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Bioinspired Materials for Dentistry
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Bioinspired Materials for Dentistry

A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (21 September 2022) | Viewed by 53111

Special Issue Editors

Dr. Tan Sui

E-Mail Website
Guest Editor
Department of Mechanical Engineering Sciences, University of Surrey, Guildford GU2 7XH, UK
Interests: materials characterisation; micromechanics; synchrotron X-ray; advanced microscopy; natural and bioinspired materials; engineering alloys; advanced energy materials
Prof. Dr. Bo Su

E-Mail Website
Guest Editor
School of Oral and Dental Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
Interests: biomimetic materials; bio-inspired materials; ceramics; ceramic composites; cell-instructive surfaces
Dr. Zohaib Khurshid

E-Mail Website
Guest Editor
Department of Prosthodontics and Dental Implantology, School of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabi
Interests: dental composite; GIC; proteins; scaffolds; dental biomaterials; regenerative dentistry
Special Issues, Collections and Topics in MDPI journals
Dr. Jingyi Mo

E-Mail Website
Guest Editor
Department of Mechanical Engineering Sciences, University of Surrey, Guildford GU2 7XH, UK
Interests: biological materials; synchrotron X-ray imaging; multiscale mechanical modelling; small angle X-ray scattering (SAXS); wide angle X-ray diffraction (WAXD)
Prof. Dr. Zhaoyong Zou

E-Mail Website
Guest Editor
State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
Interests: biomineralization; biomaterials; crystallization; bioinspired materials; calcium carbonate

Special Issue Information

Dear Colleagues,

Biological organisms such as teeth have evolved a complex architecture to achieve multifunctional roles throughout billions of years of evolution. A tooth’s natural materials usually outperform synthetic materials with similar composition in terms of mechanical, physical, and chemical properties.

By drawing inspiration from natural materials, a bioinspired design approach, innovative synthetic materials are being developed which mimic their natural counterparts’ functions and properties. In recent years, bioinspiration in conjunction with advanced materials design and fabrication technologies are starting to converge toward a fundamentally novel approach to offer more successful and cost-effective materials for dentistry.

Dental diseases such as caries, gum inflammation, soft tissue ulceration, oral cancer, and tooth loss compromise lifestyle and quality of life. Many dental materials in the market target these diseases, but there is a need for novel biomaterials which can mimic biomolecules and their biochemical activities. Traditional dental materials such as dental ceramics, resin-based dental composites, and dental implants have reported materials failures and inflammatory complications. Improvements such as enhanced reliability, longevity, and biocompatibility are urgently needed to reduce the negative impact on quality of life and high costs to the healthcare system. These materials can be modified with the help of recombinant technology, omics technology, or protein synthesis for improved clinical outcomes.

Dr. Tan Sui
Prof. Dr. Bo Su
Dr. Zohaib Khurshid
Dr. Jingyi Mo
Prof. Dr. Zhaoyong Zou
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • dentistry
  • bioinspired materials
  • dental prothesis crown
  • dental adhesives
  • periodontal membranes
  • dental composites
  • dental implant
  • cost-effective

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Published Papers (11 papers)

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Research

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15 pages, 1194 KiB  
Article
Clinical and Microbiological Evaluation of a Chlorhexidine-Modified Glass Ionomer Cement (GIC-CHX) Restoration Placed Using the Atraumatic Restorative Treatment (ART) Technique
by Jithendra Ratnayake, Arthi Veerasamy, Hassan Ahmed, David Coburn, Carolina Loch, Andrew R. Gray, Karl M. Lyons, Nicholas C. K. Heng, Richard D. Cannon, Marcus Leung and Paul A. Brunton
Materials 2022, 15(14), 5044; https://doi.org/10.3390/ma15145044 - 20 Jul 2022
Cited by 5 | Viewed by 2353
Abstract
The aims of this study were to investigate the clinical effectiveness and patient acceptability of a modified glass ionomer cement placed using the atraumatic restorative treatment (ART) technique to treat root caries, and to carry out microbiological analysis of the restored sites. Two [...] Read more.
The aims of this study were to investigate the clinical effectiveness and patient acceptability of a modified glass ionomer cement placed using the atraumatic restorative treatment (ART) technique to treat root caries, and to carry out microbiological analysis of the restored sites. Two clinically visible root surface carious lesions per participant were restored using ART. One was restored with commercial glass ionomer cement (GIC) (ChemFil® Superior, DENTSPLY, Konstonz, Germany) which acted as the control. The other carious root lesion was restored with the same GIC modified with 5% chlorhexidine digluconate (GIC-CHX; test). Patient acceptability and restoration survival rate were evaluated at baseline and after 6 months. Plaque and saliva samples around the test and control restorations were collected, and microbiological analysis for selected bacterial and fungal viability were completed at baseline, and after 1, 3, and 6 months. In total, 52 restorations were placed using GIC and GIC-CHX in 26 participants; 1 patient was lost to follow-up. After reviewing the restorations during their baseline appointments, participants indicated that they were satisfied with the appearance of the restorations (n = 25, 96%) and did not feel anxious during the procedure (n = 24, 92%). Forty-eight percent (n = 12) of the GIC-CHX restorations were continuous with the existing anatomic form as opposed to six for the GIC restorations (24%), a difference which was statistically significant (p = 0.036). There was no statistically significant reduction in the mean count of the tested microorganisms in plaque samples for either type of restorations after 1, 3, or 6 months. Restoration of carious root surfaces with GIC-CHX resulted in higher survival rates than the control GIC. ART using GIC-CHX may therefore be a viable approach for use in outreach dental services to restore root surface carious lesions where dental services are not readily available, and for older people and special needs groups. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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16 pages, 13443 KiB  
Article
Development and Analysis of a Hydroxyapatite Supplemented Calcium Silicate Cement for Endodontic Treatment
by David Yong, Joanne Jung Eun Choi, Peter Cathro, Paul R. Cooper, George Dias, Jeffrey Huang and Jithendra Ratnayake
Materials 2022, 15(3), 1176; https://doi.org/10.3390/ma15031176 - 3 Feb 2022
Cited by 9 | Viewed by 2550
Abstract
Aim: To develop an endodontic cement using bovine bone-derived hydroxyapatite (BHA), Portland cement (PC), and a radiopacifier. Methods: BHA was manufactured from waste bovine bone and milled to form a powder. The cements were developed by the addition of BHA (10%/20%/30%/40% wt), 35% [...] Read more.
Aim: To develop an endodontic cement using bovine bone-derived hydroxyapatite (BHA), Portland cement (PC), and a radiopacifier. Methods: BHA was manufactured from waste bovine bone and milled to form a powder. The cements were developed by the addition of BHA (10%/20%/30%/40% wt), 35% wt, zirconium oxide (radiopacifier) to Portland cement (PC). A 10% nanohydroxyapatite (NHA) cement containing PC and a radiopacifier, and a cement containing PC (PC65) and a radiopacifier were also manufactured as controls. The cements were characterised to evaluate their compressive strength, setting time, radiopacity, solubility, and pH. The biocompatibility was assessed using Saos-2 cells where ProRoot MTA acted as the control. Compressive strength, solubility and pH were evaluated over a 4-week curing period. Results: The compressive strength (CS) of all cements increased with the extended curing times, with a significant CS increase in all groups from day 1 to day 28. The BHA 10% exhibited significantly higher CS compared with the other cements at all time points investigated. The BHA 10% and 20% groups exhibited significantly longer setting times than BHA 30%, 40% and PC65. The addition of ZrO2 in concentrations above 20% wt and Ta2O5 at 30% wt resulted in a radiopacity equal to, or exceeding that of, ProRoot MTA. The experimental cements exhibited relatively low cytotoxicity, solubility and an alkaline pH. Conclusions: The addition of 10% and 20% BHA to an experimental PC-based cement containing 35% ZrO2 improved the material’s mechanical strength while enabling similar radiopacity and biocompatibility to ProRoot MTA. Although BHA is a cost-effective, biomimetic additive that can improve the properties of calcium silicate endodontic cements, further studies are now warranted to determine its clinical potential. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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12 pages, 2475 KiB  
Article
Effect of Sonic Activation on Push-Out Bond Strength of Fiber Post: An In Vitro Study
by Rizwan Jouhar
Materials 2021, 14(17), 5038; https://doi.org/10.3390/ma14175038 - 3 Sep 2021
Cited by 4 | Viewed by 2215
Abstract
This study aimed to evaluate the effectiveness of conventional and sonic activation techniques on push-out bond strength of fiber post cemented with two different monomers containing self-adhesive resin cement (SARC). Four groups (n = 19 each) were made based on the type of [...] Read more.
This study aimed to evaluate the effectiveness of conventional and sonic activation techniques on push-out bond strength of fiber post cemented with two different monomers containing self-adhesive resin cement (SARC). Four groups (n = 19 each) were made based on the type of SARC (Rely X U200 and Panavia SA) and technique (conventional and sonic activation). After placing the fiber post, each root was sectioned into 2 mm coronal, middle, and apical portions, and a push-out bond strength test was performed using a universal testing machine. The least push-out bond strength (13.0 ± 0.9 MPa) was found in Rely X U200 conventional technique and highest with Panavia SA sonic activation technique (15.4 ± 0.9 MPa). A significant difference was found in push-out bond strength at coronal (p = 0.002), middle (p = 0.002), and apical (p = 0.001) root sections using Rely X U200 cement with sonic activation as compared to the conventional technique. However, no difference (p > 0.05) was noticed between conventional and sonic activation techniques in Panavia SA cement at any root level. Sonic activation can be used as an adjunct with a manual technique to increase bond strength. However, it was noted that 10-MDP monomer containing SARC performed well regardless of techniques. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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10 pages, 1401 KiB  
Article
Potential Application of an Aqueous Extract of Tinospora Cordifolia (Thunb.) Miers (Giloy) in Oral Submucous Fibrosis—An In Vitro Study
by Shankargouda Patil
Materials 2021, 14(12), 3374; https://doi.org/10.3390/ma14123374 - 18 Jun 2021
Viewed by 2558
Abstract
The in vitro antifibrotic activity of Tinospora cordifolia (Thunb.) Miers (giloy) was assessed to explore its potential for the management of oral submucous fibrosis. Epithelial cells dissociated from the tissue obtained from histopathologically normal oral mucosa during surgical extraction of third molars were [...] Read more.
The in vitro antifibrotic activity of Tinospora cordifolia (Thunb.) Miers (giloy) was assessed to explore its potential for the management of oral submucous fibrosis. Epithelial cells dissociated from the tissue obtained from histopathologically normal oral mucosa during surgical extraction of third molars were cultured and fibrosis was induced by TGF-β1 in the oral keratinocytes. Cell viability was assessed by MTT and comparative gene expression analysis was carried out in the fibrosis-induced oral keratinocytes treated with various concentrations of Tinospora cordifolia extract (TcE) for matricellular protein-related gene expression. Concentrations of 0.5 µg/mL and 1 µg/mL TcE demonstrated a significant reduction in the expression of CTGF, SERPINE1, COL1A1, FN1, MMP1, MMP2, MMP3, and TIMP2 and an increase in the expression of PLAU, COL3A1, TIMP1, and TIMP3. Although TcE was found to reduce the expression of several fibrotic genes and increase the expression of antifibrotic genes, a varied effect was found, causing increased expression of COL3A1 and decreased expression of TIMP2 on TGF-β1-induced human buccal epithelial cells. However, further studies are warranted to assess the exact mechanism of antifibrotic activity and its clinical applications. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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Review

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16 pages, 645 KiB  
Review
The Impact of Autologous Platelet Concentrates on the Periapical Tissues and Root Development of Replanted Teeth: A Systematic Review
by Zohaib Khurshid, Faris Yahya I. Asiri, Shariq Najeeb and Jithendra Ratnayake
Materials 2022, 15(8), 2776; https://doi.org/10.3390/ma15082776 - 10 Apr 2022
Cited by 4 | Viewed by 2569
Abstract
Introduction: In many cases, the replanted teeth may undergo resorption or ankyloses. Recent studies show that autologous platelet concentrates (APCs) may improve the outcomes of tooth replantation. The aim of this systematic review was to summarize and critically appraise the currently available literature [...] Read more.
Introduction: In many cases, the replanted teeth may undergo resorption or ankyloses. Recent studies show that autologous platelet concentrates (APCs) may improve the outcomes of tooth replantation. The aim of this systematic review was to summarize and critically appraise the currently available literature on the use of APCs before tooth replantation. Methodology: An electronic search was conducted on the following research databases: PubMed/MEDLINE, ISI Web of Science, EMBASE and Scopus. The following medical subject heading (MeSH) keywords used were: ((tooth replantation) OR (replanted tooth) OR (teeth replantation) OR (replanted teeth)) AND ((autologous platelet concentrate) OR (platelet-rich plasma) OR (platelet-rich fibrin) OR (autologous platelet)). The studies’ data was extracted, and the research’ quality was rated using the CARE and ARRIVE protocols. Results: Ten case reports and three animal studies, one cell study and one study, which included both animal and in vitro experiments, were included in this review. In majority of the studies, APCs improved the outcomes of tooth replantation. However, there were various sources of bias in the most of the research, which may have influenced the results. Conclusions: Although majority of the studies indicate that APCs may improve outcomes of tooth replantation, majority of the studies contained numerous sources of bias. Additionally, the sample size of the included subjects is inadequate to predict the clinical efficacy of APCs in management of replanted teeth. Large-scale, multi-center and long-term studies are required to ascertain the efficacy of APCs in improve the outcomes of tooth replantation. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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34 pages, 1462 KiB  
Review
Effect of Nanostructures on the Properties of Glass Ionomer Dental Restoratives/Cements: A Comprehensive Narrative Review
by Faiza Amin, Sehrish Rahman, Zohaib Khurshid, Muhammad Sohail Zafar, Farshid Sefat and Naresh Kumar
Materials 2021, 14(21), 6260; https://doi.org/10.3390/ma14216260 - 21 Oct 2021
Cited by 30 | Viewed by 5443
Abstract
Overall perspective of nanotechnology and reinforcement of dental biomaterials by nanoparticles has been reported in the literature. However, the literature regarding the reinforcement of dental biomaterials after incorporating various nanostructures is sparse. The present review addresses current developments of glass ionomer cements (GICs) [...] Read more.
Overall perspective of nanotechnology and reinforcement of dental biomaterials by nanoparticles has been reported in the literature. However, the literature regarding the reinforcement of dental biomaterials after incorporating various nanostructures is sparse. The present review addresses current developments of glass ionomer cements (GICs) after incorporating various metallic, polymeric, inorganic and carbon-based nanostructures. In addition, types, applications, and implications of various nanostructures incorporated in GICs are discussed. Most of the attempts by researchers are based on the laboratory-based studies; hence, it warrants long-term clinical trials to aid the development of suitable materials for the load bearing posterior dentition. Nevertheless, a few meaningful conclusions are drawn from this substantial piece of work; they are as follows: (1) most of the nanostructures are likely to enhance the mechanical strength of GICs; (2) certain nanostructures improve the antibacterial activity of GICs against the cariogenic bacteria; (3) clinical translation of these promising outcomes are completely missing, and (4) the nanostructured modified GICs could perform better than their conventional counterparts in the load bearing posterior dentition. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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21 pages, 6644 KiB  
Review
The Development of Filler Morphology in Dental Resin Composites: A Review
by Jiani Liu, Hao Zhang, Huijun Sun, Yanru Liu, Wenlin Liu, Bo Su and Shibao Li
Materials 2021, 14(19), 5612; https://doi.org/10.3390/ma14195612 - 27 Sep 2021
Cited by 35 | Viewed by 6044
Abstract
Dental resin composites (DRCs) with diverse fillers added are widely-used restorative materials to repair tooth defects. The addition of fillers brings an improvement in the mechanical properties of DRCs. In the past decade, diverse fillers have emerged. However, the change of emerging fillers [...] Read more.
Dental resin composites (DRCs) with diverse fillers added are widely-used restorative materials to repair tooth defects. The addition of fillers brings an improvement in the mechanical properties of DRCs. In the past decade, diverse fillers have emerged. However, the change of emerging fillers mainly focuses on the chemical composition, while the morphologic characteristics changes are often ignored. The fillers with new morphologies not only have the advantages of traditional fillers (particles, fibrous filler, etc.), but also endow some additional functional characteristics (stronger bonding ability to resin matrix, polymerization resistance, and wear resistance, drug release control ability, etc.). Moreover, some new morphologies are closely related to the improvement of traditional fillers, porous filler vs. glass particles, core-sheath fibrous vs. fibrous, etc. Some other new morphology fillers are combinations of traditional fillers, UHA vs. HA particles and fibrous, tetrapod-like whisker vs. whisker and fibrous filler, mesoporous silica vs. porous and silica particles. In this review, we give an overall description and a preliminary summary of the fillers, as well as our perspectives on the future direction of the development of novel fillers for next-generation DRCs. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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19 pages, 2053 KiB  
Review
Longevity of Polymer-Infiltrated Ceramic Network and Zirconia-Reinforced Lithium Silicate Restorations: A Systematic Review and Meta-Analysis
by William Banh, Jared Hughes, Aaron Sia, David C. H. Chien, Santosh K. Tadakamadla, Carlos M. Figueredo and Khaled E. Ahmed
Materials 2021, 14(17), 5058; https://doi.org/10.3390/ma14175058 - 3 Sep 2021
Cited by 12 | Viewed by 3487
Abstract
The purpose of this study was to systematically review the existing literature to assess the clinical survival and success of PICN and ZLS indirect restorations as the clinical evidence for them remains lacking. PubMed, SCOPUS, Embase, Cochrane Library, Web of Science, LILACs, and [...] Read more.
The purpose of this study was to systematically review the existing literature to assess the clinical survival and success of PICN and ZLS indirect restorations as the clinical evidence for them remains lacking. PubMed, SCOPUS, Embase, Cochrane Library, Web of Science, LILACs, and SciElo databases were searched from 1 January 2000 to 1 February 2021. Clinical trials and cohort studies published in English were included while case studies, case series, and in vitro studies were excluded. Results were analyzed qualitatively and a meta-analysis using a random effects model was performed. A strength of recommendation taxonomy (SORT) analysis was conducted and risk of bias (RoB) was assessed using the Newcastle–Ottawa scale and Cochrane RoB tools. An electronic search through the databases yielded 2454 articles, of which 825 remained after duplicate removal. Five studies investigating PICN and four investigating ZLS indirect restorations remained after assessing for eligibility. The overall survival rate of PICN over 1 year was 99.6% and 99.2% over 2 years. The overall survival rate of ZLS over 1 year was 99%. The main mode of failure for both materials was catastrophic fracture. One study had a high RoB, four had a moderate RoB, and four had a low RoB. Both materials demonstrated moderate strength of recommendation at a level 2 evidence for all studies based on SORT analysis. PICN and ZLS show promising short-term clinical performance as full and partial coverage indirect restorations, but longer follow-up studies are required to confirm their long-term performance. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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20 pages, 2877 KiB  
Review
Hydroxyapatite in Oral Care Products—A Review
by Lijie Chen, Suma Al-Bayatee, Zohaib Khurshid, Amin Shavandi, Paul Brunton and Jithendra Ratnayake
Materials 2021, 14(17), 4865; https://doi.org/10.3390/ma14174865 - 27 Aug 2021
Cited by 49 | Viewed by 11252
Abstract
Calcium phosphate compounds form the inorganic phases of our mineralised tissues such as bone and teeth, playing an important role in hard tissue engineering and regenerative medicine. In dentistry and oral care products, hydroxyapatite (HA) is a stable and biocompatible calcium phosphate with [...] Read more.
Calcium phosphate compounds form the inorganic phases of our mineralised tissues such as bone and teeth, playing an important role in hard tissue engineering and regenerative medicine. In dentistry and oral care products, hydroxyapatite (HA) is a stable and biocompatible calcium phosphate with low solubility being used for various applications such as tooth remineralisation, reduction of tooth sensitivity, oral biofilm control, and tooth whitening. Clinical data on these products is limited with varied results; additionally, the effectiveness of these apatite compounds versus fluoride, which has conventionally been used in toothpaste, has not been established. Therefore, this review critically evaluates current research on HA oral care, and discusses the role and mechanism of HA in remineralisation of both enamel and dentine and for suppressing dentine sensitivity. Furthermore, we position HA’s role in biofilm management and highlight the role of HA in dental applications by summarising the recent achievement and providing an overview of commercialised HA dental products. The review also indicates the existing limitations and provides direction for future research and commercialisation of apatite-based oral care products. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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Other

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12 pages, 581 KiB  
Systematic Review
The Regenerative Potential of Decellularized Dental Pulp Extracellular Matrix: A Systematic Review
by Necdet Adanir, Zohaib Khurshid and Jithendra Ratnayake
Materials 2022, 15(18), 6386; https://doi.org/10.3390/ma15186386 - 14 Sep 2022
Cited by 3 | Viewed by 2123
Abstract
Introduction: The regeneration of dental pulp remains a challenge. Although several treatment modalities have been proposed to promote pulpal regeneration, these treatments have several drawbacks. More recently, decellularized dental pulp extracellular matrix (DP-ECM) has been proposed to regenerate dental pulp. However, to date, [...] Read more.
Introduction: The regeneration of dental pulp remains a challenge. Although several treatment modalities have been proposed to promote pulpal regeneration, these treatments have several drawbacks. More recently, decellularized dental pulp extracellular matrix (DP-ECM) has been proposed to regenerate dental pulp. However, to date, no systematic review has summarized the overall outcome and assessed the available literature focusing on the endodontic use of DP-ECM. The aim of this systematic review is to critically appraise the literature, summarize the overall outcomes, and provide clinical recommendations about DP-ECM. Methodology: Following the Participants Intervention Control and Outcomes (PICO) principle, a focused question was constructed before conducting a search of the literature and of electronic research databases and registers. The focused question was: ‘Compared to controls, does decellularized dental pulp extracellular matrix (DP-ECM) stimulate the regeneration of dental pulp cells and tissue?’ Quality assessment of the studies was carried out using Guidelines for Reporting Pre-Clinical in Vitro Studies on Dental Materials and ARRIVE guidelines. Results: 12 studies were included in this review. Data from five in vitro experiments and eight in vivo experiments were extracted and the quality of the experiments was assessed. In majority of the studies, DP-ECM appeared to have stimulated pulpal regeneration. However, several sources of bias and methodological deficiencies were found during the quality assessment. Conclusion: Within the limitations of this review and the included studies, it may be concluded that there is insufficient evidence to deduce the overall efficacy of DP-ECM for pulpal regeneration. More research, clinical and pre-clinical, is required for more conclusive evidence. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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10 pages, 621 KiB  
Systematic Review
Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review
by Maryam H. Mugri, Mohammed E. Sayed, Binoy Mathews Nedumgottil, Shilpa Bhandi, A. Thirumal Raj, Luca Testarelli, Zohaib Khurshid, Saurabh Jain and Shankargouda Patil
Materials 2021, 14(21), 6733; https://doi.org/10.3390/ma14216733 - 8 Nov 2021
Cited by 23 | Viewed by 10169
Abstract
Crown lengthening surgery and deep margin elevation are two distinct approaches used to manage decayed teeth. This systematic review examined the survival rate of badly decayed teeth when restored using the crown lengthening technique and compared it to the deep margin elevation technique. [...] Read more.
Crown lengthening surgery and deep margin elevation are two distinct approaches used to manage decayed teeth. This systematic review examined the survival rate of badly decayed teeth when restored using the crown lengthening technique and compared it to the deep margin elevation technique. The search was conducted during July 2020 and then again updated at the end of July 2021, and no restriction concerning publication status and time was applied during the search. Cochrane Database, EBSCO, Scopus, and Medline databases were searched electronically for relevant literature. Google Scholar was used as a secondary source. Predefined inclusion and exclusion criteria were used to select the relevant articles. PRISMA guidelines were followed. The focused PICO question was: ‘Does the crown lengthening technique (I) provide a better survival rate (O) than deep margin elevation technique (C) following the restoration of badly decayed teeth (P).’ A total of six articles were included after performing screening based on the eligibility criteria. Four studies focused on crown lengthening while two focused on deep margin elevation technique. A majority of the studies showed a high risk of bias owing to methodological insufficiencies. Crown lengthening (CL) treated cases showed a change in the free gingival margin at six months post-surgery. A tissue rebound was seen that was correlated to the periodontal biotype. Teeth treated with the deep margin elevation (DME) technique showed high survivability. There is a lack of high-quality trials examining surgical comparisons between CL and DME with long-term follow-up. Patient- and dentist-reported outcomes have not been given adequate consideration in the literature. Based on the limited evidence, it can be concluded that for restorative purposes, crown lengthening surgery can be successful in long-term retention of restored teeth. However, the deep margin elevation technique has a better survival ratio. Future well-designed and executed research will have an effect on the evidence and level of certainty for the best approach to treating severely decayed teeth. Full article
(This article belongs to the Special Issue Bioinspired Materials for Dentistry)
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