This study was undertaken to evaluate the influence of changes in the gingival display of the maxillary teeth on smile attractiveness assessed by Saudi Arabian dental professionals and laypeople. A total of 138 dental professional and 182 laypeople rated the attractiveness of male and female smiles in a computerized survey. A smiling photograph of a male and a female dental students were selected and digitally manipulated to create changes the amount of gingival display from 4 mm of gingival display to 4mm of gingival covered by the upper lip in 1 mm increments. Each photo was accompanied by a visual analog scale (VAS) for rating. Among dental professionals, 61% rated the female photo with a 1-mm low lip line as the most attractive smile (VAS score ± SE, 7.3 ± 3.18), while 52.7% of laypeople considered the smile with a 2-mm low lip line as the most attractive (6.7 ± 3.4). Regarding male smile photos, 61.6% of dental professionals found the 1-mm low lip line the most attractive (7.3 ± 3.18). The same rating was given by 48.3% of laypeople (6.1 ± 3.6) (p ≤ 0.009). The least attractive smile photo was the smile showing 4 mm of gingiva for male and female smiles. More than half of the laypeople believed that an attractive smile highly affects social life and communication. The Saudi Arabian population appears to be sensitive to the amount of gingival display. The difference in female smile assessment between dental professionals and laypeople highlights the importance of dentist-patient consensus regarding decisions for esthetic treatments. Esthetic treatment is of a major concern for both dentist and patient. The careful assessment of smile pillars including gingival display must be tailored to each patient.

Objectives: This study aims to investigate the underlying causes of dental implant failure, focusing on implant-related complications and associated risk factors. Understanding these factors will help improve treatment planning and enhance implant success rates. Methods: A retrospective case-control study was conducted using clinical, medical, surgical, and radiographic records of patients who underwent dental implant removal due to complications. Key factors analyzed included patient-related variables (age, gender, medical conditions, periodontal disease), implant-related factors (implant site, implant system, restoration status), and procedural aspects (previous surgical interventions and reasons for implant removal). Results: The findings revealed that implant type (p = 0.004) and type of restoration (p = 0.001) significantly influenced implant survival. Gender (p = 0.001), medical conditions, smoking status (p = 0.004), and restoration status (p = 0.005) were significantly associated with specific failure mechanisms. Lack of osseointegration (36.4%) and absence of primary stability (22.4%) were the predominant causes of implant failure. Prior surgical interventions (p = 0.001) and decisions for re-implantation (p = 0.005) significantly affected implant removal frequency. Conclusions: Implant survival is influenced by multiple factors, with implant type, restoration type, and gender playing key roles in failure outcomes. Patient-specific risk assessment, particularly regarding medical conditions and smoking, meticulous surgical technique, and appropriate prosthetic planning, is vital for improving implant longevity and minimizing failure rates.

Purpose: To evaluate the fracture resistance of zirconia overlays, considering various preparation designs and the presence of endodontic access.Materials and Methods: Ninety translucent zirconia (5Y‐PSZ) overlay restorations were divided into six groups (n = 15/group) based on different preparation designs, with and without endodontic access: chamfer margin 4 mm above the gingival level without (group 1) and with endodontic access (group 2); margin 2 mm above the gingival level without (group 3) and with endodontic access (group 4); overlay with no chamfer margin without (group 5) and with endodontic access (group 6). Restorations were bonded to mandibular first molar resin dies, and the groups with endodontic access were sealed with flowable resin composite. All restorations underwent 100,000 cycles of thermal cycling between 5°C and 55°C, followed by loading until fracture. Maximum load and fracture resistance were recorded. ANOVA with Tukey post‐hoc tests were used for statistical comparison (α < 0.05).Results: Fracture resistance significantly varied among overlay designs with and without endodontic access (p < 0.001), except for the no‐margin overlays (groups 5 and 6). Overlays with a 2 mm margin above the gingival margin with endodontic access (group 4) exhibited significantly higher fracture resistance compared to both the 4‐mm supragingival (group 2) and no‐margin (group 6) designs, even when compared to their respective intact groups (groups 1 and 5). There were no significant differences between the no‐margin and 4‐mm supragingival overlays.Conclusion: The more extensive zirconia overlay for mandibular molars is the first choice since the 2 mm margin above the gingival level design withstood considerable loads even after undergoing endodontic access. A no‐margin overlay is preferred over the 4‐mm supragingival design as it preserves more tooth structure and there was no outcome difference, irrespective of endodontic access. Caution is warranted in interpreting these findings due to the in vitro nature of the study.

Statement of problem. The effects of gastric acid on the hardness, topographic, and colorimetric properties of zirconia-reinforced lithium silicate glass-ceramics (ZLSs) for dental restorations remain unknown. Purpose. The purpose of this in vitro study was to investigate the effect of simulated gastric acid exposure on the microhardness, surface roughness, color stability, and relative translucency of ZLSs. Material and methods. Two pressable ZLSs (VITA AMBRIA, VA and Celtra Press, CP) and 2 machinable ZLSs (VITA Suprinity, VS and Celtra Duo, CD)(n=64) were randomly allocated to artificial saliva (control) or gastric juice immersion groups simulating 10 and 20 years of clinical exposure. Microhardness (Hv) was measured with a Vickers hardness device, and surface roughness (Sa) was recorded with an optical profilometer. The color stability (DE00) 00 ) and relative translucency parameter (RTP) were measured with a spectrophotometer. Data for Hv, Sa, and RTP were analyzed by repeated 2-way ANOVA, and data for DE00 00 were analyzed by 2-way ANOVA. Post hoc comparisons were obtained from Tukey HSD and Student t tests (alpha=.05). Results. Machinable ZLSs exhibited greater Hv after the simulated gastric acid challenge than pressable ZLSs. Sa was significantly impacted by material type (P=.001), P= .001), storage media (P=.050), P= .050), and their interaction (P<.001). P< .001). DE00 00 was significantly affected by the type of simulated aging media (P<.001). P <.001). After 20 years of simulated gastric acid aging, all ZLS materials surpassed the DE00 00 perceptibility threshold but did not exceed the DE00 00 acceptability threshold. VS displayed significantly lower RTP than other ZLS materials at all time points (P<.001). P <.001). Conclusions. The topographic and colorimetric characteristics of ZLS were significantly altered by exposure to simulated gastric acid. (J Prosthet Dent 2024;132:625.e1-e7)

Objectives: The aim of this study was to assess the relationship between tooth shade among different groups of patients according to their age, gender, and skin color in a Saudi population. Materials and methods: Participants were divided based on age into Group 1 (10–20 years), Group 2 (21–30 years), Group 3 (31–40 years), and Group 4 (41+ years), and according to gender. Tooth shade was measured by Vita easyshade, Shade scanner, 3D Master shade system. The skin color was determined according to the Firzpatrick Scale. It consists of six shades, namely: I, II, III, IV, V, and VI. The skin complexion of the participants was divided into six categories: white/very fair, fair, light brown, moderate brown, dark brown, and black. Results: One hundred and ninety-eight individuals were recruited. Around 70% were males. Females had 25.4% A2 followed by 22% A1, and 22% A3 shade types, while males had B3 shade (18%) followed by A2 and A3 (15.8%). A statistically significant difference was observed between shade and gender (p < 0.05). A statistically significant difference was observed between shade and age group (p < 0.05), where increased age was correlated with darker teeth shades. Shade A1 was correlated with type I skin color in 57.1% of individuals. Skin color type II had A2 as a dominant shade by 34.1%. A2 and A3 shades were equally observed in skin color III by 20.3%. Overall, statistically significant differences were observed between shade and skin color groups (p < 0.05). Conclusions: In conclusion, the most frequent classical shade noted among male and female participants was shade type A, which represents reddish brownish. Group 2 (21–30 years) had the B3 shade as the most prominent shade type among age groups. Gender, age, and skin types all showed a significant relation with the tooth shade.

Objective: The objective of this study was to evaluate the effect of different surface treatment methods on the shear bond strength (SBS) of metal brackets bonded to two types of CAD/CAM composite restorations: milled and 3D-printed. Materials and Methods: A total of 160 flat-shaped specimens (10 × 10 × 2 mm³) were prepared from four different CAD/CAM composites; two milled (Lava Ultimate™ [LU] and Grandio™ [GR]) and two 3D-printed (Crowntec™ [CT] and C&B Permanent™ [CB]). These specimens underwent thermocycling (5000 cycles at 5–55 °C), then were categorized based on the surface treatment into four groups (n = 10): Group C (control, no surface treatment), Group HF (treated with 9.6% hydrofluoric acid), Group DB (mechanical roughening by a diamond bur), and Group SB (sandblasting using aluminum oxide). Metal brackets were bonded using Transbond XT Primer and universal adhesive, stored in artificial saliva for 24 h, then thermocycled again. Shear bond strength (SBS) was tested using a universal testing machine until bracket debonding occurred. The adhesive remnant index (ARI) was assessed using a stereomicroscope to quantify the residual adhesive following debonding. Result: Regarding material, GR and LU restorations had significantly higher SBS values compared to CT and CB, ranging from 13.90 MPa to 20.35 MPa. Regarding surface treatment, SB and HF groups showed significantly higher SBS values. The ARI scores showed different adhesive modes of failure, with higher instances of scores 0 and 1, which indicate no or minimal adhesive remaining. Conclusions: Both milled and 3D-printed materials had adequate SBS for clinical use, with milled materials showing superior results. Surface treatments like sandblasting and HF significantly improved bond strength, with adhesive failure being common.