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Objectives: The objective of this clinical trial was to evaluate and compare the clinical and radiographic successes of three bioactive endodontic cements (BEC) including novel portland cement-based material releasing fluoride, resin-modified silicate glass cement, and pure tricalcium silicate-based cement-in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping., Methods: Eighty-six (86) participants with previously untreated first and second primary molars were included in this study. The teeth were randomly allocated into three groups: pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride. Cavities were capped with the assigned cement after caries excavation using standard protocols. The teeth that underwent treatment were restored using glass ionomer cement and composite resin. Clinical and radiographic evaluations were performed at 1, 6, and 12 months. The data were analyzed using Pearson chi-square, Kruskal-Wallis H and Z test (P = 0.05)., Results: The success rate was 88 % (n = 25) in the pure tricalcium silicate-based cement group, 88.5 % (n = 26) in the resin-modified silicate glass cement group, and 100 % (n = 25) in the novel portland cement-based material releasing fluoride group. The differences at the 1st, 6th, and 12th month follow-up visits were not statistically significant among the groups (P > 0.05). No difference was found between the integrity of the resin composite restorations overlying pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride according to the USPHS criteria., Conclusions: Novel portland cement-based material releasing fluoride can be considered an alternative for preserving the tooth, as it showed a high success rate in treating primary molars diagnosed with reversible pulpitis via indirect pulp capping., Clinical Significance: Novel Portland cement-based material releasing fluoride could be beneficial in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (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: The aim of the present prospective study was to evaluate the colour stability of 3D-printed non-invasive restorations after 24 months in vivo., Methods: The study included 29 patients, who received 3D-printed restorations made of a computer-aided design (CAD) / computer aided-manufacturing (CAM) hybrid material (n = 354). Restoration colour of 190 restorations was measured using a spectrophotometer. By applying the CIELAB system, *L (lightness), a* (red-green) and b* (blue-yellow) values were recorded. An evaluation of the colour differences (ΔE) after 6, 12 and 24 months was conducted., Results: Analysis of colour differences of 3D-printed restorations showed continuous discolouration of the restorations. After one year 34 % and after two years 18 % of the restorations were rated alpha or bravo, indicating no or hardly visible colour change. After two years, 54 % of the evaluated restorations yielded a colour difference with ΔE > 6.8 (delta). More than 82 % of the evaluated restorations showed values between ΔE 3.8 - 6.8 (charlie) and ΔE ˃ 6.8 (delta) after two years., Conclusions: 3D-printed non-invasive restorations showed an overall reduced colour stability after 24 months in vivo., Clinical Significance: The present study provides first clinical data regarding 3D-printed restorations. These restorations are recommended for a wearing time of about 6 months., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elisabeth Prause reports equipment, drugs, or supplies was provided by BEGO. If there are other authors, they 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 effects of different stamp materials and restoration depths on the accuracy of direct composite resin restorations using stamp technique., Methods: Eighty standard resin teeth were divided into four groups based on different stamp materials: flowable composite resin (FR), vinyl polydimethyl siloxane (VPS) for bite registration (VB), VPS for impression (VI) and transparent VPS (TV). Each material group was further divided into two subgroups based on restoration depth (1 and 2 mm; n = 10). Standardized Class I cavities were prepared and restored with the corresponding stamps. Pre- and post-treatment scans of each tooth were fitted using Geomagic Control X software, generating deviation distribution maps of the occlusal surface. The accuracy indicators, including mean height variation (MHV), root mean square (RMS), and proportions of height variation with different ranges (PHV range ), were recorded to evaluate the accuracy of restorations. Analysis of variance (ANOVA) were used for statistical analysis (α=0.05)., Results: The type of stamp material significantly affected all accuracy indicators, while restoration depth did not show a significant effect on any of the indicators. MHV values ranged from 29.70 ± 5.88 μm to 63.52 ± 9.58 μm, and RMS values ranged from 62.78 ± 8.76 μm to 101.79 ± 13.17 μm, displaying a trend of FR<0.05 mm values (72.24 ± 3.40 % for 1 mm, 71.47 ± 8.54 % for 2 mm) and the lowest PHV >0.2 mm values (0.70 ± 0.50 % for 1 mm, 0.94 ± 0.47 % for 2 mm). In contrast, the TV groups exhibited the lowest PHV <0.05 mm values (59.69 ± 10.23 % for 1 mm, 59.67 ± 5.70 % for 2 mm), while the VI groups showed the highest PHV >0.2 mm values (7.34 ± 1.58 % for 1 mm, 8.20 ± 3.16 % for 2 mm)., Conclusions: The accuracy of direct composite resin restorations using stamp made of flowable composite resin was higher than that of all tested VPS materials, thereby reducing the need for occlusal adjustment and improving clinical efficiency. Besides, restoration depth had no significant impact on the accuracy of stamp technique, regardless of the stamp material used., Clinical Significance: The accuracy of direct composite resin restorations using stamp technique with different stamp materials varies. The flowable composite resin stamp exhibits higher accuracy compared with VPS stamps, reducing the need for occlusal adjustments., 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: 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.)

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.)

Objective: To evaluate the fracture behavior of human molars with extensive MOD restorations using short-fiber-reinforced resin composite of varying viscosities., Materials and Methods: Human molars were randomly divided into seven groups (n = 12): intact teeth (control); restoration using conventional high-viscosity resin composite without (Filtek Z350XT, 3M) or with fibers (everX Posterior, GC); conventional low-viscosity resin composite without (Filtek Supreme Flowable, 3M) or with fibers (everX Flow Dentin Shade, GC); bulk-fill low-viscosity resin composite (Filtek Bulk Fill Flow, 3M) or with fibers (everX Flow Bulk Shade, GC). Restorations were performed on extensive MOD preparations, following the manufacturers' recommendations for each material. Specimens underwent fracture strength testing (N) and fracture pattern (%) categorized as repairable, possibly repairable, or non-repairable. Results were analyzed using a generalized linear model (N) and Fisher's exact test (%), with α = 0.05., Results: Restorations performed with high-viscosity materials showed fracture strength values similar to the control and higher than those of restorations using low-viscosity resin composites (p < 0.0001), except for the bulk-fill low-viscosity resin composite with fibers (p > 0.05). Teeth restored using low-viscosity resin composite with fibers showed a higher % of repairable and possibly repairable fractures than the control (p = 0.0091)., Conclusions: The viscosity of materials mediated the fracture strength, with restorations using high-viscosity resin composites promoting values similar to the intact tooth; however, the presence of fibers influenced the fracture pattern., Clinical Significance: Teeth with MOD cavities restored with high-viscosity resin composites showed similar fracture strength to intact teeth. Fiber-reinforced low-viscosity resin composite for the base of restoration resulted in a more repairable/possibly repairable fracture pattern., (© 2024 Wiley Periodicals LLC.)

Veterinary studies documenting the effect of endodontic treatment on tooth fracture resistance are scarce. The objective of this ex vivo study was to evaluate the effects of mesial access preparation and restoration, as well as pulp chamber access, instrumentation, obturation, and restoration, on the fracture resistance and characteristics of canine teeth in dogs. Sixty-five dog canine teeth were divided into 4 groups: 1. Standard endodontic treatment through a mesial access only; 2. Treatment as per group 1, adding an incisal access, instrumentation and obturation of the pulp chamber, and restoration of the access; 3. Treatment as per group 2, without pulp chamber obturation or restoration of the incisal access; and 4. Untreated teeth. The fracture resistance and characteristics of each group were documented using axial compression testing, angled 45° disto-occlusal to the long axis of the crown. The maximum force prior to fracture in groups 1, 3, and 4 were not statistically different, demonstrating that restored mesial and incisal accesses with pulp chamber instrumentation did not statistically affect fracture resistance. However, obturated and restored group 2 teeth demonstrated decreased fracture resistance compared to all other groups ( P  < .001). Additionally, 26.7% of group 1 teeth sustained complicated crown fractures, while 100% of group 2 teeth fractured within the obturation or restorative materials, preventing pulp exposure in these cases. Although the cause and clinical importance of decreased tooth fracture resistance following pulp chamber obturation and restoration remains unknown, it may provide protective value for maintaining a coronal seal in the event of tooth fracture., Competing Interests: Declaration of Conflicting InterestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

To investigate the value of bracketless invisible orthodontic treatment combined with restoration in patients with anterior esthetic restoration. Sixty-two patients requiring esthetic restoration of anterior teeth admitted to our hospital from May 2019 to August 2022 were selected and divided into observation group and control group according to random number table, with 31 cases in each group. The patients in the control group were treated with repair, while patients in the observation group were treated with bracketless invisible correction treatment combined with repair. The patients in both groups were treated with repair. After 2 weeks, dental esthetics, periodontal index related parameters, patients' esthetic acceptance of restorations, and satisfaction were compared. The aesthetic restoration effect of teeth in the observation group was significantly better than that in the control group after treatment, and the difference was statistically significant ( P  < 0.05). There was no significant difference in GI, SPD, PLI, and SBI levels before and after treatment between the two groups ( P  > 0.05). The acceptance rate of prosthesis aesthetics in the observation group was 100.00%, which was significantly higher than that in the control group (83.87%), and the difference was statistically significant ( P  < 0.05). The satisfaction scores of restoration color, shape and coordination with adjacent teeth in the observation group were higher than those in the control group, and the differences were statistically significant ( P  < 0.05). Compared with simple restorative treatment, combined with bracketless invisible orthodontic treatment helps to further improve the esthetic restoration effect of anterior teeth, has less impact on the periodontal health of patients, and has higher patient acceptance and satisfaction.

Objectives: This study evaluated the mechanical, optical, microstructural, surface, and adhesive behavior of a 3D printing resin comparing it with a machinable resin composite., Materials and Methods: Specimens of different sizes and shapes were either printed (Vitality, Smart Dent) or machinable (Grandio Blocs, Voco GmbH) resin composites with similar composition were prepared. Surface and mechanical characterization were performed with Knoop hardness, flexural strength (three-point-bending), and elastic modulus tests. The wear of the tested materials was evaluated against steatite antagonists. The optical properties stability (color change, ΔE 00, and translucency, TP 00 ) were observed after staining in red wine. In addition, the bond strength of the resin composites to two resin cement protocols were investigated with microshear bond strength tests at baseline and after thermocycling. Scanning electron microscope (SEM) coupled with Energy-Dispersive X-ray Spectroscopy (EDS) was used for microstructural and chemical characterization. Statistical analyses were performed with t- and ANOVA tests., Results: Hardness values (132.76 (16.32) KH- Machinable and 35.87 (2.78) KH - Printed), flexural strength (172.17 (26.99) MPa - Machinable and 88.69 (8.39) MPa - Printed), color and translucency change (1.86 (0.31)/0.06 - Machinable and 3.73 (0.36)/9,16- Printed), and wear depth (24.97 mm (3.60)- Machinable and 7.16 mm (2.84) - Printed) were statistically different. Average Regarding bond strength, mean values (MPa) for non-aged and aged groups were respectively 21.76 (6.64) / 31.9 (12.66) for Bifix cement (Voco GmbH, Cuxhaven, Germany) and 26.75 (5.14) / 24.36 (6.85) for Variolink cement (Ivoclar Vivadent, Schaan, Liechtenstein) in Printed and 17.79 (3.89) / 9.01 (3.36) ) for Bifix cement and 22.09 (6.55) / 11.01 (3.77) for Variolink cement in Machinable materials. The material and aging factors did affect bond strength but the cement factor did not (p = 0.202). No statistical differences were observed for mean roughness (Ra) between materials. The better dispersion and larger size of the inorganic particles in the Machinable resin were contrasted with the clustered smaller particles of printed resin, under SEM., Conclusions: The mechanical properties and color stability of the machinable resin were superior to those of the printed resin, probably due to the greater amount and dispersion of inorganic particles in the Mach resin, but bond strength after aging was stronger and more stable in the printed resin., Clinical Relevance: 3D-printed resin composites with similar compositions to machinable resin composites do not necessarily exhibit the same properties, which can impact clinical performance. Understanding these differences can assist manufacturers in improving their materials and help clinicians distinguish between materials appropriate for provisional and final restorations., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This narrative review critically examines some protocols of biomimetic restorative dentistry (BRD), which supposedly outperforms traditional adhesive techniques. This review explores the origins of BRD, introduces cognitive biases influencing the adoption of BRD protocols without evidence scrutiny, and discusses nine BRD protocols. For this, we searched randomized clinical trials and systematic reviews in the literature on the PubMed, Embase, and Cochrane Library CENTRAL databases, which lead to the following conclusions about the revised protocols: 1) The use of dyes excessively removes carious dentin; 2) Aluminum oxide air abrasion contributes to overtreatment and may pose long-term health risks to dental professionals; 3) Beveling enamel in posterior teeth is technically difficult and leads to unnecessary loss of adjacent sound enamel with no evidence of its use outperforming butt-joint preparations; 4) Deactivating matrix metalloproteinases with chlorhexidine shows no clinical evidence of improving restoration longevity. 5) "Elected" gold-standard adhesive systems perform no better than other good performing available systems; 6) Immediate dentin sealing and resin coating result in similar post-operative sensitivity and longevity of indirect fillings as delayed dentin sealing; 7) Deep margin elevation is a viable alternative to manage subgingival margins in occlusoproximal cavities; 8) The process of "decoupling" with time lacks scientific evidence to support its use; 9) Placing fiber inserts on the pulpal floor and/or axial wall to minimize stress offers no benefits over current alternatives. In conclusion, more rigorous research is needed to validate BRD protocols, focusing on important clinical outcomes that impact in the longevity of the restoration, such as fracture, debonding, post-operative sensitivity, esthetic quality, presence of caries lesions adjacent to restorations and patients' satisfaction need to be thoroughly investigated. Reliance on anecdotal evidence, clinical experience, and common sense propagates myths and undervalues the need for a critical approach in evaluating dental techniques.

Background: It was aimed to investigate the effect of sandblasting and laser surface treatment on shear bond strength in composite restoration repair in vitro., Methods: A micro-hybrid composite (Filtek Z250, 3 M-ESPE, USA) was used to prepare 120 samples. The samples were subjected to a thermal cycle test 5,000 times between 5 and 55 0 C, and they were randomly divided into 12 groups (n = 10). No surface treatment was performed in Groups 1 to 4, which were designed as control groups. The surfaces of the samples in Groups 5 to 8 were sandblasted with a Cojet device, and the surfaces of the samples in Groups 9 to 12 were applied Er, Cr: YSGG laser. After the sample surfaces were divided into groups with and without acid etching, universal adhesive was applied, and the repair process was performed using Filtek Z250 or nano-filled resin composite (Filtek Ultimate, 3 M-ESPE, USA). The thermal cycle test was repeated 5,000 times between 5 and 55 0 C on all repaired samples. The repair shear bond strength of the samples was measured using a universal testing device (Shimadzu IG-IS, Kyoto, Japan). The fracture types were evaluated by optical microscopy and scanning electron microscopy (SEM). Statistical analyses of the findings were evaluated by the Kruskal Wallis test and Mann Whitney U test at 0.05 significance degree., Results: The highest mean shear bond strength values were obtained from the samples sandblasted with CoJet, followed by Er, Cr: YSGG laser, and the control group. It was determined that there was a significant difference between the mean shear bond strength values obtained from the control group and the other surface treatment groups (p < 0.05). In general, significantly higher mean shear bond strength values were obtained when the universal adhesive was applied in total-etch mode compared to the application in self-etch mode (p < 0.05). Additionally, it was determined that higher shear bond strength values were obtained with Filtek Ultimate compared to Filtek Z250 (p < 0.05)., Conclusion: Within the limitations of this study, it can be concluded that the use of universal adhesive in total-etch mode, in addition to surface treatments on the resin composite surface in the repair protocol and the use of nano-filled resin composite as repair material can increase the mean shear bond values in repair., (© 2024. The Author(s).)

Aim: The purpose of this study was to evaluate the performance of polyethylene fiber reinforced resin composite fillings compared to bulk fill resin composite fillings in endodontically treated teeth over a two-year monitoring period., Method: A total of 240 individuals with endodontically treated lower molars and a moderate amount of tooth structure were divided into two equal groups of 120 each. One group received polyethylene fiber reinforced bulk fill resin composite restorations while the other group received only bulk fill resin composite restorations, both applied as per manufacturer guidelines. Two proficient experienced blinded assessors assessed the restorations using modified USPHS criteria at baseline, 6, 12, and 24 months., Statistical Analysis Used: Data analysis involved the utilization of Mann-Whitney U, Friedman's test, and Nemenyi post hoc test, with age data being displayed as mean and standard deviation. The significance level was established as p < 0.05, and R software was utilized for statistical analysis., Results: There were no notable distinctions in any parameters or scores between the intervention and comparator groups at various time points. Alpha scores were present for retention, gross fracture, and secondary caries at all follow up intervals., Conclusion: Both direct resin composite restorations reinforced with polyethylene fibers and direct bulk fill resin composite restorations placed in endodontically treated molars with moderate remaining tooth structure demonstrated satisfactory clinical outcomes during a 24-month follow-up period., Clinical Relevance: Bulk fill resin composites directly placed in endodontically treated molars with moderate remaining tooth structure showed promise as a treatment option over a two-year period., Clinical Trial Registration: (06-01-2022) on https://ClinicalTrials.gov with the ID (NCT05180903)., (© 2024. The Author(s).)

Objectives: To evaluate and compare the ion-releasing capability of three different restorative systems at the restoration/tooth interface elemental analysis using energy-dispersive X-ray technique. Additionally, micromorphological patterns of the restoration/tooth interfaces was investigated., Materials and Methods: Eighteen freshly extracted sound human premolars were collected for the study. The premolars were randomly assigned into 3 groups (n = 6) based on the type of restorative materials used: Giomer (Beautifill II), ion-releasing composite (Activa Presto), and RMGI (Riva Light Cure). Half of the specimens in each group were tested after 24 h (the "immediate group"), while the remaining half were tested after 6 months of storage in deionized water (the "delayed group"). Standardized box-shaped cavities along the cervical area of teeth crowns and restored them with the assigned restorative material following manufacturers' instructions. The specimens were sectioned buccolingually into 2 halves. One half of each specimen was subjected to elemental analysis using energy-dispersive X-ray technique (EDX), while the remaining half was sputter coated and underwent micromorphological analysis of the restoration/tooth interface using a scanning electron microscope (SEM). The collected data from elemental analysis test were tabulated and subjected to statistical analysis., Results: The two-way ANOVA test showed significant differences in both phosphorus and calcium levels among the tested restorative systems (p < 0.05). In the immediate subgroup, RMGI recorded the highest phosphorus level (0.1527), followed by the ion-releasing composite (0.1172), while Giomer exhibited the least levels (0.0326) (p < 0.05). The ion-releasing composite group had the highest calcium level (0.2797), followed by RMGI (0.248), and Giomer (0.2385) respectively (p < 0.05). In the delayed subgroups, Giomer recorded the highest phosphorus level (0.1526), followed by the ion-releasing composite (0.1058), and RMGI group (0.0466) respectively (p < 0.05). RMGI had the highest calcium level (0.2801), followed by the ion-releasing composite (0.2659), and Giomer had the lowest level (0.1792) (p < 0.05). The micromorphological analysis of the restoration/tooth interfaces showed good adaptation between the composite and tooth substrate in different restorative groups., Conclusions: The ion-releasing capability of the three restorative systems appears to be comparable. The rate of mineral release and diffusion is affected by time and composition., (© 2024. The Author(s).)

Background: Several calcium silicate-based sealers have recently emerged in endodontics. This study aimed to compare the immediate and delayed shear bond strength between the bioceramic and calcium hydroxide-based sealers and different resin-based restorative materials., Methods: One hundred and twenty specimens with a 3-mm depth and a 3-mm diameter were prepared. They were evenly divided into two groups, the bioceramic sealer and calcium hydroxide-based sealer groups. Each primary group was subdivided into two subgroups based on the restorative material used; i.e., the flowable resin composite and resin-modified glass ionomer subgroups. Moreover, each subgroup was further divided into the restoration process's timing: either immediately post-sealing or delayed after setting the sealers for seven days. The mode of failure was assessed by stereomicroscopic examination., Results: The highest shear bond strength was found when the bioceramic sealer was used and restored with the flowable resin composite. The strengths were 8.45 (1.17) and 6.67 (1.60) megapascals (MPa) in the immediate and delayed restoration groups, respectively. In contrast, the lowest strength, 2.91 (1.22) MPa, was recorded when calcium hydroxide-based sealer was employed and restored after allowing the sealer to set completely with resin-modified glass ionomer. Notably, there were no cohesive fractures within the tested restorative materials. All observed fractures occurred within the sealer materials, at the interface of the sealer and restorative material, or in combination. Moreover, the most common failure was a mixed failure., Conclusions: When flowable resin composite was used immediately before complete setting, bioceramic sealers showed a higher bond strength than calcium hydroxide-based sealers., (© 2024. The Author(s).)

Purpose: To evaluate interfacial three-dimensional adaptation and internal voids of different flowable materials before and after cyclic fatigue in a simulated deep-margin elevation scenario., Methods: Eighty (n &#61; 80) extracted premolars were selected and two Class II cavities were prepared. The mesial one with cervical margin 1 mm above the cementum-enamel junction (CEJ) and the distal one with cervical margin 1 mm below the CEJ. After performing adhesive procedures, specimens were divided into four groups according to the employed materials for 2 mm horizontal deep-margin relocation: nanohybrid composite (Clearfil ES2, Kuraray); conventional viscosity flowable composite (Tetric Flow, Ivoclar); medium viscosity flowable composite (Majesty ES2 Low Flow, Kuraray); high viscosity flowable composite (Majesty ES2 Super Low Flow, Kuraray). All restorations were finalized by oblique layering with nanohybrid composite (Clearfil ES2, Kuraray). To reveal interfacial and internal gap progression, specimens were scanned with a micro-CT (SkyScan 1172), before and after 500,000 cycles of mechanical chewing simulation (50 N, 1 Hz). Data were imported into Mimics software after smoothing and region growing. Only the 2 mm margin relocation volumes were considered. Obtained masks were analyzed for noise removal and volume calculation. At baseline, interfacial gap progression and internal voids, expressed in mm3, were collected and statistically analyzed with two-way ANOVA (α 0.05) for the variables substrate and restorative materials followed by Tukey post-hoc test. An additional two-way ANOVA test, followed by Tukey post-hoc test, was performed to evaluate variation in interfacial gap progression after mechanical aging., Results: At baseline, the ANOVA test showed a significant difference for the variable restorative materials (p &#61; 0.01). More specifically, the Tukey post-hoc test revealed that the highly filled medium viscosity composite performed better than the conventional viscosity composite at baseline for the interfacial gap. The internal voids ANOVA test at baseline reported no significant differences for the variable tested. Analysis of variance for internal gap progression after thermocycling showed no differences for both substrate and restorative material employed., Conclusions: Highly filled medium viscosity composite performed significantly better than the conventional viscosity flowable composite for what concern baseline interfacial gaps. Artificial aging with a chewing simulator and thermocycling did not affect interfacial gap progression on enamel and dentin. The tested restorative materials performed equally after aging.

This study aimed to clinically evaluate the performance of non-preheated bulk fill resin composite in class II cavities versus one, five and ten-time preheating cycles at 68 °C. Eighty-four recruited participants were randomly allocated into four groups (21 patients per group). One posterior Bulk-fill proximal restoration was performed for each participant according to the preheating cycles where in group I; teeth were restored with non-heated resin composite, group II: One preheating cycle of composite syringe was performed prior restoration, and group III: five preheating cycles while for group IV: Ten preheating cycles were performed. These restorations were clinically evaluated at 6, 12, 18 and 24 months. Statistical analysis was performed using one way ANOVA, with set p-value < 0.05. The results revealed that there was perfect agreement between both observers and observations WK (95% CI) [0.908 (0.780:1.000)] and [0.940 (0.824:1.000)], respectively. All restorations showed acceptable clinical performance with alpha and bravo scores. No replacement was required for any restoration. No statistically significant differences were detected between the control and intervention groups across all parameters during the various evaluation stages. It could be concluded that the clinical performance of ten cycles of repeated preheated bulk fill resin composite was equivalent to that of non-preheating resin composites after 24 months follow-up period, with great improvement in manipulation. Preheating of resin composite could be performed up to ten cycles prior to placement without any clinical adverse consequences on the performance of the restoration., (© 2024. The Author(s).)

In fixed prosthodontics, clear exposure of the preparation margin is the prerequisite for obtaining accurate digital impressions and improving the marginal fit of restorations. To resolve the issues associated with the cord retraction technique, such as pain, acute injury, and prolonged procedural time, this study proposes a new technology for intraoral digital impression taking with pneumatic gingival retraction. The new scanning head blows a high-speed airflow that instantaneously separates the free gingiva, locally exposing the subgingival preparation margin. Combined with the farthest point preservation stitching algorithm based on the distance from the normal vector and high-speed laser scanning photography, it achieves global preparation edge data and gingival reconstruction, realizing painless, non-invasive, and efficient precise acquisition of the preparation margin. Using this new technique, a patient with a full porcelain crown restoration on a posterior tooth was treated. The digital impression revealed a clear margin of the preparation, and the crown made from this data has a good marginal fit.

Background: This study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices., Methods: This study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05)., Results: A significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%)., Conclusions: The findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures., (© 2024. The Author(s).)

Background: This study aims to evaluate the microtensile bond strength (µTBS) of different resin composite restorations bonded to mid-coronal dentin and proximal root dentin using light-cured, chemical-cured, and dual-cured adhesives immediately and after aging. Nanoleakage and degree of cure were also assessed., Methods: Eighty-four molars were divided into mid-coronal dentin and proximal root dentin. Each group was further subdivided into three subgroups based on the restorative systems used, which involved the utilization of light-cured, chemical-cured, and dual-cured adhesives. Half of the specimens underwent µTBS testing after 24 h, while the other half after aging. Representative specimens were analyzed for nanoleakage. The degree of cure of the tested adhesive systems was also assessed., Results: Aging showed a significant negative effect on µTBS results and led to increased nanoleakage (p < 0.001). Furthermore, in all subgroups, the µTBS values of proximal root dentin were lower compared to mid-coronal dentin, except in the aged subgroup for the system utilizing the dual-cured adhesive. The restorative systems with chemical and dual-cured adhesives demonstrated comparable bonding properties. However, the system with the light-cured adhesive exhibited the worst bonding properties after aging when bonded to proximal root dentin and cured at a large distance (p < 0.05)., Conclusions: All tested restorative systems were negatively affected by aging, and the regional dentin had variable effects on the bonding properties. Clinicians should exercise caution when using the tested light-cured adhesive in areas where the curing distance exceeds 3 mm., (© 2024. The Author(s).)

Objectives To review the current literature surrounding chairside polishing systems for resin composites, zirconia and lithium disilicate restorations.Methods A literature search was undertaken and databases were hand-searched for the most relevant articles.Discussion The current marketplace contains a wide variety of polishing systems, each with different abrasive compounds and number of steps. Current efforts are aimed at reducing the number of steps required for polishing to improve clinical effectiveness. Reduced step systems showed some comparable results to the more traditional multi-step protocols, but the most effective results were achieved with the use of polishing paste as an additional step.Conclusions Based on the current available literature, the use of material-specific polishing systems is effective for chairside polishing of direct and indirect restorative materials. However, it is important to emphasise that, for optimum outcomes, it is essential to follow manufacturers' recommendations for each step, with particular considerations of the handpiece speed, time spent per step and use of adjunct water coolant., (© 2024. The Author(s).)

The development of minimally invasive caries treatment has dramatically changed dentistry. Instead of traditional, often invasive methods that resulted in significant loss of healthy dental tissue, this approach focuses on preserving the vitality of the pulp and minimizing tissue loss by delaying and scaling back restorative treatments. This involves the use of modern methods, with selective caries removal with or without indirect (pulp) capping being the norm for treating extensive lesions. The philosophy of minimal intervention goes beyond treatment choices to include a holistic approach from diagnosis to follow-up care, emphasizing personalized care based on risk profiles. This paradigm shift has greatly improved the standard of care, but continued attention to the risks of overdiagnosis and overtreatment is necessary to ensure optimal oral health.

Purpose: Investigating the effect of visual distraction using animated video cartoons (AVCs) on anxiety of children during class I class I glass-ionomer cement (GIC) restoration procedures., Patients and Methods: This randomized clinical trial, 42 children between the ages of 5-6 years were enrolled. These participants were divided into two groups: Group 1, consisting of 21 individuals (AVCs), who were exposed to a cartoon as a visual distraction tool, and Group 2, a control group with 21 participants who did not receive any form of distraction during their first visit. Both groups underwent class I GIC restoration procedures that were conducted in a consistent manner. To evaluate the anxiety levels of the children, measurements of their pulse rate (PR) were taken at the beginning and end of the treatment. Additionally, patient behavior was assessed using the Frankl behavior rating scale (FBRS) as well as validated self-reported dental anxiety scale, the Visual Analog Scale - Anxiety (VAS-A) score., Results: In the control group, postoperative PR increased significantly, while the AVC group experienced a decrease compared to their preoperative PR levels. Additionally, audio-visual distraction had a notable impact on FBRS scores compared to the standard approach. Similarly, the VAS-A score displayed a significant reduction when patients received audio-visual distraction compared to the control condition. Subgroup analysis by gender showed that girls tended to be more responsive to AVCs than boys when evaluated by PR and FBRS, but such findings were not observed using VAS-A. Patients with deeper caries had higher VAS-A scores than those with shallower ones. Despite the caries depth, those who received AVC seemed to be calmer, especially to those with deeper lesions, as indicated lower postoperative VAS-A scores compared to their preoperative levels, unlike the control group., Conclusion: Our study suggests that the use of AVCs can be an effective method for reducing anxiety in children undergoing class I GIC restoration procedures., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

The field of restorative and prosthetic dentistry focuses on restoring lost tooth structures and replacing missing teeth and lost tissue to restore or improve esthetics and oral health. Many systemic factors such as metabolic, bone, autoimmune, cardiovascular, and endocrine disorders can affect healing procedures, and bone density and impact oral health. Hence patients suffering from systemic disease when treated for prosthodontic rehabilitation can have negative prognostic outcomes. The commonest prosthodontic treatments that can be affected include dental implants, fixed prostheses, and removable prostheses. Understanding and managing these systemic factors play a key role in the success of prosthodontic treatment., Competing Interests: Disclosure None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Dental caries is a commonly occurring non-communicable disease throughout the world that might compromise the quality of any individual's life. Glass ionomer cements (GIC) are the most acceptable restorative materials due to their ease of manipulation, minimal tooth loss and least invasive strategy; however, they lack mechanical stability that has become a point of concern. Nanoparticles (NPs) are an outstanding option for modifying and enhancing the properties of dental materials. The focus of this study was to prepare novel, biocompatible titania dioxide (TiO 2 ) NPs as a dental-restorative material using an efficient probiotic Bacillus coagulans. The prepared NPs were incorporated into glass ionomer restorative material at varying concentrations and investigated for cell viability percentage, microhardness and surface morphology. Results indicated that pure 100% anatase phase TiO 2 NPs with particle size of 21.84 nm arranged in smooth, spherical agglomerates and clusters forms. These NPs depicted cell viability > 90%, thus confirming their non-cytotoxic behavior. GIC restorative materials reinforced by 5% titania (TiO 2 ) NPs demonstrated the highest microhardness in comparison to the control group and other experimental groups of the study. Surface morphology analysis revealed a reduction in cracks in this novel dental-restorative material supporting its compatible biological nature with better hardness strength and negligible crack propagation. Overall, these results indicated that TiO 2 NPs produced using a biological approach could be easily used as restorative materials in dental applications., (© 2024. The Author(s).)

This study evaluated the changes in surface properties of three resin-based restorative materials after two laser-assisted, in-office tooth bleaching protocols using erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) or diode (980 nm) lasers. A nanohybrid composite (Enamel Plus HRi), a Bis-GMA-free composite (Enamel Plus HRi Bio Function), and a resin-matrix CAD-CAM ceramic (Shofu Block HC) were tested. Forty specimens for each material were prepared and divided into four groups (n = 10/group). The control specimens did not undergo any bleaching treatment, whereas group 2 received bleaching with 40% hydrogen peroxide (H 2 O 2 ), while groups 3 and 4 underwent the same bleaching procedure with the use of diode (980 nm) or Er,Cr:YSGG lasers, respectively. Surface microhardness and roughness measurements were conducted using a Vickers tester and an optical profilometer. Microhardness was lower in bleached specimens, with the nanohybrid composite exhibiting the largest difference from the no bleaching group. For the Bis-GMA-free composite the microhardness difference between no bleaching and laser-assisted bleaching were smaller than seen for the conventional bleaching technique. Surface roughness was higher in bleached specimens, with nanohybrid composite showing the largest differences from the control specimens. The examined laser-assisted tooth bleaching protocols were found not to impact surface microhardness and roughness of the tested resin-based specimens and they are deemed suitable for clinical use., (© 2024 The Author(s). European Journal of Oral Sciences published by John Wiley & Sons Ltd on behalf of Scandinavian Division of the International Association for Dental Research.)

Objectives: To evaluate the clinical performance of direct restorations for pit-and-fissure caries in molars using stamp combined with single-shade composite resin (S/SCR) technique, and assess the effect of the number of stamp pressing on the trueness of S/SCR technique., Methods: Twenty molars of fifteen patients with pit-and-fissure caries but with an intact or micro-cavitated occlusal morphology were restored using S/SCR technique and were randomly divided into single pressing group (n = 10) and double pressing group (n = 10). Intraoral scans were obtained before treatment (scan 1), after filling (scan 2) and after polishing (scan 3). Deviation distribution maps of pairwise fitting were created including comparison 1 (scan1/scan 2), comparison 2 (scan1/scan 3), and comparison 3 (scan2/scan 3) using Geomagic Control X software. Root mean square (RMS) values were calculated to evaluate the trueness of restorations. Clinical performances including esthetic, functional, and biological properties of all restorations were evaluated according to FDI criteria after a 12-month follow-up. Analysis of variance, independent-samples T test and Wilcoxon rank-sum test were used for statistical analysis (α=0.05)., Results: RMS values for comparison 1, comparison 2, and comparison 3 were 0.1243 ± 0.0151, 0.0966 ± 0.0136, and 0.0605 ± 0.0137 mm in single pressing group, while 0.0831 ± 0.0140, 0.0741 ± 0.0107, and 0.0475 ± 0.0099 mm in double pressing group, respectively. RMS value of single pressing group was higher than that of double pressing group in the same comparison (p ≤ 0.001). No statistically significant differences were observed between the two groups regarding esthetic, functional and biological properties (p > 0.05). For all properties, all restorations scored within 3, with over 80% scoring 1., Conclusion: S/SCR technique presents satisfying clinical performances for pit-and-fissure caries in molars after a 12-month follow-up. Besides, double pressing can improve the trueness of restorations compared to single pressing., Clinical Significance: S/SCR technique is efficient in direct composite resin restoration for pit-and-fissure caries, with satisfying esthetic, functional and biological properties after a 12-month follow-up. Significantly, double pressing improves the trueness of S/SCR technique, reducing the need for occlusion adjustment., 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.)

Objective: To evaluate the postoperative sensitivity (POS), as well as the clinical performance of posterior restorations using a new chemically-cured bulk-fill composite (Stela Automix and Stela Capsule, SDI) comparing with a light-cured bulk-fill composite after 6 months., Methods: Fifty-five participants with at least three posterior teeth needing restoration were recruited. A total of 165 restorations were performed on Class I or Class II cavities. After the application of Stela primer, the chemically-cured composite (Stela Automix or Stela Capsule) was inserted. For the light-cured composite group, a universal adhesive (Scotchbond Universal) was applied with a bulk-fill composite (Filtek One). Participants were evaluated for spontaneous and stimulated POS in the baseline, after 48 h, 7 days, and 6 months. Additionally, each restoration was assessed using the updated version of FDI criteria after 6 months. The differences in the proportions of the groups were compared by Cochran test statistics (α = 0.05)., Results: Both chemically-cured composites showed a lower risk of POS compared to the light-cured composite at baseline and up to 48 h (p < 0.04). A significantly lower surface luster and texture was observed for the Stela Capsule composite compared to the light-cured bulk-fill composite (baseline and 6 months; p = 0.03). A significant color mismatch was observed for the light-cured bulk-fill composite compared to the chemically-cured composites (baseline and 6 months; p = 0.03). No significant differences were observed in any other item evaluations (p > 0.05)., Conclusion: Chemically-cured composites exhibit lower postoperative sensitivity and less color mismatch compared to a light-cured bulk-fill composite after 6 months of clinical service., Clinical Significance: The chemically-cured composites appear to be an appealing option for restoring posterior teeth, as they exhibit lower postoperative sensitivity compared to a light-cured bulk-fill composite, both at baseline and up to 48 h, and less color mismatch., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The aim of the present study was to evaluate the influence of multidirectional brushing on the surface roughness, morphology, and bonding interface of resin-repaired CAD-CAM ceramic and composite restorations., Materials and Methods: Twelve (N = 12) blocks (4 mm × 4 mm × 2 mm for parallel axis; 5 mm × 4 mm × 2 mm for perpendicular axis) of lithium disilicate glass-ceramic (IPS e.max CAD, Ivoclar AG) and CAD-CAM resin composite (Tetric CAD, Ivoclar AG) were obtained and repaired with direct resin composite (Clearfil AP-X, Kuraray). An abrasive slurry was prepared and the brushing was performed according to each restorative material and axis of brushing (n = 6; perpendicular to repair interface and parallel to repair interface) during 3,650 cycles (240 strokes per minute) to simulate 3 years of brushing. The surface roughness (Ra) and the profile variation for each material (restoration and direct repair resin composite) were measured at the baseline condition and after brushing, and the mean roughness and presence of steps at the repair interface were evaluated through factorial analysis of Variance (ANOVA). Scanning Electron Microscopy (SEM) images were taken to evaluate the surface topography of the repaired materials after brushing., Results: The mean roughness of the repaired CAD-CAM restorations was affected by the brushing (P < .05), mainly when evaluating the repair material and the interface (P < .05), while the restorative CAD-CAM materials presented more stable values. The profile evaluation showed higher steps at the interface when repairing lithium disilicate than for CAD-CAM resin composite., Conclusion: Repaired CAD-CAM restorations were susceptible to wear after brushing simulation. The surface roughness of the direct resin composite was the most affected leading to step development at the interface, particularly in the repaired lithium disilicate samples. Cinical maintenance recalls and polishing protocols must be considered to enhance the longevity of such restorations., 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 paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate caries preventive effects of 38 % silver diamine fluoride (SDF) pretreatment on neighboring tooth proximal to glass ionomer cement (GIC), including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations in an in vitro model., Methods: HUMAN TOOTH BLOCKS WERE RESTORED WITH: SDF+CGIC (Group 1), CGIC (Group 2), SDF+RMGIC (Group 3) or RMGIC (Group 4). Enamel specimen simulating proximal surface of neighboring tooth was placed in proximity to the restorations. The specimen underwent cariogenic challenge with cross-kingdom biofilm of Streptococcus mutans, Lacticaseibacillus casei and Candida albicans. After cariogenic challenge, the biofilm's growth kinetics, viability, and morphology were evaluated by propidium monoazide-quantitative polymerase chain reaction (PMA-qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), respectively. The enamel lesion depth, surface morphology and crystal characteristics were determined by micro-computed tomography (micro-CT), SEM and X-ray diffraction (XRD), respectively., Results: PMA-qPCR demonstrated lower microbial growth in Group 1 and 3 compared with Group 2 and 4 (p < 0.05). CLSM showed the dead-to-live ratio in Groups 1-4 were 1.15±0.12, 0.53±0.13, 1.10±0.24 and 0.63±0.10, respectively (Group 1,3 > 2,4, p < 0.05). SEM revealed Groups 1 and 3 had scattered biofilm whereas Group 2 and 4 had confluent biofilm. Micro-CT showed the enamel lesion depths (µm) were 98±9, 126±7, 103±6 and 128±7 for Group 1 to 4, respectively (Group 1,3 < 2,4, p < 0.05). SEM revealed oriented and ordered enamel prismatic patterns in Group 1 and 3, not in Group 2 and 4. XRD showed the reflections of hydroxyapatite in Groups 1 and 3 were sharper than Groups 2 and 4., Conclusion: SDF pretreatment enhances the preventive effect of GIC on proximal enamel surface on neighboring tooth through inhibiting cariogenic biofilm, reducing enamel demineralization and promoting enamel remineralization., Clinical Significance: SDF pretreatment of GIC restorations can help prevent caries on neighboring teeth, particular for patients with high caries risk., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the influence of the tooth shade, type of resin composite and cavity configuration on the color adjustment of single-shade and group shade resin composites., Methods: Class I and V cavities were prepared in artificial acrylic mandibular right molars with different shades - A1, A2, A3, A3.5 and A4. Three single-shade (OMN, UNI, CHA) and two group shade (FIL, HAR) resin composites were evaluated. Seventy-five observers, including dentists, dental students and laypersons (n = 25), participated in the study. A psychophysical experiment based on visual assessments of the color matching between each tooth and each restoration was ranked from 0 (excellent match) to 4 (huge mismatch), and mean frequencies (%) were calculated. Visual color differences among composite materials and tooth shades were statistically tested (P < 0.05)., Results: The results showed highest percentages of unacceptable color mismatches for class V compared to class I restorations, especially for more chromatic tooth shades (A3.5 and A4). The percentage of ratings of acceptability was higher for laypersons group. For class V, OMN presented significant difference only from UNI in tooth shades A1, A2, A3 and A4. However, for class I, OMN presented significant differences with CHA for A1, A2 and A4, and with HAR and FIL for A1., Conclusions: Class I resin composite restorations exhibit superior color matching than Class V, with lighter and low chroma tooth shades demonstrating better color adjustment. The color matching of both cavity configurations is comparable for single and group shade resin composites., Clinical Significance: Cavity configuration and tooth shade may impact color matching of single and group shade resin composites. This study demonstrates superior color matching in class I configurations over class V for both single and group shade resin composites. Additionally, restorations placed in teeth with lighter shades exhibit more favorable color adjustment., 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 effectiveness of deep convolutional neural network (CNN) algorithms for the detecting and segmentation of overhanging dental restorations in bitewing radiographs., Methods: A total of 1160 anonymized bitewing radiographs were used to progress the artificial intelligence (AI) system for the detection and segmentation of overhanging restorations. The data were then divided into three groups: 80% for training (930 images, 2399 labels), 10% for validation (115 images, 273 labels), and 10% for testing (115 images, 306 labels). A CNN model known as You Only Look Once (YOLOv5) was trained to detect overhanging restorations in bitewing radiographs. After utilizing the remaining 115 radiographs to evaluate the efficacy of the proposed CNN model, the accuracy, sensitivity, precision, F1 score, and area under the receiver operating characteristic curve (AUC) were computed., Results: The model demonstrated a precision of 90.9%, a sensitivity of 85.3%, and an F1 score of 88.0%. Furthermore, the model achieved an AUC of 0.859 on the receiver operating characteristic (ROC) curve. The mean average precision (mAP) at an intersection over a union (IoU) threshold of 0.5 was notably high at 0.87., Conclusions: The findings suggest that deep CNN algorithms are highly effective in the detection and diagnosis of overhanging dental restorations in bitewing radiographs. The high levels of precision, sensitivity, and F1 score, along with the significant AUC and mAP values, underscore the potential of these advanced deep learning techniques in revolutionizing dental diagnostic procedures., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology and the International Association of Dentomaxillofacial Radiology.)

Statement of Problem: Additive manufacturing (AM) technology is emerging as an innovative approach in the dental field. In recent years, manufacturers have introduced 3-dimensionally printed composite resins (3D-CRs) that are specifically designed for the AM of definitive prostheses; however, the mechanical and surface properties of these materials require investigation., Purpose: The purpose of this in vitro study was to assess and compare the mechanical and surface properties of 2 commercially available 3D-CRs for definitive restoration after artificial aging., Material and Methods: Saremco print Crowntec; Saremco Dental AG and Varseo Smile Crown Plus; Bego GmbH were printed with a layer thickness of 50 µm at a 90-degree angle. A total of 20 bar-shaped specimens (25×2×2 mm) were produced from each material to measure the flexural strength (σf) and elastic modulus (E) using a 3-point bend test, and 5 disk-shaped specimens (Ø15×3 mm) from each material were used to measure the surface microhardness using a microhardness test. Half of the specimens were tested under dry conditions, while the other half were immersed in distilled water for 30 days. Five disk-shaped specimens (Ø15×3 mm) from each material were used to evaluate surface roughness before and after undergoing toothbrushing simulations. Additionally, 5 disk-shaped specimens (Ø15×1 mm) were used to assess water sorption (w sp ) and solubility (w sl ) over 28 days. Statistical analyses were conducted using the Wilcoxon matched-pairs signed-rank test (1-tailed) with 90% power (α=.05)., Results: The mean ±standard deviation flexural strength values were 123.4 ±8.7 MPa for Saremco print Crowntec and 109.9 ±15.8 MPa for Varseo Smile Crown Plus. After aging, these values were 97.5 ±15.2 MPa for Saremco print Crowntec and 94.2 ±11.7 MPa for Varseo Smile Crown Plus. The mean Vickers hardness values were 33.2 ±0.8 N/mm 2 for Saremco print Crowntec and 31.5 ±0.6 N/mm 2 for Varseo Smile Crown Plus. After aging, the mean values were 31.7 ±0.9 N/mm 2 for Saremco print Crowntec and 29.6 ±1.0 N/mm 2 for Varseo Smile Crown Plus. The mean modulus of elasticity was 4.2 ±0.3 GPa for Saremco print Crowntec and 3.82 ±0.2 GPa for Varseo Smile Crown Plus. After 21 days, the mean sorption values were 11.52 ±0.6 mg/mm 3 for Saremco print Crowntec and 12.43 ±0.4 mg/mm 3 for Varseo Smile Crown Plus. After 28 days, the mean solubility values were 1.36 ±0.4 mg/mm 3 for Saremco print Crowntec and 0.98 ±0.3 mg/mm 3 for Varseo Smile Crown Plus. Significant differences were found between the 2 3D-CRs in flexural strength in the dry state (P=.03), in Young modulus after 30 days of water immersion (P=.023), and in Vickers hardness in the dry state (P=.01) and after 30 days of water immersion (P=.018)., Conclusions: Both 3D-CRs provided good in vitro performance and the mechanical properties required for long-term clinical application. Artificial aging decreased the flexural strength of both 3D-CRs., (Copyright © 2024 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to evaluate the effect of an adhesive loaded with 0.2 % copper (Cu) and 5 % zinc oxide (ZnO) nanoparticles (Nps) on its adhesive properties and enzymatic activity at the hybrid layer ex vivo in a randomized clinical model., Methods: Fifteen patients participated in this study, and a total of 30 third molars were used. Occlusal cavities (4 × 4 × 2 mm) were made in each tooth, and randomly divided into 2 groups: (i) Experimental group: commercial adhesive loaded with 0.2wt % CuNps and 5wt % ZnONps; and (ii) Control Group: non-loaded commercial adhesive. Teeth were restored with resin composite. Thirty days later, extractions were performed. Extracted teeth were longitudinally sectioned. Nps in powder were characterized by field emission scanning electron microscope (FE-SEM) and energy dispersive X-ray (EDX) analysis. Microtensile bond strength (μTBS), degree of conversion (DC), and nanoleakeage (NL) tests were executed. In situ zymography (Zym) was performed to evaluate the gelatinolytic activity at the hybrid layer. Student's t-test (α = 0.05) was applied for all tests., Results: μTBS and DC did not show significant differences (p > 0.05) between both groups. However, NL and gelatinolytic activity at the hybrid layer showed significant values (p < 0.05) for experimental group in comparison with control group., Conclusion: The addition of 0.2 % CuNps and 5 % ZnONps to a universal adhesive decreases NL and gelatinolytic activity at the hybrid layer, without jeopardizing its adhesive properties., Significance: This randomized clinical trial with ex vivo analysis demonstrate that a commercial adhesive modified with 0.2wt % Cu and 5wt % ZnO Nps that does not affect its adhesive properties, reducing gelatinolytic activity and nanoleakage at the hybrid layer, which should contribute to an improvement of long term bonding-dentine clinical performance., Competing Interests: Declaration of competing interest The authors declare no competing financial interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The purpose of this clinical trail was to assess the clinical behavior of posterior composite restorations supported by a substantial foundation of flowable short fiber-reinforced composite SFRC (everX Flow, GC, Japan) used without proximal surface coverage with particulate filler resin composite (PFC). Seventy patients (20 males, 50 females; mean age: 30 ± 10 years) were randomly enrolled in this trial. Patients received direct restorations of either SFRC covered only on the occlusal surface (1-2 mm) by conventional PFC composite (G-ænial Posterior, GC), or plain conventional PFC composite without fiber-reinforcement, in Class II cavities in premolar and molar vital teeth. One operator made all restorations using one-step, self-etch bonding agent (G-ænial Bond, GC) according to manufacturers' recommendations. Two blinded trained operators evaluated the restorations at baseline, at 6, 12 and 18 months using modified USPHS criteria. Results indicated that, in both groups and at different follow-up intervals, according to evaluated criteria, restorations were rated mostly with best score (Alpha) (p > 0.05). For the marginal integrity after 6 months, a single case in the intervention [increased to 3 (8.8%) after 18 months] and 3 (9.7%) cases of the control group [increased to 4 (12.9%) after 18 months] had Bravo score but with no significant difference (p > 0.05). For color match measured after 6 and 18 months, three (8.8%) cases had Bravo score in the intervention group. The use of flowable SFRC composite without any PFC surface coverage proximally in Class II restorations demonstrated satisfactory clinical outcome throughout the 18-month follow-up., (© 2024. The Author(s).)

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.)

Dental fillings, frequently used in dentistry to address various dental tissue issues, may pose problems when not aligned with the anatomical contours and physiology of dental and periodontal tissues. Our study aims to detect the prevalence and distribution of normal and overhanging filling restorations using a deep CNN architecture trained through supervised learning, on panoramic radiography images. A total of 10480 fillings and 2491 overhanging fillings were labeled using CranioCatch software from 2473 and 1850 images, respectively. After the data obtaining phase, validation (80%), training 10%), and test-groups (10%) were formed from images for both labelling. The YOLOv5x architecture was used to develop the AI model. The model's performance was assessed through a confusion matrix and sensitivity, precision, and F1 score values of the model were calculated. For filling, sensitivity is 0.95, precision is 0.97, and F1 score is 0.96; for overhanging were determined to be 0.86, 0.89, and 0.87, respectively. The results demonstrate the capacity of the YOLOv5 algorithm to segment dental radiographs efficiently and accurately and demonstrate proficiency in detecting and distinguishing between normal and overhanging filling restorations.

Background: Bulk-fill resin composites may suffer from recurrent caries around compound proximal restorations in posterior teeth, especially at the proximo-gingival interface.Over 12 months, will the bulk fill technique affect the caries recurrence rate at gingival margins when compared to the conventional incremental packing technique? How early will the first clinical, radiographical, and biochemical evidence of caries recurrence occur?, Methods: After randomization, in 30 patients with two compound (OM or OD) supragingival lesions, one tooth was restored using the bulk fill technique on one side (group 1) (n = 15). In contrast, the other tooth on the other side was restored utilizing the incremental layering technique (group 2) (n = 15). Both teeth received restorative material (X-tra fil, Voco, Cuxhaven, Germany). The FDI criteria were used to evaluate restorations. As for the periodontal assessment, the gingival index, plaque index, papillary bleeding scoring index and periodontal pocket depth were evaluated. The gingival crevicular fluid (GCF) specimens were gathered, and MMP-9 was extracted and quantitated by ELISA. A customized radiographic template was designed, and 3D printed digital bitewing radiographs were taken. Assessments were done clinically, radiographically and biochemically at baseline (1 week) and after 3, 6 and 12 months. Data was statistically analyzed., Results: The null hypothesis was accepted clinically; no statistically significant differences appeared between bulk and incrementally filled posterior restorations. As for the radiographic assessment, the null hypothesis was accepted except for increased periodontal ligament width at 3 months. The null hypothesis for the biochemical evaluation was rejected as there were significant changes in levels of MMP-9 at different testing times., Conclusions: 1. With similar results but less sensitivity and significant time saving, the bulk fill technique can be considered an efficient alternative to the incremental fill technique in restoring proximal cavities. 2. Early evidence of caries recurrence can be correlated to an increase in the MMP-9 level in gingival crevicular fluid, followed by an increase in radiographic periodontal ligament width measurement., Trial Registration: An ethical approval from the Research Ethics Committee at the Faculty of Dentistry, October 6 University, (Approval No. RECO6U/5-2022). The study was registered at the Pan African Clinical Trials Registry on 24/07/2023 with an identification number (PACTR202307573531455)., (© 2024. The Author(s).)

The purpose of this study was to investigate the fracture behavior of endodontically treated (ET) deciduous molar when directly restored with different restorative materials in Class II (MO) cavities in comparison with permanent teeth. MO cavities were prepared with 2.4-2.5 mm and 1.9-2.0 mm in buccolingual width, and mesiodistal width of each cavity walls, respectively, followed by direct restoration with different materials: resin-modified glass ionomer cement (RMGIC), composite resin (CR), and composite resin containing 25% short glass-fiber (SFRC). All specimens were subjected to mechanical loading tests at a speed of 1 mm/min and evaluated fracture resistance and fracture modes. A one-way ANOVA followed by a Tukey multiple comparisons analysis was used. Deciduous-SFRC (3,310.5±396.2 N) were significantly higher fracture resistance than permanent-RMGIC (1,633.8±346.8 N) (p<0.001), and permanent-CR (1,400.0±381.3 N) (p<0.001). For the direct restoration of MO cavity after endodontic treatment, SFRC demonstrated its promising performance in load-bearing capacity and failure mode, especially in ET deciduous molars.

Background: Complicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth., Methods: Two cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ' clinical visit in multi-visit approach group., Results: All the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively., Conclusion: Fragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance., Trial Registration: This prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023., (© 2024. The Author(s).)

To evaluate and compare the shear bond strength of composite resin restorations in primary teeth, following cavity preparation with both traditional dental burs and laser irradiation. One hundred primary molars extracted from the children visiting our department were collected and randomly divided into five groups (A-E) with 20 teeth in each group. In groups A, B, C, D, and E the teeth samples were etched with phosphoric acid, Er; YAG laser followed by acid etching, Er, Cr: YSGG laser followed by acid etching, Er; YAG laser etching only and Er, Cr: YSGG laser etching only, respectively. Following, all the samples were restored with composite resin and subjected to 500 cycles of thermocycling. The shear bond strength of the resin composite was analyzed. The type of fractures was also noted. Data obtained were subjected to statistical analysis. The mean value of shear bond strength of Group A, B, C, D, and E was 17.562 ± 0.810, 15.928 ± 0.415, 14.964 ± 0.566, 11.833 ± 0.533 and 11.187 ± 0.517, respectively. Adhesive failure was most commonly seen in all the groups. The phosphoric acid etching remains a highly effective technique for pre-treating dentin in composite resin restorations. The shear strength of composite resin to the dentin of laser-prepared cavity in primary teeth can be improved by the addition of acid etching., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Objective: To investigate the outcomes and factors influencing the success of vital pulp treatment (VPT) in permanent teeth with carious pulp exposure and signs and symptoms of irreversible pulpitis (IP)., Materials and Methods: Dental records from 2016 to 2023 of patients who received VPT for carious pulp-exposed permanent teeth with IP symptoms were reviewed. Outcomes were assessed using clinical and radiographic criteria. Univariate and multivariate analyses were performed to identify factors affecting treatment success. The Kaplan-Meier estimator was used to compare survival probabilities., Results: The overall success and survival rates were 88.24% and 97.06%, respectively. Success rates for direct pulp capping, partial pulpotomy, and full pulpotomy were 87.7%, 92.0%, and 87.7%, respectively. Key factors influencing outcomes included the presence of periapical radiographic lesions, type of pulp dressing material, and quality of the final restoration. Full pulpotomy demonstrated the highest survival time, followed by partial pulpotomy and direct pulp capping., Conclusion: VPT in permanent teeth with carious pulp exposure and IP symptoms shows high success rates. Crucial factors include periapical radiographic findings, type of pulp dressing material, and quality of the final restoration. Full pulpotomy exhibited the longest survival time., Clinical Relevance: VPT in teeth with IP symptoms shows promising outcomes, highlighting the importance of certain clinical factors in treatment success., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3-5, treated in "Assuta Tel Aviv" dental clinics, under general anesthesia or deep sedation., Methods: The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014-2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation., Results: A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages., Conclusion: The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel., (© 2024. The Author(s).)

Background: The effect of an immune-boosting beverage (SAM) containing Sambucus Nigra, an energy beverage (ENE), an in-office bleaching (BLE) agent with 25% hydrogen peroxide superior, glazing (GLA) or polishing (POL) methods, and professional dental prophylaxis (PDP) on the color of CAD-CAM restorative materials is unknown., Methods: In total 210 specimens were prepared, consisting of CAD-CAM feldspathic (FC), zirconia-reinforced lithium disilicate ceramic (ZLS) and hybrid ceramic (HC). The ceramic specimens were divided according to the polishing methods of glazing (GLA) and mechanical polishing (POL). All materials were divided into two groups: with and without BLE. A 25% hydrogen peroxide superior (HPS) gel was used for BLE. After the baseline (BAS) measurement, the specimens were immersed in 3 different beverages (distilled water (DIS), SAM, ENE). After 28 days, a fine-grained (RDA 7) prophylaxis paste was applied. Statistical analysis of ∆E00 color difference values was performed by 3-way ANOVA and Bonferroni test (α = 0.05)., Results: The effect of all other actions except material-BLE-beverage on color for BAS-Day 28 was statistically different (p < 0.05). The effect of material, material-BLE, beverage on color for Day 28-PDP was statistically different (p < 0.05). After 28 days, the lowest color change was found in FC-GLA and HC immersed in DIS (p = 0.0001) and the highest in FC-POL immersed in ENE (p = 0.0002). PDP was efficient in color recovery in HC immersed to DIS, ENE and SAM (p = 0.0010). For FC, HC and ZLS, BLE caused a higher color change (p < 0.0001). Regardless of the material, the highest color change for BLE-beverage was found in BLE-treated specimens immersed in ENE (p = 0.0496) and the lowest color change was found in non-BLE-treated specimens immersed in SAM (p = 0.0074)., Conclusions: In materials pre-exposed to 25% HPS, the effect of PDP on color recovery was lower than in unexposed materials. After 28 days, mechanical polishing produced higher color change in FC than glazing, however, in ZLS effects of glazing and mechanical polishing on color were similar. For material/polishing method, HC was the most effective. ENE caused higher color change than DIS and SAM. PDP was more effective than ENE in restoring color to DIS- and SAM-immersed specimens., (© 2024. The Author(s).)

Purpose: This German S3 clinical practice guideline offers evidence-based recommendations for the use of composite materials in direct restorations of permanent teeth. Outcomes considered were the survival rates and restoration quality and process quality of the manufacturing process. Part 1 of this two-part presentation deals with the indication classes., Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Six PICO questions were developed to guide the search. Recommendations were formulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence., Results: Composite materials are a viable option for the direct restoration of cavity Classes I-V and may also be used for restorations with cusp replacement, and tooth shape corrections. In the posterior region, direct composite restorations should be preferred over indirect composite inlays. For Class V restorations, composite materials can be used if adequate contamination control and adhesive technique are ensured., Conclusion: The guideline is the first to provide comprehensive evidence on the use of direct composite materials. However, further long-term clinical studies with comparators such as (modified) glass-ionomer cements are necessary. Regular updates will detail the future scope and limitations of direct composite restorations.

Purpose: Part 2 of this German S3 clinical practice guideline provides recommendations for the process of manufacturing composite restorations. It covers key aspects like caries removal, field isolation, matrix and adhesive techniques, as well as light curing and polishing. The outcomes of interest include survival rates and restoration quality., Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Additionally, the reference lists of relevant manuscripts were manually reviewed. Six PICO questions were developed to guide the search. Consensus-based recommendations were for- mulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence and ex- pert opinion., Results: The guideline advocates for one-stage selective caries removal near the pulp and underscores the effectiveness of various isolation techniques, adhesive systems, and the crucial role of light polymerization. The use of anatomically pre- formed sectional matrices and phosphoric acid etching is recommended to enhance restoration quality. Additionally, polish- ing composite restorations is advised to improve surface finish., Conclusion: This guideline provides comprehensive recommendations that inform clinicians on optimizing the composite restor- ation manufacturing processes. The adoption of these best practices can improve the quality and longevity of dental restorations.

Background: To predict the long-term performance of restorative materials in the oral environment, it is important to evaluate their resistance to chemical and mechanical degradation and to know the toxic potential of the type and amount of ions eluted from the filling material. In this study, home bleaching was applied to dental materials with different contents and it was aimed to determine the type and amount of ions released from these materials., Methods: In this study, amalgam, posterior composite resin, anterior composite resin, bulk fill composite resin, indirect composite resin, hybrid ceramic and all-ceramic were used as restorative materials. 10 specimens of each material were prepared according to the manufacturer's instructions. Each material group was divided into two subgroups as the bleached group and the control group. After bleaching, all specimens were stored in 1 ml of 75% ethanol/water solution. Solutions were renewed after 1, 14 and 28 days. The type and amount of ions released from the materials were determined using Inductively Coupled Plasma-Mass Spectrometer (ICP-MS). Data were analyzed using the Friedman, Wilcoxon Signed Ranks, and Mann-Whitney U tests (α = 0.05)., Results: It was determined that the amount of ions release from the restorative materials decreased over time (p < 0.05). According to the results of the Mann-Whitney U test, there was no difference between the bleaching and control groups in most of the restorative materials (p > 0.05)., Conclusion: Within the limits of this study, home bleaching system does not have a significant effect on ion release from restorative materials., (© 2024. The Author(s).)

NANOTECHNOLOGY: is the art and science of dealing with nanoscale particles. This has transformed contemporary dental practices through myriad contributions to biomaterial science. Titanium dioxide nanoparticles procured from Bacillus subtilis, an eco-friendly and biogenic source, can significantly magnify the physiochemical attributes of dental materials. However, postoperative sensitivity is a major drawback of composite restorations. The incorporation of these nanoparticles into dental adhesives can greatly benefit clinical dentistry by resolving this issue. This trial aimed to evaluate the effectiveness of a novel titanium dioxide nanofortified adhesive on the postoperative sensitivity of composite restorations., Methods: This triple-blind, parallel-group randomized controlled trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Islamabad, from May 15, 2023, to November 25, 2023. Participants (n = 60) with Class I and II primary carious lesions with a minimum cavity depth of 3-5 mm were randomly assigned to two groups (n = 30). After obtaining informed consent, the restorative procedure was accomplished using a minimally invasive approach and etch-and-rinse adhesive strategy. In group A, a nanofortified adhesive was used for composite restoration, whereas in group B, an adhesive without nanoparticles was used. Postoperative sensitivity was evaluated using the Visual Analog Scale (VAS) score at follow-up periods: of one day, one week, two weeks and one month. A Chi-square test was used to compare postoperative sensitivity between the two groups. The level of significance was set at p < 0.05., Results: A noteworthy association was observed between sensitivity and the group variable at all four evaluation periods: after one day (p = 0.002), 1 week (p = 0.002), 2 weeks (p = 0.007) and one month. In conclusion, participants who underwent restorative intervention using titanium dioxide nanoreinforced adhesives reported a notable reduction in sensitivity at all time intervals. Hence, the occurrence and severity of postoperative sensitivity are significantly reduced using Bacillus subtilis-procured nanofortified adhesives as compared to conventional adhesives without nanoparticles., Trial Registration: This trial was retrospectively registered at ClinicalTrials.gov (ID: NCT06242184) on 03/02/2024. All procedures involving human participants were performed in conformance with this protocol., (© 2024. The Author(s).)

Background: The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain., Methods: Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman's correlation test. The significance level was set at 0.05., Results: Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05)., Conclusions: In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h., Clinical Trial Registration: The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23., (© 2024. The Author(s).)