Journal of Esthetic and Restorative Dentistry最新文献

{"title":"Clinical Complications and Survival Rate of Resin Matrix Ceramic Restorations: A Systematic Review and Meta-Analysis.","authors":"Mohammed Ahmed Alghauli, Redhwan Saleh Al-Gabri, Ahmed Keshk, Mahir A Mirah, Ahmed Yaseen Alqutaibi","doi":"10.1111/jerd.13471","DOIUrl":"https://doi.org/10.1111/jerd.13471","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical implications: </strong>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.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788513","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":"The Effect of Different Surface Treatments on the Roughness, Translucency, and Staining of 3D-Printed Occlusal Device Materials.","authors":"Silvia Rojas Rueda, Hanna Sepsick, Mohammed Hammamy, Amir H Nejat, Edwin Kee, Nathaniel C Lawson","doi":"10.1111/jerd.13476","DOIUrl":"https://doi.org/10.1111/jerd.13476","url":null,"abstract":"<p><strong>Objectives: </strong>To compare surface treatments (as-printed, optical polish, resin-coated, polished) of two 3D-printed occlusal device materials (KeySplint Soft and NightGuard Flex 2) cured with or without glycerin for surface roughness, translucency, and coffee staining.</p><p><strong>Materials and methods: </strong>Discs (2 mm thick) from two 3D-printed occlusal resins (KeySplint Soft and NightGuard Flex 2) were printed using a DLP 3D printer (SprintRay Pro 95), cleaned (ProWash S), and cured (ProCure 2) with or without glycerin. Some specimens were printed in an optical polish tank. Specimens were either as-printed, resin-coated, or polished. Reference milled (ProArt CAD Splint) and heat-cured (Excel Formula Heat Cure Denture Base Material) specimens were also prepared. Surface roughness was analyzed using a contact profilometer. Translucency was measured using a spectrophotometer. Staining was evaluated after 24 days in coffee at 37°C. Data were analyzed with ANOVA and Tukey post hoc tests.</p><p><strong>Results: </strong>Surface treatments and glycerin curing showed significant differences (p < 0.01). Polishing and resin-coating produced the smoothest surfaces. Optical polish tanks improved smoothness. Polishing increased translucency. Glycerin curing reduced staining except in polished specimens. Milled materials stained less than 3D-printed materials.</p><p><strong>Conclusions: </strong>Polishing and resin-coating optimized roughness and translucency. Polishing or curing glycerin optimized stain resistance.</p><p><strong>Clinical significance: </strong>3D-printed occlusal devices should have their external surfaces polished or resin-coated and receive a final cure in glycerin to prevent staining of their internal as-printed surface. Printing in a tank with an optical polish can help to improve the roughness and translucency of the internal surface of an occlusal device.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780172","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":"The Effect of Cement Shade on the Optical Properties of Additively Manufactured Permanent Crown Materials.","authors":"Jasmina Singh, Andrew B Cameron, Joanne Jung Eun Choi","doi":"10.1111/jerd.13475","DOIUrl":"https://doi.org/10.1111/jerd.13475","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effect of cement shade and printing parameters on the optical properties of additively manufactured (AM) permanent crown materials.</p><p><strong>Methods: </strong>Two AM crown materials (Bego VarseoSmile Crown Plus and Formlabs Permanent Crown) and one conventional milled material were tested (n = 560). Dimensions for each specimen measured 10 × 10 mm and were categorized by thickness (1 and 2 mm). AM materials were additively manufactured (3D-printed) at three orientations: 0°, 45° and 90°. Specimens were cemented with four shades of dual-cure cement: light, neutral, warm, and translucent. Color change (ΔE) and translucency parameter (TP) measurements were calculated utilizing a spectrophotometer, VITA EasyShade V. Data was analyzed with a two- way ANOVA and Tukey's post hoc tests.</p><p><strong>Results: </strong>Neutral cement shade exhibited the lowest ΔE overall (2.30 ± 0.43). Translucent cement shade exhibited the least color difference between materials. Milled materials generally exhibited higher ΔE (5.57 ± 0.26-7.17 ± 0.33) than AM materials. Material thickness significantly affected the ΔE across all shades of cement (p < 0.05). 45° print orientation for 2 mm thick specimens exhibited the greatest clinically acceptable ΔE.</p><p><strong>Conclusion: </strong>Cement shade may cause clinically unacceptable color changes based on material choice and 3D-printing parameters. Clinicians providing permanent AM crowns must consider the impact of cement shade and printing parameters on aesthetic outcomes.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772365","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":"Evaluation of Polymerization Shrinkage, Microhardness, and Depth of Cure of Different Types of Bulk-Fill Composites.","authors":"Sergen Özdemir, İlker Ayaz, Nurgül Çetin Tuncer, Çağatay Barutçugil, Ayşe Dündar","doi":"10.1111/jerd.13473","DOIUrl":"https://doi.org/10.1111/jerd.13473","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to quantify polymerization shrinkage, microhardness, and depth of cure of different types of bulk-fill composites.</p><p><strong>Methods: </strong>Six bulk-fill composites were tested: SonicFill 2 (SCF), VisCalor (VVC), Admira Fusion x-tra (AFX), Filtek Bulk Fill (FBF), Fill-Up! (FUP) and GrandioSO Heavy Flow (GHF). Sixty teeth were divided into twelve groups (n = 5) according to the composite and the irradiation level applied (standard or high). Each tooth was subjected to three scans using a micro-computed tomography device. The microhardness of the composite specimens was measured using a Vickers hardness tester. Depth of cure analysis was performed by measuring the microhardness of the composites at 0.5 mm intervals from the top surface to the bottom surface.</p><p><strong>Results: </strong>The highest volumetric shrinkage was found in the AFX group when polymerized at standard irradiance. After curing, the AFX group showed the highest void ratio. Increasing irradiance significantly increased volumetric shrinkage and void ratio only in the SCF group (p < 0.05). GHF achieved the maximum microhardness value of 80% at the lowest curing depth of 2.9 mm, while VVC, AFX, and SCF showed a curing depth of more than 5 mm (p < 0.05).</p><p><strong>Conclusions: </strong>The high irradiance caused the most significant volumetric shrinkage and void ratio in the SCF group. Only the FUP and GHF groups were unable to achieve the desired curing depth of 4 mm.</p><p><strong>Clinical relevance: </strong>Irradiance, material types, and thickness are important factors in the polymerization of composites.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743153","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":"Three-Year Practice-Based Clinical Trial on the Performance of a Self-Adhesive Resin-Based Bulk-Fill Restorative.","authors":"Andreas Rathke, Frank Pfefferkorn, Michael Kent McGuire, Rick H Heard, Mikael Åström, Rainer Seemann","doi":"10.1111/jerd.13468","DOIUrl":"https://doi.org/10.1111/jerd.13468","url":null,"abstract":"<p><strong>Objective: </strong>The prospective clinical study followed up on self-adhesive resin-based bulk-fill restorations.</p><p><strong>Materials and methods: </strong>Seven general dental practitioners from a practice-based research network filled 60 cavities (20 Class I, 19 Class II, 21 Class V) in permanent vital teeth of 41 subjects with a self-adhesive, dual-curing composite hybrid (Surefil one). Modified USPHS criteria were evaluated at baseline and annually. Replacement or repair of the restoration was defined as failure. Data were analyzed using the Kaplan-Meier method and non-parametrically (p < 0.05).</p><p><strong>Results: </strong>After 3 years (1118 ± 39 days), all 29 recalled teeth were rated as vital with no hypersensitivity. One tooth showed signs of cracking. One Class I and one Class II restoration failed due to a combined marginal gap and chipping. Two restorations showed a color mismatch. The remaining restorations were found to be in clinically acceptable condition and all Class II restorations in proximal contact maintained proper contact. With one restoration failure reported after 1 year, the total of three failures resulted in an annual failure rate of 3.94%.</p><p><strong>Conclusions: </strong>The self-adhesive composite hybrid placed during daily routine showed acceptable results out to 3 years in load-bearing Classes I and II as well as non-retentive Class V cavities.</p><p><strong>Clinical significance: </strong>Three-year data confirmed the suitability of the novel self-adhesive restorative material for stress-bearing posterior restorations.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730318","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 Evaluation of Self-Adhesive Bulk-Fill Composite Versus Conventional Nano-Hybrid Composite in Cervical Cavities-A Randomized Controlled Clinical Trial.","authors":"Riham Kamal El-Shazly, Inas Mohsen Ali El-Zayat, Mohamed Mahmoud Abdel Mohsen, Mohamed Essam Mohamed Labib","doi":"10.1111/jerd.13472","DOIUrl":"https://doi.org/10.1111/jerd.13472","url":null,"abstract":"<p><strong>Objective: </strong>This randomized controlled trial assessed the clinical performance and survival of the self-adhesive bulk-fill composite Surefil One compared to conventional composite, Neo Spectra, in class V restorations.</p><p><strong>Materials and methods: </strong>Fifty-four carious cervical lesions in 15 patients were divided into two groups in a split-mouth study: Group I (27 restorations) used Neo Spectra ST HV composite with Prime&Bond Universal adhesive, while Group II (27 restorations) utilized Surefil One. The study included a 1-year follow-up, with assessments at baseline, 6 months, and 12 months using modified United States Public Health Service criteria and Visual Analogue Scores for patient satisfaction. Statistical analyses included Chi-Square test, paired t-tests, and repeated measures ANOVA, with significance set at α = 0.05.</p><p><strong>Results: </strong>Both composites performed clinically well over the 12 months. Neo Spectra demonstrated superior performance to Surefil One in color match, marginal integrity, discoloration, and surface roughness. However, both materials showed similar results in retention, secondary caries, and marginal integrity. Both materials showed no significant differences in intergroup comparisons across baseline, 6-month, and 12-month assessments and no statistically significant changes in VAS scores over time within each group.</p><p><strong>Conclusions: </strong>While Surefil One and Neo Spectra exhibited comparable clinical functionality, Neo Spectra demonstrated superior esthetic quality. Both materials achieved equivalent patient satisfaction levels, implying the need for further investigations to assess their long-term clinical performance.</p><p><strong>Clinical significance: </strong>Assessing the clinical performance of Surefil One and Neo Spectra composites in class V cavities is very valuable. Understanding the behavior of such materials in non-load-bearing areas will help clinicians make evidence-based decisions about selecting restorative materials that balance durability and esthetics according to each patient's needs.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730350","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":"Predicting Final Restoration Color Using Neural Network Models: The Impact of Substrate Lightness Versus Ceramic Shade, Translucency and Thickness.","authors":"Muneera Almedaires, Alejandro Delgado, Nader Abdulhameed, Patricia Pereira, Mateus Garcia Rocha, Dayane Oliveira","doi":"10.1111/jerd.13469","DOIUrl":"https://doi.org/10.1111/jerd.13469","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the influence of background color, ceramic shade, translucency, and thickness on the color matching of lithium disilicate restorations and to use a neural network model to predict the optimal parameters for shade matching.</p><p><strong>Methods: </strong>A neural network model was applied to evaluate the effects of lithium disilicate ceramic shade (A1, A2, A3), translucency (HT, M, T, LT), and thickness (0.5, 1.0, 1.5 mm), as well as background color (black, white, enamel and dentin shades A1-D4) on color matching. Color measurements (L*, a*, b*) were obtained using a spectrophotometer (CM-700d, Konica Minolta) in SCI mode.</p><p><strong>Results: </strong>Background color had a significant influence on color matching (p < 0.001, R² = 0.740). The model explained 71.45% of the variance in final color values, with a mean absolute error (MAE) of 0.8578 units in the CIELab space. SHAP analysis identified initial L* value (42.32%), ceramic thickness (19.51%), and translucency (10.36%) as key predictors. Component-wise, L* had an R² of 0.7594, a* had the lowest R² (0.5993), and b* performed best (R² = 0.7848).</p><p><strong>Conclusion: </strong>Background color and ceramic thickness are the most critical factors in minimizing color discrepancies in ceramic restorations. The developed model demonstrates promising potential in predicting the color outcomes of ceramic restorations.</p><p><strong>Clinical significance: </strong>Neural networks offer promise as predictive tools for clinicians, aiding in selecting materials and fabrication parameters to achieve desired esthetic outcomes.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730280","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":"Radiographic Evaluation of Current Restorative CAD/CAM Ceramics Indicated for Fabrication of Indirect Restoration.","authors":"Amir H Nejat, Edwin Kee, Meghan R Belanger, Hamidreza Rajati, Nathaniel C Lawson","doi":"10.1111/jerd.13464","DOIUrl":"https://doi.org/10.1111/jerd.13464","url":null,"abstract":"<p><strong>Objectives: </strong>To measure and compare the radiopacity values of available computer-aided design/computer-aided manufacturing (CAD/CAM) restorative materials used for the fabrication of long-term single-tooth indirect restorations.</p><p><strong>Materials and methods: </strong>1 and 2 mm thick samples (n = 10 per material) were fabricated from different CAD/CAM materials, including glass-matrix (VITA mark II, Empress CAD, VITA Suprinity, Celtra DUO, and e.max CAD), polycrystalline (3Y zirconia, Katana HTML Plus), and resin-matrix ceramics (VITA Enamic, Lava Ultimate, Flexcera Smile Ultra Plus, Sprintray Ceramic Crown, VarseoSmile TriniQ, and Rodin Sculpture 2.0). The samples were placed on a digital X-ray sensor along with an aluminum step wedge and a tooth section with similar thickness. The gray scale value was measured in Image J software and converted to mmAl using Curve Expert Pro 2.7 software. Data were analyzed with a two-way ANOVA and post hoc Tukey tests, with the significance level set at 95% (α = 0.05).</p><p><strong>Results: </strong>Type of restorative material and thickness had a significant effect on the radiopacity values (p < 0.05). Radiopacity of all tested materials was similar to (Sprintray Ceramics Crown, p > 0.05) or significantly higher (p < 0.05) than the radiopacity of the dentin, except for VITA Mark II, VITA Enamic, Flexcera Smile Ultra Plus, and VarseoSmile TriniQ, which had a significantly lower radiopacity than dentin (p < 0.05).</p><p><strong>Conclusion: </strong>Radiopacity of evaluated CAD/CAM materials was significantly different. The highest radiopacity was observed in zirconia, and the lowest radiopacity was found in Flexcera Smile Ultra Plus.</p><p><strong>Clinical significance: </strong>Radiopacity of most of the tested CAD/CAM materials was equal to or higher than that of dentin with a similar thickness. However, VITA mark II, VITA Enamic, Flexcera Smile Ultra Plus, VarseoSmile TriniQ had lower radiopacity than dentin and their radiographic evaluation would be dependent on the radiopacity of the cement for detection of recurrent caries. Understanding the radiopacity of each CAD/CAM material helps clinicians select the appropriate material and helps them detect the type of restorative material.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700711","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":"Digital Occlusal Reconstruction in Patients With Failed Veneer Restorations With Full Mouth Severely Worn Teeth.","authors":"Ning Gong, Lizhe Wang, Lei Xu, Zechun Xu, Zimeng Xu, Fei Tan","doi":"10.1111/jerd.13465","DOIUrl":"https://doi.org/10.1111/jerd.13465","url":null,"abstract":"<p><strong>Objective: </strong>Occlusal reconstruction refers to the prosthodontic modification and restoration of the dental arch's occlusal configuration. Incorporation of digital technology enables precise acquisition of individualized mandibular movement patterns, facilitating the design of final restorations and effectively enhancing the clinical efficiency and treatment outcomes of occlusal reconstruction. This case report aims to demonstrate a digital workflow for occlusal rehabilitation in severe tooth wear patients, proving that digital technologies enhance treatment efficacy.</p><p><strong>Clinical considerations: </strong>A 27-year-old female presented with severe full-arch tooth wear secondary to bruxism and a history of detachment of resin veneers on the maxillary and mandibular anterior teeth. This case utilized a digital protocol incorporating digital face bow, intraoral scanning, and CAD/CAM technology to determine the existing occlusal relationships, formulate treatment plans, fabricate provisional restorations, and produce definitive prostheses. One- and three-month follow-ups confirmed stable occlusal function and satisfactory esthetic outcomes.</p><p><strong>Conclusion: </strong>This case report demonstrates that digital technologies improve diagnostic accuracy and treatment precision through integration of intraoral scanning with digital face bow recordings. The digital approach reduced potential errors from traditional methods and optimized clinical workflows.</p><p><strong>Clinical significance: </strong>The implementation of digital workflows in full-mouth occlusal reconstruction enhances treatment efficiency and improves clinical predictability of therapeutic outcomes.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700707","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":"Advancing Adhesive Strategies for Endodontically Treated Teeth-Part I: Impact of Endodontic Irrigation Protocols on the Chemical Composition and Structural Integrity of Coronal Dentin.","authors":"Joana A Marques, Rui I Falacho, Sara Fateixa, Francisco Caramelo, João Miguel Santos, João Rocha, Markus B Blatz, João Carlos Ramos, Paulo J Palma","doi":"10.1111/jerd.13460","DOIUrl":"https://doi.org/10.1111/jerd.13460","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of four endodontic irrigation protocols on the chemical composition and ultrastructure of coronal dentin.</p><p><strong>Materials and methods: </strong>Coronal dentin fragments were assigned to five study groups: NaOCl (3% sodium hypochlorite), NaOCl/EDTA (3% NaOCl and 17% ethylenediaminetetraacetic acid), NaOCl/EDTA/CHX (3% NaOCl, 17% EDTA and 2% chlorhexidine), NaOCl/HEDP (mixture of 3% NaOCl and 9% etidronic acid), and control (distilled water). Confocal Raman microscopy was employed to analyze the spatial distribution of organic and inorganic components, while attenuated total reflection Fourier transform infrared spectroscopy and energy-dispersive spectroscopy were used to assess the surface composition of dentin. Ultrastructural evaluation was conducted using scanning electron microscopy (SEM). Statistical analysis was performed using a mixed linear model with a significance level of 0.05.</p><p><strong>Results: </strong>All NaOCl-treated groups showed reduced amide II (p < 0.001), indicating protein degradation. Exclusive NaOCl irrigation yielded the lowest amide II, highest mineral content, and increased phosphate/amide II and carbonate/phosphate ratios (p < 0.05). Chelators reduced mineral content (p < 0.001), with NaOCl/HEDP and NaOCl/EDTA/CHX producing more mineralized surfaces than NaOCl/EDTA and control groups (p < 0.05). A general decrease in organic (C and N) and an increase in inorganic (O, P, and Ca) components occurred across treatments, particularly in NaOCl and NaOCl/HEDP groups. EDTA disturbed the Ca/P equilibrium (p < 0.05). SEM showed a dense smear layer and mostly obliterated tubules in NaOCl and control samples, while chelators reduced the smear layer, partially opened tubules, and caused erosion.</p><p><strong>Conclusions: </strong>Exclusive use of 3% NaOCl produces hypermineralized, collagen-depleted coronal dentinal surfaces, with a dense smear layer. Sequential irrigation with 17% EDTA induces stronger demineralization compared to a continuous chelation protocol with 9% HEDP. Both EDTA- and HEDP-treated coronal dentin display partially opened dentinal tubules, signs of erosion, and substantial smear layer reduction.</p><p><strong>Clinical significance: </strong>Clinically recommended endodontic irrigation protocols significantly alter the chemical composition and ultrastructural integrity of coronal dentin, the primary substrate for adhesive restorations. These findings enhance the understanding of post-irrigation coronal dentin conditions and their potential implications on the interaction with adhesive restorative materials.</p>","PeriodicalId":15988,"journal":{"name":"Journal of Esthetic and Restorative Dentistry","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692374","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}