Extended reality (XR) technologies, encompassing augmented reality (AR), virtual reality (VR), and mixed reality (MR), are increasingly used in endodontic education and practice. A gap exists regarding understanding of XR's applications and limitations among endodontic educators and practitioners. This narrative review aims to (A) explain the technical foundations of AR, VR, and MR systems; (B) review current applications of XR in endodontic education and clinical practice; (C) examine limitations and barriers to adoption; and (D) outline future directions. An overview of the technical foundations of XR was provided. A comprehensive electronic search was conducted across PubMed, Scopus, and Web of Science databases to identify papers on applications of XR in endodontics. After screening, 33 articles met the inclusion criteria and were subjected to full-text review. The main features of the studies were extracted, and a narrative summary was prepared. The review shows that XR technologies have been applied in endodontic education for training in visualisation of root canal anatomy, access cavity preparation, and microsurgical procedures, with most studies demonstrating improved comprehension and procedural accuracy. Haptic feedback systems and head-mounted displays enable realistic training that surpasses traditional methods of education. However, most applications remain educational, with few clinical studies involving real patients. Challenges include hardware costs, technical setup complexity, data security concerns and lack of standardisation. When thoughtfully implemented, XR has the potential to improve endodontic education, support clinical workflow and enhance the overall practice of endodontics. Coordinated efforts among clinicians, educators, engineers and regulators are needed to validate these technologies, develop practical implementation standards and integrate XR into routine endodontic education and care.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Biodentine, an innovative biocompatible, tricalcium cement, is used widely in endodontics owing to its advantageous properties. Yet limitations concerning its radiopacity and other handling properties have compelled the development of different material modifications. This scoping review aims to map and synthesize the available evidence on the impact of different fillers and additives on the biological, mechanical, and physical properties of Biodentine in endodontics. This review was performed in line with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Modifications for Scoping Reviews (PRISMA-ScR) guidelines. A Literature search was conducted comprehensively throughout major databases such as Scopus, PubMed, Web of Science, and Google Scholar. In vitro studies evaluating the modifications of Biodentine were included. Information was charted and integrated descriptively. Broad range of modifications were noted, such as the addition of nanoparticles, radiopacifiers, bioactive additives. and antimicrobial agents. These modifications were focused on improving the physical and mechanical properties, improve antimicrobial efficacy and enhance radiopacity while preserving biocompatibility. However, significant heterogeneity was noted in modification process, property evaluating methods, and results. This scoping review indicates that modifications of Biodentine using various additives may enhance its biological, mechanical, and physical properties. Future research should focus on standardizing experimental methodologies to allow meaningful comparison across studies, identifying optimal concentrations of additives to balance material performance, and conducting well-designed in vivo and clinical studies to validate these findings and support their translation into clinical practice.
This clinical report describes the interdisciplinary treatment of a patient with hypoplastic amelogenesis imperfecta (AI) and an anterior open occlusal relationship. Prior to referral to the prosthodontics department, she had undergone active orthodontic treatment for 5 years. As she presented with skeletal, functional, and esthetic concerns, orthodontic treatment alone was insufficient to address her complex treatment goals. Given the complexity, optimal comprehensive management necessitated an interdisciplinary approach involving orthodontics, endodontics, periodontal therapy, orthognathic surgery, and definitive rehabilitation with minimum preparation adhesively bonded complete coverage restorations. A 5-year follow-up confirmed the stability of the results, with the patient reporting no further issues.
Immature teeth with pulp necrosis remain challenging because conventional root canal treatment does not restore pulp-dentin vitality. Hydrogel scaffolds for regenerative endodontics should support stem cell viability and provide a microenvironment favourable for dentin-pulp regeneration. This study evaluated κ-Carrageenan (κC)-based hydrogels, with and without gelatin, as scaffolds for stem cells from the apical papilla (SCAP), and examined how formulation-dependent properties influenced SCAP viability and odontogenic differentiation. Hydrogels were prepared as 1% gelatin, 1.5% κC, 2.5% κC, 1.5% κC+gelatin (κCG) and 2.5% κCG, with cells cultured without hydrogel as a control. Physicochemical characterisation included scanning electron microscopy, Fourier-transform infrared spectroscopy, rheology, degradation and swelling at days 1, 3, 7 and 14. SCAP were isolated and characterised using flow cytometry. Cell viability, metabolic activity, spreading, migration, alkaline phosphatase activity, Alizarin Red S staining and qPCR of differentiation-related markers were also assessed. The hydrogels showed formulation-dependent microstructure, degradation, swelling and viscoelastic properties. κC-containing formulations behaved as viscoelastic solids, and 2.5% κCG exhibited the highest storage modulus and lowest Tan (δ). SCAP remained predominantly viable in all groups. Gelatin-containing hydrogels improved long-term cytocompatibility and greater cell spreading compared to lower-concentration κC alone. Migration was comparable across groups. During differentiation, κC-containing formulations showed higher alkaline phosphatase activity and mineral deposition, with increased late-stage mineralisation observed in 2.5% κCG. Gene expression analysis indicated early upregulation of RUNX2 and BSP and increased late-stage expression of OPN, OCN, DMP1 and DSPP, with a more evident maturation-associated response in 2.5% κCG. κC-based hydrogels supported SCAP viability and promoted odontogenic differentiation in vitro. Gelatin incorporation improved late-stage mineralisation and odontogenic marker expression, with 2.5% κCG demonstrating the most favourable overall response. κC-gelatin hydrogels may serve as promising scaffold candidates for dentin-pulp regenerative strategies by supporting SCAP survival and odontogenic maturation within a tunable hydrogel microenvironment.
Endodontically treated teeth often have compromised tooth structure, which increases their susceptibility to fracture. This in vitro study compared the fracture resistance of endodontically treated mandibular premolars restored using the sandwich technique, Nayyar core composite, and semi-direct composite onlay. Seventy-six extracted mandibular premolars were randomly allocated into four groups (n = 19): intact teeth (control), conventional sandwich technique, Nayyar core composite, and semi-direct composite onlay. All groups except the control teeth group underwent standardized root canal treatment and obturation, followed by composite restoration according to the group allocation. Specimens were loaded axially in a universal testing machine until fracture. Fracture resistance was recorded in kilonewtons (kN). Data were analyzed using one-way ANOVA and Dunnett T3 post-hoc tests (p < 0.05). Mean fracture resistance was highest in the intact control group (8.70 ± 4.09 kN), followed by the sandwich technique (7.50 ± 1.55 kN), Nayyar core composite (6.10 ± 1.61 kN), and semi-direct composite onlay (4.94 ± 3.16 kN). The overall difference among the groups was statistically significant (p = 0.001). Post-hoc analysis showed significant differences between the control and semi-direct onlay groups (p = 0.019) and between the sandwich technique and semi-direct onlay groups (p = 0.022). Within the limitations of this in vitro study, the sandwich technique demonstrated the highest fracture resistance when compared with Nayyar core composite restoration and semi-direct composite onlay in endodontically treated mandibular premolars with conservative access preparation and intact marginal ridges.
Oral biofilms represent highly organized microbial ecosystems embedded within extracellular matrices enriched with calcium and phosphate ions that promote the nucleation of calcium phosphate minerals, including hydroxyapatite. During plaque mineralization, microorganisms may become incorporated within calcium phosphate-protein matrices, forming mineralized microenvironments that facilitate microbial persistence while partially shielding pathogens from host immune surveillance. Hydroxyapatite crystals can also directly influence innate immune responses. Macrophages exposed to these particles exhibit altered polarization, impaired antigen presentation, and sustained low-grade inflammatory signaling accompanied by dysregulated tissue repair mechanisms. In biological fluids, calcium phosphate nanoparticles rapidly acquire a protein corona that modulates cellular uptake, biodistribution, and systemic interactions. These particles may disrupt intracellular calcium homeostasis, promote endothelial dysfunction, influence coagulation pathways, and contribute to vascular remodeling. We propose that calcium phosphate mineralization within oral biofilms encapsulates microbial cells within mineral-protein matrices that behave as protected reservoirs capable of systemic dissemination, immune modulation, and promotion of vascular calcification. This mineral encapsulation model provides a mechanistic framework linking opportunistic oral microorganisms with chronic inflammation and cardiovascular disease and suggests potential targets for therapeutic intervention.
Traumatic dental injuries pose challenges in maintaining pulp vitality and promoting root development. Vital pulp therapy (VPT) and regenerative endodontic procedures (REP) are effective approaches for preserving tooth structure and function. Pulpotomy with calcium hydroxide (Ca(OH)₂) supports apexogenesis, whereas REP facilitates root maturation in necrotic immature teeth. While both techniques offer promising results, long-term clinical outcomes remain underreported. This case report presents a 7-year follow-up of two maxillary incisors managed with VPT and REP, demonstrating sustained pulp vitality and complete root formation. An 8-year-old female presented with a traumatic injury to her maxillary central incisors. Clinical and radiographic examinations revealed that tooth #11 had uncomplicated crown fracture with incomplete root formation, while tooth #21 had undergone initial root canal treatment. Tooth #11 was treated with pulpotomy to support apexogenesis, while tooth #21 underwent REP to promote root development. Follow-up visits over 7 years demonstrated continued root formation in both teeth, with no signs of pathology. This case report demonstrates successful long-term management of two immature maxillary incisors using VPT and REP. Pulpotomy effectively promoted apexogenesis in a vital tooth, while REP facilitated root maturation in a necrotic immature tooth. The 7-year follow-up highlights the importance of treatment planning and extended monitoring to evaluate long-term outcomes. Almaliki M, Almaghraby M, Bakhsh A. Long-term Outcome of Vital Pulp Therapy and Regenerative Endodontic Procedures in Immature Permanent Maxillary Incisors: A 7-year Follow-up Case Report. Int J Clin Pediatr Dent 2026;19(3):403-407.
This study evaluated the effects of different cleansing protocols on the wettability, surface free energy, and chemical composition of zirconia surfaces contaminated with saliva or metallic particles. Zirconia specimens (N = 90) were randomly assigned to three contamination conditions (none, saliva, metallic particles) and six cleansing protocols (C-control, A-autoclave, U-ultrasonic bath, E-ethanol, C-chlorhexidine, H2O2-hydrogen peroxide). Surface wettability was assessed by contact angle measurements with water and diiodomethane, and work of adhesion (WoA) and surface free energy (SFE) were calculated using the Owens-Wendt-Rabel-Kaelble model. Elemental composition was analyzed using energy-dispersive X-ray spectroscopy (EDS). Data were analyzed with two-way ANOVA and Tukey's post hoc test (α = 0.05). Both contamination type and cleaning method significantly influenced contact angle, WoA, and SFE (p < 0.001), including their interaction. Saliva and metallic contamination decreased surface hydrophilicity and polar SFE. Chlorhexidine was most effective, restoring low contact angles and high SFE across all conditions. Ethanol and autoclave also performed well, especially in saliva-contaminated samples. Ultrasonic cleaning effectively removed metallic debris. Hydrogen peroxide results were inconsistent, notably after metallic contamination. Contamination alters zirconia surfaces; cleaning effectiveness varies with contaminant type and protocol. Chlorhexidine is the best cleaner. Ethanol, autoclave, and ultrasonic methods are alternatives, with ultrasonic especially effective against metals because of its mechanical cleaning. Effective zirconia implant cleaning is vital to restore wettability after contamination. Findings show hydrogen peroxide alone may be inadequate, highlighting the need for more reliable cleaning methods.
To perform a comprehensive fractographic analysis of split-tooth fractured endodontically treated posterior teeth (ETT) restored with direct resin composite. 9 cases of recovered fractured ETT (2 premolars, 7 molars) that had been restored with micro and nano hybrid resin composites (3 MOD, 4 OM/OD, 2 O), were donated from dental offices with time in service ranging between 3 and 8 years. Fracture surfaces of the recovered parts were analyzed using digital 3D and scanning electron microscopy for identification of failure mode, crack origins, direction of crack propagation based on the recognition of characteristic fracture surface features as well as occlusal surface degradation in areas of contact loading. Mode I fracture (wedge-opening) occurred in all 9 specimens. Fracture origins were located on the restorations occlusal surface and fracture propagated apically with easily recognizable fractographic features (arrest lines, hackle, twist hackle, wake hackle, compression curl) on the resin composites fracture surfaces. Along with enamel cusp contact wear, signs of resin composite fatigue degradation from cyclic loading were cavitations and microcracks located in areas of contact loading and wear near origins. Limited to a small number of cases only, this fractographic research provided evidence that mesio-distal split-tooth fractures resulted from fatigue-driven occlusal surface cracks growing critically under functional loading. The presence of marked occlusal contact wear in the vicinity of crack origins on both, the resin composite and the enamel cusps, are clear occlusal stress indicators emphasizing the need for better patient and tooth risk assessment before decision making on the best treatment option.
This case series highlights the conservative management of complicated crown fractures in permanent incisors using mineral trioxide aggregate (MTA) for pulp capping and adhesive techniques for fragment reattachment. Three patients aged 15-30 were treated and monitored over 12 months. All cases showed positive outcomes with maintained pulp vitality and satisfactory aesthetic and functional results. No signs of periapical pathology or secondary caries were observed. The adhesive reattachment of the tooth fragments provided excellent marginal adaptation and colour match, enhancing the overall success of the treatment.
To study the depth of penetration into the dentin of root canals of teeth sealer for filling root canals partially coherent interferential tomograph. Studied instrumentally and medicamentally treated root canals of seven removed according to clinical indications permanent teeth before obturations and after their filling by the method of lateral compaction of gutta-percha pins with the use of sealer based on epoxy resins and eugenol. The teeth were divided into 3 groups. In group 1, root canal obturation was performed using the AN Plus sealer (based on epoxy resins); in group 2, using the Vyadent sealer (based on epoxy resins); and in group 3, using the Tiedent zinc oxide eugenol cement as the sealer. The reflection coefficient was measured in 20 root canals. A partially coherent interferometric tomograph was used to study the penetration of the dental sealer into the hard tissues of the tooth roots. The study involved. sections of tooth roots corresponding to the boundaries of the mouth and middle third of the root canals. The dependence of the reflection coefficient on the depth of the hard tissues of each sample's root was obtained after instrumental and medicamentous treatment of the root canal before and after obturation. It has been established that the AH-Plus epoxy-amine sealer from Dentsply penetrates 50 to 100 microns deeper into the hard tissues of the tooth root canal than the Vyadent and Tiedent sealer from VladMiVa. The Tiedent zinc oxide eugenol filling material demonstrated better penetration into the dentin structure of the root canal compared to the Vyadent epoxy-based sealer. All of the tested sealants had a penetration depth of at least 200 microns. All the presented samples can be used to fill root canals without compromising the quality of restoration. Изучение глубины проникновения в дентин корневых каналов зубов силеров для пломбирования корневых каналов частично когерентным интерференционным томографом. Исследовали инструментально и медикаментозно обработанные корневые каналы 7 удаленных по клиническим показаниям постоянных зубов до обтурации и после их пломбирования методом латеральной компакции гуттаперчевых штифтов с применением силеров на основе эпоксидных смол и эвгенола. Зубы были разделены на 3 группы. В 1-й группе обтурацию корневых каналов проводили с использованием силера АН Plus (на основе эпоксидных смол), во 2-й группе — с применением силера Виэдент (на основе эпоксидных смол), в 3-й группе в качестве силера использовался цинк-оксид-эвгенольный цемент Тиэдент. Измерение коэффициента отражения проведено в 20 корневых каналах зубов. Для исследования области проникновения стоматологического силера в твердые ткани корней зубов в работе использован частично-когерентный интерферометрический томограф. Исследованию подвергали участки корней зубов, соответствующие границам устьевой и средней трети корневых каналов. Получены зависимости коэффициента отражения по глубине твердых тканей корня каждого образца после инструментальной и медикаментозной обработки корневого канала до его пломбирования и после проведения обтурации. Установлено, что эпоксидно-аминный силер AH-Plus компании «Dentsply» проникает в твердые ткани канала корня зуба на 50—100 мкм глубже, чем силеры Виэдент и Тиэдент производства «ВладМиВа». Цинк-оксид-эвгенольный пломбировочный материал Тиэдент продемонстрировал лучшее проникновение в структуру дентина корневого канала по сравнению с силером на основе эпоксидной смолы Виэдент. Все исследуемые силеры обладали пенетрационной способностью как минимум на 200 мкм в глубину. Для пломбирования корневых каналов зубов возможно использовать без потери качества восстановления все представленные образцы.
Fusobacterium nucleatum is a Gram-negative obligate anaerobic bacterium typically found as a commensal in the human oral cavity, gastrointestinal and female genital tract. While it is a common cause of endodontic infections, it is a rare cause of infective endocarditis (IE), which can lead to high morbidity if diagnosis is delayed due to the challenges of culturing anaerobic bacteria. The case of a 75-year-old male patient with a history of type 2 diabetes who presented with high fever, rigors, and hemodynamic instability is presented herein. Physical examination revealed a new systolic murmur. Initial investigations identified inflammatory syndrome and elevated liver enzymes. Further imaging via contrast-enhanced ultrasound and computed tomography confirmed two abscesses in the left lobe of the liver. Blood cultures grew F. nucleatum, and a transesophageal echocardiogram demonstrated vegetation on the aortic valve. The patient met the Modified Duke criteria for a diagnosis of infective endocarditis. It was later elicited that the patient had undergone dental interventions one month prior to admission. The patient was successfully treated with a six-week course of targeted antimicrobial therapy consisting of ceftriaxone and metronidazole, resulting in favorable clinical recovery. Fusobacterium species are rare but significant causes of invasive infections such as liver abscesses and IE. This case emphasizes that anaerobic pathogens should be suspected in patients presenting with unexplained sepsis, concomitant deep-seated abscesses, or a history of recent dental procedures. Early use of echocardiography and anaerobic blood cultures are essential for the timely diagnosis of these rare clinical entities.
This systematic review aimed to consolidate the clinical presentation, diagnostic and microbial findings, management approaches, and outcomes of maxillary sinus involvement caused by extruded endodontic filling materials. Searches were performed in PubMed, Web of Science, Embase, Scopus, ScienceDirect, and ProQuest up to August 2025. Observational studies reporting extrusion of filling material into the maxillary sinus, accompanied by clinical, imaging, and/or surgical descriptions, were included. Study quality was critically analyzed using the Joanna Briggs Institute tools. Of 4076 articles initially retrieved, 52 were selected for full-text reading, 39 met the inclusion criteria and were included, comprising 34 case reports and 5 case series. Maxillary first molars were the most frequently involved teeth (59%). Extrusion occurred predominantly during primary endodontic treatment. Filling material was identified in the left maxillary sinus in 21 cases (47%) and in the right maxillary sinus in 24 cases (53%). Clinical presentations ranged from incidental asymptomatic findings to severe manifestations such as acute sinusitis. In the included studies, diagnosis was established using radiographic and tomographic imaging as well as direct endoscopic evaluation. Surgical removal represented the most common definitive management approach. Clinical outcomes were predominantly favorable, with complete symptom resolution and functional recovery. Extrusion of endodontic filling materials into maxillary sinus most often involves maxillary first molars and is associated with clinically significant complications, particularly fungal sinusitis. The present findings emphasize the need for prevention, accurate diagnosis, and timely interdisciplinary care of this iatrogenic event.
To compare the survival of single-tooth implants placed in sites with previous external cervical root resorption (ECRR) to those placed in unaffected sites. A retrospective matched cohort study was conducted using data from the Swedish National Dental Health Register (2009-2022). Patients receiving a single-tooth implant in a site with previous ECRR were identified and matched 1:1 to controls without such history by age, sex, tooth position, and timing of implant placement (± 2 years). Implant survival, defined as time from placement to removal, was analyzed using Kaplan-Meier curves and stratified Cox proportional hazards models. Restricted mean survival time (RMST) was estimated up to 10 years. Subgroup and sensitivity analyses assessed robustness. The final cohort included 605 matched pairs (n = 1,210). The mean age was 52 years, and 56% of implants were placed in the maxillary anterior region. Implant extraction occurred in 12/571 (2.1%) sites with previous ECRR and 21/564 (3.7%) control sites. Ten-year cumulative survival was 97.3% for sites with previous ECRR and 94.4% for controls. The difference was not statistically significant (HR = 0.58; 95% CI: 0.28-1.22; p = 0.15). RMST analysis showed a negligible absolute survival difference (0.11 years; 95% CI: -0.04 to 0.25; p = 0.15). Within the limitations of registry-based data and a low number of failures, no statistically significant difference in implant survival was detected between sites with and without previous ECRR. These findings suggest comparable survival outcomes but should be interpreted with caution.
Biomimetic fibrous microspheres with a high specific surface area hold substantial promise for bone tissue engineering. In this study, asymmetric open-hollow nanofibrous microspheres (HNMs) were fabricated from polypeptide poly(γ-benzyl-L-glutamate) (PBLG) via a combination of emulsion and thermally induced phase separation, yielding PBLG HNMs. To further impart biofunctionality, the copper peptide (GHK-Cu) was covalently grafted onto the microspheres to obtain osteoinductive and pro-angiogenic PBLG-GCu HNMs. The optimized microspheres exhibited an average diameter of 372 ± 102 μm, which is suitable for injectability, and an opening size of 219 ± 53 μm, enabling efficient cellular infiltration. The internal surface featured an interconnected nanofibrous network with a fiber diameter of 417 ± 78 nm, mimicking the extracellular matrix (ECM) microenvironment and providing abundant cell-interactive sites. Live/Dead staining and CCK-8 assays confirmed the cytocompatibility of the PBLG-GCu HNMs. Compared with non-functionalized PBLG HNMs, PBLG-GCu HNMs enhanced bone marrow mesenchymal stem cell (BMSC) mineralization and upregulated osteogenic gene expression, with Runx2, OPN, and OCN expression increased by 1.61-, 3.53-, and 2.29-fold, respectively. In addition, the tube formation assay verified robust angiogenic stimulation. Overall, the PBLG-GCu HNMs integrated hierarchical structural biomimicry with dual osteogenic-angiogenic bioactivity, exhibiting great potential as injectable scaffolds for repairing irregular bone defects.
This study evaluated the diagnostic accuracy of two cone-beam CT (CBCT) dose protocols for identifying the number and trajectory deviation of apical foramina. Forty lower molars were scanned in Micro-CT. Thereafter, all teeth were inserted into the mandible sockets and a titanium implant and an endodontically treated tooth with a cobalt-chromium post were inserted into adjacent sockets. CBCT acquisitions were performed using two dose protocols. The images were assessed for the number and trajectory deviation of apical foramina. Agreement with micro-CT was evaluated using the kappa test, and accuracy, sensitivity, and specificity were calculated. Analysis of variance was used to compare diagnostic performance values (α = 0.05). Kappa values indicated poor-to-acceptable agreement with micro-CT. Overall, neither the CBCT dose protocol, root type, nor the presence of high-density materials significantly influenced diagnostic performance. Under the ex vivo conditions, CBCT showed limited agreement with micro-CT for assessing the number and trajectory deviation of apical foramina.
Root canal infections, particularly those involving Enterococcus faecalis and Candida albicans, continue to pose significant challenges in endodontic therapy due to both their inherent resistance to conventional agents. This study aimed to evaluate the antimicrobial efficacy of a newly synthesized piperazine-chalcone hybrid compound, both individually and in various formulations with calcium hydroxide, against these clinically relevant pathogens. The antimicrobial activities were assessed using the disk diffusion method over 24 and 48 h, whereas in silico analyses were conducted to further investigate the compound's molecular interactions, pharmacokinetics, and toxicity potential. Results demonstrated that the piperazine-chalcone hybrid exhibited strong antimicrobial activity against both pathogens, with inhibition zone diameters ranging from approximately 26-32 mm against E. faecalis and 18-28 mm against C. albicans, exceeding those observed for calcium hydroxide and standard antimicrobial controls. Molecular docking analysis revealed favorable binding interactions of the hybrid compound with d-alanine:d-alanine ligase, with a docking score of -8.6 kcal/mol. In silico toxicological assessment predicted a favorable safety profile, with an LD50 value >5000 mg/kg and no major toxicity alerts. These findings suggest that the piperazine-chalcone hybrid holds promise as a safe and effective candidate for enhanced endodontic disinfection.
To establish a novel comprehensive three-dimensional coding system for the classification of teeth with dens invaginatus (DI) using cone beam computed tomography (CBCT) imaging. An initial draft classification of teeth with DI was developed by the project directors and steering group based on the interpretation of CBCT images. A group of 26 global experts then provided their perspectives on the classification via a consensus-building online Delphi process. Following the achievement of consensus, six endodontists independently examined CBCT images of teeth with DI to evaluate the reliability of the draft classification. Inter-rater reliability was employed to ascertain the agreement among the six assessors and intra-rater reliability was assessed following the re-evaluation of the identical CBCT images 3 weeks later. The steering group then revised and finalized the classification. The online Delphi process was completed in a single round with a 100% response rate. The inter-rater reliability score of 0.89 and the intra-rater reliability score of 0.88 revealed "almost perfect" agreement among and within the evaluators. The final CARES classification of teeth with DI includes five domains: Communication (C), cross-sectional Anatomy (A), Root formation (R), vertical Extent (E), and Supplementary features (S). The three-dimensional CARES classification system provides stakeholders with a consistent and unambiguous method of categorizing teeth with DI. The system has the potential to enhance the precision of diagnosis and clinical decision-making during the management of DI and ensures clinicians can communicate more accurately with patients and other healthcare professionals.