This systematic review and meta-analysis aimed to evaluate the success rate of direct pulp capping (DPC) on permanent teeth, comparing the use of MTA with calcium hydroxide and calcium silicate-based cements. A systematic search was carried out in 4 databases until July 2023. The selection was based on PICOS criteria and only randomized clinical trials were included. The risk of bias was assessed using RoB-2 tool, and meta-analyses were performed using RevMan 5.3 software. The overall quality of evidence was determined using the GRADE tool. Thirteen studies were included. Meta-analyses indicated significantly higher success rate for DPC using MTA compared to calcium hydroxide, while no significant difference was observed between MTA and Biodentine, showing a success rate from 80% to 100% even after 3 years of follow-up. Five studies were classified as having high risk of bias and the GRADE assessment revealed low certainty of evidence. DPC is highly effective for permanent teeth when using MTA or Biodentine. There is a need for future well-designed randomized clinical trials to evaluate the efficacy of DPC using newer bioceramic materials.

From the restorative perspective, various methods are available to prevent the progression of non-carious cervical lesions. Direct, semi-direct, and indirect composite resin techniques and indirect ceramic restorations are commonly recommended. In this context, semi-direct and indirect restoration approaches are increasingly favored, particularly as digital dentistry becomes more prevalent. To illustrate this, we present a case report demonstrating the efficacy of hybrid ceramic fragments fabricated using computer-aided design (CAD)/computer-aided manufacturing (CAM) technology and cemented with resin cement in treating non-carious cervical lesions over a 48-month follow-up period. A 24-year-old male patient sought treatment for aesthetic concerns and dentin hypersensitivity in the cervical region of the lower premolar teeth. Clinical examination confirmed the presence of two non-carious cervical lesions in the buccal region of teeth #44 and #45. The treatment plan involved indirect restoration using CAD/CAM-fabricated hybrid ceramic fragments as a restorative material. After 48 months, the hybrid ceramic material exhibited excellent adaptation and durability provided by the CAD/CAM system. This case underscores the effectiveness of hybrid ceramic fragments in restoring non-carious cervical lesions, highlighting their long-term stability and clinical success.

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The restoration of endodontically treated teeth (ETT) with more than one cusp missing and thin remaining walls is challenging for the general practitioner. The use of posts combined with full coverage restorations is a well-established approach, yet not following the minimal invasive principles of adhesive dentistry. Endocrowns are indirect monoblock restorations that use the pulp chamber of the ETT for retention. In this study the fabrication of 4 endocrowns and their clinical performance will be discussed. Two clinical cases include computer-aided design/computer-aided manufacturing manufactured molar endocrowns (one feldspathic ceramic and one hybrid composite-ceramic restoration) and the other two are dental laboratory manufactured resin composite premolar endocrown restorations. The modified United States Public Health Service criteria were used to assess the clinical behavior of the restorations at different follow up periods. Endocrown restorations present a satisfactory clinical alternative, either by the use of resin composite or glass ceramic and hybrid materials. Specific guidelines with minimal alterations should be followed for an endocrown restoration to be successful. Due to limited evidence regarding the long term evaluation of this restorative technique, a careful selection of cases should be applied.

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Orthodontic extrusion is usually performed by means of a fixed orthodontic appliance that utilizes arch wire attached to adjacent teeth and transfers the desired force by elastic from the wire to the root. However, clinicians often encounter cases where the bonding required for tooth traction is not possible because the adjacent teeth have been restored with ceramic or veneer. The purpose of this case report is to describe a modified orthodontic extrusion appliance that is useful when conventional orthodontic treatment is not possible. The modified appliance was fabricated using an artificial tooth, clear plastic sheeting, and a braided fiber-reinforced composite strip that covered adjacent teeth without bonding. It satisfied the esthetic and functional needs of the patient and established the optimal biologic width.

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