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This study produced composite resins by combining acrylate, chitosan (CH), carboxymethyl chitosan (CMCH), hydroxypropyl chitosan (HPCH), and hydroxyethyl chitosan (HECH) to create materials suitable for use in 3D stereolithography (SLA) printers. Tripropylene glycol diacrylate (TPGDA), urethane acrylate (UA), and photoinitiator (Diphenyl (2, 4, 6-trimethylbenzoyl) phosphine oxide (TPO)) were mixed. CH and its derivatives were added separately to the resin to obtain composite resins. The mechanical test results are clear; the optimum TPGDA: UA ratio was 1:1, the cure time was 60 s, and the TPO ratio was 1 %. The optimum viscosity of the resin is 340-350 cP. Hydrophobic/hydrophilic properties of cured composite resins were examined. The addition of CH and its derivatives to the resin caused a decrease in compressive strength. Adding up to 2.5 % CH, CMCH, and HECH to the resin significantly increased the tensile strength of the resin, giving it flexibility. The gel content of cured composite resins was between 97.72 % and 96.11 %. The cured composite resins demonstrated high chemical and solvent resistance to HCl, NaOH, and HF but exhibited limited resistance to toluene and chloroform. The accelerated UV aging test results show that adding CH derivatives to the resin makes the composite resin more prone to photooxidative aging., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: The objective of this clinical trial was to evaluate and compare the clinical and radiographic successes of three bioactive endodontic cements (BEC) including novel portland cement-based material releasing fluoride, resin-modified silicate glass cement, and pure tricalcium silicate-based cement-in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping., Methods: Eighty-six (86) participants with previously untreated first and second primary molars were included in this study. The teeth were randomly allocated into three groups: pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride. Cavities were capped with the assigned cement after caries excavation using standard protocols. The teeth that underwent treatment were restored using glass ionomer cement and composite resin. Clinical and radiographic evaluations were performed at 1, 6, and 12 months. The data were analyzed using Pearson chi-square, Kruskal-Wallis H and Z test (P = 0.05)., Results: The success rate was 88 % (n = 25) in the pure tricalcium silicate-based cement group, 88.5 % (n = 26) in the resin-modified silicate glass cement group, and 100 % (n = 25) in the novel portland cement-based material releasing fluoride group. The differences at the 1st, 6th, and 12th month follow-up visits were not statistically significant among the groups (P > 0.05). No difference was found between the integrity of the resin composite restorations overlying pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride according to the USPHS criteria., Conclusions: Novel portland cement-based material releasing fluoride can be considered an alternative for preserving the tooth, as it showed a high success rate in treating primary molars diagnosed with reversible pulpitis via indirect pulp capping., Clinical Significance: Novel Portland cement-based material releasing fluoride could be beneficial in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The aim of the present prospective study was to evaluate the colour stability of 3D-printed non-invasive restorations after 24 months in vivo., Methods: The study included 29 patients, who received 3D-printed restorations made of a computer-aided design (CAD) / computer aided-manufacturing (CAM) hybrid material (n = 354). Restoration colour of 190 restorations was measured using a spectrophotometer. By applying the CIELAB system, *L (lightness), a* (red-green) and b* (blue-yellow) values were recorded. An evaluation of the colour differences (ΔE) after 6, 12 and 24 months was conducted., Results: Analysis of colour differences of 3D-printed restorations showed continuous discolouration of the restorations. After one year 34 % and after two years 18 % of the restorations were rated alpha or bravo, indicating no or hardly visible colour change. After two years, 54 % of the evaluated restorations yielded a colour difference with ΔE > 6.8 (delta). More than 82 % of the evaluated restorations showed values between ΔE 3.8 - 6.8 (charlie) and ΔE ˃ 6.8 (delta) after two years., Conclusions: 3D-printed non-invasive restorations showed an overall reduced colour stability after 24 months in vivo., Clinical Significance: The present study provides first clinical data regarding 3D-printed restorations. These restorations are recommended for a wearing time of about 6 months., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elisabeth Prause reports equipment, drugs, or supplies was provided by BEGO. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To synthesize a 3D printing resin with antibacterial and long-term fluoride-releasing properties., Methods: (4,4-Bis-4-[2‑hydroxy-3-(2-methacryloyloxy)propoxy]-phenyl-pentanol-amine)-N,N-diacetic acid zirconium (IV) fluoride complex was synthesized from 4,4-bis-(4-hydroxyphenyl)-pentanoic acid and monitored using proton nuclear magnetic resonance spectroscopy. The synthesized complex was incorporated into a urethane-acrylate-based (UA) resin at 5 wt% and 10 wt% (5F-UA and 10F-UA groups, respectively). The UA resin without the synthesized complex was considered as the control group. All groups were 3D printed using a DLP printer, followed by 10 min of washing and 20 min of curing. Surface characteristics were observed using scanning electron microscopy. The mechanical properties were assessed by measuring its flexural strength and Vickers hardness. The antibacterial property was investigated with direct and indirect contact tests and a WST-8 metabolic activity assay. The suspension was fully mixed and diluted for counting the number of colony-forming units. The cell viability test was performed using a cell proliferation assay. The amount of fluoride released was measured daily for 28 days using ion chromatography. One-way analysis of variance was performed for statistical analyses using SPSS software., Results: The amount of fluoride released increased with the concentration of fluoride complex in the resin. The fluoride ions were constantly released at a low concentration from the 3D printed specimens (5F-UA: around 0.13 ppm daily; 10F-UA: around 0.22 ppm daily). The antibacterial efficacy was acceptable in both the 5F-UA and 10F-UA groups, and higher in the latter. No cytotoxicity of the resin was detected. The mechanical properties were significantly influenced by the addition of the fluoride-releasing complex., Conclusions: The present 3D printing UA resin incorporating a fluoride complex effectively inhibited the growth of S. mutans and demonstrated the ability to slowly release fluoride over an extended period of time., Clinical Significance: This study provided informative composition of a fluoride-releasing UA-based 3D printing resin, ideal for dental applications such as crowns, bridges, removable partial dentures, and orthodontic appliances, which can benefit from sustained fluoride release and antimicrobial properties. Further modifications to the resin composition can be easily achieved to enhance the resin qualities., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare. All coauthors have seen and agree with the contents of the manuscript, and there is no financial interest to report. We certify that the submission is original work and is not under review by any other publication., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: To evaluate the effects of different stamp materials and restoration depths on the accuracy of direct composite resin restorations using stamp technique., Methods: Eighty standard resin teeth were divided into four groups based on different stamp materials: flowable composite resin (FR), vinyl polydimethyl siloxane (VPS) for bite registration (VB), VPS for impression (VI) and transparent VPS (TV). Each material group was further divided into two subgroups based on restoration depth (1 and 2 mm; n = 10). Standardized Class I cavities were prepared and restored with the corresponding stamps. Pre- and post-treatment scans of each tooth were fitted using Geomagic Control X software, generating deviation distribution maps of the occlusal surface. The accuracy indicators, including mean height variation (MHV), root mean square (RMS), and proportions of height variation with different ranges (PHV range ), were recorded to evaluate the accuracy of restorations. Analysis of variance (ANOVA) were used for statistical analysis (α=0.05)., Results: The type of stamp material significantly affected all accuracy indicators, while restoration depth did not show a significant effect on any of the indicators. MHV values ranged from 29.70 ± 5.88 μm to 63.52 ± 9.58 μm, and RMS values ranged from 62.78 ± 8.76 μm to 101.79 ± 13.17 μm, displaying a trend of FR<0.05 mm values (72.24 ± 3.40 % for 1 mm, 71.47 ± 8.54 % for 2 mm) and the lowest PHV >0.2 mm values (0.70 ± 0.50 % for 1 mm, 0.94 ± 0.47 % for 2 mm). In contrast, the TV groups exhibited the lowest PHV <0.05 mm values (59.69 ± 10.23 % for 1 mm, 59.67 ± 5.70 % for 2 mm), while the VI groups showed the highest PHV >0.2 mm values (7.34 ± 1.58 % for 1 mm, 8.20 ± 3.16 % for 2 mm)., Conclusions: The accuracy of direct composite resin restorations using stamp made of flowable composite resin was higher than that of all tested VPS materials, thereby reducing the need for occlusal adjustment and improving clinical efficiency. Besides, restoration depth had no significant impact on the accuracy of stamp technique, regardless of the stamp material used., Clinical Significance: The accuracy of direct composite resin restorations using stamp technique with different stamp materials varies. The flowable composite resin stamp exhibits higher accuracy compared with VPS stamps, reducing the need for occlusal adjustments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The objective of this systematic review is to examine the methods used to minimize discoloration of the carious lesions after topical silver diamine fluoride (SDF) application., Data/sources: Two independent researchers conducted a search of English literature published up to 30th April 2024 in three databases (PubMed, Scopus, and Web of Science). They screened titles and abstracts, excluding conference proceedings, books, reviews and publications unrelated to SDF. They included only original research on methods to minimize SDF-induced discoloration. The publications lacking comparative color change data were excluded. Full texts of the included articles were then analyzed. The Cochrane guidelines for clinical trials and the guidelines for in-vitro studies on dental materials were used for the risk of bias assessment., Results: The systematic review included 33 publications from 1,283 identified publications (26 laboratory studies and 7 clinical studies). Thirteen laboratory studies and five clinical studies were rated as having 'low risk'. Three main methods to minimize discoloration were identified: masking with restoration, using chemicals, and substituting silver with nano-silver. Nine studies used resin composite or glass ionomer cement to mask the SDF-induced discoloration. Twenty-nine studies used chemicals to reduce SDF-induced discoloration. These chemicals included precipitating agents like potassium iodide, oxidizing agents like hydrogen peroxide, and chelating agents like glutathione. Seven publications used chemicals (potassium iodide or glutathione) before restoration and six of them found improved masking effect. Four studies substituted silver ions with silver nanoparticles which did not discolor carious lesion., Conclusions: Masking with restoration, using chemicals, and substituting silver ions with nano-silver particles have been reported to address the discoloring effects of SDF therapy. However, most are laboratory studies, and more clinical trials are needed to confirm their effectiveness in reducing SDF-induced discoloration., Clinical Significance: SDF effectively arrests caries, but it discolors carious lesions. This review summarizes the methods and their outcomes for reducing SDF-induced discoloration. This study is supported by the General Research Fund of Research Grant Council No. 17,100,222., Competing Interests: Declaration of competing interest The authors declare that they do not have known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: To digitally evaluate the trueness and fit of additively and subtractively manufactured fixed complete dentures in materials intended for definitive use., Methods: An edentulous maxillary model with implants at the left first molar, left canine, right canine, and right first molar site was digitized and a fixed complete denture was designed. This design was used to fabricate fixed dentures in an additively manufactured resin for definitive use (AM), a high-impact polymer composite (SM-CR), and a strength gradient zirconia (SM-ZR) (n = 10). Each fixed denture was digitized and the surface (overall, occlusal, except occlusal, and abutments), linear, and interimplant distance deviations were analyzed. The fit was assessed with the triple-scan protocol. Data were analyzed with Welch analysis of variance and Games-Howell tests (α = 0.05)., Results: SM-ZR led to lower overall deviations than AM, which had the highest occlusal and the lowest abutments deviations (P ≤ 0.007). SM-ZR had the lowest occlusal and SM-CR had the highest except occlusal deviations (P ≤ 0.002). AM mostly had higher linear and SM-CR mostly had higher interimplant distance deviations (P ≤ 0.043). AM led to the highest marginal gap at the left canine site, while SM-CR had the highest and SM-ZR had the lowest gaps at the right canine site (P ≤ 0.022)., Conclusions: SM-ZR dentures mostly had trueness and marginal fit similar to or better than the other groups. Tested fixed complete dentures were mostly smaller than the design file in terms of interimplant distances., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To evaluate the clinical performance of direct restorations for pit-and-fissure caries in molars using stamp combined with single-shade composite resin (S/SCR) technique, and assess the effect of the number of stamp pressing on the trueness of S/SCR technique., Methods: Twenty molars of fifteen patients with pit-and-fissure caries but with an intact or micro-cavitated occlusal morphology were restored using S/SCR technique and were randomly divided into single pressing group (n = 10) and double pressing group (n = 10). Intraoral scans were obtained before treatment (scan 1), after filling (scan 2) and after polishing (scan 3). Deviation distribution maps of pairwise fitting were created including comparison 1 (scan1/scan 2), comparison 2 (scan1/scan 3), and comparison 3 (scan2/scan 3) using Geomagic Control X software. Root mean square (RMS) values were calculated to evaluate the trueness of restorations. Clinical performances including esthetic, functional, and biological properties of all restorations were evaluated according to FDI criteria after a 12-month follow-up. Analysis of variance, independent-samples T test and Wilcoxon rank-sum test were used for statistical analysis (α=0.05)., Results: RMS values for comparison 1, comparison 2, and comparison 3 were 0.1243 ± 0.0151, 0.0966 ± 0.0136, and 0.0605 ± 0.0137 mm in single pressing group, while 0.0831 ± 0.0140, 0.0741 ± 0.0107, and 0.0475 ± 0.0099 mm in double pressing group, respectively. RMS value of single pressing group was higher than that of double pressing group in the same comparison (p ≤ 0.001). No statistically significant differences were observed between the two groups regarding esthetic, functional and biological properties (p > 0.05). For all properties, all restorations scored within 3, with over 80% scoring 1., Conclusion: S/SCR technique presents satisfying clinical performances for pit-and-fissure caries in molars after a 12-month follow-up. Besides, double pressing can improve the trueness of restorations compared to single pressing., Clinical Significance: S/SCR technique is efficient in direct composite resin restoration for pit-and-fissure caries, with satisfying esthetic, functional and biological properties after a 12-month follow-up. Significantly, double pressing improves the trueness of S/SCR technique, reducing the need for occlusion adjustment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: This study was designed to investigate the effect of post space conditioning with different solutions on the bond strength of glass FRC posts and evaluate the mode of resin failure., Methods: Sixty extracted human single rooted teeth were root filled using a resin sealer and suitable gutta-percha cones. Post spaces were prepared, and the teeth randomly allocated into 5 groups according to their irrigation regimens which included the following solutions: 17 % EDTA, 2 % CHX, 3 % NaOCl, 10 % ascorbic acid and QMix solutions. Post spaces were irrigated with 5 ml of the solution for 15 s and subsequently washed with distilled water and dried with paper points. Glass FRC posts were cemented into their spaces using a self-adhesive resin cement. The specimens were mounted in plexiglass molds using autopolymerizing acrylic resin. A universal testing machine was used to measure post retention at a crosshead speed of 2 mm/min. The results were analyzed by one-way ANOVA followed by Tukey HSD test (α = 0.05). Dislodged posts and post spaces were examined microscopically to evaluate retention failure., Results: The Ascorbic acid group exhibited the highest mean retentive strength value at 229 N, followed by QMix at 198 N, NaOCl at 186 N, CHX at 170 N, and EDTA at 124 N. The mean value of the ascorbic acid group was significantly higher than EDTA group, p = 0.012. The failure category was primarily mixed., Conclusions: Rinsing post spaces with ascorbic acid exhibited significantly superior bond strength. The failure mode was mixed., Clinical Significance: Irrigating post spaces with ascorbic acid solution before luting FRC posts significantly improves their bond strength compared to irrigation with EDTA solution. Irrigation with QMix solution produced the second highest retentive strength but showed no statistical significance when compared to using ascorbic acid, NaOCl, CHX, or EDTA solutions., Competing Interests: Declaration of competing interest The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the postoperative sensitivity (POS), as well as the clinical performance of posterior restorations using a new chemically-cured bulk-fill composite (Stela Automix and Stela Capsule, SDI) comparing with a light-cured bulk-fill composite after 6 months., Methods: Fifty-five participants with at least three posterior teeth needing restoration were recruited. A total of 165 restorations were performed on Class I or Class II cavities. After the application of Stela primer, the chemically-cured composite (Stela Automix or Stela Capsule) was inserted. For the light-cured composite group, a universal adhesive (Scotchbond Universal) was applied with a bulk-fill composite (Filtek One). Participants were evaluated for spontaneous and stimulated POS in the baseline, after 48 h, 7 days, and 6 months. Additionally, each restoration was assessed using the updated version of FDI criteria after 6 months. The differences in the proportions of the groups were compared by Cochran test statistics (α = 0.05)., Results: Both chemically-cured composites showed a lower risk of POS compared to the light-cured composite at baseline and up to 48 h (p < 0.04). A significantly lower surface luster and texture was observed for the Stela Capsule composite compared to the light-cured bulk-fill composite (baseline and 6 months; p = 0.03). A significant color mismatch was observed for the light-cured bulk-fill composite compared to the chemically-cured composites (baseline and 6 months; p = 0.03). No significant differences were observed in any other item evaluations (p > 0.05)., Conclusion: Chemically-cured composites exhibit lower postoperative sensitivity and less color mismatch compared to a light-cured bulk-fill composite after 6 months of clinical service., Clinical Significance: The chemically-cured composites appear to be an appealing option for restoring posterior teeth, as they exhibit lower postoperative sensitivity compared to a light-cured bulk-fill composite, both at baseline and up to 48 h, and less color mismatch., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To systematically compile data on the degree of conversion (DC) for bulk-fill composites using a network meta-analysis., Methods: A systematic search for in vitro studies of DC of bulk-fill composites was performed in PubMed, Web of Science, Scopus, and Open Grey. Risk of bias within studies and due to missing evidence was assessed using the Joanna Briggs Institute scoring system and ROB-MEN tool, respectively. The primary outcome was the DC of bulk-fill composites. Surface Under the Cumulative Ranking curve (SUCRA) was used to rank relative performance. Inconsistencies in the model were investigated to ensure its validity and the level of confidence in the network meta-analysis (CINeMA) was assessed., Results: A total of 28 studies were included in the quantitative analysis. The average DC values (%) for 0-h/top, 0-h/bottom, 24-h/top, and 24-h/bottom were 59.09, 57.14, 66.73, and 63.87, respectively. According to their SUCRA ranking, the best-performing composites were: SonicFill, Venus Bulk Fill, and SDR (0-h/top), Reveal HD, i-Flow Bulk Fill, and Venus Bulk- Fill (0-h/bottom), Venus Bulk Fill, SDR, and QuiXfil (24-h/top), and Venus Bulk Fill, Aura Bulk Fill, and i-Flow Bulk Fill (24-h/bottom). Incoherence between direct and indirect evidence was identified as the most significant factor affecting confidence., Conclusions: DC values of bulk-fill composites were within the range commonly reported for previous generations of "conventional" composites, with flowable composites tending to perform better than sculptable composites. High variability in DC data was observed, which may be attributed to incompletely understood methodological differences., Clinical Significance: DC is a fundamental parameter that influences multiple mechanical and biological properties of resin composites and is particularly relevant for the group of bulk-fill composites that are designed for use in thick layers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The fluorescence-aided identification technique (FIT) is based on the fluorescence properties of dental materials, specifically the intensity of their fluorescence compared to the autofluorescence of hard dental substances; this creates a perceived contrast between dental material and tooth. However, no studies to date have determined the extent to which the fluorescence intensity of tooth-colored dental materials must differ from that of natural autofluorescence to ensure reliable visual detection. The aim of this study was therefore to determine, for the first time, how pronounced the difference between fluorescence intensity and autofluorescence must be to reliably identify tooth-colored material., Methods: Ten dentists assessed six different resin-based composite (RBC) samples of varying fluorescence intensity placed in the cavities of ten extracted teeth under standardized fluorescence-exciting illumination. The outcome variable was fluorescence perceptibility. Their assessments of the outcome variable were compared with measurements of the fluorescence intensities of the RBCs and the surrounding dental hard tissues, which were expressed as a fluorescence intensity ratio. Demographic data of the participants, including age, gender, and professional experience, were also recorded., Results: No significant differences were found for visual fluorescence perceptibility in relation to the explanatory variables of gender (p = 0.14), age (p = 0.13), and professional experience (p = 0.34). In contrast, the fluorescence intensity ratio was significantly different (p < 0.0001)., Significance: For both clinicians and manufacturers, fluorescence intensity levels are important when selecting or developing FIT-compatible materials. Our results suggest that the fluorescence intensity levels of dental materials should be no more than 75% and no less than 200% of tooth natural autofluorescence to ensure reliable detection of tooth-colored materials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the influence of the tooth shade, type of resin composite and cavity configuration on the color adjustment of single-shade and group shade resin composites., Methods: Class I and V cavities were prepared in artificial acrylic mandibular right molars with different shades - A1, A2, A3, A3.5 and A4. Three single-shade (OMN, UNI, CHA) and two group shade (FIL, HAR) resin composites were evaluated. Seventy-five observers, including dentists, dental students and laypersons (n = 25), participated in the study. A psychophysical experiment based on visual assessments of the color matching between each tooth and each restoration was ranked from 0 (excellent match) to 4 (huge mismatch), and mean frequencies (%) were calculated. Visual color differences among composite materials and tooth shades were statistically tested (P < 0.05)., Results: The results showed highest percentages of unacceptable color mismatches for class V compared to class I restorations, especially for more chromatic tooth shades (A3.5 and A4). The percentage of ratings of acceptability was higher for laypersons group. For class V, OMN presented significant difference only from UNI in tooth shades A1, A2, A3 and A4. However, for class I, OMN presented significant differences with CHA for A1, A2 and A4, and with HAR and FIL for A1., Conclusions: Class I resin composite restorations exhibit superior color matching than Class V, with lighter and low chroma tooth shades demonstrating better color adjustment. The color matching of both cavity configurations is comparable for single and group shade resin composites., Clinical Significance: Cavity configuration and tooth shade may impact color matching of single and group shade resin composites. This study demonstrates superior color matching in class I configurations over class V for both single and group shade resin composites. Additionally, restorations placed in teeth with lighter shades exhibit more favorable color adjustment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The aim of this study was to evaluate the effect of an adhesive loaded with 0.2 % copper (Cu) and 5 % zinc oxide (ZnO) nanoparticles (Nps) on its adhesive properties and enzymatic activity at the hybrid layer ex vivo in a randomized clinical model., Methods: Fifteen patients participated in this study, and a total of 30 third molars were used. Occlusal cavities (4 × 4 × 2 mm) were made in each tooth, and randomly divided into 2 groups: (i) Experimental group: commercial adhesive loaded with 0.2wt % CuNps and 5wt % ZnONps; and (ii) Control Group: non-loaded commercial adhesive. Teeth were restored with resin composite. Thirty days later, extractions were performed. Extracted teeth were longitudinally sectioned. Nps in powder were characterized by field emission scanning electron microscope (FE-SEM) and energy dispersive X-ray (EDX) analysis. Microtensile bond strength (μTBS), degree of conversion (DC), and nanoleakeage (NL) tests were executed. In situ zymography (Zym) was performed to evaluate the gelatinolytic activity at the hybrid layer. Student's t-test (α = 0.05) was applied for all tests., Results: μTBS and DC did not show significant differences (p > 0.05) between both groups. However, NL and gelatinolytic activity at the hybrid layer showed significant values (p < 0.05) for experimental group in comparison with control group., Conclusion: The addition of 0.2 % CuNps and 5 % ZnONps to a universal adhesive decreases NL and gelatinolytic activity at the hybrid layer, without jeopardizing its adhesive properties., Significance: This randomized clinical trial with ex vivo analysis demonstrate that a commercial adhesive modified with 0.2wt % Cu and 5wt % ZnO Nps that does not affect its adhesive properties, reducing gelatinolytic activity and nanoleakage at the hybrid layer, which should contribute to an improvement of long term bonding-dentine clinical performance., Competing Interests: Declaration of competing interest The authors declare no competing financial interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Zein-incorporated magnesium oxide nanoparticles (zMgO NPs) can influence the mechanical properties of dental materials. However, the effect of this addition on the mechanical properties of resin composite has yet to be investigated. The objective of this study was to add various concentrations of zMgO NPs to conventional, flowable, and bulk-fill composite and assess the effect on the compressive strength, flexural strength, and microhardness., Methodology: 150 samples each of conventional composite, flowable composite, and bulk-fill composite (n = 450) were enhanced with concentrations of zMgO NPs at 0 %, 0.3 %, 0.5 %, 1 %, and 2 % (n = 30). 10 samples of each group were randomly allotted to the compressive strength, flexural strength, or hardness test. Characterization of the specimens was performed by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and transmission electron microscopy. Two-way ANOVA test was used to compare between groups, and one-way ANOVA followed by Tukey's test was done at p = 0.05 to determine significance., Results: Characterization yielded a uniform distribution of nanoparticles in the matrix and the formation of a new hybrid composite that maintained its properties. Composite of all types enhanced with 0.3 % and 0.5 % zMgO NPs demonstrated a statistically significant increase in compressive strength, flexural strength, and hardness when compared to the control (p < 0.05). The bulk-fill composite with zMgO NPs concentrations of all groups demonstrated a statistically significant increase (p < 0.05) in hardness when compared to the control., Conclusion: The modified composites' compressive strength, flexural strength, and hardness improved or remained consistent., Clinical Significance: An improved dental resin composite will enhance the quality of care and patient experience. The augmented strength and hardness of resin composite is desirable in prolonging the durability of the restoration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: This prospective clinical trial evaluated the clinical performance of ceramic partial coverage indirect adhesive restorations (PCIARs) in posterior teeth luted with a light-cured composite resin., Methods: From April 2016 to January 2017, a total of 60 patients (27 males, 33 females; mean age: 42.2 ± 10.86 years old) received 83 glass-ceramic PCIARs (26 onlay, 57 overlay) made of IPS Emax CAD (Ivoclar Vivadent). All restorations were luted with a light-cured composite resin (Filtek Z250, 3 M ESPE) by two operators. Two independent calibrated examiners blinded to the operators performing the treatment evaluated the restorations at baseline, 1-year, and 5-year following FDI World Dental Federation criteria including esthetic, functional, and biological properties. Data were analyzed with the Friedman test and the Wilcoxon sign test (p < 0.05)., Results: None of the restorations failed due to fracture or retention loss. One restoration was clinically unsatisfactory because of secondary caries. Marginal staining (p:0.000), marginal adaptation (p:0.018) showed significant differences between 1-year and 5-year recall., Conclusions: The PCIARs demonstrated excellent clinical performance at 1-year period. The degradation parameters appeared as minor staining and minor irregularities after 5-year, without any affect on the clinical performance., Clinical Significance: Our findings provide evidence that the clinical performance of PCIARs luted with a light-cured composite resin was clinically acceptable after a five-year evaluation period. Due to secondary caries, only one restoration was considered clinically unsatisfactory., Clinicaltrials Registration Number: NCT04838483., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to assess the seating accuracy of resin composite CAD/CAM overlay restorations, employing various preparation designs and luting materials (pre-heated composite (HC) or resin cement (RC))., Methods: A human molar's STL file was utilized to create 100 3D-printed resin tooth replicas, randomly distributed into 5 groups (n = 20) based on finishing line preparation designs: 1) Rounded shoulder above the dental equator - DE (SA); 2) Chamfer above the DE (CA); 3) Butt joint above the DE (BJ); 4) Rounded shoulder below the DE (SB); 5) Chamfer below the DE (CB). Digital impressions were acquired for all replicas, and restorations milled using Tetric CAD (Ivoclar Vivadent). The restorations were luted with HC (Tetric Prime, Ivoclar Vivadent) or RC (RelyX Universal, 3 M). Seating accuracy was evaluated through digital scans during try-in without any luting agent and post-cementation using a 3D analysis software (Geomagic wrap, 3D Systems). Data were statistically analyzed using Two-Way ANOVA (p < 0.05)., Results: The type of luting material (RC vs HC), preparation design, and their interactions significantly impacted 3D seating of the restorations (p < 0.001). HC exhibited higer volumetric increase than RC. BJ and CA designs consistently demonstrated superior seating accuracy, irrespective of the luting material used., Conclusions: The utilization of pre-heated composite resin could negatively influence the seating of overlay restorations, probably due to its higher viscosity when compared to the resin cement. However, when HC is selected as luting agent, preparation designs lacking internal angles are recommended for enhancing the precision of overlays seating., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The purpose of this study was to synthesize Al-doped mesoporous silica spheres (Al-MSSs) and evaluate the effect of them as functional fillers on the mechanical properties and aging resistance of dental resin composites., Methods: Al-MSSs were prepared by a two-step method. The effect of Al-MSSs on the performance of the composites was evaluated using neat resin matrix, commercial composites 3M Z350XT and samples containing mesoporous silica spheres (MSSs) and nonporous silica spheres (NSSs) as control. The neat resin matrix consisted of resin monomer (Bisphenol A glycerolate dimethacrylate/triethylene glycol dimethacrylate, 49.5/49.5, wt%) and photoinitiator (camphor quinone/Ethyl-4-dimethylaminobenzoate, 0.2/0.8, wt%). The mechanical properties (flexural strength, flexural modulus, compressive strength and microhardness) of them were evaluated by a universal testing machine and microhardness tester. The mechanical stabilities of the prepared composites in wet environment were evaluated by immersing them in deionized water at 37 °C. In addition, we evaluated the effect of Al-MSSs on other properties of the dental resin composites such as polymerization shrinkage, degree of conversion, curing depth, contact angle, water sorption and solubility according to ISO 4049: 2019., Results: The synthesized Al-MSSs possessed good dispersibility with an average particle size of about 505 ± 16 nm. The mechanical properties of resin composites gradually increased with the increase of the loading amounts of inorganic fillers. The reinforcing effect of Al-MSSs was similar to that of MSSs and better than that of the NSSs groups at the same filler loading. After aging in deionized water at 37 °C for 30 days, the mechanical properties of all resin composites decreased. However, the decrease percentage of the composites filled with Al-MSSs was significantly lower than the other groups, indicating that the stability of the dental composites in wet environments was significantly improved by the Al-MSSs fillers. Furthermore, Al-MSSs had no obvious influence on the biocompatibility and other properties of dental resins., Significance: The prepared Al-MSSs could effectively improve the mechanical properties and aging resistance without sacrificing other physic-chemical properties of dental resin composites., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The low durability of composite resin restorations can be attributed to the degradation of the resin dentin bonding interface. Owing to the presence of hydrophilic components in the adhesive, the integrity of the resin dentin bonding interface is easily compromised, which, in turn, leads to a reduction in bond strength. The hydrophilic nature of the adhesive leads to water sorption, phase separation, and leaching of the resin component. Therefore, hydrophobic adhesives could effectively be used to stabilize the integrity and durability of the resin dentin bonding interface., Methods: We synthesized a novel hydrophobic dentin adhesive by partially replacing bisphenol A glycidyl dimethacrylate (Bis-GMA) with a light-curable urushiol monomer. The properties of the produced adhesive, including the degree of conversion, viscosity, contact angle, water sorption/solubility, and mechanical strength, were comprehensively examined and compared to those of the commercially adhesive Adper Single Bond 2 as a positive control. The adhesive properties were determined using microtensile bond strength measurements, laser confocal microscopy, scanning electron microscopy observations, and nanoleakage tests. Finally, the novel adhesive was subjected to biocompatibility testing to determine its potential cytotoxicity., Results: At a light-curable urushiol content of 20 %, the synthesized adhesive exhibited high degrees of conversion and hydrophobicity, low cytotoxicity, good mechanical properties, and outstanding adhesive strength., Conclusions: The introduction of the light-curable urushiol into dentin adhesives can significantly enhance their hydrophobic, mechanical, and bonding properties, demonstrating potential to significantly improve restoration longevity., Clinical Significance: The integration of light-curable urushiol has endowed the experimental adhesives with several enhanced functionalities. These notable benefits underscore the suitability of this monomer for expanded applications in clinical practice., Competing Interests: Declaration of competing interest This manuscript has not been published or presented elsewhere in part or in entirety and is not under consideration by another journal. All study participants provided informed consent, and the study design was approved by the appropriate ethics review board. We have read and understood your journal's policies, and we believe that neither the manuscript nor the study violates any of these. There are no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: When dental practitioners encounter a defective restoration, they are faced with a crucial decision whether to repair or replace it. This study aims to explore international preferences for repair procedures and the clinical steps taken during the repair process., Method: An 11-question survey was distributed to dentists across 21 countries via different platforms. The survey comprised two sections: the first included five questions aimed at gathering demographic information, while the second consisted of six questions focusing on participants' practices related to the repair of composite or amalgam restorations A meta-analysis was employed to ascertain the pooled odds ratio of repairing versus replacement. The statistical analysis was carried out using the RevMan 5.3 program and forest plots were generated using the same program to visualize the results., Results: The survey was completed by 3680 dental practitioners. The results indicated a strong tendency to repair defective composite restorations (OR: 14.23; 95 % CI: 7.40, 27.35, p < 0.001). In terms of amalgam, there was a significant tendency to replace the restorations (OR: 0.19; 95 % CI: 0.12, 0.30, p < 0.001). When repairing restorations, the most common protocols were etching with orthophosphoric acid and creating an enamel bevel, regardless of the restorative material used., Conclusion: The findings of this study indicate that there exists a knowledge gap among dental practitioners regarding restoration repair. It is imperative that dental practitioners receive proper education and training on restoration repair, to ensure the usage of adequate protocols and restoration survival., Clinical Significance: A significant portion of dental practitioners lack the necessary knowledge and education required for the repair of restorations. Therefore, it is imperative to establish guidelines aimed at enhancing the management of defective restorations, along with protocols for clinical interventions. This includes the incorporation of proper courses in undergraduate, graduate, and continuing education programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study evaluated the clinical performance of Class II restorations made with flowable bulk-fill base versus conventional layering ORMOCER-based restorative material in a split-mouth randomized clinical trial., Methods: Thirty patients received two class II restorations (n = 60) performed with different strategies. All preparations received the application of the universal self-etching adhesive system according to the manufacturer's recommendation, followed by the placement of a sectional matrix, wooden wedge, and separation ring. The first restoration was performed using 4 mm of flowable bulk-fill material covered by 2 mm of conventional viscosity restorative material (Bulk-fill technique). The second restoration was performed only with the conventional viscosity material, with a maximum of 2 mm thick increments, up to fill the cavity (Layering technique). After occlusal adjustment, the same polishing system was used for all restorations. Evaluations using the FDI criteria were conducted after 7 days, 12, and 24 months. Data were analyzed with the Fisher's Exact test (α=0.05)., Results: From 30 participants, 24 attended the 24-month recall, and 48 restorations were evaluated. All restorations received acceptable overall scores for esthetic and biological properties after this period, while only 6.66 % of the restorations exhibited unacceptable overall scores for the functional properties in both groups. No significant differences between the tested restorative materials and techniques were found for each FDI criterion assessed. The success rate after 2 years was 93.33 % for both groups., Conclusion: Both restorative materials exhibited good clinical performance for the parameters analyzed with no differences between them after 24-month follow-up., Clinical Relevance: Flowable bulk-fill ORMOCER-based material is a suitable alternative for direct Class II restorations, providing good clinical outcomes and simplifying the restorative procedure., Clinical Trial Registration Number: RBR-6mvp9w., Competing Interests: Declaration of competing interest none, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The present study examined different concentrations of the butylated hydroxytoluene (BHT) inhibitor on the kinetics of conversion, polymerization shrinkage stress, and other correlated physicochemical properties of experimental resin composites (ERC). A model composite was formulated with 75 wt% filler containing 0.5 wt% camphorquinone and 1 wt% amine with BHT concentrations of 0.01 wt% (BHT-0.01); 0.1 wt% (BHT-0.1); 0.25 wt% (BHT-0.25); 0.5 wt% (BHT-0.5); 1 wt% (BHT-1), and control (no BHT). They were tested on polymerization shrinkage stress (PSS; n = 5), degree of conversion (DC; n = 3), maximum polymerization rate (Rp MAX ; n = 5), water sorption (W sp ; n = 0), and solubility (W sl ; n = 10), flexural strength (FS; n = 10), flexural modulus (FM; n = 10), Knoop microhardness (KH; n = 10), and microhardness reduction (HR; n = 10). Data concerning these tests were submitted to one-way ANOVA and Tukey's test (α = 0.05; β = 0.2). BHT-0.25, BHT-0.5, and BHT-1 showed a gradually significant decrease in PSS (p = 0.037); however, BHT-1 demonstrated a decrease in the physicochemical properties tested. Thus, within the limitations of this study, it was possible to conclude that BHT concentrations between 0.25 and 0.5 wt% are optimal for reducing shrinkage stress without affecting other physicochemical properties of ERCs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study aimed to assess the anticariogenic effects of resin cement containing varying ursolic acid (UA) concentrations and to determine the optimal UA concentrations in the microcosm biofilm model., Materials and Methods: Experimental resin cements with UA concentrations of 0, 0.1, 0.5, 1.0, and 2.0 wt% were prepared. Class I cavities were prepared on 50 extracted human molars and restored with composite inlays and experimental resin cements. Tooth samples were subjected to artificial caries induction for 10 days in a microcosm biofilm model using human saliva as an inoculum, and then mineral changes were evaluated using quantitative light-induced fluorescence (ΔF and ΔQ) and micro-computed tomography (CT). The bacterial composition of the human saliva was analyzed by 16 s RNA microbiome profiling. One-way analysis of variance with Tukey and Duncan post-hoc tests was employed for statistical analysis (p < 0.05)., Results: As the UA concentration increased, resin cement decreased ΔF and ΔQ before and after caries induction but showed a significant difference only in ΔQ at UA concentration ≥ 1.0 % (p < 0.05). The gray value analysis result of micro CT also showed a significant difference at UA concentration ≥ 1.0 % (p < 0.05). In the human saliva analysis, bacterial composition remained within normal oral microbiota ranges., Conclusion: Resin cements containing at least 1.0 % of UA exhibited an anticariogenic effect on dental microcosm biofilms., Clinical Relevance: To reduce the failure of restorations, it is essential to prevent the occurrence of secondary caries. The application of UA in resin cement can be utilized to prevent the formation of secondary caries due to the anticariogenic effect of UA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: We intend to explore the polymerization shrinkage and mechanical-physical properties of the dental resin composite modified by polyurethane oligomer PU-MA and glass flakes fillers, and provide some experimental information for developing new dental materials., Methods: Based on Bis-GMA/TEGDMA, the new dental resin composite was hand fabricated by combining PU-MA with different content (65 wt% ∼ 75 wt%) of glass flakes/Si-Al-borosilicate glass mixed fillers. The kinetics of polymerization shrinkage was investigated by using an experimental set-up based on laser triangulation. The mechanical-physical properties of specimens after 60 days water immersion and 5000 times thermo-cycles were measured by three-point bending test and micro vickers hardness tester. Data were submitted to one-way ANOVA/LSD-test (α = 0.05). Independent sample T test was used to analyze the data before and after aging. Two-way ANOVA was adopted to analyze the effect of composition and aging condition on the mechanical-physical properties (α = 0.05)., Results: PU-PG-75 % performs lower volume shrinkage (1.35%). As the increase of filler content, the water sorption and solubility increased and the depth of cure decreased significantly (P < 0.05). After aging, the flexural strength, elasticity modulus and vickers hardness of commercial products dropped obviously and PU-PG-75wt% was relatively stable., Conclusions: 20 wt% PU-MA could decrease the volume shrinkage of dental resin composite effectively. 60 days water immersion and 5000 times thermal cycles simultaneously resulted in a significant reduction in the flexural properties for experimental materials. PU-PG-75 % may have the potential to be taken as a low shrinkage dental resin composite with good mechanical properties., Clinical Significance: This new synthesized composite could perform low polymerization shrinkage and better mechanical resistance, which may provide a new idea for improving the lifespan of direct restoration., Competing Interests: Declaration of competing interest No conflict of interest exists in the submission of this manuscript. I would like to declare on behalf of my co-authors that the work described is original research that has not been published previously, and not under consideration for publication elsewhere, in whole or in part. The manuscript has been read and approved by co-authors, and that all the co-authors agree to the submission of the manuscript to Journal of Dentistry., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This 24-month, double-blind, split-mouth randomized equivalence clinical trial compared the clinical performance of a bulk-fill thermoviscous composite resin using two different preheating methods for the restoration of non-carious cervical lesions (NCCLs)., Material and Methods: A total of 120 NCCLs were randomized into two groups (n = 60 each). In one group, a bulk-fill thermoviscous composite resin (VisCalor bulk, Voco GmbH) was preheated using a dispenser heater (DH, VisCalor Caps dispenser/warmer), while in the other group, the same resin was preheated with a bench heater (BH, Caps Warmer). In the BH group, the composite underwent preheating at 68 °C using a heating bench for 3 min while in the DH group, the composite was preheated at the same temperature for 30 s using a dispenser heater. Subsequently, the preheated bulk-fill thermoviscous composite resin was directly applied to the NCCLs. The restorations were evaluated at baseline, and after 6, 12, 18, and 24 months of clinical service using the FDI criteria. The total working time was recorded. The study used TOST-P to assess groups equivalence, Kaplan-Meier analysis for retention/fracture rate, log-rank test for secondary outcomes' survival distributions, and paired t-tests for comparing time per clinical step between groups (α = 0.05)., Results: After 24 months, 106 restorations were evaluated. Four restorations were lost-two from the DH group and two from the BH group-resulting in similar retention rates for both groups (96.1%, 95% CI 86.8 - 98.9, p > 0.05). The hazard ratio was 0.83 (95% CI 0.26 to 2.72), indicating no significant difference between the groups (p > 0.05). All other FDI parameters were deemed clinically acceptable. However, the total working time for the BH group was significantly longer than that for the DH group (p < 0.001)., Conclusions: Both preheating protocols employed for the bulk-fill thermoviscous composite resin demonstrated high and equivalent survival rates after 24 months, the other FDI parameters were deemed clinically acceptable over the same period., Clinical Significance: Clinicians can choose either method for heating the thermoviscous composite resin for restoration of non-carious cervical lesions, as they do not impact important clinical outcomes after 24 months. The total working time for the bench heater is higher than that for the dispenser heater due to the need for preheating of the bench heater., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to introduce a novel technique for fabricating provisional crowns integrated as a single unit with aligner attachments., Methods: A total of 60 crowns with attachments were prepared: 20 conventional (Protemp) and 40 3D-printed (20 bonded with attachments; 20 integrated with composite attachments as a single unit) using NextDent resin. Two central incisors were scanned (once without attachments and once with attachments) to create STL files for specimen printing. Half of the specimens (30, n = 10 per group) underwent thermal cycling (5000 cycles). Shear bond strengths (MPa) were evaluated using a universal testing machine. The debonded areas and attachment failures were analyzed to determine the fracture type. Data analyses were performed using ANOVA and post hoc Tukey tests (α = 0.05)., Results: The 3D-printed specimens showed higher strength values than the bonded attachments per group (P < 0.001). The 3D-printed crowns with attachments demonstrated the highest strength (12.39 ± 1.92 MPa). Thermal cycling significantly decreased the bond strength of the attachments (P < 0.001), except in the 3D-printed crowns with composite attachments as a single unit, which showed no significant change after thermal cycling (P = 0.643). In the bonded attachment groups, the adhesive type was the predominant failure mode, while in the 3D-printed groups, attachment fractures were the primary cause of failure., Conclusion: The 3D-printed provisional crowns with attachments have high strength and is clinically appropriate for orthodontic treatment when temporization of teeth is indicated., Clinical Significance: The developed technique for fabricating 3D-printed provisional restorations with orthodontics attachments as a single unit is a promising approach. The technique may be incorporated into the digital orthodontic treatment workflow when temporization is indicated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to compare the outcome of a simplified direct composite resin-bonded fixed dental prostheses without reinforcing fibers (CR-RBFDP) and resin-bonded fixed dental prostheses using zirconia (Zr-RBFDP)., Methods: The clinical records of five private practice dental clinics and one university hospital were analyzed. Failure was defined as a RBFDP that was removed or remade for any reason. Survival analyses were performed using log-rank tests., Results: A total of 45 patients (CR-RBFDP, n = 17; Zr-RBFDP, n = 28) were followed up for 3 years. Among the CR-RBFDP cases, 1 case of framework fracture and 2 cases of discoloration occurred, whereas among the Zr-RBFDP cases, 1 case of debonding occurred. The mean duration of observation was 21.9 months. The 3-year survival rate was 92.3 % for CR-RBFDP and 91.7 % for Zr-RBFDP. Log-rank test showed no significant difference (p = 0.78)., Conclusions: Within the limitations of this short-term retrospective study, the survival rate of CR-RBFDP was not significantly different from that of Zr-RBFDP. Contrary to concerns regarding material strength, CR-RBFDP showed reliable results. This direct composite restoration has the advantages of being less invasive and being completed in a single visit., Clinical Significance: Despite differences in material strength, CR-RBFDPs without fiber reinforcement showed reliable short-term clinical results. This direct composite restoration has the advantage of being less invasive and can be restored in a single visit., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: This study aimed to evaluate how self-etching/universal dental adhesive systems (DASs) with differing compositions interact with sound (S), post-radiotherapy (irradiated; I), and artificially eroded (E) dentin in terms of bonding properties., Methods: The DASs tested were Adper Scotchbond Multipurpose (MP; control), Clearfil SE Bond (SE), FL Bond II (FL), Adper Single Bond Universal (SU) and BeautiBond Xtreme (BX). They were analyzed for initial and 6-month microtensile bond strength (µTBS, n = 12), mode of failure (40 x), scanning electron microscopy (SEM), surface wettability (W, n = 10), and degree of conversion (DC, n = 3) via Fourier-transform infrared spectroscopy (FTIR). Normal and homogeneous distribution of the data allowed their analyses through ANOVA and Tukey tests (p < 0.05)., Results: All DASs except BX exhibited higher µTBS for S decreasing for I and E. BX demonstrated the greatest stability among the altered substrates. FL showed the most hydrophobic properties, likely due to its bioactive components. Universal DASs achieved higher DC, regardless of composition., Conclusions: HEMA-free formulation combined with carboxylic and phosphoric acids in BX, achieved the most stable performance for altered substrates., Clinical Significance: Since radiotherapy and erosion affect dentin, their characteristics compromise adhesive performance and impair the achievement of durable and satisfactory restorations. The use of universal adhesives less dependent on calcium seems less susceptible to hydrolytic degradation and may be a promising option for maintaining adhesive stability over time., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Young's modulus of elasticity (or stiffness, E) is an important material property for many applications of polymers and polymer-matrix composites. The common methods of measuring E are by measuring the velocity of ultrasonic pulses through the material or by resistance to flexure, but it is difficult for ultrasound to penetrate polymers that contain filler particles, and flexural measurements require large specimens that may not mimic the clinical case. Thus, it may be difficult to determine E using conventional techniques. It would be useful to have a relatively rapid technique that could be applied to small specimens, highly filled materials, and even specimens cured in situ. We suggest using a microhardness indentation technique that was originally developed for ceramic materials. We tested two unfilled rigid polymers, four resin composites, and four unfilled polymers with lesser hardness for this study. The study found that greater Vickers hardness loads yielded more consistent results than lesser loads. We developed a modified equation for E based on Knoop microhardness indentations. We concluded that laboratories may use a microhardness indenter to estimate the elastic moduli of polymers and resin composites. The results support our initial hypotheses that the slope of the equation relating the indentation parameter and the hardness/elastic modulus ratio was different for polymers and resin composites than for ceramics; however, the intercept is the same irrespective of the material tested., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Zirconia and resin are the most commonly utilized materials in dental restorations. However, zirconia presents significant wear on opposing teeth, whereas resin materials have low wear resistance and mechanical performances. A zirconia-resin interpenetrating phase composite (IPC) dental restoration was designed and fabricated using 3D printing and vacuum infiltration processes, incorporating zirconia scaffolds with triply periodic minimal surfaces (TPMS) structures. The mechanical and tribological performances of the IPCs were investigated through compressive and tribological experiments and finite element analysis, elucidating the influence of zirconia volumetric fraction. Results showed that IPCs exhibit excellent mechanical and tribological compatibilities, which can reduce the damage and wear of the antagonistic teeth. This designing and manufacturing strategy enables the IPC restorations with promising applications in dentistry., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction and Aims: The gaps at the margins of restorative composite resin can increase as the carious process occurs underneath the materials, causing further demineralization along the tooth cavity wall. The aim of this study was to evaluate the effects of restorative resin composite containing hydrated calcium silicate (hCS) filler on enamel protection against demineralization by simulating microleakage between the test material and teeth in a cariogenic environment., Methods: The experimental resin composites were composed of 70 wt.% filler, which was mixed with a glass filler and hCS in a weight ratio of 70.0% glass (hCS 0), 17.5% hCS + 52.5% glass (hCS 17.5), 35.0% hCS + 35.0% glass (hCS 35.0), and 52.5% hCS + 17.5% glass (hCS 52.5). A light-cured experimental resin composite disk was positioned over a polished bovine enamel disk, separated by a 30-µm gap, and immersed in artificial saliva with pH 4.0 for 15, 30, and 60 days. After the immersion period, the enamel disk was separated from the resin composite disk and evaluated using a microhardness tester, atomic force microscopy, and polarized light microscopy. The opposing sides of the enamel and resin composite disks were observed using scanning electron microscopy/energy dispersive X-ray spectrometry., Results: The enamel surface showed a significant increase in microhardness, decreased roughness, and remineralization layer as the proportion of hCS increased (P < .05). In the scanning electron microscopy image, the enamel surface with hCS 35.0 and 52.5 after all experimental immersion periods, showed a pattern similar to that of a sound tooth., Conclusions: The results demonstrated that increasing the hCS filler level of restorative resin composites significantly decreased enamel demineralization., Clinical Relevance: Hydrated calcium silicate laced restorative resin composites may be a promising dental biomaterial for protecting teeth against demineralization and preventing secondary caries around restorations., Competing Interests: Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to compare the microtensile bond strength (µTBS) and failure mode of 4 different universal adhesive systems (UAs) on human dentin., Materials and Methods: The study sectioned the occlusal thirds of 32 human third molars and divided them into 4 groups based on the adhesive system used. Group A: Palfique Universal Bond, Group B: Single Bond Universal, Group C: All-Bond Universal, and Group D: One Coat 7 Universal. The specimens underwent a 10,000-cycle thermocycling ageing process prior to testing (n = 32). Afterwards, 8 beams were obtained per group and subjected to µTBS testing using a digital universal testing machine at a speed of 1 mm/min. The microtensile bond strength values were analysed in Megapascals (MPa), and the failure mode was evaluated using a stereomicroscope. Welch's parametric ANOVA with robust variance and the Games-Howell post hoc test were used for µTBS comparisons, and Fisher's exact test was used to determine the association between adhesive type and failure mode. The significance level was set at P < .05., Results: Group D showed a significantly higher µTBS than groups A (P < .001) and B (P < .001), but no significant difference was observed with group C (P= .075). Furthermore, groups B and C showed significantly higher µTBS than group A (P< .001 and P < .001, respectively), but there was no significant difference between groups B and C (P = .132). Additionally, group A exhibited a significant association with an adhesive failure mode (P < .05), whereas groups B, C, and D were significantly associated with a mixed failure mode (P < .05)., Conclusion: The One Coat 7 Universal adhesive system showed higher microtensile bond strength values and higher chemical interaction with dentin compared to Palfique Universal Bond and Single Bond Universal. However, no significant differences were observed compared to All-Bond Universal., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the mechanical and biological properties of three-dimensionally (3D) printable resins filled with 2-methacryloyloxyethyl phosphorylcholine (MPC) and silicate-based composites and compare with those of a commercially available 3D-printable resin for definitive restorations., Methods: A group of 3D-printable hybrid resins (HRs) filled with 6 wt% MPC and three different compositions of silicate-based composites (barium silicate to zirconium silicate ratios: 1.50:1 for HR1, 0.67:1 for HR2, and 0.25:1 for HR3) were prepared. The HR groups were compared with the commercially available unfilled 3D-printable resin (CR) marketed for definitive restorations in terms of flexural strength and modulus, fracture toughness, surface roughness, Vickers hardness, light transmittance (all, n = 15), cytotoxicity, and protein adsorption (both, n = 3). All data were analyzed by using non-parametric Kruskal-Wallis and Dunn's tests (α=0.05)., Results: The HR groups had significantly higher flexural strength, modulus, fracture toughness, and hardness values than the CR (P < 0.001). HR3 had the highest surface roughness and light transmittance among the groups (P ≤ 0.006). None of tested resins showed cytotoxicity. Both HR2 and HR3 showed significantly lower protein adsorption than the CR, with a difference of approximately 60% (P ≤ 0.026)., Conclusion: Both HR2 and HR3 exhibited superior mechanical properties (flexural strength, flexural modulus, fracture toughness, and Vickers hardness), light transmittance, and protein-repellent activity than the CR, with no impact on cytotoxicity., Clinical Significance: The MPC/silicate-based composite-filled resins may be a suitable alternative for definitive restorations, given their higher mechanical properties and promising biological properties to prevent microbial adhesion and subsequent biofilm formation, as well as their non-cytotoxic properties., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: To assess the influence of ferrule and core type on the fracture strength of endodontically treated anterior teeth (ETAT) and identify the failure mode type and distribution across different core types and ferrule conditions., Methods: Sixty extracted human central incisors were endodontically treated, decoronated and divided into two main groups (F=with ferrule, NF=no ferrule). Each main group was further subdivided into three subgroups according to the core material used: direct composite cores (DC), Ribbond fibre-reinforced composite cores (RIB-DC), and glass fibre post (GFP) with direct composite cores (GFP-DC). All specimens received E.max crowns and underwent thermal cycling and cyclic loading. Subsequently, the fracture resistance was tested with static loads applied to the crown restoration. Two-Way ANOVA and Chi square tests identified significant differences among the groups (p < 0.05)., Results: The means and standard deviations (SD) of fracture loads in Newtons (N) for specimens in the F subgroups were RIB-DC: 465.0 (104.20), GFP-DC: 367.6 (79.59), DC: 275.8 (68.48), and in NF subgroups were RIB-DC: 110.8 (24.33), GFP-DC: 95.6 (25.47), DC: 67.4 (7.46). Specimens with ferrule yielded significantly higher fracture loads than those without ferrule (p = 0.0054). In the F groups, fracture loads of specimens with RIB-DC cores were significantly higher than those with GFP-DC (p = 0.0019) and those with DC (p = 0.0001). Moreover, fracture loads for the GFP-DC were significantly higher than those for the DC (p = 0.0026). The GFP-DC specimens showed the highest incidence of catastrophic failures (p = 0.0420)., Conclusions: Using fibre-reinforced composite (FRC) cores significantly increased fracture resistance in ETAT with ferrule. The failure modes repairable and possibly repairable were dominant in most specimens., Clinical Significance: When restoring ETAT with insufficient coronal tooth structure, preserving 2 mm of tooth structure ferrule and preparing cores with FRC can increase fracture resistance and reduce the incidence of non-repairable catastrophic fractures of teeth., Competing Interests: Declaration of competing interest This is to explicitly declare that the authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript (Post artificial aging effect of ferrule presence and core composite material on fracture resistance of endodontically treated anterior teeth restored with E.max crowns: an in vitro study)., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: To report the clinical results obtained with fixed short-span (single crowns [SCs] and fixed partial prostheses [FPPs]) implant-supported hybrid composite restorations fabricated through tilting stereolithography (TSLA)., Methods: This retrospective clinical study included 85 patients who had been restored with 95 fixed short-span implant-supported hybrid composite (Irix Max®, DWS Systems) restorations (70 SCs and 25 FPPs up to three units) fabricated with TSLA. The full-digital model-free workflow was based on intraoral implant scanning, computer-assisted design (CAD) and 3D printing using TSLA (Dfab®, DWS Systems). The primary outcomes were the marginal adaptation, the quality of the occlusal and interproximal contact points, and the chromatic integration of the restorations, assessed independently by two experienced operators (a prosthodontist and a periodontist). A score from 1 to 5 (with 5 as the highest value, 4 for satisfactory quality, 3 for acceptable quality, and 2 and 1 as the lowest values, expressing unsatisfactory quality) was assigned by each operator to each restoration at delivery. The secondary outcomes were the survival and success of the restorations at the 1-year follow-up. The restoration was defined as successful in the absence of any complications throughout the follow-up period. A statistical analysis was conducted., Results: For the quality of the marginal closure and occlusal and interproximal contact points, the 3D-printed hybrid composite restorations scored highly; the aesthetic integration was satisfactory. One year after placement, all restorations survived, with a low incidence (4.2 % overall, 5.7 % SCs) of complications (two abutment screw loosenings, two decementation of the restorations, and one upper portion of the hybrid abutment decemented from the titanium base), for a success rate of 95.8 %., Conclusions: Within the limits of this study (retrospective design, follow-up limited to 1 year from the delivery, and only cemented restorations included) fixed short-span implant-supported hybrid composite crowns and bridges fabricated through TSLA were clinically precise, presenting a low incidence of complications at 1 year., Statement of Clinical Relevance: The use of TSLA printing technology can open new perspectives for the treatment of small edentulous gaps with definitive implant-supported prosthetic restorations., Competing Interests: Declaration of competing interest The authors report no conflict of interest related to the present clinical study. The materials presented in the study belong to the authors, who have not received any grant or financial support for the preparation of the present research., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: The aim of the study was (a) to assess the effect of universal adhesives and tooth primers with novel touch-cure activators on the conversion of dual-cured resin composite luting agents (RLAs) polymerized under the self-curing mode, and (b) to investigate the source of the catalytic effect exerted by the activators., Materials and Methods: The materials selected were the adhesive RLAs Panavia V5/Tooth Primer (PV5/TP5), Variolink Esthetic DC/Adhese Universal DC (VLE/ADC), and the self-adhesive RLAs GCem ONE/AE Primer (GCO/AEP), RelyX Universal/Scotchbond Universal Plus (RXU/SUP) and Panavia SA Universal/Clearfil Universal Bond Quick (PSU/CUQ), the later serving as a control with an aryl-sulfinate activator. Coronal dentin specimens were prepared (n = 5/material), treated with the corresponding primers/adhesives (non-irradiated) and covered with a 100 μm-thick RLA layer (SC+A group). Three specimen series were additionally prepared (n = 3 × 5/material): A self-cured without the primers/adhesives (SC group), a dual-cured (20 s irradiation) with the corresponding primers/adhesives (DC+A group) and a dual-cured without primers/adhesives (DC group). All specimens were stored for 15 min (37 °C/dark/60 %RH). After demolding the degree of C = C conversion (DC%, top RLA surfaces) was measured by ATR-FTIR spectroscopy. The primer/adhesive liquids were further analyzed by ICP-MS and the microbrush tips of ADC by SEM-EDS., Results: The touch-cure activators increased the DC% in all self-cured RLAs but failed to reach the values of the corresponding dual-cured RLAs. The effect of the activators in dual-cured specimens was negligible. The ICP-MS analysis showed the presence of V (AEP, TP5, ADC) and Cu (SUP) transitional metals in the activators, with V been located at the free ends of ADC tip bristles. The V activators demonstrated the highest DC% improvement in self-cured specimens., Conclusion: The new touch-cure activators significantly increased the conversion of the self-cured RLAs. Therefore, this step should be considered as universally applicable and not selective, as currently proposed for the self-adhesive luting agents by the manufacturers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To investigate how postpolymerization time (PPT) and atmosphere (PPA) influence the surface properties, protein adsorption, and microbial adhesion of two types of additively manufactured (AM) resins used for definitive restorations., Methods: Two different types of commercially available AM resins for definitive restorations (UR and CR) were used to create disk-shaped specimens. These specimens were divided into eight groups based on resin type (UR and CR), PPT (standard or extended), and PPA (air or nitrogen). After postpolymerization, the surface roughness (R a and S a ) and surface free energy (SFE) of all specimens were measured. The study also evaluated protein adsorption, microbial attachment, and cytotoxicity. A non-parametric factorial analysis of variance with post-hoc analyses was conducted, using a significance level (α) of 0.05., Results: The R a and S a values for CR were higher than those for UR, regardless of PPT or PPA (P < 0.05). For UR, SFE was higher with extended PPT compared to standard PPT. CR had higher SFE than UR under standard PPT. The interaction between PPT and PPA had a significant effect on protein adsorption (P < 0.05). When PPT was standard, nitrogen significantly increased protein adsorption compared to air. The interaction between resin type and PPA, and between resin type and PPT, significantly affected microbial adhesion (P < 0.05). The changes in PPT or PPA did not affect the cytotoxicity of either AM resin., Conclusion: Surface properties, protein adsorption, and microbial attachment were influenced by the interactions among PPT, PPA, and resin type. These factors can have implications for resin-based definitive restorations., Clinical Significances: Clinicians should understand the impact of PPT and PPA on the surface properties of AM resins for definitive restorations, particularly regarding protein adsorption and microbial adhesion. Additionally, the type of AM resin (based on chemical composition) could affect its biological properties., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: This study aimed to evaluate the impact of photodynamic therapy (PDT) using two photosensitizers, methylene blue and indocyanine green, on the microtensile bond strength of a universal adhesive to caries-affected dentin., Methods: The occlusal enamel of 60 third molars was cut to expose the inner one-third of the dentin. Artificial caries were induced through a pH cycling process. The samples were divided into three groups: M (Methylene blue+ diode laser), I (Indocyanine green agents+ diode laser irradiation), and control. Each group was further divided into two subgroups according to the adhesive protocol (self-etch, total-etch). After restoring with Gradia composite resin, teeth were sectioned and exposed to 5000 thermal cycles. Microtensile bond strength was measured using a universal testing machine. The data were subjected to two- and one-way ANOVA and paired comparisons were performed by the Tamhane and Tukey tests., Results: The study found significant effects of the photosensitizer, etching pattern, and their interactions on the microtensile bond strength of composite resin to caries-affected dentin (P < 0.001). In the self-etching mode, PDT with indocyanine green exhibited significantly higher bond strength values compared to PDT with methylene blue (P = 0.001) and the control groups (P < 0.001). However, no significant differences were observed in the total-etch mode. (P = 0.54)., Conclusions: The etching mode played a more significant role in the bond strength when using the universal adhesive alongside PDT with methylene blue and indocyanine green. Employing two photosensitizers in PDT during the self-etch mode significantly increased the bond strength values., Competing Interests: Declaration of competing interest The authors declared that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: To evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up., Methods: Forty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used., Results: No significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05)., Conclusion: The clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations., Clinical Significance: The level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period., Methods: Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc)., Results: The follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03)., Conclusion: This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months., Clinical Significance: SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The color adjustment potential of resin composites depends on the specific characteristics of the surrounding structures. The authors evaluated the influence of cavity wall thickness on CIEDE2000 color adjustment potential (CAP 00 ) of single-shade composites using the CIEDE2000 color difference (ΔE 00 ) formula., Methods: Two types of specimens were produced: single, using Vittra APS color DA3 (FGM Dental), Vittra APS Unique (VU) (FGM Dental), and Omnichroma (Tokuyama Dental) composites; and dual, using Vittra APS color DA3, but with cavity wall thicknesses of 3, 2, or 1 mm, restored with VU or Omnichroma. CIEL∗a∗b∗ color coordinates were obtained from digital photographs of the specimens at different locations, and ΔE 00 and CAP 00 were calculated. Statistical analysis included 2-way analysis of variance, Kruskal-Wallis, Holm-Sidak, Student-Newman-Keuls, Wilcoxon signed rank, and paired t tests (α = 5%)., Results: Cavity walls 1-mm-thick had higher ΔE 00 values and lower CAP 00 values, particularly for VU (P < .05). Restorations matched better with the control at the periphery than the central area (P < .001). Overall ΔE 00 means exceeded the color perceptibility threshold (ie, 0.8) and the acceptability threshold (ie, 1.8). Color differences (between center of restoration and control composite) were moderately unacceptable for 3-mm and 2-mm thicknesses and extremely unacceptable for 1-mm thickness. Both composites had a ΔE 00 color shift predominately determined by means of the lightness difference. Positive CAP 00 values were found for VU and Omnichroma., Conclusions: Wall thickness, especially at 1 mm, negatively impacted the color of single- shade composites. This effect was more pronounced for VU, affecting mainly the restoration's central area., Practical Implications: Color matching ability depends on the structural and material characteristics, and clinicians should be attentive to these factors when using single-shade resin composites., Competing Interests: Disclosure Drs. Castro and Durand did not report any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The aim of this in vitro study was to evaluate the effect of the combinations of two different intraoral scanners (IOS), two milling machines, and two restorative materials on the marginal/internal fit and fatigue behavior of endocrowns produced by CAD-CAM. Eight groups (n= 10) were considered through the combination of TRIOS 3 (TR) or Primescan (PS) IOS; 4-axes (CR; CEREC MC XL) or 5-axes (PM; PrograMill PM7) milling machines; and lithium disilicate (LD; IPS e.max CAD) or resin composite (RC; Tetric CAD) restorative materials. Specific surface treatments were applied to each material, and the bonding to its corresponding Endocrown-shaped fiberglass-reinforced epoxy resin preparations was performed (Variolink Esthetic DC). Computed microtomography (μCT) was performed to assess the marginal/internal fit, as well as a mechanical fatigue test (20 Hz, initial load = 100 N/5000 cycles; step-size = 50 N/10,000 cycles until a threshold of 1500 N, then, the step-size was increased if needed to 100 N/10,000 cycles until failure or a threshold of 2800 N) to evaluate the restorations long-term behavior. Complementary analysis of the fracture features and surface topography in scanning electron microscopy was performed. Three-way ANOVA and Kaplan-Meier test (α = 0.05) were performed for marginal/internal fit, and fatigue behavior data, respectively. PS scanner, CR milling machine, and RC endocrowns resulted in a better marginal fit compared to their counterparts. Still, the PM machine resulted in a better pulpal space fit compared to the CR milling machine. Regardless of the scanner and milling machine, RC endocrowns exhibited superior fatigue behavior than LD ones. LD endocrowns presented margin chipping regardless of the milling machine used. Despite minor differences in terms of fit, the 'IOS' and 'milling machine' factors did not impair the fatigue behavior of endocrowns. Resin-composite restorations resulted in a higher survival rate compared to glass-ceramic ones, independently of the digital devices used in the workflow., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Dental erosion in patients with gastroesophageal reflux disease (GERD) is a current and frequent condition that may compromise the mechanical properties and clinical durability of resin-based composites (RBCs). This study assessed the mechanical properties of conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) RBCs subsequent to simulated gastric acid aging., Materials and Method: Three conventional and three CAD/CAM composites were assessed. They were divided into an experimental group (exposed to simulated gastric acid aging) and a control group (no aging). Both groups were analyzed for Vickers microhardness (VHN), wear and flexural strength over a period of six months. The failure rate probability for each RBC was calculated through the Weibull cumulative distribution function (m). Statistical analysis was conducted using repeated measures ANOVA, 3-way ANOVA, a non-parametric Kruskal-Wallis and U Mann-Whitney tests (α = 0.05)., Results: The mechanical properties of all the RBCs dropped significantly after aging (p < 0.05). Lower VHN and flexural strength values, along with greater wear values were evident in the experimental groups, though the effects of the treatment varied between RBCs. The Weibull m of all the RBCs decreased over time., Conclusion: Conventional RBCs might show greater reduction in mechanical properties compared to CAD/CAM RBCs when exposed to gastric acid attack. Thus, CAD/CAM composites may represent a suitable choice for the treatment of patients presenting erosive issues., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgment This study was also supported in part by a grant funded by Conselleria d'Innovació, Universitats, Ciència i Societat Digital - Generalitat Valenciana (CIAICO/2022/198)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: With increasing life expectancy and improved preventive measures, teeth are retained longer, leading to a rise in prevalence of root caries lesions (RCL). However, little is known about how dentists manage this condition. The present survey aimed to evaluate the knowledge of Swiss dentists on decision making and management of RCL., Method: The survey evaluated dentists' knowledge, clinical routines, and demographics concerning RCL. Dentists were contacted via email and local newsletters, and 383 dentists from 25 (out of 26) cantons responded. Mann-Whitney U test, χ 2 test, intraclass correlation coefficients, Spearman correlation and Chi Square were used., Results: The dentists had a mean(SD) working experience of 22.5(12) years. Most dentists correctly classified an inactive (67%) and an active (81%)RCL. Although the inactive lesion did not call for restorative treatments, 61% of the dentist declared they would restore it. From the active lesion,83% would restore it. The invasive treatments leaned toward complete caries excavation with composite resin as preferred restorative material. There were significant correlations between material choice and expected success rates. Among the non-invasive options, oral hygiene instructions and (highly-)fluoridated toothpaste were favored. Most dentists declared having a recall system for such patients, with biannual follow-ups preferred. The dentists' place of education significantly influenced restorative decisions (p < 0.001), while participants' age (≥60years) impacted activity status (p = 0.048) and restorative decisions (p = 0.02)., Conclusion: Material preferences for non-invasive or invasive management varied greatly and there were minimal differences in the management of inactive or an active RCL. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones., Clinical Significance: Despite diverse material preferences for (non-)invasive treatments, a strong positive correlation existed between the chosen restorative material and its expected 2-year success rate. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones. The outcome emphasis the need to align guideline recommendations with their application in private dental practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To investigate and compare the chemical and optical stability of four restorative composite materials: two injectable resins, one flowable resin and one compomer., Methods: Two injectable nano-filled composite resins: G-aenial Universal (GU) and Beautifil Injectable XSL (BI), a flowable composite resin: Filtek Supreme Flowable (FS) and a compomer: Dyract Flow (DF), in A2 shade were tested and compared. Water sorption and solubility were conducted according to ISO4049:2019 standard; ICP-OES and F-ion selective electrode were used to test the elemental release; Degree of conversion (DC) was obtained by using FTIR; water contact angle was obtained by static sessile drop method, and a spectrophotometer was used for optical properties (ΔE ⁎ , ΔL ⁎ and TP). SPSS 28.0 was used for statistical analysis and the significant level was pre-set as α = 0.05., Results: GU performed the best in water sorption and solubility, FS had the lowest elemental release, the best colour stability, and the highest DC IM and DC 24-h . DF, the compomer had the lowest, and GU and BI, the injectable composites had the largest water contact angle, respectively. Correlations were found between water sorption and water solubility., Conclusions: The four composite restorative materials showed different chemical and optical behaviours. Overall, composite resins performed better than compomer, while additional laboratory and in vivo tests are necessary to obtain a more comprehensive comparison between injectable and flowable composite resins. W sp and W sl are influenced by many common factors, and the values are highly positively related., Clinical Significance: A comprehensive understanding of materials is crucial before selecting materials for clinical practice. Composite resins rather than compomers are recommended because of their exceptional properties, which make them eligible for a wide range of clinical applications and an elongated lifespan., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study is partially funded, and the materials were provided, by GC Corporation., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types., Methods: Initially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure., Results and Discussion: The FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR). These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The strength of temporary restorations plays a vital role in full-mouth reconstruction, and it can be impacted by the aging process. The aim of this in vitro study was to evaluate the biaxial flexural strength and fractographic features of different resin-based materials submitted to thermal aging., Material and Methods: One hundred and ninety-two resin disc-shaped specimens (6.5 mm in diameter and 0.5 mm in thickness) were fabricated and divided into six experimental groups according to the resin-based materials (Filtek Bulk-Fill flowable resin; J-Temp temporary resin; and Fuji Lining glass ionomer cement) and aging process (before and after thermal cycling). Biaxial flexural strength test was performed using a universal testing machine at a crosshead speed of 0.5 mm/min before and after thermal cycling (5 °C and 55 °C, 5760 cycles, 30 s). The mechanical properties were assessed using Weibull parameters (characteristic strength and Weibull modulus) (n = 30). Fractured specimens were examined under a polarized light stereomicroscope to identify crack origin and propagation direction. The surface microstructure of the resin-based materials was assessed by scanning electron microscopy (n = 2). The Weibull modulus (m), characteristic strength, and reliability properties were calculated, and a contour plot was used to detect differences among groups (95% confidence interval)., Results: The Weibull modulus (m), characteristic strength, and reliability of the resin-based compounds were influenced by material type and thermal aging (p < 0.05). Weibull modulus (m) revealed no differences when comparing the materials and aging process (p > 0.05), except for the preceding aging period where Filtek Bulk-Fill exhibited higher values compared to J-Temp (p < 0.05). Filtek Bulk-Fill demonstrated superior characteristic strength and reliability compared to J-Temp and Fuji Lining before and after thermal cycling (p < 0.05). Fractography of the resin-based materials showed fractures originating from surface defects exposed to tensile side and their propagation toward the compressive side. Generally, no differences in surface microstructure were observed on micrographs before and after thermal aging for Filtek Bulk-Fill and Fuji Lining. However, the aging process developed flaws in J-Temp., Conclusion: Resin-based material composition resulted in different flexural strength performance, impacting the Weibull modulus (m), characteristic strength, and reliability of the resin-based restorations., Competing Interests: Declaration of competing interest The authors have stated explicitly that there are no conflicts of interest in connection with this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the mechanical, wear, antibacterial properties, and biocompatibility of injectable composite materials., Methods: Two injectable composite resins (GU and BI), one flowable composite resin (FS), and one flowable compomer (DF), in A2 shade, were tested. Mechanical properties were tested via three-point bending test immediately after preparation and after 1-day, 7-day, 14-day, and 30-day water storage. Under water-PMMA slurry immersion, specimens were subjected to a 3-body wear test (10,000 cycles) against stainless steel balls, while the roughness, wear depth, and volume loss were recorded. After 1-day and 3-day MC3T3-E1 cell culture, cell viability was evaluated with CCK-8 test kits, while the cell morphology was observed under CLSM and SEM. Antibacterial properties on S. mutans were assessed via CFU counting, CLSM, and SEM observation. SPSS 26.0 was used for statistical analysis (α = 0.05)., Results: The mechanical properties were material-dependent and sensitive to water storage. Flexural strength ranked GU > FS > BI > DF at all testing levels. Three nanocomposites had better wear properties than DF. No significant difference on 1-day cell viability was found, but DF showed significantly lower cell proliferation than nanocomposites on 3-day assessment. GU and FS had more favourable cell adhesion and morphology. CFU counting revealed no significant difference, while FS presented a slightly thicker biofilm and BI showed relatively lower bacteria density., Conclusions: Injectable nanocomposites outperformed the compomer regarding mechanical properties, wear resistance, and biocompatibility. The tested materials presented comparable antibacterial behaviours. Flowable resin-based composites' performances are affected by multiple factors, and their compositions can be attributed., Clinical Significance: A profound understanding of the mechanical, wear, and biological properties of the restorative material is imperative for the clinical success of dental restorations. The current study demonstrated superior properties of highly filled injectable composite resins, which imply their wider indications and better long-term clinical performances., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study is partially funded, with the materials supported, by GC Corporation., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: This study used optical coherence tomography (OCT) to observe real-time internal gap formation in both bulk-fill and conventional resin composites. It aimed to provide a quantitative analysis of variations, addressing the inconclusive nature of microleakage assessment caused by differences in testing methods., Methods: Fifty extracted third molars prepared with Class I cavities, were divided into five groups (n = 10). Conventional resin Filtek Z350 XT (FZX) was applied with a double-layer filling of 2 mm per layer. Bulk-fill resins X-tra fil (XTF), Filtek Bulk Fill Posterior Restorative (FBP), Surefil SDR Flow + (SDR), and Filtek Flowable Restorative (FFR) were applied with a single-layer filling of 4 mm. Real-time OCT imaging was conducted during light curing. Post-curing, the entire sample was OCT-scanned. Following this, ImageJ software was used to measure the gap (G1 %). Subsequently, thermal cycling (TC) (5000 times, 5 °C-55 °C) was applied, followed by OCT scanning to calculate the gap (G2 %) and ΔG%. Data were analyzed using two-way repeated measures ANOVA, Kruskal-Wallis test, and Duncan's test (α=0.05)., Results: There was no significant difference in G1 % among the groups (p > 0.05). Following TC, FZX exhibited the highest G2 %, succeeded by FFR, FBP, XTF, and SDR, with SDR demonstrating the lowest G2 % (p < 0.05). FZX showed the highest ΔG% (p < 0.05), while SDR exhibited the lowest ΔG% (p < 0.05)., Conclusion: OCT proves to be a promising tool for detecting microleakage. TC exerted a more significant negative impact on conventional resin. Surefil SDR Flow + displayed the least microleakage, both before and after TC., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material., Methods: The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials., Results: A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065)., Conclusions: Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists., Clinical Significance: Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)