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Abstract Background This study aimed to evaluate the efficacy of polydopamine (PDA) functionalization on orthodontic brackets in inhibiting biofilm formation and promoting surface bioactivity to buffer the acidity of caries-causing bacteria around orthodontic brackets and prevent demineralization. The stability of the coating in artificial saliva (AS) and distilled water was evaluated, along with its effect on pH changes in simulated body fluid (SBF) and distilled water. Methods Maxillary incisor orthodontic brackets underwent PDA functionalization using a dopamine hydrochloride solution following a specific protocol. Biofilm formation on both control (Br-0) and coated (Br-PDA) brackets was assessed immediately after coating and after two months of aging (Aged Br-PDA) in artificial saliva. The adherent biofilm bacteria on brackets were quantified with colony count assessment and optical density. Surface morphology, Bioactivity, and coating stability were analyzed using Scanning Electron Microscopy (SEM). Coated and uncoated samples were immersed in SBF and deionized water, and pH changes were monitored over 7 days using a pH meter. Results PDA-functionalized brackets, both freshly coated (1.08 OD) and aged for two months (1.6 OD), showed significantly reduced biofilm formation compared to non-functionalized control brackets (2.07 OD), with p-value

Abstract Background: Impression materials can harbour microorganisms from saliva and blood, posing cross-contamination risks. However, post-setting disinfection might compromise the dimensional accuracy and mechanical properties of alginates. Hence, it was the aim of this research to assess the detail reproduction, tear strength, elastic recovery, and surface quality of the gypsum model of newly developed dental alginates with inherent antimicrobial properties. Methods: Three dental alginate groups with antimicrobial alterations were formulated. One group replaced water with 0.2% chlorhexidine solution (CHX group), while the other two utilized water-based extracts of Syzygium aromaticum (SA, clove) or Zingiber officinale (ZO, ginger) to reduce silver nitrate, resulting in two silver nanoparticles (AgNPs)/extract (clove or ginger) mixture solutions. These mixture solutions were employed for the preparation of dental alginate yielding the SA + AgNP and ZO + AgNPs groups. All modified groups were compared to an unmodified control group that used water for mixing. Elastic recovery, detail reproduction, and tear strength were assessed following the ISO 21563:2021 standard. The surface roughness of plaster models was analysed using the optical profilometer. Elastic recovery was assessed by applying and then releasing load on alginate specimens to measure their ability to recover from deformation. Detail reproduction was evaluated by observing the reproducibility of a 50 μm line in a metallic mold using a light microscope, while tear strength was determined by stretching the specimens until failure at a constant speed of 500 mm/min. Results: All tested groups exhibited elastic recovery values meeting ISO standards for hydrocolloid impression materials. Regarding detail reproduction, both the control and modified alginates successfully reproduced the 50-µm line without interruption in all specimens. Tear strength values for all tested groups remained within the acceptable documented ranges, surpassing the minimum requirement of 0.38 N/mm as mandated by ISO 21563:2021. The ZO + AgNPs (0.94 ± 0.17 N/mm) demonstrated significantly higher tear strength values and surface roughness values compared to the other tested groups. Conclusions: Chlorhexidine, Syzygium aromaticum, and Zingiber officinale green-synthesized silver nanoparticles are promising, cost-effective alternatives for disinfecting alginate impressions without compromising performance. Green nanoparticle synthesis is a safe, efficient, and non-toxic method, potentially synergizing metal ions with plant extract.

This study aimed to report forces and moments delivered by 3D-printed aligners. Tera Harz TC-85 resin and Zendura FLX (ZF) thermoformed sheets (0.76 mm) were used. Rectangular strip specimens (50 × 10 × 0.6 mm) were produced for a three-point bending test (3PB) at different temperatures. Full anatomical aligners were produced for 3D force measurements on different teeth and directions at 37 °C, using a custom-made device. ZF exhibited flexural forces between 1.7 and 2.3 N, while TC-85 from 0.3 N to 2.7 N, with temperature affecting TC-85 more significantly. At lower temperatures, TC-85 was stiffer than ZF, but at higher temperatures, it became less rigid. The 3D-force measurements indicated comparable values for both materials. Force ranged from 0.3–1.7 N and moment from 4.8–9.4 Nmm. The study concluded that TC-85 3D-printed aligners deliver biologically compatible forces for orthodontic movement and offer better control over thickness.HighlightsThe 3D-printed Tera Harz TC-85 resin revolutionises aligner production.Tera Harz TC-85 aligners generate forces within the orthodontic accepted range.Shape recovery of TC-85 can enable adaptability and larger incremental step size.The 3D printing offers greater control over aligner design and thickness.

Abstract Background The mechanical properties of fully crystallized lithium aluminosilicate ceramics may be influenced by intraoral temperature variations and postmilling surface treatment. The purpose of this study is to explore the interplay among glazing, thermocycling, and the mechanical characteristics (namely, fracture toughness and hardness) of fully crystallized lithium aluminosilicate ceramics. Methods Bending bars (n = 40) cut from LisiCAD blocks (GC, Japan) were randomly assigned to glazed or unglazed groups (n = 20) and subjected to the single edge v-notch beam method to create notches. A glazing firing cycle was applied to the glazed group, while the unglazed group was not subjected to glazing. Half of the specimens (n = 10) from both groups underwent thermocycling before fracture toughness testing. The fracture toughness (KIC) was evaluated at 23 ± 1 °C using a universal testing machine configured for three-point bending, and the crack length was measured via light microscopy. Seven specimens per group were selected for the hardness test. Hardness was assessed using a Vickers microhardness tester with a 1 kg load for 20 s, and each specimen underwent five indentations following ISO 14705:2016. The Shapiro–Wilk and Kolmogorov-Smirnov tests were used to evaluate the normality of the data and a two-way ANOVA was utilized for statistical analysis. The significance level was set at (α = 0.05). Results Regardless of the thermocycling conditions, the glazed specimens exhibited significantly greater fracture toughness than did their unglazed counterparts (P

Abstract Background The aim of this study is to evaluate the biomechanical behavior of the mesial and distal off-axial extensions of implant-retained prostheses in the posterior maxilla with different prosthetic materials using finite element analysis (FEA). Methods Three dimensional (3D) finite element models with three implant configurations and prosthetic designs (fixed-fixed, mesial cantilever, and distal cantilever) were designed and modelled depending upon cone beam computed tomography (CBCT) images of an intact maxilla of an anonymous patient. Implant prostheses with two materials; Monolithic zirconia (Zr) and polyetherketoneketone (PEKK) were also modeled .The 3D modeling software Mimics Innovation Suite (Mimics 14.0 / 3-matic 7.01; Materialise, Leuven, Belgium) was used. All the models were imported into the FE package Marc/Mentat (ver. 2015; MSC Software, Los Angeles, Calif). Then, individual models were subjected to separate axial loads of 300 N. Von mises stress values were computed for the prostheses, implants, and bone under axial loading. Results The highest von Mises stresses in implant (111.6 MPa) and bone (100.0 MPa) were recorded in distal cantilever model with PEKK material, while the lowest values in implant (48.9 MPa) and bone (19.6 MPa) were displayed in fixed fixed model with zirconia material. The distal cantilever model with zirconia material yielded the most elevated levels of von Mises stresses within the prosthesis (105 MPa), while the least stresses in prosthesis (35.4 MPa) were recorded in fixed fixed models with PEKK material. Conclusions In the light of this study, the combination of fixed fixed implant prosthesis without cantilever using a rigid zirconia material exhibits better biomechanical behavior and stress distribution around bone and implants. As a prosthetic material, low elastic modulus PEKK transmitted more stress to implants and surrounding bone especially with distal cantilever.

Background. The impact of tongue protrusion forces on the formation of malocclusions is well documented in academic literature. In the case of bone dehiscence of the buccal wall in front of the lower frontal teeth, this process may be even more pronounced. Augmentation with 3D customized allogenic bone blocks (CABB) has been proposed as a potential solution for treating such defects. The objective was to assess the impact of bone block adjustment accuracy on the resistance of teeth to protrusion forces at various stages of alveolar bone loss. Methods: A finite element analysis (FEM) was conducted to ascertain whether augmentation with a CABB will result in increased resilience to tongue protrusion forces. Three-dimensional models of the mandible with dehiscenses were created, based on the dehiscences classification and modification proposed in the journal by the authors of regenerative method. The models feature a CABB positioned at three different distances: 0.1 mm, 0.4 mm, and 1.0 mm. The material parameters were as follows: bone (homogenous, isotropic, E = 2 GPa), teeth (E = 20 GPa), periodontal ligament (E = 0.44 MPa), and membrane between bones (E = 3.4 MPa). A tongue protrusion force within the range of 0–5 N was applied to each individual frontal tooth. Results: The use of an CABB has been shown to positively impact the stability of the teeth. The closer the bone block was placed to the alveolar bone, the more stable was the result. The best results were obtained with a ¼ dehiscence and 0.1 mm distance. Conclusions: The protrusive forces produced by the tongue might not be the biggest one, but in a presence of the bone loss they might have serious results. Even shortly after the surgery, CABB has a positive impact on the incisor resilience.

Abstract Background While conventional threaded implants (TI) have proven to be effective for replacing missing teeth, they have certain limitations in terms of diameter, length, and emergence profile when compared to customised root analogue implants (RAI). To further investigate the potential benefits of RAIs, the aim of this study was to experimentally evaluate the micromotion of RAIs compared to TIs. Methods A 3D model of tooth 47 (mandibular right second molar) was segmented from an existing cone beam computed tomography (CBCT), and a RAI was designed based on this model. Four RAI subgroups were fabricated as follows: 3D-printed titanium (PT), 3D-printed zirconia (PZ), milled titanium (MT), milled zirconia (MZ), each with a sample size of n = 5. Additionally, two TI subgroups (B11 and C11) were used as control, each with a sample size of n = 5. All samples were embedded in polyurethane foam artificial bone blocks and subjected to load application using a self-developed biomechanical Hexapod Measurement System. Micromotion was quantified by analysing the load/displacement curves. Results There were no statistically significant differences in displacement in Z-axis (the loading direction) between the RAI group and the TI group. However, within the RAI subgroups, PZ exhibited significantly higher displacement values compared to the other subgroups (p

Objective: The objective of this study was to evaluate the effect of different surface treatment methods on the shear bond strength (SBS) of metal brackets bonded to two types of CAD/CAM composite restorations: milled and 3D-printed. Materials and Methods: A total of 160 flat-shaped specimens (10 × 10 × 2 mm3) were prepared from four different CAD/CAM composites; two milled (Lava Ultimate™ [LU] and Grandio™ [GR]) and two 3D-printed (Crowntec™ [CT] and C&B Permanent™ [CB]). These specimens underwent thermocycling (5000 cycles at 5–55 °C), then were categorized based on the surface treatment into four groups (n = 10): Group C (control, no surface treatment), Group HF (treated with 9.6% hydrofluoric acid), Group DB (mechanical roughening by a diamond bur), and Group SB (sandblasting using aluminum oxide). Metal brackets were bonded using Transbond XT Primer and universal adhesive, stored in artificial saliva for 24 h, then thermocycled again. Shear bond strength (SBS) was tested using a universal testing machine until bracket debonding occurred. The adhesive remnant index (ARI) was assessed using a stereomicroscope to quantify the residual adhesive following debonding. Result: Regarding material, GR and LU restorations had significantly higher SBS values compared to CT and CB, ranging from 13.90 MPa to 20.35 MPa. Regarding surface treatment, SB and HF groups showed significantly higher SBS values. The ARI scores showed different adhesive modes of failure, with higher instances of scores 0 and 1, which indicate no or minimal adhesive remaining. Conclusions: Both milled and 3D-printed materials had adequate SBS for clinical use, with milled materials showing superior results. Surface treatments like sandblasting and HF significantly improved bond strength, with adhesive failure being common.

Objectives: The study addresses the challenge of cross-infection in dentistry, focusing on improving disinfection protocols for dental hydrocolloid gel materials. This research aimed to incorporate chlorhexidine, natural plant extracts, and green-synthesized silver nanoparticles (AgNPs) into dental alginate to enhance safety and hygiene standards in dental practices. Methods: Conventional dental alginate served as the control, with experimental groups including alginate modified with 0.2% chlorhexidine (CHX-group) and alginate incorporating AgNPs synthesized from Syzygium aromaticum (SA) and Zingiber officinale (ZO) extracts (SA + AgNPs and ZO + AgNPs groups). Plant extracts were analyzed via GC/MS to confirm their composition. UV–visible spectroscopy, SEM, and EDX characterized the synthesized AgNPs. Antimicrobial efficacy against Candida albicans, Streptococcus mutans, and methicillin-resistant and methicillin-sensitive Staphylococcus aureus was evaluated using agar well diffusion assays. The dimensional accuracy of alginate impressions was assessed according to ISO 21563:2021 standards. Results: Chemical analysis of SA and ZO extracts identified 60 and 43 active compounds, respectively, supporting their use in AgNP synthesis. UV–visible spectroscopy, SEM, and EDX confirmed the formation of spherical AgNPs using SA and ZO extracts. Modified groups showed inhibitory activity against Streptococcus mutans and methicillin-resistant (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA), in contrast to the unmodified control. Both AgNP-modified groups demonstrated efficacy comparable to the CHX-group against MRSA and MSSA, with SA + AgNP showing superior performance against C. albicans. The dimensional accuracy of all groups was within clinically acceptable ranges as reported in the literature (0.027–0.083 mm). Discussion: CHX, silver nitrate, and green-synthesized AgNPs present promising options for developing self-disinfecting alginate impression materials. Utilizing plant extracts in AgNP synthesis offers a safe, efficient, and synergistic approach between metal ions and phytotherapeutic agents. This approach could potentially enhance disinfection efficacy without compromising material performance, improving dental safety and hygiene.

Abstract Half a million different plant species are occurring worldwide, of which only 1% has been phytochemically considered. Thus, there is great potential for discovering novel bioactive compounds. In dentistry, herbal extracts have been used as antimicrobial agents, analgesics, and intracanal medicaments. Glass-ionomer cement (GIC) and bioactive glass (BAG) are attractive materials in dentistry due to their bioactivity, adhesion, and remineralisation capabilities. Thus, this review summarizes the evidence around the use of phytotherapeutics in dental glass-based materials. This review article covers the structure, properties, and clinical uses of GIC and BAG materials within dentistry, with an emphasis on all the attempts that have been made in the last 20 years to enhance their properties naturally using the wisdom of traditional medicines. An extensive electronic search was performed across four databases to include published articles in the last 20 years and the search was concerned only with the English language publications. Publications that involved the use of plant extracts, and their active compounds for the green synthesis of nanoparticles and the modification of GIC and BAG were included up to May 2023. Plant extracts are a potential and effective candidate for modification of different properties of GIC and BAG, particularly their antimicrobial activities. Moreover, natural plant extracts have shown to be very effective in the green synthesis of metal ion nanoparticles in an ecological, and easy way with the additional advantage of a synergistic effect between metal ions and the phytotherapeutic agents. Medicinal plants are considered an abundant, cheap source of biologically active compounds and many of these phytotherapeutics have been the base for the development of new lead pharmaceuticals. Further research is required to assess the safety and the importance of regulation of phytotherapeutics to expand their use in medicine. Graphical Abstract

Abstract Background This study aimed to evaluate and compare the marginal gap using two different methods and the internal fit of 3D printed and zirconia crowns. Methods 3Y-TZP zirconia crowns (n = 20) were manufactured using subtractive milling (group M) and 3D printed (group P). The marginal gap was measured at 60 points using vertical marginal gap technique (VMGT). On the other hand, the silicone replica technique (SRT) was used to evaluate the internal fit and was divided into 4 groups: marginal gap, cervical gap, axial gap, and occlusal gap where the thickness of light impression was measured at 16 references. The numerical data was tested for normality using Shapiro–Wilk's test. They were found to be normally distributed and were analyzed using an independent t-test. Results Using VMGT, group P had significantly higher mean marginal gap values of 80 ± 30 µm compared to group M = 60 ± 20 µm (p

Aims: This study was conducted to systematically evaluate the biomechanical impact of varying degrees of root and bone resorption resulting from periodontitis and orthodontic tooth movement (OTM) on the mandibular anterior teeth. The objective was to determine whether these distinct resorption patterns exert a specific influence on tooth displacement and strain patterns. Methods: A finite element (FE) model of an idealized anterior mandible from the first premolar in the third to the fourth quadrant was developed without bone or root resorption and a constant periodontal ligament (PDL) thickness of 0.2 mm. Variations included three root resorption levels (0%, 20%, 50%) and three bone resorption types (circular 50%, circular 80%, vestibular 80%). Models ranged from 200,000 to 440,000 elements and 55,000 to 130,000 nodes. Orthodontic forces, namely root torque (5 Nmm), intrusion (0.2 N), and distalization (0.5 N) were applied for subsequent crown displacement and PDL strain analysis. Results: A total of 180 simulations were performed. Simulations showed that displacement was similar across different bone resorption conditions, irrespective of modeled root resorptions. Circumferential bone resorption increased tooth displacement, regardless of root resorption status. Vestibular bone resorption exhibited less increase in tooth displacement. However, when accompanied by root resorption, the combination exacerbated tooth displacement. Strains in the PDL clearly increased with a circumferential bone resorption of 80%. Conclusions: This study highlights the critical role of bone resorption in tooth displacement during OTM, particularly the challenges associated with circumferential resorption. Clinicians must consider both bone and root resorption for personalized medicine treatment of patients with severe periodontitis, in favor of low-force application strategies to optimize outcomes and minimize complications linked to excessive tooth displacement.

Abstract Background The aim of the study was to investigate the effect of material and occlusal preparation design on the internal fit and marginal gap of endocrowns made of Polyether ether ketone (PEEK) and lithium disilicate. Methods 32 endocrowns were fabricated on prepared mandibular molars and divided into two groups (n = 16) according to the material. Group L: lithium disilicate and Group P: PEEK. Each group was further subdivided into two subgroups (n = 8) according to the occlusal preparation design: full occlusal coverage (LF and PF) and partial occlusal coverage (LP and PP). Samples were analyzed using microcomputed tomography (µCT) with a voxel size of 6 μm to evaluate internal fit, and an optical microscope was used to evaluate the marginal gap. Data were collected, tabulated, and statistically analyzed. Numerical data were described as mean and standard deviation and compared using the ANOVA test. The level of significance was set at α P ≤ 0.05. Results All groups’ internal fit and marginal gaps values were within the acceptable clinical range. However, the lithium disilicates group recorded statistically significantly higher mean internal gap values than the PEEK groups. Regardless of the material, the difference between the two occlusal designs was not statistically significant in both internal fit and marginal gap records. Conclusion Within the limitations of this study, PEEK endocrown restorations revealed better internal fit and marginal gap than lithium disilicate endocrown restorations. The marginal and internal fit of both lithium disilicate and PEEK endocrown restorations were within the clinically acceptable range. The occlusal preparation design had no influence on the internal fit and marginal gap of the endocrown restoration.

Abstract Biomimetics is a branch of science that explores the technical beauty of nature. The concept of biomimetics has been brilliantly applied in famous applications such as the design of the Eiffel Tower that has been inspired from the trabecular structure of bone. In dentistry, the purpose of using biomimetic concepts and protocols is to conserve tooth structure and vitality, increase the longevity of restorative dental treatments, and eliminate future retreatment cycles. Biomimetic dental materials are inherently biocompatible with excellent physico-chemical properties. They have been successfully applied in different dental fields with the advantages of enhanced strength, sealing, regenerative and antibacterial abilities. Moreover, many biomimetic materials were proven to overcome significant limitations of earlier available generation counterpart. Therefore, this review aims to spot the light on some recent developments in the emerging field of biomimetics especially in restorative and regenerative dentistry. Different approaches of restoration, remineralisation and regeneration of teeth are also discussed in this review. In addition, various biomimetic dental restorative materials and tissue engineering materials are discussed.

The aim of this study is to study the effect of aging in different media (deionized water and artificial saliva) on the force/torque generation by thermoplastic orthodontic aligners. Ten thermoformed aligners, made of Essix ACE® thermoplastic sheets, were aged in deionized water and in artificial saliva over two weeks at 37 °C, five in each medium. The force/torque generated on upper second premolar (Tooth 25) of a resin model was measured at day 0 (before aging), 2, 4, 6, 10, and 14, using a biomechanical test set-up. The results showed that aging of aligners by storage in aging agent has no significant impact on their force/torque decay. No significant differences were also found in force/torque between the aligners stored in deionized water nor artificial saliva. The vertical extrusion-intrusion forces were measured in the range of 1.4 to 4.6 N, the horizontal oro-vestibular forces were 1.3 to 2.5 N, while the torques on mesio-distal rotation were 5.4 to 41.7 Nmm. It could be concluded that the influence of saliva only on the mechanical properties can be classified as insignificant, and no significant difference between artificial aging in deionized water or artificial saliva was observed.

Abstract Background This study aimed to compare the dimensional accuracy, hydrophilicity and detail reproduction of the hybrid vinylsiloxnether with polyether and polyvinylsiloxane parent elastomers using modified digital techniques and software. This was done in an attempt to aid in solving the conflict between the different studies published by competitive manufacturers using different common manual approaches. Methods A polyether, polyvinylsiloxanes and vinyl polyether silicone hybrid elastomeric impression materials were used in the study. Dimensional accuracy was evaluated through taking impressions of a metallic mold with four posts representing a partially edentulous maxillary arch, that were then poured with stone. Accuracy was calculated from the mean of measurements taken between fixed points on the casts using digital single-lens reflex camera to produce high-resolution digital pictures for all the casts with magnification up to 35×. Hydrophilicity was assessed by contact angle measurements using AutoCAD software. The detail reproduction was measured under dry conditions according to ANSI/ADA Standard No. 19 and under wet conditions as per ISO 4823. A metallic mold was used with three V shaped grooves of 20, 50, and 75 µm width. Specimens were prepared and examination was made immediately after setting using digital images at a magnification of 16×. Results The hybrid impression (0.035 mm) material showed significantly higher dimensional accuracy compared to the polyether (0.051 mm) but was not as accurate as the polyvinyl siloxane impression material (0.024 mm). The contact angles of the hybrid material before and after setting was significantly lower than the parent materials. With regard to the detail reproduction, the three tested materials were able precisely to reproduce the three grooves of the mold under dry conditions. Whereas, under wet conditions, the hybrid material showed higher prevalence of well-defined reproduction of details same as polyether but higher than polyvinylsiloxane that showed prevalence of details with loss of sharpness and continuity. Conclusions The digital technique used could be a more reliable and an easier method for assessment of impression materials properties. The hybridization of polyvinyl siloxane and polyether yielded a promising material that combines the good merits of both materials and overcomes some of their drawbacks.

Treatment duration is one of the most important factors that patients consider when deciding whether to undergo orthodontic treatment or not. This study aimed to build and compare machine learning (ML) models for the prediction of orthodontic treatment length and to identify factors affecting the duration of orthodontic treatment using the ML approach. Records of 518 patients who had successfully finished orthodontic treatment were used in this study. Seventy percent of the patient data were used for training ML models, and thirty percent of the data were used for testing these models. We applied and compared nine machine-learning algorithms: simple linear regression, modified simple linear regression, polynomial linear regression, K nearest neighbor, simple decision tree, bagging regressor, random forest, gradient boosting regression, and adaboost regression. We then calculated the importance of patient data features for the ML models with the highest performance. The best overall performance was obtained through the bagging regressor and adaboost regression ML methods. The most important features in predicting treatment length were age, crowding, artificial intelligence case difficulty score, overjet, and overbite. Without patient information, several ML algorithms showed comparable performance for predicting treatment length. Bagging and adaboost showed the best performance when patient information, including age, malocclusion, and crowding, was provided.

Abstract Objective Since there is no material in the market met all the ideal requirements of an impression material, thus in an attempt to find one, hybridization between the two most commonly used impression materials were done. The aim of the hybridization was to obtain a new material combining the good merits of both and eliminate their shortcomings. Thus, this study aimed to assess the impact of hybridization between polyether with addition silicone on tear strength and elastic recovery of the new material and compare such effect with regard to parent materials. Results A polyether (PE), polyvinyl siloxanse (PVS) and vinyl polyether silicone (VPES) hybrid elastomers were used in the present study. Tear strength was measured one hour after setting time of each material according to the manufacturer and the three materials showed statistically comparable tear strength in N/mm. Elastic recovery was evaluated one minute after the setting time recommended by the manufacturer. The three materials were statistically insignificant from each other, and all met the ISO4823 requirement of having greater than 96.5% recovery.

Monolateral pin-to-bar-clamp fixators are commonly used to stabilize acute extremity injuries. Certain rules regarding frame geometry have been established that affect construct stability. The influence of sagittal pin angulation on construct stiffness and strength has not been investigated. The purpose of this biomechanical study was to demonstrate the effect of a pin angulation in the monolateral fixator using a composite cylinder model. Three groups of composite cylinder models with a fracture gap were loaded with different mounting variants of monolateral pin-to-bar-clamp fixators. In the first group, the pins were set parallel to each other and perpendicular to the specimen. In the second group, both pins were set convergent each in an angle of 15° to the specimen. In the third group, the pins were set each 15° divergent. The strength of the constructions was tested using a mechanical testing machine. This was followed by a cyclic loading test to produce pin loosening. A pull-out test was then performed to evaluate the strength of each construct at the pin–bone interface. Initial stiffness analyses showed that the converging configuration was the stiffest, while the diverging configuration was the least stiff. The parallel mounting showed an intermediate stiffness. There was a significantly higher resistance to pull-out force in the diverging pin configuration compared to the converging pin configuration. There was no significant difference in the pull-out strength of the parallel pins compared to the angled pin pairs. Convergent mounting of pin pairs increases the stiffness of a monolateral fixator, whereas a divergent mounting weakens it. Regarding the strength of the pin–bone interface, the divergent pin configuration appears to provide greater resistance to pull-out force than the convergent one. The results of this pilot study should be important for the doctrine of fixator mounting as well as for fixator component design.

Abstract Background Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the reference-standard, for the diagnosis of periapical inflammatory lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA). Methods AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three diagnostic subgroups were also measured. Results A total of 80 patients were enrolled in this study. The mean intraoral thermal image temperature for AA was 37.26 ± 0.36, that for CA was 35.03 ± 0.63 and that for AAP was 36.07 ± 0.45. The differences between the mean intraoral thermal temperatures of the three diagnostic groups were statistically significant (P

ABSTRACT Objective: To evaluate, in-vitro, the change in crown inclination that occurs during orthodontic leveling and alignment using different archwire-bracket-ligation combinations. Materials and Methods: Four archwire types were tested: (1) 0.012-in stainless steel and (2) 0.0155-in stainless steel multi-stranded, (3) 0.012-in nitinol Orthonol® and (4) 0.012-in nitinol Thermalloy®. Combinations with five types of 0.022-in slot orthodontic brackets were tested: SmartClipTM and Time3® self-ligating brackets, Mini-Taurus® and Victory SeriesTM conventional brackets, and Synergy® conventional-low friction bracket. Conventional brackets were ligated with both stainless steel and elastomeric ligatures. The simulated malocclusion comprised 2.0mm gingival and 2.0mm labial displacements of a maxillary right central incisor. Rotation around the Y-axis (representing labio-palatal inclination) was measured for the different archwire-bracket-ligation combinations. Results: The largest rotation was measured whith Orthonol® and Thermalloy® wires when combined with SmartClipTM brackets (8.07±0.24º and 8.06±0.26º, respectively) and with Synergy® brackets ligated with stainless steel ligatures (8.03±0.49º and 8.0±0.37º, respectively). The lower rotation was recorded when Thermalloy®, multi-stranded, and Orthonol® wires were ligated with elastomeric rings to Mini-Taurus® brackets (1.53±0.18º, 1.65± 0.23º and 1.70±0.28º, respectively) and to Victory SeriesTM brackets (1.68± 0.78º, 2.92± 1.40º and 1.74±0.46º, respectively). Conclusions: All archwire-bracket-ligation combinations produced lingual crown inclination; however, lower changes were observed when the conventional brackets were ligated with elastomeric rings. The multi-stranded archwire produced less rotation with nearly every bracket-ligation combination, compared to the other archwires. The effect of the archwire-bracket-ligation combination on tooth inclination during leveling and alignment should be considered during planning treatment mechanics.

Objectives: Impression materials could be a source of cross-contamination due to the presence of microorganisms from blood and saliva inside the oral cavity. Nevertheless, routinely performed post-setting disinfection could compromise the dimensional accuracy and other mechanical properties of alginates. Thus, this study aimed to evaluate detail reproduction, dimensional accuracy, tear strength, and elastic recovery of new experimentally prepared self-disinfecting dental alginates. Methods: Two antimicrobial-modified dental alginate groups were prepared by mixing alginate powder with 0.2% silver nitrate (AgNO3 group) and a 0.2% chlorohexidine solution (CHX group) instead of pure water. Moreover, a third modified group was examined by the extraction of Boswellia sacra (BS) oleoresin using water. The extract was used to reduce silver nitrate to form silver nanoparticles (AgNPs), and the mixture was used as well in dental alginate preparation (BS + AgNP group). Dimensional accuracy and detail reproduction were examined as per the ISO 1563 standard guidelines. Specimens were prepared using a metallic mold engraved with three parallel vertical lines 20, 50, and 75 µm wide. Detail reproduction was evaluated by checking the reproducibility of the 50 µm line using a light microscope. Dimensional accuracy was assessed by measuring the change in length between defined reference points. Elastic recovery was measured according to ISO 1563:1990, in which specimens were gradually loaded and then the load was released to allow for recovery from the deformation. Tear strength was evaluated using a material testing machine until failure at a crosshead speed of 500 mm/min. Results: The recorded dimensional changes between all tested groups were insignificantly different and within the reported acceptable values (between 0.037–0.067 mm). For tear strength, there were statistically significant differences between all tested groups. Groups modified with CHX (1.17 ± 0.26 N/mm) and BS + AgNPs (1.11 ± 0.24 N/mm) showed higher tear strength values compared to the control (0.86 ± 0.23 N/mm) but were insignificant from AgNO3 (0.94 ± 0.17 N/mm). All tested groups showed elastic recovery values that met both the ISO standard and ADA specifications for elastic impression materials and tear strength values within the acceptable documented ranges. Discussion: The CHX, silver nitrate, and green-synthesized silver nanoparticles could be promising, inexpensive alternatives for the preparation of a self-disinfecting alginate impression material without affecting its performance. Green synthesis of metal nanoparticles could be a very safe, efficient, and nontoxic method, with the advantage of having a synergistic effect between metal ions and active chemical constituents of plant extracts.

(1) Background: Novel high-performance polymers for medical 3D printing enable in-office manufacturing of fully customized brackets. Previous studies have investigated clinically relevant parameters such as manufacturing precision, torque transmission, and fracture stability. The aim of this study is to evaluate different design options of the bracket base concerning the adhesive bond between the bracket and tooth, measured as the shear bond strength (SBS) and maximum force (Fmax) according to DIN 13990. (2) Methods: Three different designs for printed bracket bases were compared with a conventional metal bracket (C). The following configurations were chosen for the base design: Matching of the base to the anatomy of the tooth surface, size of the cross-sectional area corresponding to the control group (C), and a micro- (A) and macro- (B) retentive design of the base surface. In addition, a group with a micro-retentive base (D) matched to the tooth surface and an increased size was studied. The groups were analyzed for SBS, Fmax, and adhesive remnant index (ARI). The Kruskal–Wallis test with a post hoc test (Dunn–Bonferroni) and Mann–Whitney U test were used for statistical analysis (significance level: p < 0.05). (3) Results: The values for SBS and Fmax were highest in C (SBS: 12.0 ± 3.8 MPa; Fmax: 115.7 ± 36.6 N). For the printed brackets, there were significant differences between A and B (A: SBS 8.8 ± 2.3 MPa, Fmax 84.7 ± 21.8 N; B: SBS 12.0 ± 2.1 MPa, Fmax 106.5 ± 20.7 N). Fmax was significantly different for A and D (D: Fmax 118.5 ± 22.8 N). The ARI score was highest for A and lowest for C. (4) Conclusions: This study shows that conventional brackets form a more stable bond with the tooth than the 3D-printed brackets. However, for successful clinical use, the shear bond strength of the printed brackets can be increased with a macro-retentive design and/or enlargement of the base.

Background: This study compared the effect of various grafting materials on the area and volume of minerals attached to dental implants. Materials and Methods: In this animal study, 13 dogs were divided into three groups according to the time of sacrificing (2 months, 4 months, or 6 months). The implants were placed in oversized osteotomies, and the residual defects were filled with autograft, bovine bone graft (Cerabone), or a synthetic substitute (Osteon II). At the designated intervals, the dogs were sacrificed and the segmented implants underwent micro-computed tomography analysis. The bone-implant area (BIA) and bone-implant volume (BIV) of bone and graft material were calculated in the region of interest around the implant. The data were analyzed by two-way analysis of variance (ANOVA) at P < 0.05. Results: There was no significant difference in BIA and BIV between the healing intervals for any of the grafting materials (P > 0.05). ANOVA exhibited comparable BIA and BIV between the grafting materials at 2 and 4 months after surgery (P > 0.05), although a significant difference was observed after 6 months (P < 0.05). Pairwise comparisons revealed that BIA was significantly greater in the autograft-stabilized than the synthetic-grafted sites (P = 0.035). The samples augmented with autograft also showed significantly higher BIV than those treated by the xenogenic (P = 0.017) or synthetic (P = 0.002) particles. Conclusion: All graft materials showed comparable performance in providing mineral support for implants up to 4 months after surgery. At the long-term (6-month) interval, autogenous bone demonstrated significant superiority over xenogenic and synthetic substitutes concerning the bone area and volume around the implant.

Guided implant placement has been shown to be more accurate than free-handed insertion. Still, implant position deviations occur and could possibly pose risks. Thus, there is a quest to identify factors that might impair the accuracy of implantation protocols using templates. This study aimed to investigate the influence of autoclaving cycles (cycle 1: 121 °C, 1 bar, 20.5 min; cycle 2: 134 °C, 2 bar, 5.5 min) on the Vickers hardness and flexural modulus of five different materials used for 3D-printed insertion guides. The specimens were subjected to Vickers hardness tests, showing significant changes in the Vickers hardness for two and three materials out of five for cycle 1 and 2, respectively. The results of the three-point bending tests (n = 15 specimens per material) showed decreasing flexural moduli after autoclaving. However, changes were significant only for one material, which presented a significant decrease in the flexural modulus after cycle 2. No significant changes were detected after cycle 1. In conclusion, our findings show that autoclaving can alter the mechanical properties of the templates to some extent, especially with cycle 2. Whether these modifications are associated with dimensional changes of the templates and reduced accuracy of the implantation protocols remains to be investigated.

Shear bond strength (SBS) testing is a commonly used method for evaluating different dental adhesive systems. Failure mode analysis provides valuable information for better interpretation of bond strength results. The aim of this study was to evaluate the influence of specimen dimension and loading technique on shear bond strength and failure mode results. Eighty macro and micro flowable composite cylindrical specimens of 1.8 and 0.8 mm diameter, respectively, and 1.5 mm length were bonded to dentinal substrate. Four study groups were created (n = 20): Macroshear wireloop, Gp1; Microshear wireloop, Gp2; Macroshear chisel, Gp3; and Microshear chisel, Gp4. They were tested for SBS using chisel and wireloop loading devices followed by failure mode analysis using digital microscopy and SEM. Two- and one-way ANOVA were used to compare stress at failure values of different groups while the Kruskal–Wallis test was used to compare between failure modes of the tested groups. Gp4 recorded the highest mean stress at failure 54.1 ± 14.1 MPa, and the highest percentage of adhesive failure in relation to the other groups. Specimen dimension and loading technique are important parameters influencing the results of shear bond strength. Micro-sized specimens and chisel loading are recommended for shear testing.

Abstract Background Torque of the maxillary incisors is crucial to occlusal relationship and esthetics and can be influenced by many factors. The aim of this study was to assess the relative influence of the material of the orthodontic appliance (adhesive, bracket, ligature, and wire) on tooth displacements and developed stresses/strains after torque application. Methods A three-dimensional upper right central incisor with its periodontal ligament (PDL) and alveolus was modeled. A 0.018-in. slot discovery® (Dentaurum, Ispringen, Germany) bracket with a rectangular 0.018 x 0.025-in. wire was generated. The orthodontic appliance varied in the material of its components: adhesive (composite resin or resin-modified glass ionomer cement), bracket (titanium, steel, or ceramic), wire (beta-titanium or steel), and ligature (elastomeric or steel). A total of 24 models were generated, and a palatal root torque of 5° was applied. Afterwards, crown and apex displacement, strains in the PDL, and stresses in the bracket were calculated and analyzed. Results The labial crown displacement and the palatal root displacement of the tooth were mainly influenced by the material of the wire (up to 150% variation), followed by the material of the bracket (up to 19% variation). The magnitude of strains developed in the PDL was primarily influenced by the material of the wire (up to 127% variation), followed by the material of the bracket (up to 30% variation) and the ligature (up to 13% variation). Finally, stresses developed at the bracket were mainly influenced by the material of the wire (up to 118% variation) and the bracket (up to 59% variation). Conclusions The material properties of the orthodontic appliance and all its components should be considered during torque application. However, these in silico results need to be validated in vivo before they can be clinically extrapolated.

This study compared two resin composites with similar filler systems and different matrix compositions. The depth of cure (DoC), polymerization shrinkage, and marginal leakage were evaluated. A Filtek Bulk Fill resin composite (FB) and a Filtek Supreme resin composite (FS) were used. For the DoC and polymerization shrinkage, cylindrical specimens with different thicknesses were prepared. The DoC was attributed to the bottom/top ratios of Vickers microhardness numbers. For polymerization shrinkage, each specimen was firstly scanned using micro-computed tomography (µCT) then cured for 20 s, then for 10 s, and then for 10 s, and they were rescanned between each curing time. Data were processed using the Mimics software. For marginal leakage, standardized 5 mm cavities were prepared in 90 molars. After etching and bonding, materials were packed according to groups: FB-bulk, FB-incremental, and FS-incremental, which were cured for 20, 30, and 40 s, respectively. After thermo-cycling, teeth were stored in 1% methylene blue dye for 24 h and then sectioned and observed for dye penetration. The results showed insignificant differences in the shrinkage and leakage between the different packing techniques and curing times of both materials. In conclusion, the introduction of a novel matrix into resin composite composition enabled bulk-filling in one layer up to 5 mm deep while keeping a tolerable polymerization shrinkage.

Abstract Background The aim of this study was to compare the torque efficacy of square and rectangular wires in 0.018- and 0.022-in. conventionally ligated brackets. Methods Brackets of the same prescription were evaluated in both slot dimensions. Identical acrylic resin models of the maxilla were bonded with the brackets and mounted on the Orthodontic Measurement and Simulation System. Ten 0.018 × 0.018 in., 0.018 × 0.022 in., and 0.018 × 0.025 in. stainless steel wires were evaluated in the 0.018-in. brackets and ten 0.019 × 0.019 in., 0.019 × 0.025 in., and 0.019 × 0.026 in. stainless steel wires were evaluated in the 0.022-in. brackets. A 15° buccal root torque was gradually applied to the right central incisor bracket, and the moments were recorded at this position. One-way ANOVA was applied for both bracket slot sizes along with post hoc analysis for the various archwire sizes. Results The mean measured moments varied between 10.78 and 30.60 Nmm among the assessed wire-and-bracket combinations. Both square and rectangular archwires in the 0.018-in. bracket system exerted statistically significantly higher moments in comparison with their counterparts in the 0.022-in. bracket system. Rectangular archwires exerted statistically significantly higher moments than square archwires, both for the 0.018- and the 0.022-in. bracket system. Conclusions Rectangular archwires seem to be more efficient in torque exertion, especially in 0.018-in. brackets.

Dental implants are important tools for restoring the loss of teeth. The rapid growth and periodic regeneration of antlers make Sika deer a good and less invasive alternative model for studying bone remodelling in mammals. We developed a special loading device for antlers and analysed the bone reaction around unloaded implants and under immediate loading conditions until osseointegration occurred. In micro-computed tomography images, the density of antler tissue around the implants increased as the loading time increased. This finding was histologically confirmed by the good osseointegration observed in unloaded and loaded specimens. Antler tissue displays a similar healing process to human bone. The use of an antler model is a promising alternative for implant studies that does not require animal sacrifice.

The present study aimed to evaluate in vitro whether biomechanical loading modulates proinflammatory and bone remodeling mediators production by periodontal ligament (PDL) cells in the presence of bacterial challenge. Cells were seeded on BioFlex culture plates and exposed to Fusobacterium nucleatum ATCC 25586 and/or cyclic tensile strain (CTS) of low (CTSL) and high (CTSH) magnitudes for 1 and 3 days. Synthesis of cyclooxygenase-2 (COX2) and prostaglandin E2 (PGE2) was evaluated by ELISA. Gene expression and protein secretion of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) were evaluated by quantitative RT-PCR and ELISA, respectively. F. nucleatum increased the production of COX2 and PGE2, which was further increased by CTS. F. nucleatum-induced increase of PGE2 synthesis was significantly (P

Obesity is increasing throughout the globe and characterized by excess adipose tissue, which represents a complex endocrine organ. Adipose tissue secrets bioactive molecules called adipokines, which act at endocrine, paracrine, and autocrine levels. Obesity has recently been shown to be associated with periodontitis, a disease characterized by the irreversible destruction of the tooth-supporting tissues, that is, periodontium, and also with compromised periodontal healing. Although the underlying mechanisms for these associations are not clear yet, increased levels of proinflammatory adipokines, such as leptin, as found in obese individuals, might be a critical pathomechanistic link. The objective of this study was to examine the impact of leptin on the regenerative capacity of human periodontal ligament (PDL) cells and also to study the local leptin production by these cells. Leptin caused a significant downregulation of growth (TGFβ1, and VEGFA) and transcription (RUNX2) factors as well as matrix molecules (collagen, and periostin) and inhibited SMAD signaling under regenerative conditions. Moreover, the local expression of leptin and its full-length receptor was significantly downregulated by inflammatory, microbial, and biomechanical signals. This study demonstrates that the hormone leptin negatively interferes with the regenerative capacity of PDL cells, suggesting leptin as a pathomechanistic link between obesity and compromised periodontal healing.