Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 14 appraisals
Journal of prosthodontic research
Peri-implant soft-tissue responses to tooth-colored abutment materials: A systematic review.
PURPOSE: This systematic review aimed to investigate and compare peri-implant soft-tissue responses to tooth-colored abutment materials frequently used in implant dentistry. STUDY SELECTION: A comprehensive electronic search was performed in three databases (MEDLINE via PubMed, Google Scholar, and Scopus) to identify relevant literature. The study-selection criteria included original research articles written in English that investigated the effects of various tooth-colored abutment materials on peri-implant soft-tissue responses. RESULTS: In total, 136 articles were included in this systematic review. Tooth-colored abutment materials, particularly zirconia and polyetheretherketone (PEEK), facilitated favorable soft-tissue adaptation, enhanced esthetics, and contributed to long-term implant success. Zirconia demonstrated excellent biocompatibility, enhanced cell viability and attachment, and lower inflammatory responses compared to titanium, suggesting improved soft-tissue integration and reduced biofilm-related risks. PEEK exhibited favorable mechanical properties and biocompatibility but limited cell attachment due to its hydrophobicity, indicating the need for surface modification. Titanium remains the clinical standard for integration but is associated with greater inflammation and biofilm formation than tooth-colored materials. CONCLUSIONS: This review highlights the effects of tooth-colored abutment materials on peri-implant soft-tissue responses and emphasizes the importance of selecting appropriate materials for successful dental implants. Zirconia represents a promising biological alternative to titanium, promoting a stable soft-tissue barrier that contributes to minimizing inflammation and maintaining long-term tissue health. Conversely, while PEEK offers strong mechanical properties, it faces challenges regarding cell proliferation and matrix production, limiting its optimal biological performance. Further research will provide deeper insights into the best options for enhancing patient and esthetic outcomes.
14 July 2026
Read appraisal →BMC oral health
Accuracy of virtual facebow compared to conventional facebow: a systematic review
BACKGROUND: Digital technologies are rapidly evolving and have been introduced across many fields in dentistry, particularly prosthetic and restorative dentistry. In digital treatment planning, virtual articulators are helpful in simulating complex maxillomandibular movements and analyzing occlusion. Despite these advancements, evidence-based literature standardizing the transfer of clinical data to virtual environments remains limited. The aim of this review was to explore the accuracy of various methods in transferring maxillary digital models to virtual articulators compared with conventional facebow techniques. METHODS: The research (PICO) question focused on assessing the accuracy of virtual facebow transfer compared to that of conventional facebows. An electronic search was performed in 3 databases between January 2014 to December 2025: PubMed/MEDLINE, Scopus, and Web of Science. Eligibility criteria included in vitro studies, clinical trials, case reports, clinical reports, and clinical techniques that evaluated the accuracy of virtual articulation in fixed prosthodontics for dentate patients, published in English. Studies were excluded if they were not in English, involved orthognathic surgery, focused on edentulous patients, or were published before 2014. A comprehensive search was conducted in December 2025. Two reviewers (PE, HA) independently examined the identified papers in accordance with the predetermined qualifying criteria. For each included study, publication details, study characteristics, and methodological aspects were documented. RESULTS: The total number of articles retrieved was 1,916. Of these articles, 10 met the inclusion criteria and were used for qualitative synthesis. Several techniques were reported for transferring the maxillary model to virtual articulator, such as digital photographs, face scans with or without intraoral or extraoral scan body, smartphone applications, digital photographs using Kois glasses, CBCT, and stereophotogrammetry. Most studies showed comparable accuracy of different digital methods that transfer the maxillary cast to the articulator. However, one study showed that the photography-based method demonstrated superior trueness and precision compared to both facial scanning and the conventional facebow technique. Another study found that the accuracy of positioning a maxillary digital scan relative to a 3D facial scan using a virtual facebow technique is highly dependent on the facial scanning method employed. CONCLUSIONS: Virtual facebow transfer can be recorded using techniques such as digital photographs, face scans, virtual facebow software, and smartphone scanning. Virtual facebow systems demonstrate promising repeatability and clinically acceptable transfer accuracy in selected workflows; however, due to heterogeneity among available studies, definitive conclusions regarding any improvement over conventional techniques cannot yet be drawn. Further standardized in vitro and clinical studies with large sample sizes, standardized assessments, and comparison methods are needed to draw meaningful conclusions in order to prove precedence of one method over the other. However, the use of a device to facilitate the transfer of a virtual maxillary cast to a virtual articulator has been promising.
13 July 2026
Read appraisal →The Journal of prosthetic dentistry
A simulation-based study of 3D printing angle optimization by integrating deep learning and NSGA-III for prosthesis and retainer manufacturing
STATEMENT OF PROBLEM: Current dental 3-dimensional (3D) printing workflows lack automated tools for optimizing build orientations that preserve critical clinical surfaces. Existing slicing software programs often require manual adjustment and may place supports in functional areas. PURPOSE: The purpose of this simulation-based study was to develop and evaluate a computational framework by integrating deep learning and Non-dominated Sorting Genetic Algorithm III (NSGA-III) to optimize build orientations for dental crowns and retainers by minimizing the support area (SA) and printing height (PH). A secondary objective was to assess the effects of angular resolution and mesh simplification on optimization outcomes. MATERIAL AND METHODS: A 3-stage framework was developed using PointNet++ for cast classification, MeshSegNet for feature recognition, and NSGA-III for dual-objective optimization. Mesh simplification was applied to enhance computational efficiency. Twenty-four dental casts were tested in a repeated-measures design at 1, 5, and 10 degrees angular resolutions. Nonparametric statistical analyses were performed using the Friedman test (α=.05) with post hoc Wilcoxon signed-rank tests and Bonferroni correction. RESULTS: Mesh simplified reduced computation time by 87.0% without altering optimal orientation distributions. Reduced angular resolution significantly affected PH and SA outcomes under most conditions (P<.001), except for SA in the PH-optimized group (P=.004). Post hoc analysis confirmed the largest degradation in accuracy between 1 and 10 degrees. Compared with commercially available software programs, the proposed framework consistently avoided the placement of supports on critical surfaces. CONCLUSIONS: The proposed framework provides an automated and efficient approach to optimizing build orientations in dental 3D printing. Although simulation results demonstrated improved optimization performance, further experimental validation is required before clinical application.
2 July 2026
Read appraisal →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 →Clinical oral investigations
Effectiveness of BRIX3000 for chemo-mechanical caries removal: a systematic review and meta-analysis of time and pain outcomes
AIMS: This systematic review was conducted to critically assess and statistically synthesise data from all available clinical studies on this topic. This study focused on the efficacy and safety of this agent (BRIX3000), the time required for caries removal, and the pain experienced by patients during the procedure, to provide clinicians and researchers with clear evidence on whether BRIX3000 is genuinely effective. MATERIALS AND METHODS: Electronic literature searches were performed using PubMed, Scopus, and Web of Science to collect eligible randomised clinical trials that had evidence regarding the efficacy of BRIX3000 for chemo-mechanical caries removal in comparison with the conventional rotary instruments and other atraumatic restorative treatment (ART) methods. The selected studies included children and adults of both sexes, with no age or gender preference, who had dentinal carious lesions in primary or permanent teeth without pulpal involvement. RESULTS: Nine randomised trials (eight in paediatric and one in adult populations) were included. Pooled analyses indicated that BRIX3000 was associated with a longer mean caries removal time than control techniques (MD 4.58 min, 95% CI 2.45 to 6.70; p < 0.0001; I² = 96%) and with lower pain scores on the Wong-Baker FACES scale among paediatric patients (MD - 2.50, 95% CI - 4.37 to - 0.62; p = 0.009; I² = 92%). Complete caries removal did not differ significantly between groups in either the paediatric (OR 0.45, 95% CI 0.02 to 8.34; p = 0.59) or adult (OR 0.73, 95% CI 0.15 to 3.49; p = 0.69) subgroup. All pooled estimates exhibited substantial heterogeneity, and the adult evidence comprised only two trials. Most included studies were judged to be at low overall risk of bias on the RoB 2 tool. CONCLUSION: Within the limits of substantial heterogeneity, short follow-up, and a small adult evidence base, BRIX3000 may represent a useful chemo-mechanical alternative - particularly in paediatric and anxiety-prone patients - at the cost of a modest increase in procedural time. Adequately powered trials with longer follow-up are required to confirm these preliminary findings. CLINICAL RELEVANCE: Our results indicate that BRIX3000 can be a viable option for patients with extensive fear of conventional methods, as well as for the paediatric population.
7 June 2026
Read appraisal →The International journal of prosthodontics
Accuracy of Stereophotogrammetry in Implant Scanning Compared to Intraoral Scanning in Completely Edentulous Patients-A Systematic Review and Meta-analysis
PURPOSE: To evaluate the accuracy of full-arch implant impressions by comparing photogrammetry and intraoral scanning (IOS) techniques through a systematic review and meta-analysis following the Cochrane protocol. MATERIALS AND METHODS: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science up to May 2024. Keywords based on the PICO question were used without time or language restrictions. In vitro studies assessing full-arch implant rehabilitations that compared photogrammetry to IOS were included. The risk of bias was assessed using the Quin Tool Method. Data were analyzed through metaanalysis in RevMan (Cochrane), grouping the results into three subgroups: angle deviation, precision (μm), and trueness (μm). RESULTS: The search yielded 6,348 studies: 11 met the eligibility criteria, and 7 provided sufficient data for quantitative meta-analysis. Photogrammetry demonstrated superior precision, with a mean difference (MD) of -0.03 (95% CI: -0.04, -0.02) and a high weight of 94.2%, indicating consistent evidence. The results for angle deviation were MD = -0.12 (95% CI: -0.16, -0.08, P < .00001), and for trueness the results were MD = -0.16 (95% CI: -0.19, -0.13, P < .00001). The photogrammetry group also showed favorable results. Although trueness exhibited expressive MD values, it had a lower overall weight (5.8%). CONCLUSIONS: Within the limitations of this study, photogrammetry significantly improves the accuracy of fullarch implant rehabilitations compared to IOS. These findings support the adoption of photogrammetry for more accurate and consistent outcomes in dental implant procedures.
28 May 2026
Read appraisal →The International journal of prosthodontics
A Systematic Review and Meta-analysis Evaluating the Survival, Failure, and Complication Rates of Metal-Ceramic, Veneered, and Monolithic All-Ceramic Tooth-Supported Single Crowns-Part 1
PURPOSE: To evaluate five-year survival rates of metal-ceramic, veneered all-ceramic, and monolithic all-ceramic tooth-supported single crowns (SCs) and assess biological and technical complications. MATERIALS AND METHODS: A systematic search of Medline (PubMed), Embase, and CENTRAL (2014-2024) identified clinical studies on tooth-supported fixed dental prostheses (≥3 years mean follow-up). Manual screening and 30 studies from previous reviews were added. Sixty-four studies met inclusion, reporting on 3,509 metal-ceramic and 8,051 all-ceramic SCs. Robust Poisson regression models were used to estimate pooled five-year survival rates. RESULTS: Twelve studies investigated metal-ceramic crowns, 49 all-ceramic crowns, and three both. Five-year survival rates were: 98.5% for monolithic lithium-disilicate reinforced glass-ceramic, 97.3% for veneered densely-sintered zirconia, 97.1% for metal-ceramic, 96.8% for monolithic densely-sintered zirconia, 95.7% for veneered leucite/lithium-disilicate reinforced glass-ceramic, 94.5% for densely-sintered alumina, 94.3% for glass-infiltrated alumina, 90.4% for feldspathic/silica-based ceramic. Survival rates of feldspathic/silica-based ceramic (P<0.0001), glass-infiltrated alumina (P=0.019), densely sintered alumina (P=0.002), and veneered leucite/lithium-disilicate reinforced glass-ceramic (P=0.021) were significantly lower than monolithic lithium-disilicate SCs. Except for feldspathic/silica-based ceramic and metal-ceramic crowns, material/design types performed similarly in anterior and posterior regions. Monolithic lithium-disilicate and monolithic zirconia crowns showed significantly fewer ceramic fractures and chipping compared to veneered alternatives. CONCLUSIONS: Lithium-disilicate and zirconia-based all-ceramic SCs achieve five-year survival rates comparable to metal-ceramic crowns. Monolithic designs reduce fracture and chipping risk, improving long-term clinical outcomes.
28 May 2026
Read appraisal →Clinical oral investigations
Treatment of gingival recession type 1 using coronally advanced flap with leucocytes-platelet rich fibrin: a randomized controlled trial
OBJECTIVE: This study aimed to evaluate the clinical outcomes of gingival recession Type 1 (RT1) treatment using a coronally advanced flap (CAF) alone and in combination with L-PRF at 6 months. MATERIALS AND METHODS: A total of 70 RT1 from 19 patients were included. Participants were randomly assigned to the test group (TG, CAF + L-PRF, n = 42) and the control group (CG) (CAF alone, n = 28). Clinical parameters were assessed at baseline and at 6 months: the primary outcomes were percentage of root coverage (%RC) and complete root coverage (CRC); and the secondary outcomes included mean root coverage (MRC), changes in gingival thickness (GT) and volumetric tissue gain, recession area reduction, analgesic consumption, healing quality (the Inflammatory Proliferative Remodeling [IPR] score), and patient-reported outcome measures (PROMs). Statistical analyses were performed to determine differences between groups; a random-intercept mixed-effects model was used for all site-level outcomes. RESULTS: At six months, %RC was 89.30% ± 20.33% (TG) and 81.60% ± 27.93% (CG) (p > 0.05). For the TG and CG, respectively, %CRC was 73.81% and 57.14%; the mean GT gain was 0.16 ± 0.10 mm and 0.11 ± 0.10 mm (p = 0.08); the mean volume gain was 1.13 ± 1.25 mm3 and 0.86 ± 0.84 mm3 (p = 0.32); the mean number of pills taken was 1.67 ± 0.98 and 2.25 ± 1.02 (p = 0.04); the esthetic satisfaction was 95% ± 5% and 90% ± 7% (p = 0.31); willingness to undergo the procedure again: 93% ± 4% and 88% ± 6% (p = 0.22); sensitivity reduction: 85% ± 6% and 80% ± 8% (p = 0.19). There was no statistically significant difference in healing quality and PROMs. CONCLUSION: Both CAF alone and CAF combined with L-PRF yielded comparable clinical and volumetric outcomes in RT1 treatments. No statistically significant advantages were observed with the adjunctive use of L-PRF. CLINICAL RELEVANCE: Because CAF alone achieves high predictability for RT1 defects, the routine adjunctive use of L-PRF provides limited additional clinical benefits.
11 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
Read appraisal →Journal of prosthodontic research
Flexural strength of translucent zirconia for single crowns and fixed dental prostheses-A systematic review
PURPOSE: The aim of this systematic review was to analyze the reported flexural strength values of commercially available translucent zirconia materials. Additionally, data were evaluated to assess the impact of different specimen preparations and test methods. STUDY SELECTION: This systematic review was conducted according to the PRISMA guidelines. Electronic searches were performed to identify in vitro studies published between January 1, 2013, and March 15, 2025, that reported flexural strength values of translucent zirconia and included the names of the tested materials and manufacturers. Flexural strength values were analyzed to assess the effects of yttria content, specimen processing, surface treatments, and test methods using Kruskal-Wallis analysis of variance (α = 0.05) and forest plots. RESULTS: A total of 78 laboratory studies met the inclusion criteria. The overall flexural strength values were significantly higher for 4Y-PSZ (803± 233 MPa) than for 5Y-PSZ materials (570 ± 116 MPa) (P = 0.005). Specimen processing, surface treatments, and test methods significantly affected the flexural strength values for 5Y-PSZ (P < 0.001) but not for 4Y-PSZ (P > 0.05). CONCLUSIONS: This systematic review highlights the challenges in comparing the flexural strength values of translucent zirconia owing to differences in processing parameters. Further standardization of test methods and adherence to ISO 6872 would improve comparability. Our findings support the clinical use of 4Y-PSZ for three-unit fixed dental prostheses (FDPs) and 5Y-PSZ for three-unit FDPs in the anterior region based on ISO 6872.
13 Apr 2026
Read appraisal →Journal of prosthodontic research
Clinical performance, accuracy, and physical-mechanical properties of 3D-printed removable partial denture metal frameworks compared with conventionally and partially digitally produced frameworks: A systematic review.
PURPOSE: This systematic review evaluated the clinical performance, physical-mechanical properties, and accuracy of removable partial denture (RPD) frameworks fabricated using three-dimensional (3D) printing technologies-specifically, selective laser sintering (SLS), selective laser melting (SLM), and direct metal laser sintering (DMLS)-compared to those produced by conventional casting or methods using a partial digital workflow. STUDY SELECTION: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a literature search was conducted in the PubMed, Scopus, Web of Science, and Cochrane databases in October 2024. Studies were included if they compared the fit, accuracy, mechanical and physical properties, and clinical outcomes of metal RPD frameworks made using 3D printing technologies with those produced using conventional casting or partial digital methods. The risk of bias was assessed using appropriate tools (modified CONSORT, ROB2, and ROBINS-I) based on the study design and a qualitative analysis was conducted. This study received no funding and was registered with PROSPERO (#CRD42024597225). RESULTS: Thirty studies were included: 12 compared 3D printing technologies with conventional casting, eight with partial digital methods, and 10 with both. Clinically, 3D-printed frameworks could improve retention and patient satisfaction. The laboratory results showed higher density, better mechanical properties (yield strength, surface roughness, and microhardness), and varied accuracy by component and method, with SLM and DMLS often outperforming conventional casting. The evidence was limited by methodological variability, a moderate risk of bias in many studies, and inconsistencies across the study designs and parameters. CONCLUSIONS: 3D-printed RPD metal frameworks demonstrated clinical accuracy and mechanical-physical performance comparable or superior to those of conventional and partially digital methods for RPD frameworks, with ongoing advances expected to further enhance their precision and clinical applicability.
13 Apr 2026
Read appraisal →Journal of prosthodontic research
The clinical performance of CAD/CAM-fabricated hybrid ceramic restorations in cases with severe wear: A 3-year clinical trial
PURPOSE: To evaluate the clinical use of CAD/CAM hybrid ceramics in patients with severe tooth wear. METHODS: Forty-nine patients with severe tooth wear underwent prosthetic management with 116 hybrid ceramic restorations. The restorations were evaluated at 1 week and at 3, 6, 12, 18, 24, 30, and 36 months after placement. The amount of wear on the restorations, antagonist teeth, and opposite teeth was compared using digital superimposition analysis. A questionnaire was used to evaluate participants' satisfaction with the restorations. Complications were recorded, and survival rates were estimated using Kaplan-Meier analysis. RESULTS: The clinical performance of the restorations was stable for esthetic, functional, and biological parameters up to 3 years, except for greater changes in "surface and margin staining" and "fracture and retention." There was no significant difference in the amount of progressive wear among the restorations, antagonist teeth, and opposite side teeth until 18 months; however, the wear on the restorations increased gradually up to 36 months. Higher scores and identical satisfaction results were obtained for the chewing efficiency and cleanability during the observation period. The most common complications were restoration dislodgement (5.2%) and partial marginal chipping (4.3%), which were clinically repaired. Four restorations (3.4%) were extensively fractured and replaced. The estimated survival rate of the hybrid ceramic restorations at 3 years was 88.0%. CONCLUSIONS: The clinical use of hybrid ceramic restorations in patients with severe tooth wear improved chewing efficiency and esthetics, provided adequate resistance for load-bearing, and delivered a stable treatment outcome after functional use.
13 Apr 2026
Read appraisal →Journal of prosthodontic research
Cleaning methods of contaminated lithium disilicate ceramics: A systematic review and network meta-analysis
PURPOSE: To evaluate the effects of various cleaning methods on the bond strength between lithium disilicate (LS2) ceramics and resin cement under short- and long-term aging conditions using network meta-analysis (NMA) and pairwise meta-analysis (PMA). STUDY SELECTION: An electronic search of seven databases (PubMed, Scopus, Embase, Web of Science, Google Scholar, Defense Technical Information Center, and LILACS) with a manual search of the reference lists was conducted for articles published up to March 10, 2025. Eligible studies included those that assessed the bond strength of LS2, either uncontaminated or contaminated with human saliva, fit-checking materials, try-in paste, or their combinations, using different cleaning methods. Risk of bias was evaluated using the RoBDEMAT tool. A frequentist multivariable random-effects model was used to calculate the effect sizes. RESULTS: Fifteen studies met the inclusion criteria. Under short-term aging conditions, NMA showed higher bond strengths in the uncontaminated LS2 group and the contaminated groups cleaned with hydrofluoric acid etching, commercial ceramic cleaning agents, or phosphoric acid etching than those uncleaned or cleaned with water or alcohol. In long-term aging, PMA and NMA exhibited higher bond strengths in the uncontaminated LS2 group and contaminated group cleaned with phosphoric acid etching than those contaminated groups cleaned with water or alcohol. CONCLUSIONS: Phosphoric acid etching effectively eliminates contaminants, whereas the application of water or alcohol is ineffective. Although ceramic cleaning agents effectively decontaminate surfaces under short-term aging conditions, their performance deteriorates over time, potentially compromising long-term bond durability.
13 Apr 2026
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