Search Results (277)

Background: Dental adhesive materials are important for achieving adequate adhesion results; however, they are not the only factor contributing to final bond strength, as improper operatory field isolation and contamination also significantly influence clinical outcomes. Objectives: This narrative review aims to provide a clinical perspective, supported by evidence-based arguments, to identify clinical procedures for optimizing adhesive protocols, including the execution of absolute isolation with a rubber dam, appropriate cleaning and preparation of the dental substrate, and protocols applicable to total-etch and self-etch techniques. Methods: The literature included in this review was selected through a structured search in PubMed, Scopus, and Web of Science, prioritizing systematic reviews, meta-analyses, long-term clinical studies, and foundational experimental investigations related to adhesive systems and substrate management. Results: A well-established clinical protocol that integrates proper adhesive selection, contamination-free operative field control, and adequate substrate preparation is essential for achieving predictable outcomes in adhesive dentistry. Conclusions: Although simplified adhesive systems offer acceptable bond strength results, established techniques continue to demonstrate consistent reliability, contributing to restorative longevity. Full article

Background: Partial ceramic veneers in the esthetic zone are a novel, conservative alternative to traditional veneer preparations intended to preserve maximum tooth structure. This narrative review summarizes the available clinical case reports on partial ceramic veneers and includes a case illustration demonstrating a step-by-step approach to closing a space between the maxillary left lateral incisor and canine. Methods: The review synthesizes the limited case-report evidence, focusing on patient selection, treatment planning, and clinical execution. The case illustration details each step, including a diagnostic digital wax-up to preview the proposed outcome and a minimally invasive preparation limited to rounding sharp areas and optimizing the path of insertion. Results: Published reports emphasize that careful case selection and a well-executed plan are essential. In the case illustration, hand-crafted partial veneers achieved a natural appearance, with a high esthetic outcome confirmed using the White Esthetic Score (WES) system. Conclusions: Although evidence remains limited, partial ceramic veneers can be predictable in appropriately selected cases. More long-term clinical data are needed, and the case illustration may help guide early-career clinicians. The case illustration is limited in that it does not provide quantifiable outcomes like in vitro studies; however, qualitatively, it fulfilled the patient’s esthetic and functional demands. Full article

Background: Cavity disinfection is commonly performed in pediatric restorative dentistry to reduce residual bacterial contamination. Although boric acid has been proposed as a potential antimicrobial agent, its effect on marginal integrity and adhesive performance in primary teeth remains unclear. This study evaluated the effects of 3% and 5% boric acid, compared with 2% chlorhexidine (CHX), on microleakage and microshear bond strength of composite restorations in primary teeth bonded with a two-step self-etch adhesive system. Methods: Seventy-two extracted primary second molars were allocated to four groups (n = 18) for microleakage assessment: control, 2% CHX, 3% boric acid, and 5% boric acid. Standardized Class V cavities were prepared, disinfectants were applied for 60 s, and restorations were completed using Clearfil SE Bond and resin composite. Microleakage at occlusal and gingival margins was evaluated using dye penetration. For microshear bond strength testing, 60 primary molars (n = 15 per group) were treated similarly, and shear force was applied to bonded composite microcylinders. Data were analyzed at the p < 0.05 significance level. Results: Both boric acid groups showed significantly higher occlusal and gingival microleakage than the control and CHX groups (p < 0.05). Gingival microleakage was greater than occlusal microleakage in the boric acid groups (p < 0.05). Microshear bond strength was significantly reduced in the boric acid groups compared with the control (p < 0.05), whereas CHX had no significant effect. Failure modes did not differ significantly. Conclusions: While 2% CHX did not adversely affect adhesive performance, 3% and 5% boric acid increased microleakage and reduced bond strength. Caution is advised when using boric acid with self-etch adhesive systems in primary teeth. Full article

Background: The microtensile bond strength (μTBS) test is the gold standard for evaluating adhesive performance in restorative dentistry. However, the conventional non-trimming technique—referred to in this study as the monoblock sectioning technique (MST)—is difficult to apply to hard and brittle CAD/CAM materials such as zirconia and ceramics, thereby limiting test reproducibility. This study compared a newly developed defined-area bonding (DAB) method with MST to determine whether DAB could serve as a reliable specimen preparation technique for μTBS testing. Methods: CAD/CAM resin blocks and resin core materials were bonded using either ESTECEM II or Panavia V5. MST specimens were obtained by bonding the blocks first and subsequently sectioning them into individual beams. In contrast, DAB specimens were produced by pre-shaping the sticks and bonding them within a defined 1 mm² area. μTBS, failure modes, and fracture/interface morphology (SEM) were evaluated. Results: MST produced significantly higher μTBS values than DAB (p < 0.001), with central MST beams showing the highest bond strengths. DAB values were statistically equivalent to MST peripheral values for both cements. More than 80% of failures were cohesive within resin cement across all groups. SEM revealed uniform cement layer thickness (50–60 μm) and similar peripheral-like fracture patterns in DAB specimens. Conclusions: Although MST yielded higher μTBS overall, the DAB method produced bond strengths equivalent to the MST peripheral region and demonstrated consistent fracture characteristics. Because DAB requires minimal cutting, it offers a promising, reproducible approach for μTBS testing of high-hardness materials that are otherwise difficult to section. Full article

With the growing clinical use of ion-releasing resin composites, their repairability has become an important consideration in minimally invasive restorative dentistry. Therefore, this study investigated the repair bond strength of a universal composite restorative to commercially available and experimental ion-releasing resin composite materials. Specimens (n = 8 per group) were produced from three commercially available ion-releasing composite materials (ACTIVA BioACTIVE-RESTORATIVE, Cention Forte, Beautifil II), one experimental ion-releasing resin composite containing 20 wt% bioactive glass fillers, and two conventional resin composites (3M Filtek Supreme XTE, Ceram.x Spectra ST), and aged by thermal cycling in artificial saliva (5000 cycles, 5–55 °C). Substrate surfaces were sandblasted (Al₂O₃, 50 µm), silanized (Monobond Plus), and repaired using adhesive (OptiBond FL) and universal resin composite (Ceram.x Spectra ST). After further thermal cycling, micro-tensile repair bond strength was assessed and analyzed using one-way ANOVA followed by Tukey’s post hoc test. Failure modes were determined by stereomicroscopy (25× magnification) and statistically compared among the groups. Highest mean repair bond strength values were obtained for ACTIVA BioACTIVE-RESTORATIVE, Beautifil II, and 3M Filtek Supreme XTE (53.8, 46.2, and 43.0 MPa, respectively), which did not differ significantly among each other. ACTIVA BioACTIVE-RESTORATIVE attained significantly higher bond strength than the experimental composite, Ceram.x Spectra ST, and Cention Forte, and showed the highest incidence of cohesive failures (40%). No significant bond strength differences were detected among Beautifil II, 3M Filtek Supreme XTE, experimental composite, Ceram.x Spectra ST, and Cention Forte (36.2–46.2 MPa). In conclusion, ion-releasing resin composites can be repaired with conventional universal composite and show repair bond strength values at least as high as those of conventional composite materials. Full article

Zirconium is a widely used material in the field of dentistry, employed for implants and their components as well as for the creation of crowns and veneers. Given that its biocompatibility has been studied and demonstrated in various fields of application, it is necessary to analyze how surface modification of this material influences its properties. The purpose of this study was to analyze the biocompatibility, initial adhesion (48 h), and morphology of periodontal ligament stem cells (PDLSCs) seeded on different zirconium surfaces treated with laser micropatterning, as well as plastic coverslips as a control. The Neubauer chamber was used to count the cells adhered to each of the sets, and confocal and scanning electron microscopy were employed to examine the adhesion and morphology of periodontal ligament stem cells on each of the zirconium surfaces studied. Results: Statistically significant differences were found in terms of primary cell adhesion, with sets 3 (grid topography) and 4 (channel topography) showing the most favorable characteristics for fibroblast adhesion. It was concluded that regular and moderately rough surfaces promoted better cell proliferation and development. Full article

Background: Traditional reliance on intraradicular posts for the restoration of root-filled teeth is decreasing due to advances in adhesive dentistry. Immediate pre-endodontic dentin sealing (IPDS) aims to protect dentin during endodontic procedures and improve adhesive outcomes. For teeth with minimal remaining structure and absent ferrule, internal adhesive ferrule approaches using fiber-reinforced composites or fiber mesh offer an alternative to posts. Methods: Four endodontically treated teeth with severely reduced coronal structure were restored using the IPDS protocol, reinforcement with an internal adhesive ferrule ring and fiber composites, and postless adhesive build-ups. Clinical and radiographic assessments were performed up to 2.5 years post-treatment. Results: All teeth remained asymptomatic, with stable periodontal and periapical conditions. Restorations maintained structural integrity and favorable adhesive performance. Conclusions: Within the limitations of this small case series, the IPDS approach combined with fiber-reinforced postless restorations showed favorable short-term clinical outcomes. Given the small sample size, case heterogeneity, and lack of a control group, these observations should be considered preliminary, and well-designed, long-term controlled studies are required to confirm the durability and broader applicability of this technique. Full article

Finite element analysis (FEA) is increasingly used in conservative and restorative dentistry to investigate the mechanical behavior of adhesive direct and indirect polymer-based restorations. Despite the growing number of FEA-based studies, the literature currently lacks a dedicated critical synthesis specifically addressing the methodological validity and clinical interpretability of FEA in adhesive restorative dentistry. This narrative review critically examines the current literature on the application of FEA in adhesive restorative dentistry, with particular attention to class I to class V cavities in anterior and posterior teeth restored with direct or indirect polymeric materials, including inlays, onlays, overlays, and tabletop restorations. A structured, non-systematic search of major databases was conducted, and selected studies were qualitatively appraised with emphasis on modeling assumptions, stress distribution, and clinical meaning. Unlike previous broad overviews of dental biomechanics, this review provides a clinically oriented framework for interpreting FEA findings across restorative strategies. FEA consistently identifies trends related to cavity configuration, cuspal support, restoration design, material stiffness, polymerization shrinkage, and adhesive interface behavior, helping to explain clinically observed failure patterns and supporting minimally invasive approaches. However, simplified material models, idealized bonding conditions, and static loading protocols limit prediction of long-term performance. When interpreted within these constraints and integrated with experimental and clinical evidence, FEA remains a valuable complementary tool for rational restorative decision-making. Full article

Background/Objectives: Accurate three-dimensional (3D) facial scanning is increasingly important in digital dentistry for diagnosis, treatment planning, and virtual patient creation. Multiple facial scanning technologies are available; however, their metric reliability varies depending on acquisition principles and anatomical orientation. This study aimed to evaluate the trueness, orientation-dependent performance (vertical midline versus horizontal facial measurements), and scanning time of four facial scanning technologies using calibrated manual anthropometry as the reference standard. Methods: Thirty dentate adult participants received adhesive fiducial markers on five predefined facial landmarks. Four linear facial distances were measured clinically using a digital caliper and compared with corresponding measurements obtained from standardized 3D facial scans. Digital measurements were extracted following uniform metric normalization. Inter-examiner reliability, measurement trueness, orientation-related differences, and scanning time were analyzed. Results: Inter-examiner reliability was excellent for both clinical and digital measurements (ICC > 0.93). All facial scanning technologies significantly overestimated manual distances (p < 0.001). The structured-light scanning system showed the smallest deviations (typically <1 mm) and the highest overall accuracy, followed by the depth-fusion system, while photogrammetry-based and NeRF-based approaches demonstrated larger errors, frequently exceeding 2–3 mm. Horizontal facial distances consistently showed greater deviations than vertical midline measurements across all systems. Scanning time differed significantly between technologies, with passive image-based approaches being the fastest and NeRF-based acquisition requiring the longest capture time. Conclusions: Active structured-light facial scanning demonstrated the highest trueness for linear facial anthropometry, whereas passive photogrammetry and NeRF-based approaches showed lower metric trueness and are currently more suitable for educational applications. Full article

Context: The increasing incidence of secondary caries and the failure of restorations have intensified research into dental restorative materials capable of actively interacting with the oral environment. In this context, antibacterial and bioregenerative nanomaterials have attracted growing scientific interest due to their potential to inhibit biofilm formation while simultaneously supporting mineral repair processes. Objective: This narrative review analyzes recent developments in nanostructured materials for restorative dentistry and oral health applications, with particular emphasis on antibacterial agents, bioactive systems, and emerging dual-function approaches that integrate multiple biological functions into restorative materials. Scope of the Review: The analyzed literature indicates that metallic nanoparticles, cationic monomers, and natural nanopolymers can reduce bacterial adhesion and metabolic activity under experimental conditions. In parallel, bioactive nanomaterials such as nanohydroxyapatite, bioactive glass, and calcium phosphate-based systems have demonstrated the ability to release remineralizing ions and to promote mineral deposition at the tooth–material interface. Dual-function hybrid materials aim to combine these antibacterial and bioregenerative effects within a single restorative system. Interpretative Perspective: Despite these advances, most available evidence derives from in vitro and preclinical studies, with significant heterogeneity across experimental models, evaluation methods, and outcome variables. This variability limits direct comparisons between studies and necessitates a cautious interpretation of claims regarding long-term antibacterial efficacy, functional tissue regeneration, and routine clinical applicability. Conclusions: Antibacterial and bioregenerative nanomaterials represent a relevant and continuously evolving research direction in restorative dentistry. Their successful clinical translation will depend on establishing standardized testing protocols, conducting comprehensive safety assessments, and generating clinically relevant evidence supporting long-term efficacy and biological compatibility. Their successful clinical translation will depend on establishing standardized testing protocols, conducting comprehensive safety assessments, and generating clinically relevant evidence supporting long-term efficacy and biological compatibility. Full article

Conventional glass ionomer cement (GIC) is a reaction product formulated from glass powders and polycarboxylic acid aqueous solution. This material has garnered significant attention in restorative dentistry due to its favorable properties, including chemical adhesion to tooth structure, biocompatibility, and sustained fluoride release, coupled with its minimal pulp irritation. However, its low mechanical strength, high brittleness, and susceptibility to cracking limit its use in stress-bearing areas of teeth. To expand the clinical application scope of GIC and develop an “ideal” dental restorative material, enhancing traditional GIC is necessary. This narrative review summarizes the main strategies for enhancing GIC, covering modifications to both the powder and liquid components. The key findings indicate that incorporating reinforcing fillers into the powder or modifying the polyacid chemistry can significantly improve mechanical properties such as compressive, tensile, and flexural strength. Additionally, some modifications help maintain or enhance fluoride release. However, the translation of many laboratory-based improvements to clinical practice requires further validation. In conclusion, while numerous promising enhancement routes exist, future development should focus on synergistic approaches and rigorous clinical evaluation to advance towards high-performance, durable restorative materials. Full article

Background/Objectives: Dental anxiety is a common clinical problem that negatively affects patient cooperation, treatment acceptance, and physiological stability during dental procedures. This randomized controlled clinical trial study aimed to evaluate the effectiveness of music-based interventions in reducing dental anxiety and stress responses during restorative dental treatment. The null hypothesis was that music exposure would not result in significant differences in anxiety levels or physiological stress parameters compared with standard dental care. Methods: Seventy-five patients with moderate to high pre-treatment dental anxiety (MDAS ≥10) were randomly assigned to three groups: classical music, Turkish music, and control (no music) (n = 25 per group). Anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS). Restorations were performed using a standardized adhesive protocol. Physiological parameters, including systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and oxygen saturation (SpO₂), as well as salivary cortisol and alpha-amylase levels, were measured before and after restorative treatment. Salivary cortisol and amylase levels were measured using a Human ELISA Kit. Statistical analysis was performed using paired t-tests and one-way ANOVA with Tukey’s post hoc test (p < 0.05). Results: Both music groups showed significant reductions in SBP, DBP, HR, cortisol, amylase, and MDAS scores compared to the control group (p < 0.05). Oxygen saturation increased significantly in the music groups, whereas it decreased significantly in the control group. There were no significant differences between classical and Turkish music regarding their anxiety-reducing effects. Conclusions: Music-based interventions effectively reduce dental anxiety and physiological stress during restorative dental procedures. This study is novel in simultaneously evaluating subjective anxiety scores and multiple physiological and biochemical stress markers in adult patients undergoing restorative treatment, supporting music as a simple and non-invasive adjunct in clinical dentistry. Full article

Glass ionomer-based restorative materials are widely used in pediatric dentistry because of their chemical adhesion to tooth structure, ion-releasing capacity, and clinical handling advantages; however, their mechanical durability under simulated oral aging conditions remains a critical factor influencing long-term clinical performance. This in vitro study aimed to evaluate and compare the surface microhardness of three contemporary glass ionomer-based restorative materials—Beautifil Bulk Restorative, EQUIA Forte HT, and Fuji II LC—before and after thermocycling. A total of 90 disc-shaped specimens (10 mm in diameter and 2 mm in thickness) were prepared, with 30 samples allocated to each material group. Microhardness measurements were performed using the Vickers hardness test at baseline and after 10,000 thermocycling cycles between 5 °C and 55 °C to simulate intraoral aging. Results were expressed as the mean ± standard deviation, and statistical analyses were conducted using non-parametric tests. Thermocycling resulted in a statistically significant reduction in microhardness values for all tested materials (p < 0.05). Beautifil Bulk Restorative exhibited the highest microhardness values both before and after thermocycling, followed by Fuji II LC and EQUIA Forte HT, with significant differences observed among all groups (p < 0.001). Within the limitations of this study, Beautifil Bulk Restorative may be considered a favorable option for restorations in young permanent teeth, whereas EQUIA Forte HT, exhibiting lower microhardness values, may be more suitable for primary teeth, where physiological wear is expected. Full article

Glass ionomer cements (GICs) are widely used in restorative and luting dentistry due to their fluoride release and chemical adhesion to dental tissues; however, their limited mechanical strength necessitates reinforcement strategies. The objective of this study was to investigate the effects of hemp-derived, green-synthesized titanium dioxide (TiO₂) nanoparticles on the surface and mechanical properties of two commercially available GICs with different clinical indications. TiO₂ nanoparticles were synthesized using Cannabis sativa leaf extract via a biogenic reduction method and characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX), confirming anatase-phase crystallinity, spherical morphology, and nanoscale particle size (28–49 nm). The nanoparticles were incorporated into Ketac™ Molar Easymix (restorative) and Ketac™ Cem Radiopaque (luting) GICs at 1%, 3%, and 5% (w/w), with nanoparticle-free formulations serving as controls (n = 10). Surface roughness, Vickers microhardness, and flexural strength were evaluated. Surface roughness increased in a concentration-dependent manner in both materials, with the highest values observed at 5% TiO₂ incorporation. In Ketac™ Molar Easymix, 1% and 3% TiO₂ significantly enhanced flexural strength and microhardness, whereas 5% resulted in reduced performance, consistent with SEM-observed nanoparticle agglomeration. In contrast, Ketac™ Cem Radiopaque exhibited no significant changes in flexural strength, although maximum microhardness values were recorded at 1% TiO₂ concentration. These findings demonstrate that low concentrations of hemp-derived TiO₂ nanoparticles can effectively reinforce restorative GICs and highlight the potential of green nanotechnology as a sustainable approach for improving dental biomaterials. Full article

Using multifunctional dual-cure smart bioactive resin luting agents (DRLs) offers benefits in adhesive dentistry, but their optical stability remains a concern. Their pre-cured form is a shear-thinning structure with thixotropic gel-like behavior. The effect of their hydrophilicity and different thicknesses of nanoceramic hybrid on the final shade of milled esthetic restorations needs further investigation. This study examined how the optical function deterioration of dual-cure smart bioactive resin luting agents used to bond a CAD/CAM nano-ceramic hybrid composite would influence the restoration’s final shade at three different thicknesses. A nanoceramic hybrid composite (GD) was cut into blocks and grouped by thickness (0.8, 1.0, 1.5 mm). Ten blocks from each group were assigned to subgroups based on the DRL type: Panavia SA Universal (PN), Predicta Bioactive (PR), and ACTIVA BioACTIVE (AC). Color and whiteness changes after a 24 h/day (24 days) coffee immersion were analyzed using statistical methods (ANOVA and Tukey’s HSD for ΔE₀₀; Welch’s ANOVA and Games-Howell for ΔWI_D and ΔL*). DRL type significantly affected ΔE₀₀, ΔWI_D, and ΔL* (p < 0.001). All materials showed the least color change and optical function deterioration at a restoration thickness of 1.5 mm, which was below the acceptability threshold (AT). Despite PR’s bioactive functionality, it maintained its primary optical function with the least color change at GD thicknesses of 1.0 and 1.5 mm (p < 0.001). AC exhibited the greatest ΔE₀₀ above AT, especially at a thickness of 0.8 mm (p < 0.001). ΔL*, ΔE₀₀, and ΔWI_D varied significantly based on DRL type, GD thickness, and the interaction between DRL and thickness (p < 0.05). This suggests that although dual-cure smart DRLs containing bioactive glasses are advantageous, their optical function shifts may become more noticeable in thin, translucent restorations. Increasing the restoration thickness can help mitigate this by altering the optical pathway. Full article