Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Operative dentistry
Color Match of Single-Shade and Group-Shade Resin Composites: A Visual and Instrumental Analysis
OBJECTIVE: Single-shade materials are favored for simplifying clinical workflows without compromising the esthetics of restorations, although evidence supporting their use remains limited. Therefore, this laboratory evaluated color match of single-shade versus group-shade resin composites. METHODS: Sixty sound human molars were divided into three subgroups (n = 20), based on the tooth-shade correspondence for the tested group-shade resin composite: L (light) including A1, B1, B2, C1 and D2; M (medium) including A2, A3, C2, D3 and D4, and D (dark) including A3.5, A4, B3, B4, C3 and C4 shaded teeth. Standardized class V cavities (4 × 4 × 2 mm) were prepared. Half of the specimens within each subgroup were restored with single-shade (Omnichroma), while the other half was restored with group-shade resin composite (SimpliShade). Tooth/restoration ΔE00 color differences were calculated at 24 hours (T1), and after seven days (T2) by a spectrophotometer (VITA Easyshade V). A visual analysis was performed after 14 days (T3). Also, a novel computer vision algorithm (CVA) analysis, was employed to evaluate color match at three weeks (T4). Student's t-test was used to compare the two groups within each subgroup and time point and one-way ANOVA was used to compare the values between subgroups, within each group and time point. RESULTS: Instrumental analysis at T1 showed higher mean ΔE00 for single-shade compared to group-shade resin composites (p < 0.05), within each subgroup. Within single-shade specimens, significantly higher mean ΔE00 differences were found at T2 between D (8.24 ± 1.85) vs L (5.65 ± 2.24) (p = 0.007) and M (6.49 ± 2.5) (p = 0.03). Within group-shade specimens, a significant difference was found between L (4.16 ± 2.19) and M (2.17 ± 1.05) at T1 (p = 0.034). Visual analysis reported a significant difference (p = 0.0153) between L-group shade (1.03 ± 1.04) and L-single shade (1.97 ± 0.78) restorations (p = 0.0153). No significant differences were detected when CVA analysis was employed. CONCLUSIONS: Overall, group-shade showed better color match than single-shade resin composites, especially when spectrophotometric and visual evaluation were employed.
11 June 2026
Read appraisal →JMIR formative research
Feasibility of Large Language Model-Based Standardized Virtual Patients to Support Clinical Decision-Making Training in Operative Dentistry: Mixed Methods Study
BACKGROUND: Clinical decision-making training in operative dentistry commonly relies on real or standardized patients to develop undergraduate students' ability to deliver safe, effective, and patient-centered care. However, training with real or standardized patients can be limited in scalability, cost-effectiveness, and accessibility. Large language models, with their human-like language capabilities, may have the potential to simulate patients in clinical encounters and help overcome some limitations associated with traditional training approaches. OBJECTIVE: This study aimed to evaluate the feasibility of using large language model-based standardized virtual patients to support undergraduate dental students' clinical decision-making training in operative dentistry. METHODS: This mixed methods cross-sectional feasibility study was conducted during a simulation-based clinical decision-making training session in the Operative Dentistry and Cariology course at the College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Eligible participants were second-year undergraduate dental students enrolled in the course. A convenience sampling approach was used, with all eligible students (N=50) invited to participate. A total of 41 students completed the study, 23 (56%) of whom were male. The students were divided into 8 groups. Each group interacted with 2 standardized virtual patients powered by ChatGPT-4o (OpenAI) through the Chatbase platform to complete comprehensive history-taking and then reviewed the standardized virtual patients' intraoral photographs and bitewing radiographs. For each standardized virtual patient, students as a group recorded diagnoses, performed a risk assessment, and formulated a treatment plan. Students then completed the Student Satisfaction and Self-Confidence in Learning questionnaire. The quality of the standardized virtual patient responses and overall dialogue realism were evaluated using the Dialogue Authenticity Scale. The dialogues were also thematically analyzed to identify authenticity-undermining response features and explore their context and underlying causes. RESULTS: Students perceived the simulation-based training session positively, with all questionnaire items showing high median scores (4.00-5.00 on a 5-point scale), and both item-level IQRs and 95% CIs spanning no more than 1.0 scale point. In addition, standardized virtual patient responses were largely authentic, with an overall median authenticity rating of 4.50 (IQR 4.00-5.00; 95% CI 4.00-5.00) on a 6-point scale across all interactions. However, several authenticity-undermining response features were identified, including responses that were inconsistent with typical human behavior, contained information beyond a patient's likely knowledge, or were factually incorrect. CONCLUSIONS: This proof-of-concept study supports the feasibility of implementing large language model-based standardized virtual patients in undergraduate simulation-based clinical decision-making training in operative dentistry. In a dental context where this application has been only minimally evaluated, this study provides early evidence of positive student perceptions, acceptability, and largely authentic dialogue, while also identifying important performance limitations. Further research is warranted to optimize performance and to evaluate the educational effectiveness of this approach in improving undergraduate students' clinical skills and knowledge.
20 May 2026
Read appraisal →Clinical oral investigations
Clinical performance of alkasite and glass-hybrid restorations compared with resin composite in class II cavities: a randomized clinical trial
OBJECTIVES: The aim of this randomized clinical trial was to evaluate the 18-month clinical performance of alkasite and glass-hybrid restorations compared with resin composite in Class II restorations. MATERIALS AND METHODS: A total of 50 patients requiring at least three Class II restorations in premolar and molar teeth were recruited. Each patient received three restorations, which were randomly assigned to one of the following materials: an alkasite (Cention N, Ivoclar Vivadent), a glass-hybrid (Equia Forte HT, GC Corp.), or a resin composite (Gradia Direct Posterior, GC Corp.). Alkasite and glass-hybrid served as test groups while resin composite served as the control group. During the 18-month follow-up, restorations were scored at baseline, 6, 12, and 18 months using the FDI criteria. Data were analyzed using the Chi-square and Cochran's Q tests (α = 0.05). RESULTS: No significant differences were detected among the groups for esthetic, functional, or biological criteria over 18 months (p > 0.05). Regarding esthetic properties, the control group showed 100% success for all esthetic criteria at all recall visits, while the alkasite group maintained a 96% success rate at all time points, and glass-hybrid showed 98% success at 6 and 12 months and 92% at 18 months. Minor score-2 changes in color match and gloss were detected in the glass-hybrid and alkasite groups but were not significant (p > 0.05). For functional and biological outcomes, all groups achieved 100% success rates for all evaluated parameters. CONCLUSIONS: Alkasite and glass-hybrid groups exhibited clinical performance comparable to resin composite over the 18-month follow-up in Class II cavities. All materials demonstrated excellent functional and biological stability while achieving clinically acceptable aesthetic results.
10 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Influence of Operative Techniques on Clinical and Laboratory Outcomes in Class II Resin-Based Composite Restorations: A Systematic Review
BACKGROUND Operative technique is a major determinant of the long-term success of Class II resin-based composite restorations. Variations in adhesive strategy, layering approach, matrix system, and curing protocol influence marginal integrity, polymerization stress, postoperative sensitivity, and secondary caries. Because resin-based composite placement is technique-sensitive, synthesizing evidence on how specific operative steps affect outcomes is essential. This systematic review evaluated the influence of operative techniques on the clinical and laboratory performance of Class II resin-based composite restorations. MATERIAL AND METHODS A comprehensive search of PubMed, Cochrane Library, and Embase identified 57 records. After duplicate removal and screening, 21 studies were included (11 randomized controlled trials and 10 in vitro investigations). Techniques assessed were adhesive protocols, layering strategies, matrix systems, and curing methods. Data extraction focused on restoration longevity, marginal adaptation, postoperative sensitivity, and secondary caries. Risk of bias was evaluated using the Cochrane tool for randomized trials and modified CONSORT/Joanna Briggs Institute criteria for in vitro studies. Meta-analysis was not feasible because of heterogeneity. RESULTS Multi-step adhesive approaches showed the highest 5-year survival (up to 91%) and lower secondary caries rates. Incremental layering reduced postoperative sensitivity and improved marginal adaptation. Sectional matrices produced tighter proximal contacts (76% vs 42%), while soft-start curing reduced marginal gap formation (112 µm to 45 µm). One-step adhesives and uncontrolled bulk-fill placement showed higher failure and hypersensitivity. CONCLUSIONS Multi-step adhesives, incremental layering, sectional matrices, and soft-start curing provide the most favorable outcomes and support technique standardization in clinical practice.
1 May 2026
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