Nayely Jimena Teran Sanchez

Background: Freehand direct composite resin veneers offer a minimally invasive approach for managing aesthetic alterations in anterior teeth; however, their long-term colour alteration and surface performance remain uncertain. This systematic review evaluated colour alteration, marginal discolouration, and surface-quality deterioration after at least 24 months of clinical service. Methods: MEDLINE/PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched. Randomised and non-randomised trials and longitudinal clinical studies evaluating freehand direct anterior composite restorations were eligible. Risk of bias was assessed using RoB 2 and the JBI cohort checklist. Single-arm proportions were pooled separately using random-effects models with Freeman–Tukey transformation. Logit-REML models, binomial-normal generalised linear mixed models, Hartung–Knapp adjustments, leave-one-out analyses, and influence diagnostics were used as sensitivity analyses. Results: Eight studies were included. Colour alteration was evaluated in 893 restorations, with a pooled proportion of 14% (95% CI: 5–26%; I² = 95.0%). Marginal discolouration involved 566 restorations and yielded a pooled proportion of 21% (95% CI: 10–34%; I² = 91.8%). Surface-quality deterioration was assessed in 896 restorations, with a pooled proportion of 21% (95% CI: 9–35%; I² = 95.6%). GLMM estimates were 11%, 19%, and 18%, respectively. Hartung–Knapp and leave-one-out analyses produced compatible results, although prediction intervals were wide. No study materially altered the overall interpretation. Conclusions: The pooled proportions of recorded aesthetic deterioration were 14% for colour alteration, 21% for marginal discolouration, and 21% for surface-quality deterioration. However, between-study heterogeneity was substantial, and prediction intervals were wide (0–63%, 0–68%, and 0–74%, respectively), indicating considerable variability in the outcomes expected across clinical settings. Absence of recorded deterioration should not be interpreted as equivalent to overall aesthetic success or clinical acceptability. Accordingly, the pooled estimates should be interpreted cautiously and primarily as average estimates across heterogeneous clinical settings.

Background: Palatal graft harvesting can cause pain, bleeding, and delayed healing, with postoperative recovery varying across patients and over time. Topical hyaluronic acid (HA) may reduce donor-site morbidity and promote tissue repair. Identifying the postoperative time points and clinical domains in which HA may provide benefit could support more informed, patient-centered postoperative management. Objective: To evaluate the time-specific effects of topical HA on palatal wound healing and postoperative morbidity after autogenous gingival graft harvesting and to examine their clinical implications for postoperative care. Methods: Randomized clinical trials comparing topical HA with placebo, no application, or standard care were reviewed. Separate random-effects meta-analyses were performed at each postoperative time point using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Between-study variance was estimated using REML. Leave-one-out, Hartung–Knapp, and formulation-based sensitivity analyses were performed. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Eight randomized trials were included. HA increased complete epithelialization at day 14 (RR = 2.11; 95% CI, 1.13–3.94) and day 21 (RR = 1.62; 95% CI, 1.29–2.03). WHI favored HA at day 7 (MD = 0.58; 95% CI, 0.42–0.75). Pain reductions at days 3 and 7 and bleeding reductions at days 1 and 3 were not statistically significant. Analgesic consumption was lower at day 3 (MD = −0.80; 95% CI, −1.34 to −0.26), while color match favored HA at days 14 and 21. Hartung–Knapp analyses increased uncertainty for WHI, pain, and color match. No result was rated at high overall risk of bias; certainty ranged from low to very low. Conclusions: Topical HA appears to provide its most consistent benefit in accelerating palatal epithelialization and selected healing outcomes rather than uniformly reducing all dimensions of postoperative morbidity. These time- and outcome-specific effects may inform patient-centered and risk-adapted postoperative strategies, particularly when early wound closure is a clinical priority. However, the current aggregate evidence does not permit identification of individual treatment responders. Future adequately powered randomized trials incorporating standardized HA formulations, patient-level characteristics, potential effect modifiers, and harmonized outcome assessment are needed to support precision treatment selection.

Background/Objectives: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the periodontal supporting tissues. Regenerative responses may vary according to patient-related biological characteristics, periodontal defect morphology, the local inflammatory microenvironment, cellular source, biomaterial selection, and delivery strategy. Cell-based regenerative therapies may therefore provide a biological foundation for the future development of personalized periodontal regenerative approaches. This systematic review and meta-analysis evaluated the effectiveness of cell-based therapies for periodontal regeneration and considered how the current evidence may inform future personalized regenerative strategies. Methods: A comprehensive electronic search was conducted in MEDLINE via PubMed, Web of Science, Embase, and the Cochrane Library, with additional searches performed in SciELO and Latindex, in accordance with PRISMA guidelines. Randomized and quasi-randomized controlled clinical trials evaluating cell-based regenerative therapies for periodontal defects were included. The primary outcomes were clinical attachment level (CAL) gain and probing depth (PD) reduction, while radiographic bone regeneration was considered a secondary outcome. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Leave-one-out sensitivity analyses were performed to assess the stability of the pooled estimates. Results: Six clinical trials were included in the qualitative synthesis, and five contributed to the quantitative analysis. Cell-based regenerative therapies showed a small, non-significant effect for CAL gain (SMD = 0.17; 95% CI: −0.12 to 0.45; I² = 0%) and PD reduction (SMD = 0.13; 95% CI: −0.22 to 0.48; I² = 33.0%). Radiographic bone regeneration showed a larger favorable effect, although statistical significance was not reached and substantial heterogeneity was present (SMD = 1.25; 95% CI: −0.08 to 2.58; I² = 88.2%). Leave-one-out analyses did not materially alter the non-significant interpretation for CAL or PD, although some variation in effect magnitude and direction was observed. Radiographic bone regeneration was more sensitive to the exclusion of individual studies. Overall, superiority of cell-based regenerative therapies over control interventions was not demonstrated. Risk-of-bias assessment indicated a low overall risk for most randomized trials, with some concerns in one trial and moderate risk in the quasi-randomized study. Conclusions: Cell-based regenerative therapies showed preliminary but inconclusive signals of benefit for periodontal regeneration. However, no statistically significant superiority over control interventions was demonstrated for CAL gain, PD reduction, or radiographic bone regeneration. Further well-designed clinical trials are required before these approaches can be considered for routine or personalized periodontal regenerative strategies.

Background/Objectives: The growing adoption of digital technologies in prosthodontics has led to the widespread use of computer-aided design and computer-aided manufacturing (CAD/CAM) and three-dimensional (3D) printing for dental prostheses. However, differences in mechanical performance, particularly flexural strength and fracture resistance, remain a concern. Objective: To systematically evaluate and compare the flexural strength and fracture resistance of milled CAD/CAM and 3D-printed dental prostheses. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. A comprehensive search was performed across multiple databases, including PubMed, Scopus, Web of Science, and Cochrane Library. In vitro studies comparing milled and 3D-printed prosthetic materials were included. Data extraction and risk of bias assessment were performed independently by multiple reviewers. A random-effects meta-analysis using standardized mean differences (SMD) was conducted. Results: Five studies were included in the meta-analysis for flexural strength. Milled CAD/CAM materials demonstrated significantly higher flexural strength compared to 3D-printed resins (SMD = 3.70; 95% CI: 0.80–6.59; p = 0.012), with substantial heterogeneity (I² = 93.3%). Fracture resistance results were inconsistent and influenced by individual studies, with sensitivity analyses showing variability in pooled estimates. Overall, the risk of bias was considered low, although some concerns were identified in randomization and blinding. Conclusions: CAD/CAM-milled materials exhibit superior flexural strength, while fracture resistance outcomes remain variable. Although 3D-printed materials may be clinically acceptable, further standardized studies are required to confirm their mechanical reliability.