Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis

The Influence of Surface Treatment on the Color of Enamel and Dentin: An In Vitro Study Using Machine Learning-Based Analysis

OBJECTIVE

To investigate how surface treatment affects the color of enamel and dentin, and to evaluate whether the color differences are acceptable.

MATERIALS AND METHODS

Freshly extracted premolars were prepared using diamond burs (blue, red, and yellow tapes). Tooth surfaces were divided into control and acid-etched areas and treated with phosphoric acid (5, 15, 30, 45, and 60 s). Adhesives were applied and light-cured. Hyperspectral images were captured to analyze reflectance spectra, calculating L, a, b, and ΔE2000 values under the D65 illuminant. Enamel and dentin slices underwent atomic force microscopy for surface roughness. A random forest model was trained to assess the effects of multiple factors on color differences. Statistical analyses included one-way ANOVA, Tukey tests, and independent-sample t-test.

RESULTS

Extended acid-etching times notably increased ΔE2000 values for enamel, surpassing acceptable thresholds in all groups except for the 5-s acid-etching followed by adhesive application. Dentin ΔE2000 remained stable regardless of surface treatment. Machine learning highlighted the influence of acid etching and surface roughness on enamel. Bur tape color had minimal impact.

CONCLUSIONS

The effects of acid etching on the color vary between enamel and dentin. Greater attention should be focused on enamel surface. Acid-etching time should be appropriately reduced.

CLINICAL SIGNIFICANCE

Comprehending the varying impacts of surface treatment on the color of enamel and dentin could contribute to achieving superior esthetic outcomes.

Effectiveness of horizontal posts to support MOD cavities compared with other restorative approaches in endodontically treated teeth: systematic review with meta-analysis of laboratory studies

BACKGROUND

Endodontically treated teeth often face challenges in maintaining structural integrity, particularly when restored with MOD cavities. This systematic review aimed to evaluate the mechanical behavior of endodontically treated premolar and molar teeth with MOD cavities, restored with horizontal posts and composite materials, compared with alternative restorative approaches such as fiber-reinforced composites and indirect restorations.

METHODS

A comprehensive search was conducted in December 2024 across various databases, including PubMed, Scopus, Web of Science, and Google Scholar. All studies that examined the application of horizontal posts in posterior endodontically treated teeth compared to other restorative methods were included, and manual searches of included studies and associated scientific websites were performed. The meta-analysis was accomplished through the Review Manager (RevMan 5.4) of the Cochrane Collaboration.

RESULTS

The web search yielded 718 records, and 1 was added from the manual search. Following the PRISMA guidelines, 26 studies were ultimately included in this review. Horizontal posts in endodontically treated teeth significantly improved fracture resistance compared with untreated MOD cavities and many restorative methods, though they did not match sound teeth. Combining horizontal posts with materials like polyethylene fiber Ribbond or nanohybrid composites achieved fracture resistance comparable to sound teeth, while finite element analyses showed reduced stress concentrations. Horizontal posts also reduced non-restorable fractures compared to MOD cavities and bulk-fill composites, highlighting their mechanical advantage, especially when paired with advanced composites.

CONCLUSIONS

The insertion of horizontal posts significantly increased the fracture resistance of endodontically treated premolars and molars compared to composite restorations. Notably, fracture resistance levels were comparable to those observed in teeth restored with glass-fiber-reinforced composite and indirect ceramic restorations. However, there was no evident benefit from inserting root canal posts in enhancing fracture resistance. None of the restorative approaches achieved the fracture resistance levels of intact premolar and molar teeth.

CLINICAL SIGNIFICANT

Proper support of ETTs with MOD cavities restored with direct composite restorations can preserve tooth integrity, particularly in case of large cavities. These supporting concepts are crucial in achieving complications-free restorations that maintain long-term clinical functionality.

Effect of Nd:YAG Laser Surface Pretreatments and Bonding Protocols on Shear Bond Strength of Monolithic Zirconia with Varying Yttria Contents to Composite Resin

This study aimed to evaluate the impact of different surface pretreatments and bonding protocols on the shear bond strength (SBS) of two monolithic zirconia materials to composite resin.A total of 200 zirconia specimens, 3Y-TZP (n = 100) and 5YSZ (n = 100), were allocated into five groups: Control with no treatment, air-particle abrasion (APA), Nd:YAG (neodymium-doped yttrium aluminum garnet) laser treatment (L), a combination of APA and L, and laser treatment followed by cold plasma (CAP). Half of the specimens received a primer application before bonding with resin cement. Surface morphology was assessed using scanning electron microscopy, and SBS testing was conducted with a universal testing machine.The SBS analysis was done using multiway analysis of variance (p ≤ 0.05).Different surface pretreatments and 10-methacryloyloxydecyl dihydrogen phosphate primer application significantly increased SBS values (p ≤ 0.001). APA was associated with the highest SBS values, followed by APA + laser and laser + CAP. However, the combination of APA with L slightly reduce the bond strength. While the application of laser alone possesses the lowest SBS among the surface pretreatment methods, the control group was the worst by far. Different zirconia materials showed no impact on SBS values.APA surface pretreatment might still be the gold standard for zirconia adhesion. Laser surface pretreatment is a viable, less destructive option. Combining APA with laser slightly reduces SBS, while combining two inert surface pretreatment methods, such as laser and CAP, leads to enhancement of SBS compared with laser alone. Zirconia primer is highly recommended for bonding protocol. No special considerations should be taken for different yttria contents, as both materials reported comparable bond strength within the same coupled variables.

Clinical Complications and Survival Rate of Resin Matrix Ceramic Restorations: A Systematic Review and Meta-Analysis

OBJECTIVES

The existing evidence regarding the clinical complications and survival rates associated with resin matrix ceramics (RMC) remains inconclusive. This systematic review aimed to assess the clinical complications, success, and survival rates of RMC restorations.

MATERIALS AND METHODS

A comprehensive search was conducted on PubMed, Scopus, and Cochrane databases in October 2024. Clinical studies evaluating the complications of RMC (polymer infiltrated ceramic network [PICN], and resin nano ceramic [RNC]) restorations were included. The risk of bias was assessed using Cochrane tools. A meta-analysis was performed using review manager, employing the inverse variance test with a fixed effects model, and results were presented as risk ratios with a 95% confidence interval, with an alpha level set at ≤ 0.05.

RESULTS

Twenty-one studies were included. RMC full and partial crowns exhibited higher rates of clinical complications than ceramic restorations. Laminate and occlusal veneers demonstrated comparable outcomes between RMC and lithium disilicate materials. RMC intracoronal restorations showed clinical complications similar to those of lithium disilicate inlays and onlays but demonstrated lower complications compared to direct composite restorations. The overall success and survival rates of RMC restorations were found to be dependent on the restoration size and cavity design, with poorer success and survival rates associated with full and partial coverage crowns.

CONCLUSIONS

Resin matrix or hybrid ceramics may not be the preferred choice for full and partial coverage restorations. However, resin matrix ceramics demonstrated favorable clinical outcomes for intracoronal restorations and veneers, showing preference over direct composite restorations. Long-term randomized clinical trials are recommended to provide further evidence.

CLINICAL IMPLICATIONS

The selection of materials is fundamental for the clinical success of restorations, ensuring prolonged, complication-free survival. It is essential to comprehend the clinical behavior of resin matrix ceramics or hybrid ceramics before their adoption in further clinical applications.

Does the Type of Resin Luting Material Affect the Bonding of CAD/CAM Materials to Dentin?

Background/Objectives: This study aimed to investigate the microtensile bond strength (µTBS) of composite-based (Cerasmart), polymer-infiltrated (Vita Enamic), and feldspathic (Cerec) CAD/CAM blocks luted to dentin using a dual-cure resin cement (LinkForce), as well as micro-hybrid (G-aenial) and flowable composites (G-aenial Universal Flo), and evaluate the microhardness (HV) of luting materials through the CAD/CAM blocks. Methods: Cerasmart, Enamic, and Cerec were luted to dentin using three luting materials; LinkForce, G-aenial, and Universal Flo (n = 5). For HV, 117 disk-shaped specimens from LinkForce, G-aenial, and Universal Flo (n = 13) were polymerized through 3 mm thick CAD/CAM. Thirty-nine light-cured specimens without CAD/CAM were used as control. Following 24 h storage, the µTBS and HV were evaluated. Data were analyzed using the two-way ANOVA and post hoc Tukey tests (p < 0.05). Results: The µTBS to dentin and HV were significantly influenced by the type of luting material and CAD/CAM material. With all the CAD/CAM materials, LinkForce and Universal Flo exhibited a significantly similar µTBS to that of dentin (p > 0.05). Compared with the control group, all the HV values of the luting materials decreased significantly (p < 0.05). Conclusions: Heavily filled flowable composites exhibit a bonding effectiveness similar to that of dual-cure resin cements. All the luting materials showed similar HV when polymerized through the polymer-infiltrated CAD/CAM material.

The effect of different adhesive strategies and diamond burs on dentin bond strength of universal resin cements

OBJECTIVES

To evaluate the shear bond strength (SBS) of universal cements (UCs) to dentin prepared with different diamond burs using various adhesive strategies.

MATERIALS AND METHODS

One-hundred-twenty molars were prepared to expose the mid-coronal dentin. The teeth were divided into two groups according to diamond bur preparations: coarse and super-fine grit burs. The specimens were bonded to lithium disilicate discs using two UCs (RelyX Universal, RXU and Panavia SA Luting Multi, PSA) with different adhesive strategies (self-adhesive, SA; self-etch, SE and etch-and-rinse, ER). SBS was measured using a universal testing machine. The cement-dentin interfaces were observed using scanning electron microscopy.

RESULTS

Dentin SBS was significantly influenced by the adhesive strategies and the type of UCs (p < 0.05) but not for the different diamond bur preparations (p > 0.05). UCs used with ER had significantly higher SBS values than UCs used in SA mode (P < 0.05), except for PSA with super-fine diamond bur. RXU in SE mode exhibited significantly higher SBS than SA mode (P < 0.05). Regarding UCs, RXU showed a higher SBS than PSA, particularly in the SE modes when the dentin was prepared with a coarse diamond bur (P < 0.05).

CONCLUSION

The use of UCs combined with universal adhesives exhibited higher dentin bonding performance compared with the use of UCs alone.

CLINICAL SIGNIFICANCE

The etch-and-rinse mode combined with a universal adhesive is recommended to achieve the highest dentin bond strength of universal cements.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

Failure and complication rates of different materials, designs, and bonding techniques of ceramic cantilever resin-bonded fixed dental prostheses for restoring missing anterior teeth: A systematic review and meta-analysis

OBJECTIVES

The objective of this review was to assess clinical trials that have examined the materials, design, and bonding of ceramic cantilevered resin-bonded fixed dental prostheses (RBFDPs) as a potential option for replacing missing anterior teeth. The evaluation primarily focuses on the rate of restoration failure and clinical complications.

MATERIALS AND METHODS

A thorough search of databases including PubMed/MEDLINE, Scopus, and the Cochrane Library, was conducted. The most recent search was performed in October 2023. Clinical studies that compared ceramic cantilevered RBFDPs with double retainers or cantilevered RBFDPs using different ceramic materials or bonding systems were included. The outcome measures considered were restoration failure and complication rates.

RESULTS

Twelve studies met the eligibility criteria. The pooled data showed a statistically significant decrease in complication events when using cantilever designs compared with double retainer designs (p < 0.05); however, there were no differences found between the two designs in terms of restoration failure. The complication and failure rate of cantilever RBFDPs did not show a statistically significant difference with or without ceramic primer application before luting with phosphate monomer-containing luting resin (p > 0.05).

CONCLUSIONS

Ceramic cantilevered RBFDPs have lower complication rates compared with those with double retainers. The use of a ceramic primer prior to luting composite resin for ceramic cantilevered RBFDPs decreases the occurrence of complications and failures, although this effect was not statistically significant. Additional research is required to confirm these findings. Glass ceramic cantilever RBFDPs showed a decrease in success after 6 years, requiring ongoing monitoring, but both zirconia and glass-infiltrated alumina cantilever RBFDPs have demonstrated durability with excellent long-term success and survival rates for up to 10 and 15 years.

CLINICAL SIGNIFICANCE

Cantilever ceramic RBFDPs in the anterior region are a less invasive and valuable treatment option, providing good esthetic results.

Survival rate, bond, and fracture strength of laminate veneers bonded to different tooth substrates: A systematic review of in vitro studies

PURPOSE

This study aimed to evaluate how different tooth substrates affect the survival rate, shear bond strength, fracture strength, and mode of failure of laminate veneers (LVs).

METHODS

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In vitro studies comparing the bonding of laminate veneers to different substrates were included. Electronic databases and manual searches were performed to identify relevant studies. Data on survival rate, shear bond strength, fracture strength, and failure modes were extracted and analyzed using Review Manager software.

RESULTS

A total of 10 studies were included in the review, comprising 621 laminate veneers. The findings revealed that laminate veneers bonded to enamel substrate had lower failure rates than those bonded to tooth substrate with severely exposed dentin or existing composite restorations (ECRs). The failure modes observed were debonding, chipping, cracks, or fractures.

CONCLUSIONS

Bonding laminate veneers to enamel substrate showed higher survival rates compared to bonding to tooth substrates with severely exposed dentin or ECRs, underscoring the significance of enamel preservation. When dealing with exposed dentine surfaces or ECRs, it is crucial to perform appropriate surface treatment before luting to improve adhesion. This involves immediate dentine sealing, as well as the use of suitable primers and bonding agents.

The physical-mechanical properties of 3D-printed versus conventional milled zirconia for dental clinical applications: A systematic review with meta-analysis

AIM OF STUDY

This systematic review aimed to compare the physical-mechanical properties of 3D-printed (additively manufactured (AM)) zirconia compared to conventionally milled (subtractive manufactured: SM) zirconia specimens.

MATERIALS AND METHODS

A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies that evaluated AM zirconia specimens and restorations regarding the physical-mechanical properties and mechanical behavior of zirconia. The main topic focused on 3Y-TZP. However, records of 4YSZ and 5YSZ were also included to gather more comprehensive evidence on additively manufactured zirconia ceramic. The quality of studies was assessed using the ROB2 tool, Newcastle Ottawa scale, and the Modified Consort Statement. Of 1736 records, 57 were assessed for eligibility, and 38 records were included in this review, only two clinical trials meet the inclusion criteria and 36 records were laboratory studies. There were no signs of mechanical complications and wear to antagonists with short-term clinical observation. SM thin specimens ≤1.5 mm showed statistically significant higher flexural strength than AM zirconia (p ≤ 0.01), while thicker specimens showed comparable outcomes (p > 0.5). The fracture resistance of dental restorations was dependent on the aging protocol, restoration type, and thickness. The bond strength of veneering ceramic to zirconia core was comparable.

CONCLUSIONS

The results pooled from two short-term clinical trials showed no signs of mechanical or biological complications of additively manufactured 3Y-TZP zirconia crowns. The flexural strength might depend on the specimens' thickness, but it showed promising results to be used in clinical applications, taking into account the printing technique and orientation, material composition (yttria content), solid loading, and sintering parameters. 3D-printed restorations fracture resistance improved when adhered to human teeth. The veneering ceramic bond was comparable to milled zirconia specimens. Long-term RCTs are recommended to confirm the mechanical behavior of 3D-printed restorations.

3D-printed intracoronal restorations, occlusal and laminate veneers: Clinical relevance, properties, and behavior compared to milled restorations; a systematic review and meta-analysis

OBJECTIVES

To assess the feasibility of producing 3D-printed intracoronal restorations, thin and ultrathin veneers, and to compare their mechanical behavior, accuracy, biological, and stain susceptibility to the currently applied milled restorations.

MATERIALS AND METHODS

The databases were comprehensively searched for relevant records up to January 2024 without language restrictions. All studies that assessed 3D-printed partial coverage restorations including inlays, onlays, laminate, and occlusal veneers were retrieved.

RESULTS

The web search yielded a total of 1142 records, with 8 additional records added from websites at a later stage. Only 17 records were ultimately included in the review. The included records compared 3D-printed; alumina-based- and zirconia ceramics, lithium disilicate ceramics, polymer infiltrated ceramics, polyetheretherketone (PEEK), resin composites, and acrylic resins to their CNC milled analogs. The pooled data indicated that it is possible to produce ultrathin restorations with a thickness of less than 0.2 mm. 3D-printed laminate veneers and intracoronal restorations exhibited superior trueness, as well as better marginal and internal fit compared to milled restorations (p < 0.05). However, it should be noted that the choice of materials and preparation design may influence these outcomes. In terms of cost, the initial investment and production expenses associated with 3D printing were significantly lower than those of CNC milling technology. Additionally, 3D printing was also shown to be more time-efficient.

CONCLUSIONS

Using additive manufacturing technology to produce restorations with a thickness ranging from 0.1 to 0.2 mm is indeed feasible. The high accuracy of these restorations, contributes to their ability to resist caries progression, surpassing the minimum clinical threshold load of failure by a significant margin and reliable adhesion. However, before 3D-printed resin restorations can be widely adopted for clinical applications, further improvements are needed, particularly in terms of reducing their susceptibility to stains.

CLINICAL SIGNIFICANCE

3D-printed intracoronal restorations and veneers are more time and cost-efficient, more accurate, and could provide a considerable alternative to the currently applied CNC milling. Some limitations still accompany the resin materials, but this could be overcome by further development of the materials and printing technology.

Touch-cure activation by marketed universal resin luting cements of their associated primer to dentin

PURPOSE

The aim of this study was to investigate the dentin shear bond strength (SBS) and bonding interface of three recently developed "universal" resin luting cements based on different modalities.

METHODS

The dentin SBS and interfacial analysis of three recently launched "universal" resin luting cements, namely, G-Cem One, RelyX Universal and Panavia SA cement universal, were studied. All bonding protocols, including the previous use of their dedicated primer or universal adhesive in touch-cure mode or light-cure mode were performed. Variolink Esthetic LC used in conjunction with Scotchbond Universal Plus was used as a control group. For each group (n = 9), 10 specimens were tested for dentin SBS and two were examined by scanning electron microscopy. SBS were analyzed by two-way ANOVA followed by Dunnett's test.

RESULTS

SBS values showed that the three "universal" resin luting cements tested exhibit different adhesive behaviors. G-Cem One with its touch-cure activated primer had a greater SBS to dentin (25.5 MPa) than that of the control group (22.1 MPa).

CONCLUSION

"Universal" resin luting cements have variable efficacy when used in self-curing mode. The touch-curing mode is also of concern but may show high potential for some formulations.

The influence of Zircos-E® etchant, silica coating, and alumina air-particle abrasion on the debonding resistance of endocrowns with three different preparation designs

OBJECTIVES

The study aimed to evaluate the debonding resistance of three different endocrown designs on molar teeth, using three different zirconia surface pretreatments.

MATERIAL AND METHOD

Ninety human mandibular first molars were divided into three main groups: endocrowns without ferrule, with 1 mm ferrule, and with 2 mm ferrule. The subgroups were defined by their surface pretreatment method used (n = 15): 50 μm alumina air-particle abrasion, silica coating using 30 μm Cojet™ particles, and Zircos-E® etching. The endocrowns were fabricated using multilayer zirconia ceramic, cemented with self-adhesive resin cement, and subjected to 5000 thermocycles (5-55°C) before debonding. The data obtained were analyzed using a two-way ANOVA.

RESULTS

All test specimens survived the thermocyclic aging. The results indicated that both the preparation design and the surface treatment had a significant impact on the resistance to debonding of the endocrowns (p < .001). The 2 mm ferrule followed by the 1 mm ferrule designs exhibited the highest debonding resistance, both were superior to the endocrown without ferrule. Zircos-E® etching and silica coating yielded comparable debonding resistance, which were significantly higher than alumina air-particle abrasion. All endocrowns demonstrated a favorable failure mode.

CONCLUSIONS

All designs and surface treatments showed high debonding resistance for a single restoration. However, ferrule designs with Zircos-E® etching or silica coating may represent better clinical options compared to the nonferrule design or alumina airborne-particle abrasion. Nonetheless, further research, including fatigue testing and evaluations with different luting agents is recommended.

3D-printed versus conventionally milled zirconia for dental clinical applications: Trueness, precision, accuracy, biological and esthetic aspects

OBJECTIVES

This systematic review aimed to compare the clinical outcome, internal gap, trueness, precision, and biocompatibility of 3D-printed (AM) compared to milled (SM) zirconia restorations.

DATA SOURCE

A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies compared AM zirconia to SM zirconia restorations regarding clinical outcome, fit, trueness, precision, and biocompatibility.

STUDY SELECTION

Of 1736 records, only 59 were screened for eligibility, and 22 records were included in this review. The quality of studies was assessed using the revised Cochrane risk-of-bias tool (ROB2), and the Modified Consort Statement. One clinical study exhibited a low risk of bias. All laboratory studies revealed some bias concerns. Short-term observation showed 100 % survival with no signs of periodontal complications. 3D-printed zirconia crowns showed statistically significant lower ΔE and a better match to adjacent teeth (p ≤ 0.5). The fit, trueness, and precision vary with the printing technique and the tooth surface.

CONCLUSIONS

3D-printed zirconia crowns provide better aesthetic color and contour match to adjacent natural teeth than milled crowns. Both 3D printing and milling result in crowns within the clinically acceptable internal and marginal fit. Except for nanoparticle jetting, the marginal gap of SM crowns was smaller than AM crowns, however, both were clinically acceptable. Laminate veneers might be more accurately produced by 3D printing. 3D-printed axial surface trueness was better than milled axial surfaces. Long-term RCTs are recommended to confirm the clinical applicability of 3D-printed restorations.

CLINICAL SIGNIFICANCE

Internal fit and gap, precision, and trueness are fundamental requirements for successful dental restorations. Both techniques produce restorations with clinically acceptable marginal and internal fit. Axial surfaces and narrow or constricted areas favored 3D-printed than conventionally milled zirconia.

Clinical survival and complication rate of ceramic veneers bonded to different substrates: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Evidence on the long-term clinical assessment and longevity of ceramic veneers bonded to different substrates is limited.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effect of various substrates, including enamel, dentin, or an existing composite resin restoration, on the clinical survival and complication rates of ceramic veneers.

MATERIAL AND METHODS

The PubMed, Scopus, and the Cochrane Library electronic databases were searched, and related journals were hand searched without time or language restrictions to identify clinical trials that compared the survival rate and clinical complication rates when bonding ceramic veneers to different tooth substrates. The success rate of the included participants was estimated by the number of veneers that did not require a clinical intervention, and the survival rate by all veneers that did not fail absolutely. The risk difference (RD) with 95% confidence intervals (CIs) for dichotomous outcomes was used to quantify the intervention effect.

RESULTS

Of 973 screened articles, 6 clinical studies were included. The survival and success rates varied depending on the bonding substrate. Enamel-bonded veneers had almost perfect rates of survival (99% with a range of 98% to 100%) and success (99% with a range of 98% to 100%). Veneers bonded to composite resin or surfaces with minimal dentin exposure had slightly lower survival rates (94% with a range of 91% to 97% and 95% with a range of 91% to 100%, respectively) and success rates (70% with a range of 60% to 80% and 95% with a range of 90% to 99%). Severe dentin exposure significantly decreased both survival rates (91% with a range of 84% to 98%) and success rates (74% with a range of 64% to 85%). The combined findings suggested that ceramic veneers bonded to enamel had fewer clinical complications (RD: -0.04; 95% CI: -0.09 to 0.02) and lower failure rates (RD: -0.13; 95% CI: -0.32 to 0.07) compared with those bonded to exposed dentin. Additionally, veneers attached to teeth with minimal dentin exposure were significantly less likely to require clinical interventions (RD: -0.16; 95% CI: -0.31 to -0.01) and had a reduced incidence of failure (RD: -0.08; 95% CI: -0.17 to 0.01) compared with those with severe dentin exposure.

CONCLUSIONS

Ceramic veneers bonded to enamel showed higher survival and success rates with lower clinical incidences of complications and failure than those bonded to dentin or teeth with existing composite resin restorations.

Clinical benefits of immediate dentin sealing: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The clinical complications, success, and survival rates of indirect restorations delivered with the immediate dentin sealing protocol are unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to find and collect evidence on the clinical complication, success, and survival rates of indirect restorations delivered with immediate dentin sealing.

MATERIAL AND METHODS

Electronic databases were searched for clinical studies on immediate dentin sealing up to December 2023, without language or time limitations. The records were included if they were clinical trials evaluating the clinical complication and survival rates of indirect restorations bonded to tooth substrate sealed immediately after preparation with suitable resin bonding. The extracted data were analyzed via Review Manager 5.4 for meta-analysis (α=.05).

RESULTS

A total of 11 studies were included in this review. The clinical complication rate was lower for immediately sealed dentin than for protocols without dentin sealing. The survival rate of restorations luted with the immediate dentin sealing protocol was higher (96.4% to 100%) than that of immediate dentin sealing (81.8% to 96.7%), negatively correlated with the observation time. The intensity and incidence of postoperative sensitivity were statistically significantly lower for restorations with immediate dentin sealing than for those without dentin sealing or conventionally cemented (P<.05).

CONCLUSIONS

Immediate dentin-sealed indirect restorations had fewer clinical complications and higher success and survival rates than those delivered without dentin sealing. To avoid postoperative sensitivity or reduce its intensity, dentin surfaces should be sealed immediately after preparation. More long-term randomized clinical trials are recommended to confirm these evidence-based conclusions.

Comparing Various Resin Luting Cement Systems in Different Etching Modes Through Bond Durability and Morphological Features

OBJECTIVES

This study aimed to investigate bond performance of various resin luting cement (RLC) systems on enamel and dentin in different etching modes and to compare the RLC-tooth interface morphology using scanning electron microscopy (SEM).

METHODS AND MATERIALS

The self-adhesive RLC systems used in combination with universal adhesives were as follows: Scotchbond Universal Adhesive Plus + RelyX Universal (3M Oral Care) and Clearfil Universal Bond Quick ER + SA Luting Multi (Kuraray Noritake Dental). These RLC systems were also used alone as self-adhesive RLC systems without universal adhesives (self-adhesive mode). The conventional RLC systems for comparison materials were as follows: BeautiBond Xtream + ResiCem EX (Shofu) and Tooth Primer + Panavia V5 (Kuraray Noritake Dental). Twelve specimens were prepared for each group to measure shear bond strength (SBS) in different etching modes. A stainless-steel rod was used as a substitute for indirect restorations. Bonded specimens were allocated to baseline (stored for 24 hours) and artificially aged (thermocycling [TC] for 10,000 cycles) groups. Representative treated tooth surfaces and RLC-tooth interfaces were observed using SEM.

RESULTS

Three-way analysis of variance (ANOVA) revealed that all the factors (etching mode, storage period, and RLC system) had a significant influence on the enamel SBS values (p<0.05). Enamel SBS was significantly higher in etch-&-rinse (ER) mode than in self-etch (SE) mode, regardless of RLC system or storage period. Three-way ANOVA showed that all the factors had a significant influence on the dentin SBS values (p<0.001). Most RLC systems showed significantly higher dentin SBS in SE mode than in ER mode, regardless of storage period. However, the combination with Scotchbond Universal Adhesive Plus and RelyX Universal showed no significant difference in SBS values between etching modes at the baseline and showed a significantly higher SBS value in ER mode than in SE mode after TC.

CONCLUSIONS

The self-adhesive RLC systems with universal adhesives tended to show higher enamel and dentin bond performance than the self-adhesive RLC systems alone. The morphology of treated tooth surfaces and resin cement-tooth interfaces were dependent on the RLC system and etching mode used. The RLC systems with primer application showed a thin, high-density layer above the intact dentin in both etching modes, suggesting chemical interaction.

Comparative study of two bioactive dental materials

OBJECTIVES

New bioactive materials were introduced to not only restore the lost dental hard tissue but also to release fluoride that inhibits demineralization and occurrence of secondary caries. The current study thus aims to assess Fluoride release as well as the mechanical and physical properties of two new commercially available bioactive restorative materials.

METHODS

Two materials, Cention® Forte (CF) (Ivoclar Vivadent), Surefil one™ (SO) (Denstply Sirona), were evaluated in terms of fracture toughness (FT), flexural strength (FS), flexural modulus (FM) (ISO 4049), compressive strength (CS), and Vickers hardness (VH). In addition, thermogravimetric analysis (TGA) was performed, as well as pH measurements and quantification of Fluoride release after immersion in distilled water at times of 0, 7, 14 and 21 days. The sealing ability was evaluated using silver nitrate dye penetration on natural teeth. Finally, Energy-Dispersive X-Ray Spectroscopy (EDX) was used to investigate the surface composition of the two studied material surfaces. The data were statistically analyzed using Independent T-Tests; the chosen significance level was α = 0.05.

RESULTS

CF had significantly higher FT values compared to SO (p = 0.001). Also the FS results showed that CF had significantly higher values (90.11 MPa), followed by SO (22.15 MPa). The CS values showed the same order with significantly higher values for CF (231.79 MPa). While the FM and VH showed the reverse order with SO having significantly higher values than CF. pH measurements showed that CF evolved towards significantly higher pH values after 3 weeks in distilled water, while thermal properties showed more stability and higher resistance to degradation for CF compared to SO. The silver nitrate penetration results showed significantly better sealing ability for CF compared to the self-adhesive SO. Finally, EDX surface analysis results were consistent with the release profiles and confirmed the composition of the two tested materials.

SIGNIFICANCE

Both materials, demonstrated enhanced Fluoride release ability, and hence good remineralisation potential in vitro that could prevent recurrent carious lesions in vivo. The composition based on acrylic polymerization showed better mechanical resistance to bending and fracture, and higher sealing ability than those based on acid base reaction.

Resin composite cements: Current status and a novel classification proposal

OBJECTIVES

Currently, a classification of resin cements that includes relatively recently formulated ("universal") cements is lacking. Furthermore, the terminology used to define different resin cements in the scientific reports is inconsistent. Accordingly, this work aims to: (i) propose a novel classification of resin composite cements; (ii) disambiguate the term "universal cements" and (iii) present an overview of the properties of these cements.

METHODS

An analysis of peer-reviewed literature (PubMed search), as well as market research on definitive resin composite cements were performed.

RESULTS

A tendency toward simplified and versatile luting materials was observed both in the scientific literature and on the dental market with the advent of self-adhesive/one-step resin cements. However, additional priming procedures were necessary to improve their bonding performance in certain clinical situations. Hence, several cements that can be applied both in adhesive and self-adhesive mode were introduced. These cements are associated with a universal adhesive resin, that can be used as a tooth and/or restorative material primer, without the need for other priming systems, regardless of the substrate. These systems should be considered truly universal. Therefore, we hereby suggested a new classification of resin-based cements: (1) adhesive/multi-step; (2) self-adhesive/one-step; (3) universal cements (one- or multi-step). Despite promising in vitro results, clinical trials and long-track laboratory studies are necessary to confirm the reliability of the universal cements.

CONCLUSIONS

This review presented the current advances in the field of resin-based cements, which are reflected in the proposed classification. The term "universal cement" was disambiguated, which will help standardize the terminology used in published research.

CLINICAL SIGNIFICANCE

The classification of resin-based cements and a better understanding of the proper terminology will help standardize the terminology in published research, as well as improve the understanding of the clinical practitioners of the different indications and possible modalities of use of the available cements.