta-analysis of thirty cohort studies indicated that risk of early implant failure in smokers was 100 % higher than in non-smokers (OR, 2.00; 95 %CI, 1.43-2.80). Three case-control studies found that risk of early implant failure of smokers was 59 % higher than that of non-smokers (OR, 1.59; 95 %CI, 1.28-1.97)., Conclusions: Smoking was significantly associated with early dental implant failure, particularly at the maxillary location, at both implant and individual level. These findings suggest smoking cessation is a crucial factor in reducing risk of early dental implant failure., Clinical Significance: There is uncertainty about the extent to which smoking influences early dental implant failure, our meta-analysis of findings emphasize smoking was significantly associated with early dental implant failure, particularly at the maxillary location., Competing Interests: Declaration of competing interest The authors declare no conflict of interest, financial or otherwise., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: This study aimed to compare the outcome of a simplified direct composite resin-bonded fixed dental prostheses without reinforcing fibers (CR-RBFDP) and resin-bonded fixed dental prostheses using zirconia (Zr-RBFDP)., Methods: The clinical records of five private practice dental clinics and one university hospital were analyzed. Failure was defined as a RBFDP that was removed or remade for any reason. Survival analyses were performed using log-rank tests., Results: A total of 45 patients (CR-RBFDP, n = 17; Zr-RBFDP, n = 28) were followed up for 3 years. Among the CR-RBFDP cases, 1 case of framework fracture and 2 cases of discoloration occurred, whereas among the Zr-RBFDP cases, 1 case of debonding occurred. The mean duration of observation was 21.9 months. The 3-year survival rate was 92.3 % for CR-RBFDP and 91.7 % for Zr-RBFDP. Log-rank test showed no significant difference (p = 0.78)., Conclusions: Within the limitations of this short-term retrospective study, the survival rate of CR-RBFDP was not significantly different from that of Zr-RBFDP. Contrary to concerns regarding material strength, CR-RBFDP showed reliable results. This direct composite restoration has the advantages of being less invasive and being completed in a single visit., Clinical Significance: Despite differences in material strength, CR-RBFDPs without fiber reinforcement showed reliable short-term clinical results. This direct composite restoration has the advantage of being less invasive and can be restored in a single visit., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: This study aimed to investigate the clinical performance of zirconia-based fixed dental prostheses (FDPs) in comparison to metal-ceramic (MC) FDPs., Methods: A comprehensive search on MEDLINE (PubMed), Web of Science (Core Collection), Scopus up to June 2024 was conducted. Studies that compared the success, survival and complication rates between zirconia based FDPs and MC FDPs were eligible for inclusion., Results: Thirty-one articles were identified, of which 22 were included for systematic review and 7 RCTs were included for meta-analysis. 10, 9 and 3 studies were classified to mean follow-up ≤ 5 years, 5 years < mean Follow-up ≤ 10 years, mean Follow-up >10 years, respectively. In the pooled analysis, 180 bilaminar zirconia (ZC) FDPs and 206 MC FDPs were included. ZC FDPs were significantly associated with more failures (RR=3.64, p = 0.009) and more Ceramic Chipping (RR=2.92, p < 0.0001) when compared to MC FDPs. Higher risks of Framework Fracture (RR=4.57, p = 0.18), Loss of Retention (RR=4.79, p = 0.17), Secondary Caries (RR=1.25, p = 0.68), Endodontic complications (RR=1.30, p = 0.74) and Marginal Integrity (RR=1.07, p = 0.88) were also found in ZC FDPs when compared to those of MC FDPs, but with no statistical difference., Conclusion: The current evidence continues to support the preference for traditional MC FDPs over ZC FDPs. Studies indicate that ZC FDPs have higher failure rates and more complications compared to MC FDPs, with ceramic chipping being a significant concern. There is lack of long term (>10 years follow-up) evidence of the clinical performance of ZC FDPs and monolithic zirconia FDPs., Clinical Significance: The study suggests that despite the growing popularity of zirconia, evidence shows MC FDPs may still be considered preferable to ZC FDPs., Competing Interests: Declaration of competing interest This study did not receive any grants from public, commercial, or not-for-profit sectors, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: to compare two-year clinical success rates of caries management in children (Hall Technique HT, Nonrestorative caries treatment NRCT, Conventional restorations CR), and to evaluate pain perception, behaviour, technique acceptability by patients, parents and dentists., Methods: 122, 3-8-year-olds were enrolled in 2-year parallel group randomised controlled trial (CR, n = 52, HT, n = 35, NRCT, n = 35). Caries was recorded using Nyvad criteria to measure clinical success/ failure rates. Child's pain perception (Visual Analogue Scale of Faces), child behaviour (Frankl scale), parents' and dentists' treatment opinions (5-point Likert scale) were assessed. Statistical analysis included Chi-square, non-parametric Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests (p < 0.05), absolute risk reduction (ARR) and number needed to treat (NNT)., Results: After two years, with 116 participants, clinical success rates were: CR=60.8 % (n = 31), HT=93.8 % (n = 30), NRCT=42.5 % (n = 14) (p < 0.001). Major/minor failure rates differed: CR=17.6 % (n = 9) / 21.6 % (n = 11); HT=6.2 % (n = 2)/ 0 %, NRCT=33.3 % (n = 11)/ 24.2 % (n = 8), (p < 0.05). When comparing HT to CR, ARR = 0.33; NNT= 3 (95 % CI 0.02 -0.58); NRCT to CR, - no observed benefit from NRCT. More than 70 % of children demonstrated "positive/definitely positive" behaviour during treatment. Pain intensity was "very low/low" in 92.3 % of cases for CR, 88.6 % for HT, and 77.1 % for NRCT . NRCT was "very easy" to perform for 82.9 % of participants, compared to 42.3 % for CR and 17.1 % for HT (p < 0.05). CR were reported to take longer than NRCT and HT (p < 0.05)., Conclusion: Clinical success rates of HT were superior to CR and NRCT. All treatment techniques were well tolerated by children, CR was more time-consuming and HT - technically more difficult to perform., Clinical Significance: caries management in primary molars can be successfully performed using minimal intervention, particularly, sealing in caries lesions with Hall technique. NRCT can prevent caries progression when adequate access to mechanical plaque disruption and fluoride is provided. However, occasional fluoride application, and uncontrolled toothbrushing with fluoride toothpaste cannot replace restorative procedures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: There is a paucity of data on the outcome of fixed tooth- and implant-supported porcelain-fused-to-metal (PFM) and ceramic-based (CB) restorations fabricated during undergraduate dental education. Therefore, this retrospective study examined the outcome of fixed restorations placed in patients participating in an undergraduate program., Methods: Patient records were searched for data on fixed PFM and CB restorations. For these restorations, the functional period in situ and technical and biological complications, namely restoration fracture, decementation, screw loosening, secondary caries, and loss of vitality, were recorded. Periodontal parameters were also documented. Kaplan-Meier survival and complication estimates after 1 and 5 years were calculated for restoration types, materials, designs (veneered/non-veneered), cementation/retention modes and localizations with group sizes ≥ 15. Regression models were used to analyze the influence of demographic data and abovementioned restoration characteristics on restoration survival, technical and biological outcome., Results: 1196 restorations with a mean observation time of 5 years were included in the analysis. The different restoration types exhibited survival rates of > 90.8% after 5 years, accompanied by a favorable biological outcome. However, monolithic resin-matrix or feldspathic ceramic restorations were found to have a higher fracture rate than lithium disilicate or zirconium dioxide ceramic restorations resulting in lower survival rates for these restorations. Additionally, resin-matrix ceramic restorations showed a higher decementation rate than lithium disilicate restorations., Conclusions: Fixed tooth- and implant-supported CB restorations fabricated from lithium disilicate and zirconium dioxide ceramics demonstrated better survival and lower complication rates than restorations fabricated from resin-matrix or feldspathic ceramics in an undergraduate dental education program., Clinical Significance: Due to the more favorable outcome of CB restorations fabricated from lithium disilicate or zirconium dioxide ceramics, undergraduate dental education should focus on the application of these ceramics to increase restoration survival by reducing technical complications., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess the clinical performance of monolithic screw-retained implant-supported zirconia crowns (MSI) bonded or mechanically retained on prefabricated Ti-bases using a complete digital workflow., Methods: A retrospective analysis was conducted on patients who underwent single dental implant procedures between January 2017 and May 2018. Inclusion criteria were: patients over 18 years of age; implants placed in posterior sites; MSI on prefabricated Ti-base realized by using a complete digital workflow; a minimum follow-up period of 2 years. Cemented crowns and fixed dental prosthesis were excluded. Mechanical complications included: fracture of Ti-base; loss of retention; loosening of Ti-base screws. Technical complications included: fracture and debonding of monolithic zirconia. Biological complication was set strictly at a probing pocket depth of 5 mm and bleeding on probing or pus secretion., Results: A total of 144 dental implants placed in 127 patients were included, 73 with a fully tapered implant system (BLX) and 71 with a conical connection system (Nobel Parallel CC). Of the 73 BLX implants, 4 experienced loosening of the Ti-base screw, while 3 Nobel Parallel CC implants experienced the same problem. In addition, 4 fractures of the Ti-base and 6 fractures of the inner surface of the monolithic zirconia were observed in the Nobel Parallel CC implants. Cumulative survival was 100 % for bonded crowns and 85 % for mechanically retained crowns. Radiographic evaluation revealed a mean CBL of 0.12 mm for the BLX and 0.13 mm for the Nobel Parallel CC implants with no statistically significant differences between the Ti-base types. There was no evidence of bleeding on probing or pus secretion. All probing pocket depths were <3 mm., Conclusion: The use of a prefabricated Ti-base remains a clinically acceptable choice, however, MSIs bonded to prefabricated Ti-bases had fewer mechanical and technical complications than the MSI mechanically retained to a prefabricated Ti-base., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This systematic review attempted to assess patient acceptance of repairs instead of complete replacement for partially defective restorations and to identify factors affecting patients' decision-making for or against repairs., Study Selection: Observational and qualitative studies reporting on (1) the proportion of patients accepting or preferring repairs, (2) the proportion of dentists / dental students / dental schools stating that their patients accept or prefer repairs, (3) factors affecting patients' decision-making for or against repairs., Sources: Electronic databases (MEDLINE via PubMed, Scopus, EMBASE via Ovid, and Web of Science) were last searched in August 2024 (PROSPERO database: CRD42023449437)., Data: Twenty-one sources reporting on 20 survey studies addressing individual dentists / dental students and dental schools were included. None of the included studies directly addressed patients (e.g., by interviewing patients). Of the surveyed dentists and dental students, 86.3 % (95 %-CI: 77.8-91.8 %) reported that their patients accept or prefer repairs. Dental schools rated patient acceptance as high as 93.0 % (95 %-CI: 82.3-97.4 %). None of the included studies reported factors affecting patients' decision-making for or against repairs., Conclusions: Repairs of partially defective restorations instead of complete replacement seem to be associated with a high level of patient acceptance as most dentists, dental students, and dental schools stated that their patients accept or even prefer repairs instead of complete replacement., Clinical Significance: Within the shared decision-making process, dentists can expect their patients to accept or even prefer repairs instead of complete replacement., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: The aim of this study was to predict the risk of dental implant loss by clustering features associated with implant survival rates., Materials and Methods: Multiple clinical features from 8513 patients who underwent single implant placement were retrospectively analysed. A hybrid method integrating unsupervised learning algorithms with survival analysis was employed for data mining. Two-step cluster, univariate Cox regression, and Kaplan‒Meier survival analyses were performed to identify the clustering features associated with implant survival rates. To predict the risk of dental implant loss, nomograms were constructed on the basis of time-stratified multivariate Cox regression., Results: Six clusters with distinct features and prognoses were identified using two-step cluster analysis and Kaplan‒Meier survival analysis. Compared with the other clusters, only one cluster presented significantly lower implant survival rates, and six specific clustering features within this cluster were identified as high-risk factors, including age, smoking history, implant diameter, implant length, implant position, and surgical procedure. Nomograms were created to assess the impact of the six high-risk factors on implant loss for three periods: 1) 0-120 days, 2) 120-310 days, and 3) more than 310 days after implant placement. The concordance indices of the models were 0.642, 0.781, and 0.715, respectively., Conclusions: The hybrid unsupervised clustering method, which clusters and identifies high-risk clinical features associated with implant loss without relying on predefined labels or target variables, represents an effective approach for developing a visual model for predicting implant prognosis. However, further validation with a multimodal, multicentre, prospective cohort is needed., Clinical Significance: Visual prognosis prediction utilizing this nomogram that predicts the risk of implant loss on the basis of clustering features can assist dentists in preoperative assessments and clinical decision-making, potentially improving dental implant prognosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To assess radiographic, clinical and patient-reported outcomes of single zirconia implant-supported crowns on titanium base abutments (TBA) over a 7.5-year period., Methods: Twenty-four patients received bone-level titanium implants and screw-retained zirconia implant crowns utilising TBA. Marginal bone level (MBL), clinical parameters (probing depth-PD, bleeding on probing-BoP, plaque control record-PCR), technical complications (USPHS criteria) and patient satisfaction were assessed at crown delivery (baseline), 1 year (FU-1) and at 7.5 years (FU-7.5) of follow-up., Results: Eighteen patients were available for re-examination at 7.5 years. The mean MBL at FU-7.5 (0.35 ± 0.20mm) did not significantly change compared to baseline (0.54 ± 0.39, p=.352) and to FU-1 (0.54 ± 0.45mm, p=0.524). From baseline to 7.5 years, the mean PD increased significantly, from 3.0 ± 0.6mm to 3.7 ± 0.8mm (p=0.005). However, BoP and PCR did not significantly change; (BOP: from 27.1 ± 20.7% to 25.0 ± 20.0%, p=0.498; PCR: from 11.1 ± 21.2% to 25.0 ± 25.1%, p=0.100). Nine patients presented with more than one bleeding site. This denoted a peri-implant mucositis prevalence of 50%, whilst none of the implants presented peri-implantitis. One incidence of minor and major ceramic chipping were reported on 2 out of the 18 crowns, resulting in a prosthetic survival rate of 94.4%. Seventeen patients were highly satisfied with their result., Conclusion: Single implant-supported zirconia crowns on TBA displayed: (i) minor number of technical complications, (ii) high prosthetic survival rate, (iii) stable marginal bone level and (iv) high patient satisfaction at 7.5 years., Clinical Implications: Titanium base abutments despite their high use in clinical practice, lacked medium- and long-term studies. The presented findings highlight their clinical performance at 7.5 years as they display satisfying radiographic, clinical and patient-related outcomes. TBA appear to be a suitable abutment choice for medium-term implant-supported restorations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To evaluate the fracture resistance (FR) of polyetheretherketone (PEEK) abutments produced by additive and subtractive methods compared to milled zirconia abutments., Methods: Custom abutments were designed on Ti-base abutments and produced from three different materials, namely additively manufactured PEEK (PEEK-AM), subtractively manufactured PEEK (PEEK-SM), and zirconia (N = 60). PEEK-AM abutments were printed using PEEK filaments (VESTAKEEP®i4 3DF-T, Evonik Industries AG) on a M150 Medical 3D Printer (ORION AM) by fused filament fabrication (FFF). All surface treatments were carried out according to the manufacturer's instructions. All abutments were cemented on Ti-bases with hybrid abutment cement and then restored with milled zirconia crowns. Each subgroup was divided into non-aged and aged subgroups (n = 10). The aged groups were subjected to thermomechanical aging (49 N, 5-55 °C, 1.2 million cycles). FR tests were performed by using an universal testing machine. Data were statistically analyzed with one-way and two-way ANOVA and t-test., Results: The survival rate of the specimens after aging was determined as 100%. It was found that both the material and aging had a significant effect on the FR (p<.001). There was a statistical difference among the fracture values of the groups (p<.001). In both the aged and non-aged groups, PEEK-AM showed the statistically lowest FR, while the highest FR was seen in the zirconia group, which was significantly higher than the PEEK-SM (p<.001)., Conclusion: Hybrid abutments were successfully manufactured, and extrusion-based processed PEEK seems to be a good alternative to subtractive processed PEEK. However, since subtractive manufacturing still appears to be superior, further developments in additive manufacturing are needed to further improve the quality of 3D-printed PEEK parts, especially in terms of accuracy and bonding between adjacent layers., Clinical Significance: Additively manufactured PEEK abutments have the potential to be an alternative for implant-supported restorations in the posterior region., Competing Interests: Declaration of competing interest All other authors have no conflicts of interest to declare. The authors do not have any financial interest in the companies whose materials are included in this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Endocrowns can be fabricated from various materials as a treatment option for endodontically treated teeth. This mixed cohort study aimed to demonstrate the clinical efficacy of Endocrowns made of feldspathic, zirconia lithium silicate, and lithium disilicate ceramics using a chairside CAD/CAM system., Methods: The present study compared the clinical outcomes of 141 Endocrown restorations in posterior teeth of 85 patients in a two-year follow-up. The efficacy of restorations was evaluated in three aspects: esthetics, biological response, and function, with the aid of the FDI guideline, and presented as descriptive analyses. Additionally, the data were analyzed using Chi-square and Spearman correlation tests. The significance level was set at p = 0.05., Results: The study findings revealed that the type of restorations (feldspathic ceramic, zirconia lithium silicate, and lithium disilicate) (p > 0.05) and underlying teeth (molars and premolars) (p > 0.05) play no part in restorations' failure. Caries' recurrence is primarily responsible for the failure of the endocrowns. Secondary caries and radiolucency were observed in four teeth (2.83 %). The clinical efficacy of 126 restorations (89.36 %) fell into the category of "clinically excellent" and "clinically good." Ten restorations (7.09 %) were classified as "clinically sufficient/satisfactory," and only five restorations (3.54 %) needed replacement due to having "clinically unsatisfactory" and "clinically poor" quality., Conclusions: Endocrowns showed a high success rate and durability in the short term, therefore can be considered a safe choice for restoring endodontically treated teeth. It is worth noting that caries were the most common reason for the failure of the restorations., Clinical Significance: Endocrowns made of different ceramics have been proven reliable restorations for endodontically treated molars and premolars., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This prospective clinical trial evaluated the clinical performance of ceramic partial coverage indirect adhesive restorations (PCIARs) in posterior teeth luted with a light-cured composite resin., Methods: From April 2016 to January 2017, a total of 60 patients (27 males, 33 females; mean age: 42.2 ± 10.86 years old) received 83 glass-ceramic PCIARs (26 onlay, 57 overlay) made of IPS Emax CAD (Ivoclar Vivadent). All restorations were luted with a light-cured composite resin (Filtek Z250, 3 M ESPE) by two operators. Two independent calibrated examiners blinded to the operators performing the treatment evaluated the restorations at baseline, 1-year, and 5-year following FDI World Dental Federation criteria including esthetic, functional, and biological properties. Data were analyzed with the Friedman test and the Wilcoxon sign test (p < 0.05)., Results: None of the restorations failed due to fracture or retention loss. One restoration was clinically unsatisfactory because of secondary caries. Marginal staining (p:0.000), marginal adaptation (p:0.018) showed significant differences between 1-year and 5-year recall., Conclusions: The PCIARs demonstrated excellent clinical performance at 1-year period. The degradation parameters appeared as minor staining and minor irregularities after 5-year, without any affect on the clinical performance., Clinical Significance: Our findings provide evidence that the clinical performance of PCIARs luted with a light-cured composite resin was clinically acceptable after a five-year evaluation period. Due to secondary caries, only one restoration was considered clinically unsatisfactory., Clinicaltrials Registration Number: NCT04838483., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To investigate fatigue methods for the evaluation of translucent zirconia and to associate in vitro failures with clinically reported ones., Data: Studies published in English that used fatigue tests on dental translucent zirconia., Sources: Two databases (MEDLINE/PubMed and Scopus) were electronically searched without any restriction on year of publication., Study Selection: A total of 4555 studies were identified. After removal of duplicates (78) and irrelevant articles (4316) that did not meet the inclusion criteria, 161 articles were considered eligible based on their titles and abstracts. These articles were fully read, leading to the inclusion of 41 studies in the review., Results: The most widely used fatigue method for evaluation of translucent zirconia was step-stress (18 articles), followed by staircase (seven articles), and step-wise (two articles). Most studies had been conducted in a wet environment with the use of a stainless steel piston to apply load to cemented structures on a dentin-like substrate. Most fracture analyses indicated the fracture originated on the cementation or contact surface where the load was applied. Moreover, studies that utilized anatomical structures (dental crowns) reported fractures starting at the cervical margin of the crowns., Conclusion: Most studies used the step-stress method. Only three studies reported failures similar to those found in clinical trials that used translucent zirconia restorations., Clinical Significance: The study findings can assist on correlating clinical failures to the ones observed in vitro., Competing Interests: Declaration of competing interest The author (ADB) is an Editorial Board Member of Journal of Dentistry and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: to assess the survival rates of removable partial dentures (RPDs) and identify factors impacting their longevity., Methods: electronic health records were retrieved of patients aged ≥18 who received RPDs between 2010 - 2021 with a follow-up of ≥ three months. Data extracted included demographics, medical history, dental charting, periodontal screening and recording scores, prostheses details and related interventions, including new dentures/denture remakes, and maintenance. Multivariate Mixed-Effect Cox regression was performed to identify potential RPD survival risk factors. Reduced model selection was reached using a backward step-down by comparing the performance of these multivariable models using the ANOVA test., Results: 1893 RPDs from 1246 patients were included, with a median follow-up of 21.8 months (range from 3 to 131.3 months). Three hundred and twelve patients received a maxillary RPD, 460 received a mandibular RPD, and the remaining 474 patients received both maxillary and mandibular RPDs. Metal-based RPDs had a median survival of 73 months (95%CI: 70 - 82) versus 45 months (95% CI: 37-67) for acrylic ones. Multivariable mixed effects Cox model showed that the lifespans of RPDs were longer amongst patients receiving more maintenance care within three months [Hazards Ratio (HR)=0.89 (0.83, 0.96)] and after three months [HR=0.53 (0.46, 0.61)] of denture delivery, patients wearing both maxillary and mandibular RPDs [HR=0.67 (0.52, 0.87)], and patients receiving metal-based RPDs [HR=0.31 (0.23, 0.42)]., Conclusions: Metal-based dentures, dual arch restoration, and increased maintenance positively impact the survival of RPDs., Clinical Significance: Adapting consent and warranty practices is advised to reflect RPD performance variations., Competing Interests: Declaration of competing interest No conflict of interest was present at the time of preparing this manuscript. There is no internal or external funding to report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: When dental practitioners encounter a defective restoration, they are faced with a crucial decision whether to repair or replace it. This study aims to explore international preferences for repair procedures and the clinical steps taken during the repair process., Method: An 11-question survey was distributed to dentists across 21 countries via different platforms. The survey comprised two sections: the first included five questions aimed at gathering demographic information, while the second consisted of six questions focusing on participants' practices related to the repair of composite or amalgam restorations A meta-analysis was employed to ascertain the pooled odds ratio of repairing versus replacement. The statistical analysis was carried out using the RevMan 5.3 program and forest plots were generated using the same program to visualize the results., Results: The survey was completed by 3680 dental practitioners. The results indicated a strong tendency to repair defective composite restorations (OR: 14.23; 95 % CI: 7.40, 27.35, p < 0.001). In terms of amalgam, there was a significant tendency to replace the restorations (OR: 0.19; 95 % CI: 0.12, 0.30, p < 0.001). When repairing restorations, the most common protocols were etching with orthophosphoric acid and creating an enamel bevel, regardless of the restorative material used., Conclusion: The findings of this study indicate that there exists a knowledge gap among dental practitioners regarding restoration repair. It is imperative that dental practitioners receive proper education and training on restoration repair, to ensure the usage of adequate protocols and restoration survival., Clinical Significance: A significant portion of dental practitioners lack the necessary knowledge and education required for the repair of restorations. Therefore, it is imperative to establish guidelines aimed at enhancing the management of defective restorations, along with protocols for clinical interventions. This includes the incorporation of proper courses in undergraduate, graduate, and continuing education programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the clinical conditions of single-unit posterior restorations on teeth prepared without finishing line, after 5.6 years of clinical service., Materials and Methods: 50 crowns (25 zirconia-based (Zr) and 25 porcelain-fused-to-metal (PFM)) were selected from 34 patients. The restorations were evaluated according to the California Dental Association (CDA) Quality Criteria, and periodontal variables were studied in the abutment teeth compared with the unrestored contralateral teeth. Variables were examined using Mann-Whitney and Pearson´s Chi-Square tests (α = 0.05). The success of the prosthesis was calculated using Kaplan-Meier test., Results: CDA Quality Criteria was considered satisfactory-excellent in all restorations except for one of them, due to chipping on a PFM crown. At, 66 months, the success rates for PFM and Zr crowns were 85.7 % and 100 %, respectively. The plaque index (PI) showed that the restored abutment teeth accumulated significantly less plaque than the control teeth, but the gingival index (GI) was statistically higher in the abutment teeth. In 80 % of cases the probing depth (PB) was ≤3 mm. In addition, in 21 % of the cases, gingival recession was less than 2 mm. The restoration material had a statistically significant effect on GI and PB, with Zr crowns showing less inflammation and less deep pockets than PFM restorations. On the contrary, greater gingival recession was found at the margins of the Zr crowns when compared to the PFM. No statistical differences were found between the two materials in the GI., Conclusions: Cemented crowns on vertical preparations show good clinical behavior after 5 years. The periodontal parameters (PI, GI, PD) of the Zr restorations are significantly better than those of PFM, with the exception of gingival recession., Clinical Relevance: The use of restorations on vertically prepared teeth is a suitable alternative to classical horizontal preparations., Competing Interests: Declaration of competing interest Mario Gonzalez-Bonilla declares that he has no conflict of interest. Santiago Berrendero declares that he has no conflict of interest. Belen Moron-Conejo declares that she has no conflict of interest. Francisco Martinez-Rus declares that he has no conflict of interest. Maria Paz Salido declares that she has no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To assess the influence of ferrule and core type on the fracture strength of endodontically treated anterior teeth (ETAT) and identify the failure mode type and distribution across different core types and ferrule conditions., Methods: Sixty extracted human central incisors were endodontically treated, decoronated and divided into two main groups (F=with ferrule, NF=no ferrule). Each main group was further subdivided into three subgroups according to the core material used: direct composite cores (DC), Ribbond fibre-reinforced composite cores (RIB-DC), and glass fibre post (GFP) with direct composite cores (GFP-DC). All specimens received E.max crowns and underwent thermal cycling and cyclic loading. Subsequently, the fracture resistance was tested with static loads applied to the crown restoration. Two-Way ANOVA and Chi square tests identified significant differences among the groups (p < 0.05)., Results: The means and standard deviations (SD) of fracture loads in Newtons (N) for specimens in the F subgroups were RIB-DC: 465.0 (104.20), GFP-DC: 367.6 (79.59), DC: 275.8 (68.48), and in NF subgroups were RIB-DC: 110.8 (24.33), GFP-DC: 95.6 (25.47), DC: 67.4 (7.46). Specimens with ferrule yielded significantly higher fracture loads than those without ferrule (p = 0.0054). In the F groups, fracture loads of specimens with RIB-DC cores were significantly higher than those with GFP-DC (p = 0.0019) and those with DC (p = 0.0001). Moreover, fracture loads for the GFP-DC were significantly higher than those for the DC (p = 0.0026). The GFP-DC specimens showed the highest incidence of catastrophic failures (p = 0.0420)., Conclusions: Using fibre-reinforced composite (FRC) cores significantly increased fracture resistance in ETAT with ferrule. The failure modes repairable and possibly repairable were dominant in most specimens., Clinical Significance: When restoring ETAT with insufficient coronal tooth structure, preserving 2 mm of tooth structure ferrule and preparing cores with FRC can increase fracture resistance and reduce the incidence of non-repairable catastrophic fractures of teeth., Competing Interests: Declaration of competing interest This is to explicitly declare that the authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript (Post artificial aging effect of ferrule presence and core composite material on fracture resistance of endodontically treated anterior teeth restored with E.max crowns: an in vitro study)., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To investigate vitamin-D levels effect on the survival/success and on marginal bone levels of dental implants., Methods: Patients with peri-implant disease and healthy control patients with functionally loaded dental implants were included in this retrospective case-control study. Forty patients with 201 implants were in the diseased-cohort, while thirty-three patients with 90 implants were in the control-cohort. Patient blood 25(OH)D levels were assessed through quantitative blood test. The correlation between abnormal 25(OH)D levels and disease status of each patient was assessed using Fisher's exact tests. The correlation of each implant's outcomes with vitamin-D status was assessed using Kaplan-Meier survival analysis and Mann-Whitney U tests., Results: Patients with blood 25(OH)D levels >70 ng/mL (hypervitaminosis-D) had a 21.1-fold increase in the risk of implant failure or severe peri-implant bone loss regarding patients with intermediate (>30, ≤70 ng/mL) levels. Kaplan-Meier survival analysis revealed that implants in the hypervitaminosis-D cohort had a survival probability of 73.7 % (95 % CI:56.5-84.5 %) at 19-years after surgery, compared to 95 % for implants in patients with intermediate 25(OH)D levels (95 % CI:88.3-97.9 %). Additionally, implants in the hypervitaminosis-D cohort lost bone faster than implants in the intermediate cohort. These results were specific to the patient cohort with elevated blood 25(OH)D levels and not observed in patients taking vitamin-D supplementation. The impact of hypervitaminosis-D was enriched for implants in the maxilla, and not as apparent for implants in the mandible., Conclusions: Blood 25(OH)D levels >70 ng/mL were correlated with adverse implant outcomes, including implant failure and peri-implant bone loss, especially in the maxilla., Clinical Relevance: These results suggest that hypervitaminosis D may be a previously unidentified risk factor for dental implant complications and should be further investigated to elucidate the underlying mechanism., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: The aim of this study was to evaluate the use and reintervention rate of fillings compared to preformed metal crowns in the everyday clinical practice of German dentists., Methods: In this retrospective, longitudinal analysis, fee codes from the Kassenzahnärztliche Vereinigung Westfalen-Lippe for restorations placed in primary molars between 2012 and 2015 in children until 7 years of age followed for a 7-year period (latest until December 2022) were filtered and analyzed with the Fine and Gray competing risk regression and Cox proportional hazards regression to calculate the risk of reintervention divided into the main outcomes "Successful", "Minor Failure/Repair" and "Major Failure/Endodontic Treatment/Extraction". 367,139 primary molars (one-surface fillings: n = 117,721; two-surface fillings n = 198,815; three-surface fillings n = 36,695; more than three-surface fillings n = 8,267 and preformed metal crowns n = 5,641 were included in this study., Results: Teeth treated with preformed crowns needed significantly less re-interventions. Subdistribution hazard ratio for minor events was 0.117 (95 %-CI: 0.097 to 0.141) and hazard ratio of major events (HR=0.786; 95 %-CI: 0.695 to 0.890) when compared to one-surface fillings in multivariable adjusted analysis. Within 7-year follow-up preformed crowns required less repairs (80.6 % success rate, minor failure 4.4 %, major failure 16.3 %) than the teeth treated with composite fillings (46.2 %-52.6 % success rate, minor failure 27.0 %-39.5 %, major failure 15.5 %-28.4 %, p < 0.001)., Conclusion: Within the German healthcare system fillings are the first choice for treating primary molars despite considerably higher reintervention rates. This encourages a discussion on the indication of fillings and the more durable preformed metal crowns to reduce unnecessary reintervention in young children., Clinical Significance: This study gives an unprecedented insight into the German healthcare system regarding the reintervention rates of the most relevant treatment techniques for caries in primary molars., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: To evaluate the longevity of cantilevered zirconia-based resin-bonded fixed partial dentures (RBFPDs) in replacing missing posterior teeth, as well as the quality of life and patient satisfaction experienced by those receiving zirconia RBFPDs., Methods: A prospective single-arm uncontrolled clinical trial was conducted to replace one or more missing premolars or molars with a span of 5 to 8 mm using cantilevered zirconia RBFPDs. Thirty-six participants with 40 prostheses were recruited and underwent a 3-year clinical evaluation. The retainer designs included a minimum thickness of 0.8 mm, a minimum of 200° circumferential wraparound with an occlusal bar, and a connector dimension of 3 × 3 mm. Patient-reported outcomes, including patient satisfaction and Oral Health Impact Profile (OHIP), were assessed., Results: The average age of participants was 45.8 years, and 72.5 % were women. The success rate of the posterior zirconia RBFPDs was 76.2 %, with an estimated mean success duration of 46.1 months. The survival rate was 88.1 %, with an estimated mean survival duration of 49.4 months. Participants were highly satisfied with the treatment, achieving an average satisfaction score of 80.8 ± 11.9. Participants' total OHIP scores decreased from 52.3 to 39.6 after 3 years, indicating a significant improvement in oral health-related quality of life (P = 0.009)., Conclusions: After 3 years, a moderately high survival rate and favourable patient-reported outcomes of posterior cantilevered zirconia RBFPDs were achieved. Therefore, it can be recommended as a conservative treatment option to replace missing posterior teeth, provided that retainer design considerations are taken into account., Clinical Significance: Cantilevered zirconia RBFPDs for posterior teeth can serve as a conservative treatment option that is both aesthetically pleasing and biocompatible. It offers a more cost-effective alternative compared to dental implants, which are often prohibitively expensive for the majority of patients. This approach has the potential to greatly improve patient-reported outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: This study aimed to evaluate the shear bond strength and failure behavior between cobalt-chromium (Co-Cr) alloy and different types of denture base resins (DBRs) over time., Methods: Seventy-two disk-shaped specimens (8 mm in diameter and 2 mm in thickness) were manufactured using a selective laser melting technology-based metal 3D printer. Three types of DBRs were used: heat-cure (HEA group), cold-cure (COL group), and 3D-printable (TDP group) DBRs (n = 12 per group). Each DBR specimen was fabricated as a 5 mm × 5 mm × 5 mm cube model. The specimens of the TDP group were manufactured using a digital light processing technology-based 3D printer. Half of the DBRs were stored in distilled water at 37 °C for 24 h, whereas the remaining half underwent thermocycling for 10,000 cycles. Shear bond strength was measured using a universal testing machine; failure modes were observed, and metal surfaces were evaluated using energy dispersive spectrometry., Results: The shear bond strength did not differ between the DBR types within the non-thermocycled groups. Contrarily, the TDP group exhibited inferior strength compared to the HEA group (P = 0.008) after thermocycling. All three types of DBRs exhibited a significant decrease in the shear bond strength and an increased tendency toward adhesive failure after thermocycling., Conclusions: The bond strength between 3D-printable DBRs and Co-Cr alloy was comparable to that of heat-and cold-cure DBRs before thermocycling. However, it exhibited a considerable weakening in comparison to heat-cure DBRs after simulated short-term use., Clinical Significance: The application of 3D-printable DBR in metal framework-incorporated removable partial dentures may be feasible during the early phase of the treatment. However, its application is currently limited because the bond strength between the 3D-printable DBR and metal may weaken after short-term use. Further studies on methods to increase the bond strength between these heterogeneous materials are required., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up., Methods: Forty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used., Results: No significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05)., Conclusion: The clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations., Clinical Significance: The level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period., Methods: Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc)., Results: The follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03)., Conclusion: This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months., Clinical Significance: SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: Composite materials are widely used in dentistry for direct tooth restorations. However, they are highly sensitive to the working technique employed during the restorative procedure. Even minor procedural errors can have a significant impact on the quality including the longevity of the restoration. Hence the aim of this study was to determine the material preferences and analyse the clinical problems associated with direct composite restorations in a cohort of dentists., Methods: A 20-item online questionnaire was created in English and administered 1830 general dentists and specialists in 13 countries. The first section of the questionnaire included four questions to elicit demographic data, and the second section comprised 16 questions focused on material preferences for conservative restorations, durability of composite restorations, and the most challenging stages the dentists faced during the composite restorative procedures., Results: Respondents decided most often to use composite materials for the tooth restorations (OR 997.4, 95% CI 233.8-4254.8, P value <.001). Most respondents indicated that the durability of composite restorations was approximately 7 to 10 years (41.5%). Among the factors affecting durability, maintenance of a dry cavity was the most often reported reason (47.1%) and the foremost challenge faced by dentists (61.0%) during the composite restorative procedures., Conclusions: Our study confirmed that resin-based composites are the most popular material for direct restoration in many countries. Although working with this material is difficult and involves multiple steps, maintaining a dry cavity during bonding, and material application may affect the therapeutic success and durability of these restorations. Clinicians need to be attentive to this issue and be prepared to adapt their decision-making and consider opting for alternative restorative materials, if appropriate., Competing Interests: Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Multilayer monolithic zirconia (M-Zr) crowns can be engineered to achieve gradational translucency and color intensity. However, this modification may compromise the mechanical strength, raising concerns regarding the ability of M-Zr crowns to withstand occlusal stresses. The effects of M-Zr crown thickness on translucency and ability to endure occlusal forces were investigated at different tooth positions (incisors, premolars, and molars). The objective was to determine the minimal thickness of M-Zr crowns used in tooth preparation to meet aesthetic and functional demands., Methods: M-Zr samples (Vita A1) with four thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were prepared and subjected to translucency testing using a digital colorimeter by 3-third and 9-square division methods. Crown-shaped M-Zr samples with three thicknesses (1.0, 1.5, and 2.0 mm) and three tooth positions (incisor, premolar, and molar) were digitally designed, and 2.0 mm metal abutments were fabricated. The samples were bonded to the abutments; their fracture characteristics were evaluated using a universal testing machine, and their fracture surfaces examined using an optical microscope. Statistical analyses included the Shapiro-Wilk test, Pearson correlation, and one-way and two-way ANOVA with a post hoc Tukey HSD test (α = 0.05)., Results: Color analysis results revealed a significant negative correlation between thickness and translucency (r < -0.96, P < 0.01), with the highest values in the incisal region. Cross-sectional profiles confirmed the uniform thickness and morphology of the digitally designed M-Zr crowns. The results of fracture strength analysis showed position-dependent variability, a strong positive correlation with thickness (r > 0.96, P < 0.01), and fracture strengths consistently exceeding 1200 N across all tooth positions. Fracture patterns indicated that thinner crowns at the incisors and molars were more prone to cracking, whereas those at the premolars demonstrated significantly higher strength (4872.51 N, P < 0.05), only with crack or even no fracture occurring at 2.0 mm., Conclusions: Thickness significantly influenced both the translucency and fracture strength of M-Zr, with the tooth position playing an additional role, albeit to a lesser extent. Although thinner crowns exhibited lower strength at each tooth position, even at a thickness of 1.0 mm, fracture strength exceeding 1200 N was maintained, surpassing the typical occlusal forces. Thus, it can be asserted that M-Zr crowns with a minimum thickness of 1.0 mm can meet both aesthetic and functional requirements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of nonsurgical endodontic treatment and retreatment for mature permanent teeth with or without apical periodontitis using the single-cone (SC) obturation technique with calcium silicate-based bio-ceramic (CSBC) sealers and to compare these failure rates to other sealer materials and obturation techniques., Methods: A comprehensive search was conducted using MEDLINE (PubMed), Embase, Cochrane Library, Scopus, Web of Science, and gray literature up to March 2023. Two reviewers assessed the eligibility of the included studies. Eligible studies were critically appraised for risk of bias and quality of evidence. Subsequently, a meta-analysis of pooled data was conducted utilizing the RevMan software (P < .05) to evaluate the failure rate of non-surgical root canal therapy using CSBC sealers and SC obturation procedures. Separately, another analysis was conducted to compare those results with the outcome of nonsurgical root canal therapy using alternative obturation materials and methods., Results: Five studies were included. The pooled failure rate for nonsurgical endodontic treatment and retreatment combined using CSBC sealers and SC obturation technique was 6.8% [95% confidence interval (CI) = (3%-12%), I 2  = 46%]. A second analysis was conducted on the 3 included clinical trials to compare the outcomes of the intervention (CSBC sealers and SC obturation technique) and control groups (other sealers and other obturation techniques). This analysis found no significant difference between the 2 groups regarding clinical and radiographic failure of endodontic treatment and retreatment [Risk ratio = 0.71, 95% CI = (0.33, 1.51), I 2  = 0]. This difference was also not statistically significant when the failure rate of primary root canal treatment and retreatment were separately analyzed [Combined Risk ratio of primary root canal treatment = 0.94, 95% CI = (0.46, 1.93), I 2  = 0%; Combined Risk ratio of retreatment = 0.21, 95% CI = (0.001, 75.46), I 2  = 0%]., Conclusions: The overall results of this systematic review and meta-analysis demonstrate that the SC obturation technique with CSBC sealer provides similar results compared to other obturation materials and techniques in facilitating the healing of apical periodontitis., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To report the implant survival rates, clinical, and radiographic status after a period of more than 5 years in the function of 4 inter-foraminal implants retaining mandibular overdentures (OVDs) in individuals with T2DM., Methods: 78 completely edentulous participants with type 2 diabetic mellitus (T2DM) who had worn mandibular OVDs retained by 4 inter-foraminal implants for long-term functional life were selected for this study. The participants were divided into 2 groups according to glycosylated haemoglobin A1c (HbA1c) levels before implant placement: group I with an HbA1c value > 6.5 % (inadequately controlled T2DM), and group II with an HbA1c value ≤6.5 % (well-controlled T2DM). The inadequately controlled T2DM was further subdivided into 2 groups: Group IA with an HbA1c value > 6.5 % and ≤8 % (moderately controlled), and Group IB has an HbA1c value > 8 % (poorly controlled). Implant survival rate, plaque index (PI), bleeding on probing (BOP), probing depth (PD), and radiographic crestal bone level (CBL) around implants were measured., Results: Among 312 implants, 6 failed, 4 in well-controlled diabetics, and 2 in inadequately controlled diabetics. The overall survival rate was 98.07 %. The mean PI in group Ι was 36.4 (group IA =37.76, group IB = 34.27), and in group ΙΙ it was 19. The mean BOP in group Ι was 45.5 (group IA =47.84, group IB = 41.76), and in group ΙΙ it was 22. The mean PD in group Ι was 4.1 (group IA =4.3, group IB = 3.85) and in group ΙΙ was 2.2. The mean radiographic CBL in group Ι was 3.4 (group IA =3.7, group IB = 2.9), and in group ΙΙ was 1.5. Group IA exhibited a significantly greater level of PI, BOP, PD, and CBL compared to group IB and group IΙ (P1=0.017, P2=0.001)., Conclusions: Individuals with T2DM can benefit from 4 inter-foraminal implants retained mandibular OVDs, and their inability to maintain proper glucose control may not exclude implant success., Clinical Significance: This study is a significant step toward improving knowledge of options available for treatment and anticipated outcomes for T2DM completely edentulous populations undergoing implant therapy., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could influence the work reported in this paper. This clinical research didn't receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material., Methods: The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials., Results: A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065)., Conclusions: Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists., Clinical Significance: Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal., Methods: The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups., Results: During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002)., Conclusion: Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization., Clinical Significance: SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs)., Methods: A total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan-Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05)., Results: After 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5-99.9) for PHT group and 90.8 % (81.1-96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable., Conclusions: Both composites showed high rates of retention rates after 24 months., Clinical Significance: The clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions., Registration of Clinical Trials: RBR-6d6gxxz., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the clinical outcome of different designs of zirconia dental implants., Data: This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228)., Sources: The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level., Study Selection: Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described., Result: The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs., Conclusion: Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed., Clinical Significance: Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To assess the mechanical durability of monolithic zirconia implant-supported fixed dental prostheses (iFDP) design on one implant, with a distal and a mesial extension cantilever bonded to a titanium base compared to established designs on two implants., Materials and Methods: Roxolid Tissue level (TL), and tissue level x (TLX) implants were used to manufacture screw-retained 3-unit iFDPs (n = 60, n = 10 per group), with following configurations (X: Cantilever; I: Implant, T: Test group, C: Control group): T1: X-I-X (TL); T2: X-I-X (TLX); T3: I-I-X (TL); T4: I-I-X (TLX); C1: I-X-I (TL); C2: I-X-I (TLX). The iFDPs were thermomechanically aged and subsequently loaded until fracture using a universal testing machine. The failure load at first crack (F initial ) and at catastrophic fracture (F max ) were measured and statistical evaluation was performed using two-way ANOVA and Tukey's post-hoc tests., Results: The mean values ranged between 190 ± 73 and 510 ± 459 N for F initial groups, and between 468 ± 76 and 1579 ± 249 N for F max , respectively. Regarding F initial , neither the implant type, nor the iFDP configuration significantly influenced measured failure loads (all p > 0.05). The choice of implant type did not show any significant effect (p > 0.05), while reconstruction design significantly affected F max data (I-I-X a  < X-I-X b  < I-X-I c ) (p < 0.05). The mesial and distal extension groups (X-I-X) showed fractures only at the cantilever extension site, while the distal extension group (I-I-X) showed one abutment and one connector fracture at the implant/reconstruction interface., Conclusion: Results suggest that iFDPs with I-X-I design can be recommended regardless of tested implant type followed by the mesial and distal extension design on one implant abutment (X-I-X)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post., Methods: A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05)., Results: Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0-9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99-12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 - 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05)., Conclusions: Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs., Clinical Significance: Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning., Competing Interests: Declaration of competing interest The authors listed in the Title Page declare no conflict of interest regarding the submitted manuscript entitled ‘Crown vs. composite for glass fiber post-retained restorations: an 8-year randomized clinical trial’., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: The aim of this study was to investigate the influence of preparation characteristics on the survival, success, and clinical performance of partial indirect lithium disilicate restorations with immediate dentin sealing., Methods: This retrospective clinical study evaluated partial indirect lithium disilicate restorations placed in conjunction with Immediate Dentin Sealing (IDS) in (pre)molar teeth between March 2018 and May 2021. The restorations were luted using pre-heated composite. The study focused on survival, success, and clinical performance, which was evaluated using the modified United States Public Health Service (USPHS) criteria. Results were analyzed using the Kaplan-Meier estimates, log-rank tests, and Fisher exact tests., Results: Partial indirect lithium disilicate restorations (N = 454) were evaluated in 214 patients. The mean evaluation time was 37 months, with a cumulative survival rate of 99.2 % and a cumulative success rate of 97.6 %. Fourteen failures occurred, with endodontic pathology as the predominant failure mode, followed by secondary caries, debonding, and tooth fracture. No statistically significant influence of the preparation variables on survival and success was observed (p > .05). The short-term clinical performance was clinically acceptable in > 90 % of the evaluations., Conclusions: This retrospective study on partial indirect lithium disilicate restorations in conjunction with IDS demonstrates survival and success rates of 99.2 and 96.7 % over a mean evaluation period of 37 months. A marked influence of the studied preparation characteristics on the survival, success and clinical performance of lithium disilicate partial restorations could not be demonstrated. Partial lithium disilicate restorations exhibit good clinical performance in >90 % of the cases., Clinical Significance: The results of this study suggest that preparation characteristics had no significant impact on the survival, success, and clinical performance of partial lithium disilicate restorations in conjunction with IDS. Results show good clinical performance and high survival and success rates, regardless of preparation characteristics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Post and core (PC) is frequently used, but clinical evidence concerning how long a post must be is scarce. Recommendations in dental literature range from half of the root which should be incorporated, to post space preparations conducted as deep as possible increasing the risk for root perforation thus tooth loss. Therefore, the aim of this retrospective survival analysis is to evaluate the post length as well as the post-clinical crown ratio on a large patient cohort with long follow-ups., Materials and Methods: Overall 1026 PC in 731 patients could be included in this study (2004-2023). The files were analysed due to the parameters post length and post-clinical crown ratio on X-Ray. Furthermore, the influence of the type of covering prosthetic restoration, location, type of tooth, luting material, PC material, bone attachment and therapist was evaluated. The statistical analysis was assessed using Kaplan-Meier (univariate influences) and Cox regression (multifactorial influences)., Results: Survival until extraction as well as decementation was significantly influenced by bone attachment and covering prosthetic restoration. Posts reaching the middle third of the root showed highly significant (p < 0.001) better survival probabilities than those reaching the coronal or apical third. Regarding the post-clinical crown ratio, no significant difference was found for post = crown/post > crown, whereas post

Objectives: To evaluate the fracture strength and linear elongation at break of three-units fixed partial dentures (FPDs) fabricated with traditional and new materials for fixed prosthodontics before and after ageing., Methods: Sixty models of three-units FPDs were fabricated and cemented onto a Co-Cr model simulating the replacement of a maxillary second premolar. The samples were randomly divided into 3 groups: metal-ceramic (MCR), graphene-doped polymethylmethacrylate (PMMA-GR) and polymethylmethacrylate (PMMA). Half of the samples were directly subjected to fracture test, while the remaining half underwent an ageing process and then a fracture loading test using an electrodynamic testing machine. Fracture load and elongation at break values were taken and statistically analysed., Results: Significant differences were detected between the different materials (p<0.05). All groups showed a reduction of the fracture load and elongation at break values after ageing, but not statistically significant, except for PMMA group (p = 2.012e-19) (p = 3.8e-11)., Conclusions: MCR and PMMA-GR three-units FPDs showed higher fracture strength and lower elongation at break compared to PMMA. MCR and PMMA-GR had higher resistance to ageing processes compared to PMMA., Clinical Significance: PMMA-GR could be considered a material for long-term provisional restorations as its mechanical behaviour and ageing resistance are more like MCR than PMMA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the effect of prolonged (P) polymerization time of a universal adhesive system applied in etch-and-rinse (ER) or self-etch (SE) strategies on the clinical performance of restorations in non-carious cervical lesions (NCCLs), after 36 months of clinical service., Methods: A total of 140 restorations were randomly placed in 35 subjects according to the polymerization time groups: ER (10 s); ER-P (40 s); SE (10 s); and SE-P (40 s) at 1,200 mW/cm 2 . Composite resin was placed incrementally. The restorations were evaluated immediately and after 6, 12, 18, and 36 months using the FDI criteria. Data were analyzed using the Kaplan-Meier survival test for retention loss, and the Kruskal-Wallis' test for secondary outcomes (α = 0.05)., Results: After 36 months, 19 restorations were lost: ER 6, ER-P 2, SE 9, SE-P 2. The retention rates were 82.3% for ER; 94.1 % for ER-P; 73.5 % for SE; and 94.1 % for SE-P, with a significant difference between ER vs. ER-P and SE vs. SE-P, as well as ER vs. SE-P and ER-P vs. SE (p < 0.0001). Minor defects were observed in 18 restorations for the marginal staining criteria: ER 5, ER-P 2, SE 8, SE-P 3; and in 33 restorations for the marginal adaptation criteria: ER 11, ER-P 4, SE 12, and SE-P 6 (p > 0.05). No restorations showed recurrence of caries or postoperative sensitivity., Conclusions: A prolonged polymerization time of 40 s improves the clinical performance of the universal adhesive for both adhesive strategies evaluated, even after 36 months., Clinical Significance: Prolonging the polymerization time of a universal adhesive from 10 to 40 s has been shown to improve its clinical performance when used in NCCLs., Competing Interests: Declaration of competing interest Declarations of interest: The authors of the article entitled “Prolonged Polymerization of a Universal Adhesive in Non-Carious Cervical Lesions: 36-month Double-Blind Randomized Clinical Trial” certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2023. Published by Elsevier Ltd.)

This study aimed to evaluate the fatigue performance of simplified ceramic restorations (leucite-reinforced glass ceramic) adhesively cemented onto substrates of different resin composites. Three options from the same commercial line were selected (Tetric N-Line, Ivoclar), classified as Conventional (CRC), Bulk-fill (BRC) and Flowable (FRC), which were used to make discs using a cylindrical metallic device (n = 19; Ø = 10 mm, thickness = 2.0 mm). A total of 57 discs (Ø = 10 mm, thickness = 1.0 mm) were made from CAD/CAM prefabricated blocks of a leucite reinforced glass-ceramic (Empress CAD, Ivoclar) to simulate a monolithic restoration, then were randomly distributed to be bonded on 19 discs of each three different resin composite substrates (CRC; BRC; or FRC) with a dual resin cement (Multilink N; Ivoclar). The samples were subjected to a compression test with a hemispherical stainless-steel piston (Ø = 40 mm) at a monotonic regimen (n = 4; 1 mm/min loading rate and 500 kgf loading cell until fracture). The cyclic fatigue test was performed underwater at a frequency of 20 Hz (n = 15). The first step was applied using 200N for 5000 cycles, followed by increments of 50N at each step of 10,000 until failure. The outcome considered for both tests was the occurrence of radial crack. Specific statistical tests (α = 0.05) were performed for monotonic (One-way ANOVA; Tukey's test) and fatigue data (Kaplan-Meier test; Log-rank test). Fractography of fractured samples were also performed. The FRC group had the lowest failure load in both test regimes (p < 0.05; monotonic: 726.64N; fatigue: 716.67N). There were no differences between the CRC and BRC groups (p > 0.05; monotonic: 989.30 and 990.11N; fatigue: 810.00 and 833.33N, respectively). The same result was obtained considering cycles for fatigue failure (FRC < CRC=BRC). Leucite glass-ceramic bonded to substrates made of flowable resin composite behaves worse mechanically than bonding to conventional or bulk-fill resin composite substrates., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Quantify the survival of posterior composite restorations (PCR) placed during the study period in permanent teeth in United States (US) general dental community practices and factors predictive of that survival., Methods: A retrospective cohort study was conducted utilizing de-identified electronic dental record (EDR) data of patients who received a PCR in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The final analyzed data set included 700,885 PCRs from 200,988 patients. Descriptive statistics and Kaplan Meier (product limit) estimator were performed to estimate the survival rate (defined as the PCR not receiving any subsequent treatment) after the first PCR was observed in the EDR during the study time. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates., Results: The overall median survival time was 13.3 years. The annual failure rates were 4.5-5.8 % for years 1-5; 5.3-5.7 %, 4.9-5.5 %, and 3.3-5.2 % for years 6-10, 11-15, and 16-20, respectively. The failure descriptions recorded for < 7 % failures were mostly caries (54 %) and broken or fractured tooth/restorations (23 %). The following variables significantly predicted PCR survival: number of surfaces that comprised the PCR; having at least one interproximal surface; tooth type; type of prior treatment received on the tooth; Network region; patient age and sex. Based on the magnitude of the multivariable estimates, no single factor predominated., Conclusions: This study of Network practices geographically distributed across the US observed PCR survival rates and predictive factors comparable to studies done in academic settings and outside the US., Clinical Significance: Specific baseline factors significantly predict the survival of PCRs done in US community dental practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The present study aimed to evaluate the impact of the existence of an abutment screw-access hole and the filling effects on the fatigue mechanical behavior of a luted lithium-disilicate glass-ceramic. Seventy-two discs (Ø = 10 mm, 1.0 mm in thickness) of lithium disilicate (IPS e.max CAD, Ivoclar AG) were obtained from prefabricated blocks. Thirty-six abutment specimens of an opaque zirconia (Yz - IPS e.max ZirCAD, Ivoclar AG) and titanium (Ti - Luminesse Ti-Cam discs, Talladium Inc.) were confectioned, and allocated according to 6 groups: Yz and Ti rigid (without screw access hole); Yz unfilled, Yz filled, Ti unfilled and Ti filled (with the screw access (Ø = 2.5 mm) in the center). For the unfilled groups, only a polytetrafluoroethylene tape was used. Resin composite (Tetric N-Ceram, Ivoclar AG) was applied to the screw access hole for the filled groups (Yz and Ti). A cyclic fatigue test was carried out (load of 200 N, 10,000 cycles each; 20 Hz of frequency, step size of 100 N until failure detection (radial/cone crack). The fatigue failure load (FFL) and number of cycles until failure (CFF) were recorded for statistical purposes. The stress distribution (MPa) was evaluated by finite element analysis. A statistically positive effect of the abutment material and the presence of the screw access hole was observed (p ≤ 0.05). The rigid groups (without screw access holes) depicted almost 100% of survival after the fatigue tests. Among the other groups, the Yz-filled group showed the best performance (p ≤ 0.05), followed by the Yz unfilled group. The Ti groups depicted lower values of FFL and CFF, with the Ti unfilled group showing the most unfavorable fatigue behavior (p ≤ 0.05). The lowest tensile stress concentration in the restorative material was observed with the use of rigid abutments, the filled groups depicted intermediate values, while unfilled groups showed the highest stress concentration (Yz rigid = 306.3 MPa; Ti rigid = 310.4 MPa < Yz filled = 490.7 MPa; Ti filled = 498.9 MPa < Yz unfilled = 707.6 MPa; Ti unfilled = 719.7 MPa). Therefore, the presence of a screw-access hole decreases the mechanical performance of a lithium disilicate ceramic regardless of the abutment material. In the presence of a screw-access hole, zirconia abutments depicted a higher fatigue failure load when compared with titanium. The filling of the abutment screw-access hole with resin composite increased the mechanical performance of the simulated restoration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To assess the long-term clinical outcome of posterior inlay-retained fixed dental prostheses (IRFDPs) with a modified design made from zirconia ceramic., Methods: In 30 patients thirty 3-unit IRFDPs were placed to replace 7 premolars (4 in the maxilla, 3 in the mandible), and 23 first molars (15 in the maxilla, 8 in the mandible). Preparations were accomplished in agreement with the general principles for ceramic inlay restorations and modified with a short retainer-wing bevel preparation within the enamel at the buccal and oral sides. The frameworks were milled from 3Y-TZP ceramic, and the pontics were veneered with feldspathic ceramic. All IRFDPs were bonded with a phosphate monomer containing luting resin after air-abrasion of the intaglio surfaces. The patients were recalled 6-12 months after placement, and then annually. Kaplan-Meier analysis was used to calculate the survival and complication rates of the IRFDPs., Results: The mean observation time was 10.6 ± 1.5 years. The 10-year cumulative survival rate was 89% with 4 failures, two of them were due to deep secondary caries with loss of retention, one due to repeated debonding with enamel fractures, and one due to generalized progressive periodontitis. The most common complication was chipping of the veneering ceramic (20.1%). Eighteen IRFDPs were free of any type of complication up to 15.4 years, which corresponds to a 10-year cumulative success rate of 70.4%., Conclusion: The long-term clinical performance of modified IRFDPs made of veneered zirconia ceramics was favorable after 10 years, therefore, they represent a treatment alternative to replace posterior single missing teeth., Clinical Significance: Zirconia-based IRFDPs fabricated in the modified design may represent a substance-preserving alternative to conventional posterior FDPs to replace posterior single missing teeth, particularly in cases where implants cannot be placed, and when the adjacent teeth already have small restorations or defects., Competing Interests: Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: This study investigated the impact of preparation design and material types on fracture strength in maxillary premolars endocrowns after thermodynamic aging., Materials and Methods: Eighty two-rooted maxillary premolar crowns underwent endodontic treatment (N = 80, n = 10). The teeth were categorized into ten groups (4-mm deep with no intracanal extension lithium disilicate glass ceramic & multilayer zirconia endocrowns (LE0 & ZE0); 4-mm deep with 4-mm intracanal extension in one canal (LE1 & ZE1); 4-mm deep with 2-mm intracanal extensions in both canals (LE2 & ZE2); flat overlays with no endocore (LO & ZO); glass fiber reinforced post & core and crown (LC & ZC)). After cementation, all specimens were subjected to 1500 thermocycles and 1,200,000 chewing cycles with an axial occlusal load of 49 N. A static loading test was performed at a non-axial 45° loading using a universal testing machine and failure modes (Type I: restoration debonding; Type II: restoration fracture; Type III: restoration/tooth complex fracture above bone level; Type IV: restoration/tooth complex fracture below bone level) were evaluated using a stereoscope. Data were ananalzed using 2-way ANOVA and Tukey's tests (alpha = 0.05)., Results: The endocrowns manufactured from multilayered zirconia and pressed lithium disilicate glass ceramic exhibited a fracture load ranging between 1334 ± 332 N and 756 ± 150 N, with ZC presenting the highest and LE2 the lowest values. The differences were not statistically significant (p > 0.05)., Conclusion: All endocrowns tested in this study performed similar considering the different designs and materials tested. The distribution of fracture modes did not differ significantly depending on the design of the restoration and the type of material used., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To compare the success of silver diamine fluoride-modified atraumatic restorative technique (SMART) with that of the conventional drill and fill method in restoring carious lesions in primary molars., Method: Children (4-8years old) reporting to a tertiary care hospital setting with asymptomatic cavitated dentinal carious lesions in primary molars were randomly allocated to two groups; SMART and Conventional; and subsequently restored with Glass Ionomer Cement (GIC). Follow-up evaluations were carried out by blinded independent evaluator at 6-months intervals to assess the status of restorations. Primary outcome was the success of restorations at 24 months and the secondary outcome was the child's behaviour and acceptance of the treatment at the time of interventions. Two sample Z-test of proportion, logistic regression analysis and Chi-square test were used to compare the outcomes in two groups., Results: A total of 226 children (SMART group, 112 and conventional, 114) were included with 280 and 282 GIC restorations placed by the SMART and the conventional method respectively. At 24-months, 459 (81.6 %) primary molars were available for evaluation. Success rates of restorations was 38.4 % and 45.8 % % in SMART and conventional groups respectively (p = 0.105). The rate of acceptability of treatment in the SMART and conventional group was 79 % and 56 % (p<0.001) respectively., Conclusion: There was no significant difference in the success rates of GIC restorations by SMART and conventional technique in carious primary molars at 24 months. SMART was better accepted by children as compared to the conventional restorative technique., Clinical Significance: SMART can be an alternative option to treat the asymptomatic carious lesions in primary molars and is well accepted by children than the conventional drill and fill technique thus implying that it has a useful role in un-cooperative children., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: Even if survival of post and core (PC) itself was frequently investigated in recent literature, clinical data concerning the risk for extraction of teeth restored with PC is still scarce. Since most authors found the loss of retention of refitable post and cores as the most common cause of failure, it is impossible to draw a conclusion on tooth survival on the results of those studies. Therefore, the aim of the present study was to improve the clinical evidence on the survival of teeth treated with post and cores on a large number of cases over a long observation period., Materials and Methods: 735 patients were treated with 1053 post and cores in the observation period (2004-2022) and could be included in the study. The patient files were analysed due to the parameters: Type of covering prosthetic restoration, location, type of tooth, luting material, post and core material, bone attachment and therapist. The survival probability was assessed using Kaplan-Meyer analysis. Cox regression was used to assess possible multifactorial influences., Results: The overall average survival time until necessary extraction of a tooth restored with a post and core was 11.74 years. A root fracture in primary crown retained removeable partial dentures (RPDs) during the first five years was the most common reason for extraction in this study. A significant influence on the survival time of teeth restored with post and cores was found for the type of covering restoration, bone attachment, age of the patient and post and core material., Conclusions: Post and core restored teeth should be avoided as abutments for primary crown retained RPDs., Clinical Significance: If it is inevitable to utilise post and core restored teeth for primary crown retained RPDs, post and core materials with matching mechanical properties to that of dentine should be preferred., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)