Journal of Esthetic and Restorative Dentistry最新文献

{"title":"Artificial Intelligence Assisted Thermal Imaging for Gingival Inflammation Assessment: A Novel Approach.","authors":"Zeynep Turgut Çankaya, Ahmet Koyuncu, Sühan Gürbüz","doi":"10.1111/jerd.70045","DOIUrl":"https://doi.org/10.1111/jerd.70045","url":null,"abstract":"<p><strong>Background: </strong>The integration of thermal imaging with artificial intelligence (AI) offers a novel, non-invasive approach for assessing gingival inflammation. While thermal imaging has been widely applied in other medical fields, its use in evaluating gingival health remains largely unexplored. This study is the first to utilize AI-supported analysis of thermal gingival images in patients with mouth breathing habits, aiming to detect and classify gingival inflammation severity. This research establishes specific thermal thresholds for gingival health and disease in this unique population.</p><p><strong>Methods: </strong>Forty participants were included, stratified according to periodontal status and clinically confirmed breathing pattern (mouth or nasal breathing), under standardized imaging conditions. From these participants, 160 images were annotated, producing 1734 labeled data points categorized according to bleeding on probing (BoP) for diagnosis, with Gingival Index (GI) applied only for secondary stratification of inflammation severity. Preprocessing included image resizing, outlier removal, and calculation of mean RGB values. The XGBoost algorithm was used for classification, with hyperparameters optimized via grid search and 5-fold cross-validation to ensure robust model performance.</p><p><strong>Results: </strong>The XGBoost Achieved Outstanding Classification Results, With an Accuracy of 92.74%, Precision of 92.95%, Sensitivity of 92.74%, and an F1 Score of 92.78%. Cross-Validation Confirmed the Model's Reliability, With Mean-Test and Validation-Scores of 88.28% and 89.43%, Respectively.</p><p><strong>Conclusions: </strong>This study represents the first application of AI-supported thermal imaging for evaluating gingival inflammation in mouth breathers, marking a significant step forward in periodontal diagnostics. By establishing specific thermal thresholds in this unique population, it highlights the potential of this innovative approach as a non-invasive, real-time, and scalable diagnostic tool. Future research should focus on refining AI algorithms and expanding datasets to enhance clinical applicability, paving the way for advanced diagnostics and personalized care in periodontology.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Sculptable Bulk-Fill Composites Susceptible to Color Change: A Systematic Review.","authors":"Jamieson Wong, Constance Yeo, Michelle The, Filip Taneski, Uros Josic, Lorenzo Breschi, Vesna Miletic","doi":"10.1111/jerd.70044","DOIUrl":"https://doi.org/10.1111/jerd.70044","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review examines changes in optical properties of sculptable bulk-fill resin composites in staining media, highlighting the potential impact on the long-term aesthetic performance.</p><p><strong>Materials and methods: </strong>Electronic searches across MEDLINE, Embase, Web of Science, and SCOPUS were conducted in January 2025 and updated on 27/05/2025. The RoBDEMAT framework (Risk of Bias tool for Pre-Clinical Dental Material Research) was utilized for risk of bias assessment. Inclusion criteria were primary studies in English, in vitro studies with a control group, and spectroscopic measurement of optical properties. Studies with visual color determination, no control group, materials other than sculptable bulk-fills, and no full text available were excluded.</p><p><strong>Results: </strong>Twelve studies were selected for analysis. Coffee, tea, wine, and tomato-based products generally caused greater staining than lighter-colored or acidic beverages, while non-pigment control media caused minimal but measurable changes. Compared to other restorative materials, some bulk-fills (SonicFill, Fill-up) performed better, whereas fiber-reinforced everX exhibited greater susceptibility to color change and whitening index variation, particularly after bleaching.</p><p><strong>Conclusions: </strong>Sculptable bulk-fills showed variable color stability, with performance influenced by material type, polishing, staining medium, and duration of exposure. Wide methodological variability hindered meta-analytical comparisons, highlighting the need for standardized research protocols.</p><p><strong>Clinical significance: </strong>This systematic review highlights that the color stability of bulk-fill composites is highly material-dependent, with certain products more resistant to staining and bleaching-induced changes than others. Clinically, this underscores the importance of material selection in achieving long-term aesthetic outcomes, particularly for restorations in patients with high consumption of staining beverages or undergoing bleaching treatments.</p><p><strong>Registration: </strong>PROSPERO CRD42024603712.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restorative and Adhesive Strategies for Cervical Carious Lesions: A Systematic Review, Pairwise and Network Meta-Analysis.","authors":"Alain Manuel Chaple Gil, Laura Pereda Vázquez, Meylin Santiesteban Velázquez, Lazareth Liz Ortiz Santiago","doi":"10.1111/jerd.70043","DOIUrl":"https://doi.org/10.1111/jerd.70043","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical lesions often demand specialized approaches due to their anatomical position, and the effectiveness of these techniques may vary among clinicians.</p><p><strong>Objectives: </strong>To assess the clinical effectiveness of various adhesive strategies combined with different restorative materials for managing cavitated cervical carious lesions in adults, with a specific focus on restoration retention. The study also aimed to rank these combinations through network meta-analysis.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Randomized controlled trials comparing at least two restorative protocols in adult populations were included. Pairwise and network meta-analyses were performed using random-effects models. The certainty of the evidence was evaluated using the CINeMA framework.</p><p><strong>Results: </strong>Seventeen RCTs met the inclusion criteria. Conventional composites applied with two-step etch and rinse adhesives and compomers demonstrated the highest retention rates in pairwise comparisons. Glass ionomer cement showed the most stable long-term performance. However, the network meta-analysis revealed no statistically significant differences among treatments. Notably, compomers ranked highest in overall performance but were supported by studies with substantial heterogeneity and a high risk of bias.</p><p><strong>Conclusions: </strong>Although compomers achieved the highest retention rates in direct comparisons, the underlying evidence is limited by methodological concerns, reducing confidence in their clinical reliability. In contrast, conventional composites bonded with two-step etch-and-rinse adhesives emerged as the most robust and evidence-based option for restoring cervical carious lesions. The optimization of adhesive protocols, particularly the incorporation of selective enamel etching, remains a key determinant for long-term restoration success.</p><p><strong>Clinical significance: </strong>This systematic review and network meta-analysis provides robust, evidence-based guidance for the restoration of cavitated cervical carious lesions in adults. Optimizing adhesive protocols, especially with selective enamel etching, significantly enhances the longevity of cervical carious lesion restorations. Evidence supports two-step etch-and-rinse adhesives with conventional composites as a dependable choice, ensuring durable retention, favorable esthetic integration, and long-term performance in this highly visible and esthetically sensitive region of the dentition.</p><p><strong>Prospero: </strong>Registration number: CRD420251083691.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Orthodontic-Orthognathic Retreatment of Adult Skeletal Class II Deformity With Mandibular Deviation: A Surgery-Early Approach.","authors":"Nan Wei, Qixiang Liang, Chenyu Zhao, Hong Ai, Zheng Chen","doi":"10.1111/jerd.70041","DOIUrl":"https://doi.org/10.1111/jerd.70041","url":null,"abstract":"<p><strong>Objective: </strong>To assess clinical outcomes of the surgery-early approach in managing skeletal Class II malocclusion and mandibular deviation.</p><p><strong>Materials and methods: </strong>A 21-year-old female underwent staged treatment: (1) limited presurgical orthodontics for dental alignment, (2) bimaxillary surgery (LeFort I impaction, BSSRO, and genioplasty) to correct skeletal discrepancies, and (3) postoperative orthodontic refinement using miniscrews and progressive archwires. Progress was monitored through clinical examinations, cephalometric analysis, and CBCT imaging.</p><p><strong>Results: </strong>Skeletal Class I relationship, reduced mandibular plane angle, and stable TMJ function were achieved. Total retreatment duration was 24 months.</p><p><strong>Conclusion: </strong>The surgery-early approach effectively addresses complex skeletal discrepancies with reduced retreatment time, contingent upon meticulous preoperative 3D assessment to define the safe anatomic range for tooth movement, ensuring periodontal integrity and stable outcomes. This necessitates interdisciplinary collaboration to achieve optimal outcomes.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Resin Coating on Dentin Bond Strength Under Immediate and Delayed Cementation Protocols.","authors":"Rena Takahashi, Siqi Zeng, Yuna Kanamori, Shin Rozan, Yasushi Shimada","doi":"10.1111/jerd.70037","DOIUrl":"https://doi.org/10.1111/jerd.70037","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effects of resin coatings on bond strength using immediate and delayed cementation protocols.</p><p><strong>Materials and methods: </strong>One hundred twenty dentin specimens were assigned to four groups: Noncoated, TK-100B (a novel single-bottle adhesive), Hybrid Coat II, and Clearfil SE bond 2. The specimens of the latter three groups were resin coated with their respective materials. Each group was subdivided into immediate and delayed cementation after 1-week provisionalization with a polycarboxylate cement. All specimens were luted with resin cement and subjected to shear bond testing. Data were analyzed by two-way analysis of variance and Tukey's post hoc test (α = 0.05).</p><p><strong>Results: </strong>TK-100B and Clearfil SE Bond 2 produced significantly higher bond strengths than the non-coated group for both cementation schedules. Delayed cementation reduced the bond strengths of Hybrid Coat II and Clearfil SE Bond 2 (p < 0.05), whereas the non-coated group and TK-100B showed no time-related changes. Most failures in the resin-coated groups occurred at the resin-cement interface.</p><p><strong>Conclusions: </strong>Bonding strength was enhanced with TK-100B and Clearfil SE Bond 2. A 1-week delay weakened Hybrid Coat II and Clearfil SE Bond 2 but had no effect on non-coated dentin or TK-100B, confirming material-specific effects.</p><p><strong>Clinical significance: </strong>Both the novel single-bottle adhesive TK-100B and the established Clearfil SE Bond 2 yield high bond strengths when used as resin coatings in both immediate and 1-week delayed cementation.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Performance and Survival Outcomes of Milled Versus Pressed Lithium Disilicate Veneers: A Systematic Review.","authors":"Nishanth A Sudharson, Poonam Bali, Prathibha Mariam Thomas, Nirmal Kurian, Kevin George Varghese","doi":"10.1111/jerd.70038","DOIUrl":"https://doi.org/10.1111/jerd.70038","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this systematic review was to assess and compare the clinical performance, marginal adaptation, esthetic outcomes, and long-term survival of lithium disilicate veneers fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) and heat-pressed techniques. An electronic search was performed in PubMed, Scopus, and Cochrane Library databases on February 24, 2025. Keywords and MeSH terms related to \"lithium disilicate,\" \"CAD/CAM,\" \"pressed veneers,\" \"anterior teeth,\" and \"laminate veneers\" were used to identify relevant studies published between 2013 and 2025.</p><p><strong>Materials and methods: </strong>This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO Registration number; CRD420251003590). Randomized controlled trials, clinical trials, retrospective studies, case series, and ex vivo studies published in English were included. Eligible studies evaluated lithium disilicate veneers placed on anterior teeth with a minimum follow-up of 6 months and reported outcomes related to marginal adaptation, survival, esthetics, or patient satisfaction. Data extraction was performed by two reviewers independently. Risk of bias was assessed using the ROB 2.0, QUIN, and ROBINS-I tools, and the GRADE framework was employed to evaluate the quality of evidence.</p><p><strong>Results: </strong>A total of 401 records were retrieved, out of which eight studies were included after screening. Of these, five studies compared CAD/CAM and heat-pressed veneers, two evaluated CAD/CAM-only, and 3 focused on heat-pressed-only interventions. Two were ex vivo studies. Heat-pressed veneers demonstrated superior marginal adaptation in both clinical and laboratory settings. CAD/CAM veneers showed better internal fit and workflow efficiency. Long-term survival (up to 10 years) was higher in heat-pressed veneers, particularly in complex cases like fluorosis or anterior FPDs. Color match (ΔE values) was within clinically acceptable limits across all materials. Only one randomized controlled trial exhibited low risk of bias; the remaining studies ranged from moderate to high risk. GRADE assessment downgraded most outcomes to low or very low certainty due to study design limitations and heterogeneity.</p><p><strong>Conclusions: </strong>Both CAD/CAM and heat-pressed lithium disilicate veneers offer satisfactory esthetic and clinical outcomes when proper case selection and bonding protocols are followed. While CAD/CAM techniques enhance reproducibility and efficiency, heat-press methods appear superior in marginal adaptation and long-term survival. Further well-designed randomized trials with standardized outcome measures are essential to strengthen current evidence.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snap-On PMMA Provisional Restorations in a Full Digital Workflow for the Rehabilitation of Worn Dentition: A Clinical Report.","authors":"Theodoros Tasopoulos, Panagiotis Zoidis, Heidar Shahin, George Kouveliotis, Vassiliki Rizou, Olga Naka","doi":"10.1111/jerd.70040","DOIUrl":"https://doi.org/10.1111/jerd.70040","url":null,"abstract":"<p><strong>Objective: </strong>To highlight the application of digitally fabricated Snap-On PMMA provisional restorations as a minimally invasive and adaptable methodology for assessing the vertical dimension of occlusion and occlusal stability during the comprehensive rehabilitation of worn dentition.</p><p><strong>Clinical considerations: </strong>A clinical case is presented involving a 58-year-old male with severe anterior tooth wear, multiple edentulous spaces, and occlusal dysfunction. The patient underwent full-arch digital rehabilitation through a workflow incorporating intraoral scanning, facial scanning, cone-beam computed tomography (CBCT), and virtual smile design. Snap-On PMMA milled provisional restorations enabled real-time evaluation of the proposed VDO, phonetics, esthetics, and centric occlusion in a reversible, non-invasive manner. Their use also enabled immediate implant loading at site #22 and facilitated the digital transfer of the validated occlusal scheme from the provisional stage to the definitive CAD/CAM restorations. Definitive restorations were fabricated using monolithic zirconia and lithium disilicate, selected for their superior mechanical strength, longevity, and esthetic potential.</p><p><strong>Conclusion: </strong>Snap-On PMMA provisional restorations represent an effective diagnostic and transitional tool in the management of worn dentition. Integrated into a fully digital workflow, they enhance treatment predictability by allowing reversible clinical validation and direct digital transfer of occlusal parameters to the final prostheses. Combined with advanced restorative materials, this approach improves treatment predictability, patient satisfaction, and the long-term clinical success of managing complex cases of worn dentition.</p><p><strong>Clinical significance: </strong>Snap-On PMMA provisionals offer a minimally invasive, reversible way to assess occlusion, function, and esthetics before final restoration. This technique enhances accuracy and predictability in full-mouth rehabilitations, making it highly valuable in esthetic dentistry.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Probability of Survival and Damage Mechanisms of Resin Matrix Ceramics: Insights Into Wear Progression and Surface Damage Under Fatigue.","authors":"Mirelle M Ruggiero, Mariana I M Freitas, Yu Zhang, Altair A D B Cury","doi":"10.1111/jerd.70036","DOIUrl":"https://doi.org/10.1111/jerd.70036","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the probability of survival, failure modes, and fatigue-induced wear progression, as well as assessed damage tolerance under simulated mastication in two resin matrix ceramics (polymer-infiltrated ceramic networks (PICN) and resin nanoceramic (RNC)).</p><p><strong>Methodology: </strong>Specimens underwent step-stress accelerated life testing (SSALT) (n = 21), mouth-motion simulation (n = 12), followed by wear analysis and flexural strength testing. Probability of survival and flexural strength were analyzed using Weibull statistical modeling. Damage mechanisms were characterized by optical microscopy, scanning electron microscopy (SEM), and high-resolution 3D quantitative analysis of wear depth and volumetric loss after mouth motion simulation. Two-way ANOVA was used, followed by Tukey Post Hoc with a significance level of 5% (α = 0.05).</p><p><strong>Results: </strong>At 600 N, PICN exhibited significantly lower probability of survival (6%) compared to RNC (60%). SEM images showed delamination and radial cracking for both groups, being more frequent in PICN. Both materials demonstrated progressively significant increases in volumetric wear with the increase in the number of cycles and showed 0.014 mm³ for PICN and 0.016 mm³ for RNC after 100,000. Flexural strength was higher for RNC (303 MPa) than for PICN (189 MPa). Also, it decreased after 1,000 cycles for PICN, while for RNC it decreased only after 100,000 cycles, and it was always higher than for PICN. SEM images showed that fracture originated at wear craters.</p><p><strong>Conclusions: </strong>RNC exhibited superior probability of survival, particularly under more demanding conditions compared to PICN. Both materials showed a progressive increase in surface wear as the number of cycles increased. The flexural strength of RNC remained consistently higher over time. Regarding failure mechanisms, both materials experienced delamination and crack formation; however, radial cracks were more frequently observed in PICN, indicating a higher susceptibility to structural failure under fatigue conditions.</p><p><strong>Clinical significance: </strong>Selection of restorative materials must balance mechanical performance and long-term durability under functional loading. Resin nanoceramic appears to be a more reliable option than polymer-infiltrated ceramic networks for restorations in high-stress areas, such as posterior teeth or patients with parafunctional habits.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inverted T-Shape Connective Tissue Graft for Interdental Papilla Reconstruction: A Clinical Case Series.","authors":"Abdusalam E Alrmali, Vanessa Frazao Cury, Jessica Latimer, Preston D Miller, Hom-Lay Wang","doi":"10.1111/jerd.70035","DOIUrl":"https://doi.org/10.1111/jerd.70035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the clinical application and outcomes of the inverted T-shape connective tissue graft (IT-CTG) technique for reconstructing deficient interdental papillae in cases of advanced gingival recession, focusing on both quantitative and qualitative results in a consecutive case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical considerations: &lt;/strong&gt;The IT-CTG technique was performed using a remotely mucoperiosteal tunnel approach, with the donor graft harvested in an inverted T configuration from the palate. Patient selection included five individuals with RT2 or RT3 recession and papilla loss in the esthetic zone, following defined inclusion and exclusion criteria. All surgical steps were standardized, including graft shape, the use of thin suture material, and a consistent postoperative care protocol. Quantitative outcomes such as papilla height gain and Jemt's papilla index improvement were assessed at 3, 6, and 12 months. Among five treated sites, complete papilla fill (Jemt index score 2) was achieved in two sites (both RT3 cases; 40%) after restorative procedures had been performed, and partial fill (Jemt index score 1-2, corresponding to 50%-75% improvement) was observed in the remaining three sites (RT2 cases; 60%). The mean Jemt's papilla index improved from a baseline of 0.2 to 1.8 in the final follow-up. Acceptable esthetic outcomes and minimal morbidity were consistently noted across all patients. The addition of restorative procedures is expected to further enhance papilla fill and support creeping attachment over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The inverted T-shape connective tissue graft technique achieved acceptable papilla reconstruction, satisfactory esthetic outcomes, and minimal complications in this case series. While the results are promising, further controlled studies with larger sample sizes and longer follow-up are necessary to confirm the efficacy and broader applicability of this approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;Loss of interdental papilla in advanced gingival recession presents a significant esthetic and functional challenge, often resulting in compromised smile esthetics and patient dissatisfaction. The IT-CTG technique offers an innovative surgical solution for interdental papilla reconstruction, especially in cases where traditional approaches may be limited by poor vascularity and difficult access. By employing enhanced vascularization and a remotely tunneled approach, IT-CTG may improve esthetic outcomes and restore papillary architecture in the anterior esthetic zone. This technique is particularly beneficial in cases of RT2 and RT3 recession with papilla loss, where achieving optimal fill in a single procedure is challenging. Integration of IT-CTG into clinical practice expands the treatment options for clinicians managing complex mucogingival defects, though careful case selection and adjunctive restorative procedures may be required to support complete papi","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover Image, volume 37, Issue 10","authors":"","doi":"10.1111/jerd.70039","DOIUrl":"https://doi.org/10.1111/jerd.70039","url":null,"abstract":"<p>The cover image is based on the article <i>The Multilayer Flowable Injection Technique for Highly Esthetic Restorations</i> by Yolanda M. Liaropoulou et al., https://doi.org/10.1111/jerd.13500.\u0000 \u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":"37 10","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jerd.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}