Dentistry Journal

Although dental implants appear to be an alternative for treatment of tooth loss, fixed prosthetic restorations are an irreplaceable part of oral rehabilitation. Regarding the EU directives concerning cobalt health risks, titanium alloys may be an alternative to cobalt–chromium and nickel–chromium for metal–ceramic dental restorations. The presented review briefly describes the specific properties of titanium, and the challenges met during production and use of titanium–ceramic fixed prosthetic restorations. Full article

Background. The use of zygomatic implants (ZIs) provides a highly predictable treatment option for rehabilitation in patients with severe atrophic maxillae. However, these long implants can potentially cause a number of more serious complications than those seen with conventional dental implants. The aim of this study is to report a case of peri-zygomatic cutaneous fistula following placement of monolateral double zygomatic implants and to analyse the available literature on this complication. Methods. The 55-year-old patient was treated with placement of 3 ZIs, two on the left side. Left periorbital swelling with pain appeared 10 days after surgery with progressive worsening of symptoms. After antibiotic treatment, she developed a left cutaneous fistula with purulent discharge. CT showed two ZIs on the left side with the apical portions in close contact with a 1 cm-wide portion of resorbed zygomatic external cortex and a layer of granulation tissue. Results: Due to the limited amount of bone involved by the fixation tip, the left ZIs were removed and the skin fistula repaired. The patient healed without complications but required prosthesis replacement. Conclusions. After conducting a literature review, peri-zygomatic fistulas seem to be more common in patients with two ZIs placed on the same zygoma. In this case, the amount of available zygomatic bone is relatively limited; the bone drill holes can often be too close together and cause overheating, leading to inter-implant bone resorption and infection, with further orbito-zygomatic fistula development. The authors identified the lack of distance between ZI fixtures as one of the main causes of extraoral ZI infection. Full article

Background: The present study investigated the relation between dental inclination, colorimetric variation, and aesthetic perception according to the modification of incisor inclination. Smile aesthetics, shaped by morphological factors and patient perception, are vital for social attractiveness and treatment success. This study aimed to assess the effect of varying head tilt on the perceived colour of upper central incisors by simulating changes in torque of the tooth, as well as evaluate factors influencing the perception of an aesthetic smile, including morphological characteristics and gingival aesthetic parameters. Methods: The study was comprised of three stages: colour analysis, evaluation of micro- and mini-aesthetic smile features, and an image-based assessment to determine evaluator perceptions and overall smile attractiveness. A sample of 50 students with complete, lesion-free anterior dentition was analysed. To simulate the effect of orthodontic torque changes during colour analysis, subjects tilted their heads downward and upward, representing palatal and buccal crown torque, respectively. Standardized macro-intraoral photographs were captured under controlled lighting conditions using a DSLR camera stabilized on a tripod in the different positions: the neutral head position (p0), 15° upward (p + 15), and 15° downward (p − 15). Digital colour analysis was conducted in the CIELAB colour space (L*, a*, b*). In the next stage, focusing on micro- and mini-aesthetic evaluation, an additional 50 smiles were generated using artificial intelligence via the SmileCloud program—one digitally enhanced smile per subject—complementing the initial set of 50 spontaneous smiles. These 100 smile images were evaluated by 50 laypersons and 50 dentists using a visual analogue scale via an online questionnaire, in order to assess perceptions, determine smile attractiveness, and quantify gingival aesthetic parameters. Results: The statistically significant regression results are as follows: those for the L* values in all three head inclinations: downward (−15 degrees), upward (+15 degrees), and total tilting (−15 to +15 degrees), as well as for the a* values for downward tilting and the b* values for total tilting. When the head is tilted downwards, the central incisors are positioned retrusively, and the L* b* values reveal a darker and more yellowish appearance, whereas, with the head tilted upwards, the central incisors protrude, and L* a* values indicate a brighter and more greenish appear. In the evaluation stage of the smile aesthetics study, no significant differences were observed in the judgments between laypersons and dentists or between males and females. Smiles with a high or average anterior line, parallel arc, upward lip curvature, visible first/second premolars, a smile index of 5.08–5.87, and symmetry score of 1.04 were rated as more attractive. Significant asymmetries were observed between upper dental hemi-quadrants in gingival contour and interdental papilla height, highlighting subtle morphological variations relevant to smile aesthetics. Conclusions: Aesthetic assessment revealed that the findings suggest a measurable impact of head position on dental colour perception and aesthetic evaluation. Evaluator variables including profession and gender exerted negligible effects on aesthetic perception, whereas smile attractiveness features and gingival aesthetic parameters demonstrate significant clinical applicability in patient management. Full article

Background/Objectives: The effectiveness of clear aligner therapy depends significantly on the precision of force delivery through the aligner–attachment interface. This study aimed to evaluate the microscopic compatibility between different orthodontic clear aligner materials (Duran+ and Zendura FLX) and attachment designs (rectangular and optimized) using scanning electron microscopy (SEM). Methods: Fifty-six samples were divided into four groups: rectangular attachments with Duran+ aligners (n = 14), rectangular attachments with Zendura FLX aligners (n = 14), optimized attachments with Duran+ aligners (n = 14), and optimized attachments with Zendura FLX aligners (n = 14). Attachments were bonded to bovine incisors using standardized protocols. Clear aligners were thermoformed at 220 °C for 40 s. Cross-sectional samples were analyzed using SEM at 250× magnification. Gap measurements were taken at seven points for rectangular attachments and five points for optimized attachments. Results: Gap measurements ranged from 14.75 ± 1.41 µm to 91.07 ± 3.11 µm. Zendura FLX demonstrated significantly better adaptation than Duran+ with rectangular attachments (42.10 ± 1.07 µm vs. 44.52 ± 1.51 µm, p < 0.001). Optimized attachments showed better overall adaptation than rectangular attachments. All combinations showed regional variation with the largest gaps at gingival borders (67.18–91.07 µm) and the smallest at flat buccal surfaces (14.75–20.98 µm). Conclusions: Perfect adaptation was not achieved with any material–attachment combination tested. Material selection and attachment design significantly influence microscopic adaptation, with multi-layer materials and optimized geometries showing superior performance. These findings provide mechanical explanations for clinical limitations in clear aligner therapy. Full article

Objectives: This article introduces a digital technique for virtual articulator mounting by employing the scan of a facebow worn by the patient as a virtual reference. Methods: The digital technique enables the transfer of the maxillary arch orientation relative to the cranial base into a CAD-CAM environment (Ceramill Mind; AmannGirrbach), without the need for ionizing radiation or identification of facial landmarks. By digitally aligning the intraoral scans of the dental arches (Trios 4; 3Shape) with a 3D facial scan and the scanned facebow in position (Artex; AmannGirrbach), clinicians can reproduce the cranium-to-maxilla spatial relationship accurately and intuitively. Results: This radiation-free protocol provides virtual cross-mounting and allows for the use of a semi-adjustable articulator within common CAD-CAM software. Conclusions: Given that intraoral scanners, facial scanners, and design software with articulator simulation are becoming more available in modern clinical workflows, this method introduced here could be a viable radiation-free and easy-to-use alternative. However, larger cohorts and standardized testing protocols are needed to determine its clinical reproducibility and reliability. Full article

Background: Reduced bond strengths in hypmineralised enamel have been reported with increased restorative failures. This study aimed to investigate the shear bond strengths of resin composite to hypomineralised enamel and dentin bonded with two different adhesive systems and pre-treatments. Methods: Thirty-six freshly extracted first permanent molars with MIH and 17 sound third molars were used for shear bond strength tests in enamel and dentin. Specimens of control groups were bonded to resin composite using Scotchbond^TM Universal Plus and Adper^TM Scotchbond 1XT. MIH-affected enamel specimens of six test groups were pre-treated with various chemical agents, such as 35% phosphoric acid, 5% NaOCl, resin infiltration with ICON^®, or a combination of these agents prior to bonding with composite resin using Scotchbond^TM Universal Plus. Bonded specimens were subsequently sheared at a crosshead speed of 1.0 mm/min, after which their fracture modes were recorded. The mean bond strengths of all groups were compared using a one-way analysis of variance test (ANOVA) and a Bonferroni–Holm analysis was performed for pairwise comparison between the groups. The association between modes of failure was examined with Pearson’s chi-square test. Results: Mean shear bond strength values were highest for sound dentin specimens (Group SD 2) bonded with Scotchbond^TM Universal Plus (23.76 ± 7.68 MPa). Sound enamel specimens (Group SE 2) exhibited significantly higher mean bond strength values than MIH-enamel specimens (Group HE 2) when bonded with Scotchbond^TM Universal Plus (19.68 ± 6.25 vs. 11.53 ± 3.29 MPa, p < 0.001). Oxidative pre-treatment followed by resin infiltration significantly improved bond strengths to hypomineralised enamel (Group HE 6) (17.84 ± 2.98 MPa, p < 0.05). Bond strengths to sound and hypomineralised enamel and dentin did not differ significantly for both adhesives. Conclusions: Within the limitations of an in vitro study, oxidative pre-treatment in combination with resin infiltration seems to be beneficial when planning adhesive restorations with composite in hypomineralised enamel. Both Scotchbond^TM Universal Plus and Adper^TM Scotchbond 1XT can be used for bonding of resin composite to MIH-affected enamel and dentin. Full article

Background/Objectives: This study aimed to evaluate the efficacy of a 445 nm diode laser in enhancing enamel resistance to acid-induced demineralization and to investigate the associated compositional and structural modifications using scanning electron microscopy (SEM), electron spectroscopy for chemical analysis (ESCA), and X-ray diffraction (XRD) crystallographic analysis. Methods: A total of 126 extracted human teeth were used. A total of 135 (n = 135) enamel discs (4 × 4 mm) from 90 teeth were assigned to either a laser-irradiated group or an untreated control group for SEM, ESCA, and XRD analyses. Additionally, 24 mono-rooted teeth were used to measure pulp temperature changes during laser application. Laser irradiation was performed using a 445 nm diode laser with a pulse width of 200 ms, a repetition rate of 1 Hz, power of 1.25 W, an energy density of 800 J/cm², a power density of 3980 W/cm², and a 200 µm activated fiber. Following acid etching, SEM was conducted to assess microstructural and ionic alterations. The ESCA was used to evaluate the Ca/P ratio, and XRD analyses were performed on enamel powders to determine changes in phase composition and crystal lattice parameters. Results: The laser protocol demonstrated thermal safety, with minimal pulp chamber temperature elevation (0.05667 ± 0.04131 °C). SEM showed that laser-treated enamel had a smoother surface morphology and reduced acid-induced erosion compared with controls. Results of the ESCA revealed no significant difference in the Ca/P ratio between groups. XRD confirmed the presence of hydroxyapatite structure in laser-treated enamel and detected an additional diffraction peak corresponding to a pyrophosphate phase, potentially enhancing acid resistance. Results of the spectral analysis showed the absence of α-TCP and β-TCP phases and a reduction in the carbonate content in the laser group. Furthermore, a significant decrease in the a-axis lattice parameter suggested lattice compaction in laser-treated enamel. Conclusions: Irradiation with a 445 nm diode laser effectively enhances enamel resistance to acid demineralization. This improvement may be attributed to chemical modifications, particularly pyrophosphate phase formation, and structural changes including prism-less enamel formation, surface fusion, and decreased permeability. These findings provide novel insights into the mechanisms of laser-induced enhancement of acid resistance in enamel. Full article

Backgroud: The aim of this study was to create an accessible, simple and reliable method for assessing the relative density of bone tissue in dentistry based on the analysis of digital panoramic radiographs. Methods: Measurement of average gray values on orthopantomograms was carried out using ImageJ Version 1.54i software. To estimate the relative bone density, functions for selecting regions of interest (ROI), calculating the area of selection, and statistics of the selected area were used. Statistical characteristics of samples and testing of hypotheses using statistical criteria were performed using Microsoft Excel. Results: we found that when manually selecting the reference and comparison areas for areas without signs of pathological changes in bone tissue, the average standard deviation was 0.058, and the coefficient of variation was 0.055 ± 0.011%, which makes the choice of the jaw angle as a reference more preferable. The average relative bone density of the assessed defective areas to the jaw angle was 0.64 ± 0.11, and the average relative bone density of the areas without pathology to the jaw angle was 1.052 ± 0.058. Conclusions: a research protocol was developed and justified using the ImageJ software package, which establishes a strict procedure for quantitative assessment of relative bone density based on the results of digital panoramic radiography. The proposed protocol can be used to monitor the condition of bone tissue after all types of dental treatment over time. Full article

The increasing popularity of Multi/Unit abutments in dental restorations is attributed to their clinical advantages, yet little is known about their mechanical behavior, particularly in terms of fatigue performance. Background/Objectives: This study aimed to evaluate the mechanical behavior of Multi/Unit abutments with a focus on the impact of implant and prosthetic platform diameters on fatigue performance. Methods: Five dental restoration models were analyzed using Finite Element Analysis by incorporating implants of identical length and body diameter but varying implant platform size (3.5 and 4.1 mm) and prosthetic platform size (3.5, 4.1, and 5.5 mm). Mechanical stresses on critical sections of the screws were assessed under cyclic loads. Results: The results revealed that the implant platform diameter had minimal influence on the fatigue performance of the prosthetic screw, while a wider prosthetic platform significantly improved its mechanical behavior by reducing stress and allowing the use of larger screw metrics. These findings emphasize that the prosthetic platform diameter plays a crucial role in protecting the prosthetic screw, which is often the critical component in dental restorations that use Multi/Unit abutments. Conclusions: The study highlights the importance of carefully selecting platform dimensions to optimize the mechanical performance and longevity of dental restorations utilizing Multi/Unit abutments. Full article

Background/Objectives: The goal of this research was to determine the prevalence and distribution of the oro-maxillofacial pathologies in patients with diabetes mellitus and to determine the correlation between diabetes mellitus and oro-maxillofacial disorders. Methods: The retrospective study group consisted of 6868 patients (mean age 49.84 ± 22.79 years) admitted in Oral and Maxillofacial Surgery Department between 2018 and 2024. Qualitative data were analyzed by Chi-square (χ²) test. Odds Ratio (OR) and Relative Risk (RR) were measured for each oro-maxillofacial pathology. Quantitative data were analyzed by Student’s T-test. Results: Among patients with diabetes mellitus (DM), the estimated risk of malignant tumors was 5.29 times higher (RR = 5.29; p = 0.001) compared to the non-DM group, with 15.0% of diabetic patients affected, versus 1.4% in the non-diabetic group. The probability of periodontal disease in diabetic patients was 4.66 times higher (RR = 4.66; p = 0.001), affecting 5.5% of the DM group, compared to only 0.6% in the non-DM group. Diabetic patients had a likelihood 3.53 times higher (RR = 3.53; p = 0.001) of developing apical periodontitis, with 5.3% of the DM group affected, in contrast to 1.0% of the non-DM group. The presence of root remnants was 1.43 times more likely (RR = 1.43; p = 0.001) in diabetic patients, with 9.0% of the DM group affected, compared to 6.1% in the non-DM group. Conclusions: The strong correlation between diabetes and oral pathologies, particularly malignancies and periodontal disease, underscores the need for early screening, preventive care, and targeted management strategies for diabetic patients. Full article

Objectives: This study aimed to investigate the effects of the quorum-quenching enzyme N-acyl-homoserine lactone (AHL)-lactonase Est816 on biofilm formation in subgingival plaque microbiota from participants with advanced periodontitis. Methods: Subgingival plaque samples were collected from 30 adults with untreated Stage III or higher periodontitis and cultured anaerobically. Est816 was applied in vitro, with phosphate-buffered saline (PBS) serving as the control. Biofilm composition was analyzed via 16S rRNA sequencing, and alpha diversity metrics were assessed. Differential taxa abundance was assessed with the multivariate statistical software MaAsLin3. Biofilm morphology, biomass, and thickness were evaluated using scanning electron microscopy (SEM), crystal violet staining, and confocal laser scanning microscopy (CLSM). Results: Est816 significantly reduced microbial richness (Chao1 Index, p = 0.031), biofilm biomass (64% reduction, p < 0.001), and thickness (76% reduction, p < 0.001) compared to controls. SEM revealed fragmented biofilm architecture in Est816-treated samples. Conclusions: AHL-lactonase Est816 inhibited polymicrobial subgingival-plaque-derived biofilm formation while reducing species richness, phylogenetic diversity, and community evenness. These findings demonstrate Est816’s potential as an adjunctive therapy for disrupting pathogenic biofilms in periodontitis. Full article

Background: Immediate implant placement in the esthetic zone, particularly in Class II extraction sockets with partial facial bone loss, presents challenges in achieving soft and hard tissue stability. Customized computer-aided design/computer-aided manufacturing (CAD/CAM) titanium abutments may offer advantages over prefabricated stock abutments. This study compared the clinical, radiographic, and patient-reported outcomes of customized CAD/CAM titanium abutments versus stock Laser-Lok stock abutments. Materials and methods: In a single-center, double-blind randomized clinical trial, 48 patients received immediate maxillary anterior implants restored with either customized CAD/CAM titanium abutments (n = 24) or stock titanium abutments (n = 24). Primary outcomes included peri-implant probing depth (PD), mucosal height, Pink Esthetic Score (PES), crestal bone level changes, and patient satisfaction assessed at baseline, 6, and 12 months post-loading. Statistical analysis included effect sizes and 95% confidence intervals. Results: At 12 months, the customized abutment group showed significantly shallower PD (mean difference: −0.54 mm; 95% CI: −0.72 to −0.35; p < 0.001), higher PES (12.21 ± 0.35 vs. 10.41 ± 1.17; p < 0.0001; Cohen’s d = 2.08), and less crestal bone loss (1.75 ± 0.36 mm vs. 2.33 ± 0.52 mm; p < 0.0001). Patient satisfaction scores were also higher in the customized group (p = 0.003). Within-group improvements were observed in both groups over time. No implant failures occurred. Conclusions: At 1-year follow-up, customized CAD/CAM titanium abutments demonstrated improved peri-implant soft tissue parameters, esthetics, and patient satisfaction compared to stock abutments. While these findings support their use in esthetically demanding immediate implant cases, the short-term duration and single-center design warrant further long-term multicenter studies to confirm durability. Trial registration: Registered at ClinicalTrials.gov on 19/01/2025 (NCT06791655). Full article

Background/Objectives: The dental industry is continuously developing high-performance polymer (HPP) materials with different qualities for denture frameworks. The aim of this in vitro study was to assess how thermal ageing (TA) affects the flexural strength (FS) and microhardness of two different HPP materials: Nanoksa G-plus and Bio-HPP/PEEK. Methods: The TA process was carried out for 5000 cycles at 5 °C and 55 °C in distilled water. To assess FS, a total of 40 bar-shaped specimens measuring 65.0 mm × 10.0 mm × 2.5 mm (20 per group) were obtained; TA and No-TA (NTA) subgroups were prepared for each material group (10 per subgroup); and a three-point bending test was conducted using an Instron universal testing machine. Each specimen that fractured during the FS test was subjected to microhardness measurement using a Vickers hardness tester. The mean FS and microhardness of the TA and NTA specimens were statistically examined using the t-test. Results: Both the TA and NTA Bio-HPP/PEEK specimens exhibited significantly greater (p < 0.0001) microhardness and FS qualities than the Nanoksa G-Plus specimens. The FS and microhardness of the Bio-HPP/PEEK and Nanoksa G-Plus materials significantly decreased (p < 0.05) after TA. Conclusions: The Bio-HPP/PEEK material showed better FS and microhardness properties than the Nanoksa G-Plus material. TA considerably decreased the FS and microhardness of the Bio-HPP/PEEK and Nanoksa G-Plus materials. Full article

Background/Objectives: This study evaluates the effectiveness of a toothpaste containing Java Tea and Little Ironweed in alleviating tooth sensitivity compared to a conventional potassium nitrate toothpaste. Methods: A total of 90 healthy patients aged 18–70 with up to two teeth exhibiting gingival recession were recruited into this study. All selected teeth had a visual analog scale (VAS) score ≥ 4 in response to tactile or air blast stimuli. Excluded teeth included those requiring restoration or participants undergoing treatments affecting sensitivity or taking pain medication/anti-sensitivity agents. Participants were randomly divided into three groups and instructed to brush twice daily with different toothpastes. The S1 group was prescribed toothpaste containing Java Tea and Little Ironweed extract, the S2 group was prescribed toothpaste containing Java Tea and Little Ironweed extract with 0.7% potassium nitrate, and the S3 group was prescribed toothpaste containing potassium nitrate. VAS scores were recorded at baseline, 2 weeks, and 4 weeks. Data were then compared and statistically analyzed between the groups. Results: For the tactile test, the final number of included teeth was 47 in the S1 group, 46 in the S2 group, and 22 in the S3 group. For the air blast test, the number of teeth included was 38 in the S1 group, 30 in the S2 group, and 27 in the S3 group. At baseline, mean VAS scores were comparable across groups for both tactile (S1: 6.89 ± 0.98; S2: 6.65 ± 1.52; S3: 6.82 ± 1.99) and air blast tests (S1: 7.39 ± 1.15; S2: 7.53 ± 1.31; S3: 6.89 ± 2.12). All groups showed significant reductions in VAS scores from baseline at both 2 and 4 weeks. A Kruskal–Wallis test indicated significant between-group differences in VAS scores at 2 and 4 weeks (p = 0.001). Post hoc analysis (Dunn’s test with Bonferroni correction) at 2 weeks revealed that the S1 group had significantly higher VAS scores than those of S2 (tactile p = 0.001, air blast p = 0.001) and S3 (tactile p = 0.002, air blast p = 0.018). By 4 weeks, the S2 group demonstrated superior efficacy, with significantly lower VAS scores compared to those of S1 (tactile p < 0.001, air blast p = 0.030) and S3 (tactile p = 0.035, air blast p = 0.001). Conclusions: All tested toothpastes effectively reduced dentin hypersensitivity over the study period. Potassium nitrate toothpaste provided more rapid initial relief, when compared to the herbal formulation alone; however, both achieved similar outcomes by 4 weeks. The herbal toothpaste supplemented with potassium nitrate demonstrated superior efficacy and may offer a promising natural alternative for managing dentin hypersensitivity. Full article

Objectives: This study aimed to compare the clinical durability, mechanical performance, and stress behavior of three NiTi rotary systems—BlueShaper (Blue), BlueShaper Pro (Dual Wire), and BlueShaper Gold (fully gold-treated NiTi)—through a multimodal evaluation that included simulated instrumentation in 3D-printed replicas, mechanical testing, and finite element analysis (FEA). Methods: Sixty instruments (n = 20 per group) were tested. Simulated canal preparation was conducted in standardized 3D-printed mandibular molars with a 40° mesial root curvature until fracture occurred. Mechanical tests included torsional and flexural loading using a universal testing machine and stainless steel blocks with a standardized 40° curvature. FEA simulations evaluated von Mises stress, shear stress, total deformation, cyclic fatigue behavior, and contact pressure between the instrument and canal wall. Results: BlueShaper Gold prepared an average of 7.5 canals before fracture, followed by BlueShaper Pro (5.67 canals) and Blue (5.00 canals) (p < 0.001). Gold exhibited the highest torsional resistance (6.08 ± 3.08 N) and the longest fatigue life (325 ± 55.7 cycles), with the lowest von Mises stress and damage factor in FEA. BlueShaper Pro showed the longest time to fracture in mechanical testing (73.85 ± 7.10 s) and balanced mechanical behavior. Blue demonstrated the lowest performance across most parameters, including the shortest fatigue life and highest stress concentration. Conclusions: BlueShaper Gold exhibited the highest mechanical strength and fatigue resistance. BlueShaper Pro demonstrated the longest fatigue life and balanced mechanical behavior. Blue showed the lowest performance across most parameters. The strong correlation among clinical, mechanical, and FEA data reinforces the critical role of alloy composition in determining instrument durability, even when design remains constant. Full article

Objectives: To study the effects of internal and marginal polymerization shrinkage stress and distribution in different resin composite class III dental restorations in relation to the restorative technique using numerical finite element analysis (FEA). Methods: A 3D model of a human hemi-maxilla with a sound maxillary central incisor were created. Four class III distal cavities were shaped and differently restored. Four groups of resin composite combinations were analyzed: group C (three increments of conventional composite); group B (two increments of bulk-fill composite); group FC (flowable base + three increments of conventional composite); and group FB (flowable bulk-fill base + two increments of conventional composite). The resulting four models were exported to FEA software for static structural analysis. Polymerization shrinkage was simulated using thermal analogy, and stress distribution was analyzed using the Maximum Principal Stress criterion at the marginal and internal cavity interfaces. Results: Group FC showed the highest stress at the level in the proximal region (9.05 MPa), while group FB showed the lowest (4.48 MPa). FB also exhibited the highest internal dentin stress, indicating potential risks for long-term bond degradation. In the cavo-surface incisal angle, the average peak stress across all groups was 3.76 MPa. At the cervical cavo-surface angle, stress values were 3.3 MPa (C), ~3.36 MPa (B), 3.41 MPa (FC), and 3.27 MPa (FB). Conclusions: Restorative technique did not significantly influence marginal stress distribution in class III composite restorations. However, the bevel area at the cervical margin showed the highest concentration of shrinkage stress. Full article

Introduction: Dental caries remains a public health concern, and early detection prevents its progression and complications. Panoramic radiographs are essential diagnostic tools, yet the interpretation of panoramic X-rays varies among practitioners. Artificial intelligence (AI) presents a promising approach to enhance diagnostic accuracy in detecting dental caries. This scoping review examines the current literature on the use of AI programs to analyze panoramic radiographs for the diagnosis of dental caries. Methods: This scoping review searched PubMed, Scopus, Web of Science, and Dentistry and Oral Sciences Source, adhering to PRISMA guidelines. The review included peer-reviewed, original research published in English that investigated the use of AI to diagnose dental caries. Data were extracted on the AI model characteristics, advantages, disadvantages, and diagnostic performance. Results: Seven studies met the inclusion criteria. The Deep Learning Model achieved the highest performance (specificity 0.9487, accuracy 0.9789, F1 score 0.9245), followed by Diagnocat and Tooth Type Enhanced Transformer. Models such as CranioCatch and CariSeg showed moderate performance, while the Dental Caries Detection Network demonstrated the lowest. Benefits included improved diagnostic support and workflow efficiency, while limitations involved dataset biases, interpretability challenges, and computational demands. Conclusions: Applying AI technologies to panoramic X-rays demonstrates the potential for enhancing caries diagnosis, with some models achieving near-expert performance. However, future research must address the generalizability, transparency, and integration of AI models into clinical practice. Future research should focus on diverse training datasets, explainable AI development, clinical validation, and incorporating AI training into dental education and training. Full article

Background: Immediate implant therapy is a highly effective solution for replacing non-restorable teeth, particularly in the esthetic zone, where achieving optimal results can be challenging. In this area, even small imperfections can significantly affect a patient’s satisfaction due to the high visibility of the teeth involved. This narrative review provides an overview of findings from case reports and systematic reviews that highlight the success of immediate implant therapy in the esthetic zone. Additionally, it includes a case illustration to emphasize how meticulous planning, combined with advanced techniques, can achieve successful outcomes. Methods: A comprehensive literature review was conducted to evaluate the effectiveness of immediate implant placement and loading for non-restorable teeth in the esthetic zone. Key factors identified for success include atraumatic tooth extraction, precise implant placement, and effective soft tissue management to achieve natural esthetics and long-term stability. To illustrate these principles, the review features a clinical case involving the replacement of a maxillary right central incisor rendered non-restorable due to trauma. Treatment incorporated advanced digital planning, atraumatic extraction, immediate implant placement, and provisionalization. The final restoration involved soft tissue contouring and ceramic veneers on adjacent teeth, enhancing the patient’s overall smile and confidence. Results: Evidence from the literature indicates that well-planned immediate implant therapy achieves high success rates and long-term stability. In the clinical case presented, the workflow met the patient’s esthetic and functional needs, resulting in a natural, harmonious smile, and improved patient satisfaction. Conclusions: Immediate implant therapy in the esthetic zone is highly effective when critical considerations—such as bone preservation, guided implant placement, soft tissue shaping, and appropriate restoration—are meticulously addressed. Advanced techniques and careful planning are essential for fulfilling both esthetic and functional patient needs, ultimately delivering predictable and successful outcomes. Full article

The areca nut (AN) is chewed by approximately 600 million people worldwide. Among AN chewers, ~5% develop oral submucosal fibrosis (OSF), a progressive fibrotic disorder of the oral cavity. OSF is characterized by subepithelial fibrosis and mucosal rigidity, leading to restricted mouth opening, difficulty in mastication, deglutition, and speech. These impairments severely compromise oral hygiene and routine dental care, diminishing patients’ quality of life. At least 4% of OSF patients develop oral cancer. The prevalence of OSF correlates with AN chewing, particularly when accompanied by other risk factors such as tobacco use. The International Agency for Research on Cancer has identified chronic chemical and mechanical irritation of the oral mucosa from AN chewing as a major cause of OSF. The active chemical ingredients of AN include alkaloids such as arecoline, flavonoids, and tannins. Of these, arecoline is considered the most potent fibrogenic agent. In vitro, arecoline induces cultured fibroblasts to differentiate into highly contractile α-smooth muscle actin (α-SMA)-expressing myofibroblasts, the effector cells of fibrosis, and to express profibrotic markers and mediators, including transforming growth factor-β 1 (TGF-β1) and cellular communication network factor 2 (CCN2), which is associated with malignant progression of OSF. In vivo, mice exposed to AN extract or arecoline show submucosal collagen accumulation and myofibroblast differentiation, concomitant with upregulated pro-fibrotic gene (TGF-β1, Col1A1, α-SMA) expression. Although myofibroblasts can be seen in OSF patient-derived samples, substantial disease heterogeneity exists, which has thus far hindered the generation of high-quality data necessary to gain insights into underlying mechanisms and disease progression. Consequently, treatment options for OSF are limited and primarily symptomatic. Collectively, evidence from human and animal studies establishes OSF as an AN-induced fibrotic disorder and underscores the urgent need for mechanism-focused research to identify reliable diagnostic markers and therapeutic targets to address its growing global burden. Full article