Unveiling the consequences of early human saliva contamination on membranes for guided bone regeneration.

AIMS: GBR membranes have various surface properties designed to elicit positive responses in regenerative clinical procedures; dental clinicians attempt to employ techniques to prevent the direct interaction of contaminated oral fluids with these biomaterials. However, saliva is uninterruptedly exhibited in oral surgical procedures applying GBR membranes, suggesting a persistent interaction with biomaterials and the surrounding oral tissues. This fundamental study aimed to investigate potential alterations in the physical, chemical, and key biological properties of membranes for guided bone regeneration (GBR) caused by isolated early interaction with human saliva. METHODS: A reproducible step-by-step protocol for collecting and interacting human saliva with membranes was developed. Subsequently, membranes were evaluated for their physicochemical properties, protein quantification, DNA, and 16S rRNA levels viability of two different cell lines at 1 and 7 days, and ALP activity. Non-interacted membranes and pure saliva of donors were applied as controls. RESULTS: Qualitative morphological alterations were noticed; DNA extraction and 16S quantification revealed significantly higher values. Furthermore, the viability of HGF-1 and MC3T3-E1 cells was significantly (p < .05) reduced following saliva interaction with biodegradable membranes. Saliva contamination did not prejudice PTFE membranes significantly in any biological assay. CONCLUSIONS: These outcomes demonstrated a susceptible response of biodegradable membranes to isolated early human saliva interaction, suggesting impairment of structural morphology, reduced viability to HGF-1 and MC3T3-E1, and higher absorption/adherence of DNA/16S rRNA. As a result, clinical oral procedures may need corresponding refinements.

Low-Migration Compounds with Amine Functionality as Coinitiators of Radical Polymerization.

The utilization of two-component systems comprising camphorquinone (CQ) and aromatic amines has become prevalent in the photopolymerization. However, there are still concerns about the safety of this CQ/amine system, mainly because of the toxicity associated with the leaching of aromatic amines. In light of these concerns, this study aims to develop novel coinitiator combinations featuring CQ and amines which cannot be leached out of materials, enabling free radical polymerization of representative dentalmethacrylate resins under blue light irradiation. This approach involves the initial design and analysis of hydrogen donors with low C─H bond dissociation energy through molecular modeling. Subsequently, copolymerizable methacrylate functional groups are incorporated via chemical modification, allowing it to act as both coinitiator and copolymerization monomer to achieve low migrationand leachability properties. This work presents, for the first time, the synthesis of the innovative coinitiator and compares its performance with the benchmark CQ/ethyl-4-dimethylaminobenzoate (EDB)-based photoinitiation system (PIS). The results demonstrate the effectiveness of the newly proposed PIS. Finally, an in-depth investigation is conducted into the reaction mechanism associated with this PIS through molecular orbital calculations and electron spin resonance studies.

Bisphenol A release from CAD/CAM splint materials.

This study aimed to investigate the bisphenol A (BPA) release from four CAD/CAM splint materials: three polycarbonate-based (DD BioSplint C, Splint Plus Biostar, Temp Premium Flexible) and one polymethylmethacrylate-based (Temp Basic) material. From each material, ten cylindrical samples (n = 40) were immersed in high-performance liquid chromatography (HPLC) grade water following ISO 10993-12 and incubated for 24 h in an incubation shaker at 37°C and 112 rpm. Following BPA derivatization, analysis was performed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). After 24 h of incubation, all investigated materials released significant amounts of BPA compared to water blanks. The material-dependent elution increased in the following order: DD BioSplint C < Splint Plus Biostar < Temp Basic < Temp Premium Flexible. Subtracting extraneous BPA, the concentrations ranged between 2.27 ng/mL and 12.65 ng/mL. After extrapolating the concentrations in relation to the average surface area of occlusal splints, the amount of BPA per mL exceeded the Tolerable Daily Intake (TDI) set by the European Union for a person weighing 70 kg by 1.32-6.16 times. Contrary to the release from previously investigated materials, BPA elution from CAD/CAM splint materials was highly elevated. Considering the increasing adaptation of CAD/CAM techniques, elution from them may represent a relevant BPA source in daily dental practice.

Effect of propolis added to single-bottle adhesives on water permeation through the hybrid layer.

Water treeing and water droplets are observed within adhesive layers and on the hybridized surface after bonding sound dentin using single-bottle etch-and-rinse adhesives, indicating permeability of the hybrid layer to water. The aim of this study was to assess the efficacy of dentin sealing by adhesives containing propolis by quantifying the area of water transudation from dentinal tubules after dentin hybridization. Brazilian red propolis was added to experimental adhesive and Single Bond (3M/ESPE) adhesive; experimental adhesive and Single Bond without propolis were used as controls. Under simulated pulp pressure, two layers of adhesive were applied to etched human dentin discs. Three minutes after light-curing, the hybridized dentin surface was replicated, and epoxy resin replicas were created to obtain scanning electron microscope images. Data were evaluated using ANOVA and Tukey's test. Single Bond containing propolis significantly decreased water permeation through the hybrid layer compared with the control group. Three minutes after polymerization, the experimental adhesive without propolis had formed a permeable hybrid layer. The addition of Brazilian red propolis significantly reduced surface water on hybridized dentin in a concentration-dependent manner. Two-step etch-and-rinse adhesives containing propolis were effective in reducing water permeation through the hybridized dentin surface.

Results of patch testing 2-hydroxyethyl methacrylate (HEMA) in the European baseline series: A 4-year retrospective study.

BACKGROUND: 2-Hydroxyethyl methacrylate (HEMA) was added to the European baseline series (EBS) in 2019. Few recent data are available on the frequency and relevance of positive reactions to this hapten. OBJECTIVES: To investigate the frequency and relevance of positive patch tests to HEMA in the EBS in a university hospital in Amsterdam, The Netherlands. PATIENTS AND METHODS: Retrospective study in patients with positive patch tests to HEMA investigated between June 2019 and August 2023. RESULTS: Of 2927 consecutive patients, 88 (79 women and 9 men; 3.0%) had a positive reaction to HEMA. The prevalence in women was 3.9%, in men 1.0%. Forty-three (49%) reactions were judged to be of current clinical relevance and 21 (24%) of past relevance. In this group of 64 patients with relevant reactions, 18 (28%) had occupational contact with (meth)acrylate-containing products, of who 11 (61%) were nail stylists. In 46 patients with non-occupational allergic contact dermatitis, 31 (67%) had allergic reactions to nail cosmetics. Glues and glue-containing products accounted for 22% of the materials causing allergic contact dermatitis and dental products for 8%. CONCLUSIONS: Allergic reactions to HEMA are very frequent in women investigated in Amsterdam. Nearly two thirds of cases were caused by nail cosmetics.

Viability and oxidative stress of dental pulp cells after indirect application of chemomechanical agents: An in vitro study.

AIM: This study evaluated the transdentinal cytotoxic effects of enzymatic agents (EA) for chemomechanical carious tissue removal on human dental pulp cells. METHODOLOGY: The groups were based on the performed dentine treatments (n = 8): G1: Positive Control (PC - no treatment); G2: Negative Control (NC - 35% H2 O2 for 2 min); G3: Brix 3000™ (BX) for 30 s; G4: BX for 2 min; G5: Papacarie Duo™ (PD) for 30 s; G6: PD for 2 min. The cells were evaluated for viability (VB; MTT assay) and production of reactive oxygen species (ROS; DCFH-DA assay) and nitric oxide (NO; Griess reagent). A scanning electron microscope provided morphological chemical analyses and energy-dispersive X-ray spectroscopy. The data were submitted to the one-way anova statistical test complemented by Tukey (p < .05). RESULTS: Cell viability decreased by 21.1% and 58.4% in G5 and G6, respectively. ROS production in G3 and G4 maintained basal levels but increased by 171.2% and 75.1% in G5 and G6, respectively. CONCLUSIONS: The Brix3000™ enzymatic agent did not cause indirect cytotoxic effects on pulp cells, regardless of the application time. Conversely, Papacarie Duo™ reduced viability and increased ROS production by pulp cells.

Investigation of zinc polycarboxylate cement used in dental treatments in terms of retrospective dosimeter.

Zinc polycarboxylate cement is one of the few dental materials that demonstrate true adhesion to tooth structure. It is suitable for use in living organisms without causing harm. Its strong adhesion to teeth and low level of irritancy are two important parameters for the dental applications. In this study, the dosimetry properties of zinc polycarboxylate cement using thermoluminescence (TL) method were investigated and determined the effectiveness of its use as a good dosimeter. According to the results of this study, the sample shows a good TL properties with three main peaks found around 140°C, 220°C and 330°C. It has a wide linear dose response between 72 Gy and 2.3 kGy and good reusability of the TL peak found at 330°C. Unfortunately, the TL peak intensity values are rapidly faded within a short waiting time interval. Zinc polycarboxylate cement, which is frequently used in dental crowns, can be used as a retrospective dosimeter for measuring the amount of radiation in space studies and nuclear accidents due to its wide linear dose-response curve in the high dose region.

Effects of different beverages on the color stability and fluorescence of resin composites: in situ study.

OBJECTIVE: To evaluate the color change (ΔE) and fluorescence (FL) of resin composites after the consumption of beverages. MATERIALS AND METHODS: One hundred and sixty disc-shaped specimens (6 × 2 mm) of Filtek Z350 XT (FZX) and Forma (FOR) resin composites were randomized for use in devices by five volunteers who ingested 100 ml daily of red wine (RW), beer (BE), energy drink (ED) and water (WT) over 15 days. The data were collected from digital photographs and analyzed using the CIE-Lab and RGB scales to obtain ΔE and FL and statistics via two-way ANOVA (for ΔE) and ANOVA for repeated measures (for FL), α = 0.05. RESULTS: The highest ΔE values were obtained for FZX and FOR in the RW (ΔE = 10.5 for FZX and ΔE = 9.90 for FOR) and BE (ΔE = 6.3 for FZX and ΔE = 6.1 for FOR) drinks. For FL, there were different levels of change between the composites, with a much more significant reduction in FL intensity with RW. CONCLUSION: Beverages have the potential to stain the composites evaluated, especially alcoholic beverages. CLINICAL SIGNIFICANCE: Before carrying out an esthetic treatment with resin composites, it is ideal to investigate the types of drinks consumed by patients, for greater predictability of treatment.

Clinical outcome of non-surgical root canal treatment using different sealers and techniques of obturation in 237 patients: A retrospective study.

OBJECTIVES: The aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment. MATERIALS AND METHODS: A total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI). RESULTS: There were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome. CONCLUSIONS: Based on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome. CLINICAL RELEVANCE: A bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

Mechanical and biological properties of polymer materials for oral appliances produced with additive 3D printing and subtractive CAD-CAM techniques compared to conventional methods: a systematic review and meta-analysis.

OBJECTIVES: The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured. MATERIALS AND METHODS: The protocol was registered online at Open Science Framework (OSF) registries ( https://osf.io/h5es3 ) and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022. INCLUSION CRITERIA: in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I2 = 0%, while statistical analysis was conducted using a random-effects model with I2 > 0%. RESULTS: 13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge's g with 95% CI = -1.25[ -1.84, - 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge's g with 95% CI = -0.01 [-2.71, - 2.68]). While flexural strength was higher in the control group (Hedge's g with 95% CI = 2.32 [0.10-4.53]). CONCLUSION: 3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials. CLINICAL RELEVANCE: The use of "mixed splints" combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties.

Supra-Alveolar Bone Regeneration: Progress, Challenges, and Future Perspectives.

Periodontitis is a highly prevalent disease that damages the supporting tissues of a tooth, including the alveolar bone. Alveolar bone loss owing to periodontitis is broadly categorized as supra-alveolar and intra-alveolar bone loss. In intra-alveolar bone loss, the defect has an angular or oblique orientation to the long axis of the tooth in an apical direction. In contrast, the defect is perpendicular to the long axis of the tooth in supra-alveolar bone loss. Unlike intra-alveolar bone defects, supra-alveolar bone defects lack supporting adjacent space, which makes supra-alveolar bone regeneration more challenging. In addition, the limited availability of resources in terms of vascularity and underlying tissues is another obstacle to supra-alveolar bone regeneration. Currently, supra-alveolar bone loss is the least predictable periodontal defect type in regenerative periodontal therapy. In addition, supra-alveolar bone loss is much more common than other alveolar bone loss. Despite its prevalence, research on supra-alveolar bone regeneration remains sparse, indicating an unmet need for significant research efforts in this area. This review summarize recent advances, obstacles, and future directions in the field of supra-alveolar bone regeneration. We discuss the biomaterials, bioactive molecules, and cells that have been tested for supra-alveolar bone regeneration, followed by pre-clinical and clinical approaches employed in this field. Additionally, we highlight obstacles and present future directions that will propel supra-alveolar bone research forward.

The formation of cariogenic plaque to contemporary adhesive restorative materials: an in vitro study.

The research exploiting the ability of dental materials to induce or prevent secondary caries (SC) development still seems inconclusive. Controlling bacterial adhesion by releasing bacteriostatic ions and improving the surface structure has been suggested to reduce the occurrence of SC. This paper analyses the impact of five distinctively composed dental materials on cariogenic biofilm formation. Forty-five specimens of three composites (CeramX Spectra ST, Admira Fusion, Beautifil II) and two glass-ionomers (Fuji II LC, Caredyne Restore), respectively, were incubated in bacterial suspension composed of Streptococcus mutans, Lactobacillus acidophilus, Streptococcus mitis, Streptococcus sanguinis, and Streptococcus salivarius at pH 7.0 and 5.5. Coverslips were used as a control. Adhered bacteria were collected after 2, 4, 6, 12, 24, and 48 h and analyzed using quantitative polymerase chain reaction (qPCR). Fluoride leakage was measured at each collection. The specimens' surface topography was assessed using interferometry. In the present study, surface roughness seemed to have a partial role in bacterial adhesion and biofilm formation, together with chemical composition of the materials tested. Despite differences in fluoride leakage, biofilm accumulation was similar across materials, but the number of adhered bacteria differed significantly. A release of other ions may also affect adhesion. These variations suggest that certain materials may be more prone to initiating secondary caries.

The impact of various substrates, ceramic shades, and brands on the ultimate color and masking capacity of highly translucent monolithic zirconia: an in vitro study.

This study aimed to examine the impact of substrates, ceramic shades, and brands on the color and masking ability of highly translucent monolithic zirconia (HTMZ) using CIELab and CIEΔE2000 metrics. A total of 156 1-mm thick HTMZ disks in shades A1, A2, and A3 were produced using Dental Direkt and Kerox zirconia brands. Four 3-mm thick substrates (nickel-chromium alloy, non-precious gold alloy (NPG), zirconia shade A2, and resin composite shade A2) were prepared. HTMZ disks were overlaid on these substrates, and color measurements were taken with a spectrophotometer. Color differences (ΔE) were analyzed using CIELab and CIEΔE2000 formulas. The influence of brand, shade, substrate, and their interactions on ΔE values was assessed with a General Linear Model (GLM) and LSD pairwise comparison test. Spearman's correlation test examined the relationship between CIELab and CIEΔE2000 values. Results indicated that ΔEab was significantly influenced by substrate type and shade, while ΔE2000 was also affected by the ceramic brand. Mean color differences across ceramic-substrate groups were within clinically acceptable and perceptible ranges (clinically perceptible: ∆Eab ≥ 1.3 and ∆E2000 ≥ 0.8; clinically acceptable: 0.8 < ∆E2000 ≤ 1.8 and 1.3 < ∆Eab ≤ 2.7), except for NPG, which had ΔE values exceeding the perceptible range (ΔE2000: 1.1 ± 0.11 to 1.8 ± 0.31; ΔEab: 1.61 ± 0.15 to 2.16 ± 0.36). A significant correlation (r = 0.974, P < 0.001) was found between ΔEab and ΔE2000. Various ceramic brands and shades led to notable ΔE variations, yet average color differences within all ceramic-substrate groups remained clinically acceptable. Both ΔEab and ΔE2000 were reliable methods with a strong correlation for measuring color differences.

Exploring the effectiveness of doxycycline in restorative dentistry: a systematic review of in vitro studies.

This systematic review evaluated the efficacy of doxycycline in MMP inhibition, its antibacterial action, and other properties relevant to dental materials testing. The study protocol was registered at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/ZVK2T ). Reporting was based on PRISMA statement. The search was carried out in the databases: PubMed, Scopus, Web of Science, Embase, Lilacs, and Google Scholar. Articles were restricted to Portuguese, English, and Spanish, with no date limit. In vitro studies were selected based on the following outcomes: DOX antibacterial and anti-metalloproteinase activity and its influence in physico-chemical properties. Two researchers independently selected the articles and collected the data. Of 1507 documents, 82 were fully evaluated and 21 were included. Different forms of doxycycline incorporation were found, both as free form and incorporated into carrier agents. The drug was tested as primers, incorporated in adhesive or glass ionomer cement. No studies were found that evaluated its incorporation in resin composite or resin cement. The results confirmed the therapeutic properties of the medication, with more significant results when incorporated in an adhesive. However, although promising, the use of this substance requires standardization in application methods and adopted concentrations, allowing for more direct comparisons between studies. Furthermore, long-term studies are interesting to conduct, ensuring biocompatibility and complete understanding of long-term effects on dental materials.

Evaluation of early bacterial adhesion on CAD/CAM dental materials: an in situ study.

The aim of this research was to determine if there are differences in early bacterial adhesion among CAD/CAM dental materials after 24 h exposure in the oral environment. One hundred twenty specimens were prepared according to the manufacturer's recommendations and divided into six groups: RBC (resin-based composite), PMMA (polymethyl methacrylate), PEEK (polyether ether ketone), ZP (zirconia polished), ZG (zirconia glazed), and cobalt-chromium alloy (CoCr alloy). Twenty healthy participants were instructed to carry an intraoral device with six specimens, one per group, for 24 h. Thereafter, real-time polymerase chain reaction (qPCR) and scanning electron microscopy (SEM) analyses enabled quantification and 2D view of biofilm formed on the specimens' surfaces. Kruskal-Wallis test and Dunn's post hoc analysis were used for inter-group comparison and data were presented as median (minimum-maximum). RBC specimens accumulated less bacteria, in comparison with ZG (p = 0.017) and PEEK specimens (p = 0.030), that dominated with the highest amount of adhered bacterial biofilm. PMMA, CoCr, and ZP specimens adhered more bacteria than RBC (p > 0.05), and less than ZG (p > 0.05) and PEEK (p > 0.05). The bacterial number varied considerably among participants. The obtained results enable a closer view into the susceptibility of CAD/CAM materials to microorganisms during the presence in the oral environment, which can be beneficial for a proper selection of these materials for a variety of dental restorations.

Preheating and "snow-plow" composite application technique affect double bond conversion but not bond strength to dentine.

OBJECTIVE: To measure degree of conversion (DC) of a flowable composite, microtensile bond strength (MTBS) to dentine in the snow-plow technique with/without preheating and temperature in the preheated composite. MATERIALS AND METHODS: For DC, snow-plow specimens of Filtek Ultimate Flowable (Flow) and Filtek Bulk Fill (Bulk) (3M) were prepared by light-curing composites simultaneously in standardized molds while in control groups light-curing was separate. DC of Flow was measured using micro-Raman spectroscopy. For MTBS, specimens were prepared on dentine of human extracted molars by simultaneous (snow-plow) or separate (control) light-curing. MTBS was measured using a universal testing machine after 24 h and 6 months. Data were analyzed using ANOVA with Tukey's post hoc (α = 0.05). RESULTS: Increased curing time significantly increased DC in snow-plow from 13.4% ± 11.6% (10 s) to 31.8% ± 4.4% (40 s) albeit significantly lower than controls (p < 0.05). Preheated Bulk improved conversion in snow-plow (44.3% ± 1.7%) and control (50.5% ± 2.6%) (p < 0.05). No significant differences occurred in MTBS between groups (p > 0.05). MTBS values ranged between 66.7 ± 8.4 MPa (snow-plow group_21°C_baseline) and 54.1 ± 15.8 MPa (control_21°C_long-term). Temperature in the preheated Bulk dropped to ~38°C after 30 s. CONCLUSIONS: Snow-plow technique, irrespective of preheating, resulted in lower DC of Flow than separate light-curing of composite increments. Snow-plow, irrespective of preheating, resulted in similar initial and long-term MTBS to dentine. CLINICAL SIGNIFICANCE: Clinicians with preference for flowable composite liners in Class II restorations should be aware that the snow-plow technique of simultaneous light-curing of flowable and bulk-fill composite increments affects monomer-to-polymer conversion, albeit no effect on immediate, and long-term bonding to dentine was detected. Preheating sculptable bulk-fill composite improves conversion of the flowable liner in the snow-plow technique but has no detectable effect on bond strength to dentine.

Shedding light on the problem: Proficiency and maintenance practices of light-curing units among dental assistants.

BACKGROUND: Proper light curing is crucial for the success of restorative dentistry and to bond brackets to teeth, yet the responsibility is often delegated to dental assistants (DAs). This study assessed the proficiency and maintenance protocols of DAs when using light-curing units (LCUs) in Saudi Arabia. METHODS: Self-administered questionnaires were distributed to practicing DAs. The questionnaire contained sections on knowledge, adherence to best practices, and how to maintain the LCU. Demographic data were collected as well. Descriptive statistics and linear regressions at a significance level of (p = 0.05) were conducted to identify any relationships that influenced the DAs' LCU knowledge, practice, and maintenance protocols. RESULTS: Among the surveyed DAs, 66% were responsible for using the LCU during treatment, 16% used their fingers for support when light curing, 50% held the LCU tip 1-2 mm from the restoration during curing, and 51% did not have a specific maintenance protocol at their workplace. 70% did not know the output from the LCU, and their educational background correlated with knowledge (b = -14.42, p < 0.001). The type of institution type correlated with adherence to best practices (b = -13.65, p = 0.011), and level of knowledge and adherence to maintenance protocols showed a direct correlation (b = 0.002, p = 0.041). CONCLUSIONS: The findings revealed that a significant percentage of the DAs who replied had insufficient knowledge and did not follow the best practices and maintenance protocols for the LCUs they were using. Their educational background and workplace factors influenced this knowledge gap, while the absence of a maintenance protocol and suboptimal practices were associated with the type of institution. CLINICAL SIGNIFICANCE: To maintain the best practice, clinicians and institutions should improve the education and training of DAs. Otherwise, inadequate light curing by the DAs may jeopardize the long-term success of many dental procedures.

Double Monolithic Protocol: The Solution to Fluorescence Limitations.

OBJECTIVE: The present paper aims to demonstrate the incorporation of the double monolithic protocol (DMP) into a chairside digital workflow to reproduce the fluorescence properties of natural teeth with chairside monolithic restorations when exposed to different light sources. CLINICAL CONSIDERATIONS: A female patient reporting dissatisfaction with her upper anterior teeth was rehabilitated using seven veneers and a three-element bridge. The DMP was applied to the bridge, which consisted of a primary lithium disilicate framework to which leucite-reinforced glass ceramic veneers were cemented. The fluorescence of the different substrates and ceramic restorations was evaluated throughout the rehabilitation process, under 365 and 405 nm light. CONCLUSIONS: The DMP allows chairside procedures to be optimized by achieving predictable, mechanically resistant, and esthetic restorations. CLINICAL SIGNIFICANCE: The DMP is a new chairside solution for developing ceramic restorations with optimal esthetics and combined mechanical properties, eliminating the need for sintering or glazing procedures.

Implant-supported single all-ceramic crowns made from prefabricated (stock) or individualized CAD/CAM zirconia abutments: A 5 year randomized clinical trial.

AIM: The aim of this randomized, prospective, and clinical multicenter study was to compare the overall clinical performance of two restorative options over a 5-year period: individualized CAD/CAM abutments veneered with a hand-layered ceramic, and prefabricated zirconium dioxide abutments veneered with press ceramic and inserted into a single edentulous gap in the anterior maxilla. MATERIALS AND METHODS: Forty subjects were recruited from two universities: 20 from the University of XX and 20 from the University of XY. Each subject received an implant to restore a single edentulous gap in the maxillary anterior region (14-24 FDI). 20 patients were randomized into each Group. Group A received a one-piece single crown produced from a prefabricated zirconia abutment with pressed ceramic and Group B received an individualized CAD/CAM zirconia abutment with a hand-layered technique. After 5 years, the aesthetic and radiographic parameters were assessed. RESULTS: Group A had four dropouts and one failure, resulting in a 95% survival rate and 95% success rate. Group B had two dropouts and two failures which resulted in a 90% survival rate and 90% success rate. No crestal bone level changes were observed, with a mean DIB of 0.06 mm in Group A and 0.09 mm in Group B. No statistically significant differences were present at baseline, 6 months, 1 year, 3 years, or 5 years for DIB values between time points and groups. Pink aesthetic score/white aesthetic score, Peri-Implant and Crown Index, and Implant Crown Aesthetic Index values were stable over time at all five points for both groups. CONCLUSION: Both implant-supported restorative options represent a valuable treatment option for the restoration of implant crowns in the anterior maxilla. CLINICAL SIGNIFICANCE: In general, the use of ceramic abutments in the anterior zone represents a valuable treatment procedure with both standardized and CAD/CAM individualized abutments and following the recommendations from the respective manufacturer(s).

Interdisciplinary Delphi study by PROSEC North America: Recommendations on single indirect restorations made from ceramic and nonmetallic biomaterials for posterior teeth.

OBJECTIVE: This article puts forward consensus recommendations from PROSEC North America regarding single indirect restorations made from ceramic and nonmetallic biomaterials in posterior teeth. OVERVIEW: The consensus process involved a multidisciplinary panel and three consensus workshops. A systematic literature review was conducted across five databases to gather evidence. The recommendations, informed by findings from systematic reviews and formulated based on a two-phase e-Delphi survey, emphasize a comprehensive treatment strategy that includes noninvasive measures alongside restorative interventions for managing dental caries and tooth wear. The recommendations advocate for selecting between direct and indirect restorations on a case-by-case basis, favoring inlays and onlays over crowns to align with minimally invasive dentistry principles. The recommendations highlight the critical role of selecting restorative biomaterials based on clinical performance, esthetic properties, and adherence to manufacturer guidelines. They emphasize the importance of precision in restorative procedures, including tooth preparation, impression taking, contamination control, and luting. Regular follow-up and maintenance tailored to individual patient needs are crucial for the longevity of ceramic and nonmetallic restorations. CONCLUSIONS: These PROSEC recommendations provide a framework for dental practitioners to deliver high-quality restorative care, advocating for personalized treatment planning and minimally invasive approaches to optimize oral health outcomes. CLINICAL SIGNIFICANCE: The PROSEC North America recommendations highlight the importance of minimally invasive techniques in posterior tooth restorations using ceramic and non-metallic biomaterials. These principles prioritize tooth structure conservation and personalized treatment planning, essential for enhancing clinical outcomes and long-term oral health.