Influence of tooth preparation design on margin discrepancy and internal gap in digitally fabricated fixed complete coverage zirconia prostheses: A systematic review of in vitro studies

STATEMENT OF PROBLEM

A systematic review of the effect of tooth preparation design on margin discrepancy and internal gap in digitally fabricated fixed complete coverage zirconia prostheses is lacking.

PURPOSE

The purpose of this systematic review was to evaluate the effect of tooth preparation design on margin discrepancy and internal gap in digitally fabricated fixed complete coverage zirconia prostheses.

MATERIAL AND METHODS

Electronic databases (Ovid, Medline/Embase, PubMed, Scopus, Web of Science, and Google Scholar) and manual searches were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant studies evaluating the effect of different tooth preparation designs (finish lines, taper, and occlusal reduction) on the marginal discrepancy and internal adaptation of fixed complete coverage zirconia prosthesis fabricated by using a completely digital workflow.

RESULTS

The electronic search identified 130 articles, of which 27 in vitro studies were included for both qualitative and quantitative analyses. Of these, 17 studies examined the finish lines, 1 on occlusal reduction, 9 on taper, 1 on both occlusal reduction and finish line, and only 2 investigated fixed partial dentures, while the majority focused exclusively on single crowns.

CONCLUSIONS

The selected articles generally reported clinically acceptable marginal fit and internal adaptation, whereas the results of marginal fit favored the rounded shoulder finish line and internal adaptation favored the chamfer finish line. A planar occlusal reduction with a chamfer finishing line provided better marginal fit. Taper had positive effects on marginal fit and internal adaptation.

Prevalence of upper cervical vertebral anomalies in children with non-syndromic cleft lip and/or palate in comparison with children without cleft in Iranian population

BACKGROUND

To evaluate the prevalence of upper cervical vertebral anomalies (CVA) in Iranian children with cleft lip and/or palate (CL/P) and compare it with children without a cleft.

METHODS

A case-control study on lateral cephalograms from Orthodontics Research Center, Shiraz University of Medical Sciences, Shiraz, Iran of 92 subjects (41 females and 51 males) with non-syndromic CL/P with a mean age of 13.54 ± 4.63 years, and 184 age- and sex-matched individuals (82 females and 102 males) with no craniofacial anomalies or skeletal malocclusion as the control group. Upper cervical vertebrae (C1-C3) were examined regarding the following CVA: (1) posterior arch deficiencies: spina bifida and dehiscence; (2) Fusion Anomalies (FAs): fusion and occipitalization; (3) accessory ossicles. Vertebral artery canal morphology was also evaluated.

RESULTS

The prevalence of CVA was significantly higher in the cleft group (62%) than in the control group (25%) (P < 0.001). FAs, fusion, accessory ossicle, and deviation of artery canal type 2 were the anomalies with significantly higher prevalence in the cleft group compared to the noncleft group (all P < 0.05). 11 individuals (11.9%) of the cleft group and five (2.7%) of the control group had more than one CVA. When considering the subgroups of the CL/P, the prevalence of CVA was significantly higher in almost all the CL/P subgroups compared to the control group (all P < 0.05).

CONCLUSIONS

Upper CVA, especially fusion anomalies, were significantly more prevalent in children with non-syndromic CL/P compared to the children without cleft in an Iranian population. A female predilection for CVA was also noted in both the general population and the cleft group.

Effect of photobiomodulation and selective caries removal in deep cavities on postoperative sensitivity, pulp vitality and dentin neoformation: randomized clinical trial and tomographic evaluation

OBJECTIVES

This randomized clinical trial aimed to evaluate the effect of selective caries removal in deep cavities of posterior teeth associated or not by photobiomodulation (PBM) on postoperative sensitivity, pulp vitality, and dentin neoformation.

MATERIALS AND METHODS

Twenty seven permanent molars with deep Class I cavities were allocated into three groups (n = 9): selective caries removal (Control), selective caries removal followed by infrared (IR; 810 nm) or red (R; 660 nm) laser irradiation. After the cavities were restored with a two-step self-etch adhesive and composite layers, the participants scored their tooth sensitivity perception on a visual analogue scale, as well as after 1, 3, and 6 months. Two teeth per group were randomly selected for cone beam computed tomography (CBCT) scanning upon restoration and after 6 months to evaluate the thickness, mineralization density, and area of neoformed dentin. The sensitivity scores among groups were statistically analyzed by the Friedman test (p < 0.05) while dentin neoformation aspects were descriptively compared.

RESULTS

All teeth remained vital, and the sensitivity mean scores were not significantly different among groups (p < 0.05). Most of the CBCT sections revealed dentin neoformation in all groups. The mineralization density of affected dentin and the remaining dentin area increased in all groups, albeit higher values were found in IR and R groups.

CONCLUSION

Selective removal of infected dentin followed by mild self-etch adhesive application and composite restoration was effective in maintaining pulp vitality, attenuating postoperative sensitivity, and dentin neoformation after 6 months. PBM therapy improved the mineralization density and area of neoformed dentin.

CLINICAL RELEVANCE

Selective caries removal in deep cavities is a regenerative, effective, safe, and simplified treatment that can be combined with photobiomodulation therapy to optimize dentin neoformation.

Clinical effectiveness of aloe vera gel as an adjunct to mechanical debridement in patients with periodontitis: A systematic review and meta-analysis

Background

This study aimed to evaluate the clinical effect of aloe vera gel as an adjunct to scaling and root planing (SRP) on plaque index (PI), gingival index (GI), and probing pocket depth (PPD) in periodontitis treatment.

Methods

Randomized controlled trials (RCTs) were included, focusing on aloe vera gel as an adjunct to SRP in periodontitis patients. An extensive literature search was conducted across PubMed, PubMed Central, Scopus, OVID, Google Scholar, and Cochrane Library databases up to October 2024. The risk of bias was assessed using the Revised Cochrane Risk of Bias tool (ROB 2.0), and statistical analysis was performed using Review Manager 5.4.1.

Results

Fifteen RCTs were included in this systematic review, and separate meta-analyses were conducted for each outcome. For PI, the random effects model showed a mean difference (MD) of -0.23 (95% CI: -0.69, 0.23), favoring the experimental group (P=0.33). The fixed effects model for PI favored the control group (MD=0.12; P=0.20). For GI, the random effects model favored the experimental group (MD=-0.28, P=0.01), while the fixed effects model favored the control group (MD=0.17; P<0.001). For PPD, the random effects model favored the experimental group (MD=-0.45, P=0.009).

Conclusion

As an adjunct to SRP, aloe vera gel significantly improved PI, GI, and PPD in periodontitis patients.

Trial registration

PROSPERO ID: CRD42020201315.

Evaluation of the roughness, color match, and color stability of two monochromatic composite resins: a randomized controlled laboratory study

OBJECTIVE

To assess the efficacy of monochromatic resins in capturing adjacent tooth color across various shades and cavity types, both before and after thermocycling. Furthermore, the surface roughness of the restorations was evaluated.

METHODOLOGY

This is a laboratory test that used 40 mandibular incisors with a healthy crown obtained from the Human Teeth Bank of the UFVJM School of Dentistry. The teeth were randomly assigned to two groups: one group was restored with Omnichroma composite resin, while the other one was restored with Vittra APS Unique composite resin. Three preparations were performed on each tooth in both groups, namely: Classes III, IV and V. Evaluations of USPHS and modified FDI criteria, analysis of roughness using a using a digital surface roughness tester and color reading with a spectrophotometer before and after thermocycling were performed. The data were submitted to descriptive statistics, Chi-square test and the T-test using the SPSS software, and a p-value of < 0.05 was considered statistically significant.

RESULTS

There was no significant difference between the groups in relation to the parameters of shape (p > 0.05), marginal integrity (p > 0.05) and color (p > 0.05) in the USPHS analysis, as well as the ΔE in the CIEL* a* b* analysis (p > 0.05) and color in the FDI analysis (p > 0.05), in all classes. Clinically detectable differences were observed between classes IV (ΔE = 3.80) and V (ΔE = 5.02) restorations of the Omnichroma resin compared to the tooth. The ∆E of Vittra resin was considered unacceptable in all classes (ΔE varied from 4.35 to 5.52). The Vittra resin class III restoration showed the best adaptability (L*: p = 0.462; a*: p = 0.252 and b*: p = 0.335). There was no statistically difference between groups in the surface roughness analysis either initially (p = 0.564) or after thermocycling (p = 0.690).

CONCLUSIONS

It was concluded that the color match of the composite resins Omnichroma and Vittra APS Unique was found to be clinically satisfactory in USPHS and FDI analysis. Both resins showed low surface roughness.

Relevance and Timing of Implant-Driven Rehabilitation in Central Giant Cell Granuloma Cases-A Scoping Review

OBJECTIVES

Central giant cell granuloma (CGCG) is a rare benign tumor. Extended aggressive lesions require large resections, which can lead to bone defects and tooth loss. Rehabilitative treatment is necessary to restore good aesthetics and function. However, the protocol for implant treatment post-CGCG is still unclear. The objective of this scoping review is to shed light on the rehabilitation protocol for CGCG sites by outlining the relevance and timing of implant surgery and prosthetic rehabilitation.

MATERIALS AND METHODS

The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and searched databases for data published between 1999 and 2023. The scoping review aimed to answer the question: "In patients with a diagnosed and treated CGCG, able to receive an implant, does the CGCG tumor recur before or after implant surgery"? Only articles that described cases where patients with a diagnosed CGCG received an implant in a site previously affected by CGCG were included.

RESULTS

The review describes seven case reports and one case series that discuss implantology-driven restoration after CGCG exeresis in humans. The patients, aged between 7 and 80 years, underwent surgical removal of CGCG and received implant-supported prosthetic rehabilitation. A total of 34 implants were placed between 4 and 60 months after the tumor-resection surgery. No recurring lesions were observed during the follow-up period, which ranged between 2 and 12 years.

CONCLUSIONS

Based on the limited evidence available, it appears that implant placement after CGCG removal is safe after a minimum of 4 months of healing. However, further research is necessary to confirm this conclusion.

Bibliometric analysis of trends in dental management of the children with Autism Spectrum Disorder (ASD)

This study aimed to present a complete overview of the trends, difficulties, and improvements in dental treatment for children diagnosed with autism spectrum disorder through rigorous bibliometric analysis. The dimensional database field was chosen to enable the inclusion and recall of the greatest number of relevant entries. All peer-reviewed international journals published between 2004 and 2023 were included in this study. The sophisticated search keywords' Autistic Disorder" OR "Autism Spectrum Disorder" AND "Dental management" were used. Studies that examined patterns and difficulties in the dental care of children with ASD were included in the inclusion and exclusion criteria for this analysis. Among the listed countries, The United States had the highest number of documents and citations. Barbara Sheller is the most cited author, followed closely by Arthur H.Friedlander, Michael E.Mahler, and John A.Yagiela. This study also revealed that most articles involved multinational collaborations, highlighting the global scope of dental research. The United States leads in terms of research output and citations, followed by India and China. Research on autism spectrum disorder has grown substantially over the past few years, and the authors recommend that future research concentrate on creating effective behavioral techniques that will assist children with autism spectrum disorder in coping with dental treatment.

Development of human salivary gland cell lines for modeling radiation-induced damage in three-dimensional spheroid cultures

No permanent cure exists for salivary gland (SG) damage and consequent xerostomia (dry mouth) in patients undergoing radiotherapy for head and neck cancers. The lack of commercially available healthy human SG-derived cell lines has hindered in vitro studies of radiation-induced glandular injury. In this study, we successfully immortalized and characterized two novel human major SG-derived cell lines. Leveraging these cell lines and hyaluronic-acid hydrogels, we bioengineered distinct multicellular SG spheroids and microtissues expressing key acinar, ductal, myoepithelial, and mesenchymal cell markers in long-term cultures. Further, using this platform, we developed a proof-of-concept radiation injury model, demonstrating spheroid disruption characterized by actin depolymerization, DNA damage, apoptosis, and loss of SG-specific markers following radiation exposure. Notably, these detrimental effects were partially mitigated with a radioprotective agent. Our findings demonstrate that the bioengineered SG spheroids provide a scalable and versatile platform with significant potential for disease modeling and drug testing, thereby accelerating the development of targeted therapies for radiation-induced xerostomia.

Do Salivary Cullin7 Gene Expression and Protein Levels Provide Advantages over Plasma Levels in Diagnosing Breast Cancer?

In addition to the tumor suppressor role of Cullin 7 (Cul7), one of the proteins belonging to the Cullin (Cul) family, studies have also suggested that Cul7 may act as an oncogene under certain conditions. The role of the Cul7 molecule in breast cancer is still unclear, and understanding its function could have significant implications for identifying novel therapeutic targets or improving diagnostic strategies in breast cancer management. In this study, the levels of the Cul7 molecule in plasma and noninvasive material saliva were investigated, and its possibility as a marker for breast cancer was discussed. Protein levels of blood and saliva samples taken from breast cancer patients and a healthy control group were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) method. Gene expression levels between the two groups were analyzed by the qPCR (quantitative Polymerase Chain Reaction) method. In our study, Cul7 mRNA and protein expression levels were examined in 60 breast cancer patients and 20 healthy female controls, and a statistically insignificant difference was found between the patient and control groups in both plasma and saliva samples (p > 0.05). No correlation was found between the clinical characteristics of the patients and plasma and saliva Cul7 gene expression and protein levels (p > 0.05). Considering the possibility of Cul7 being a biomarker at the protein and mRNA levels, plasma is thought to be a better study material for Cul7. Our findings suggest that in the context of a study on salivary material, the expression of Cul7 at the mRNA level may have better potential utility as a biomarker.

Role of viruses in periodontitis: An extensive review of herpesviruses, human immunodeficiency virus, coronavirus-19, papillomavirus and hepatitis viruses

Periodontitis is the inflammation of the supporting structures around the dentition. Several microbial agents, mostly bacteria, have been identified as causative factors for periodontal disease. On the other hand, oral cavity is a rich reservoir for viruses since it contains a wide variety of cell types that can be targeted by viruses. Traditionally, the focus of research about the oral flora has been on bacteria because the most widespread oral diseases, like periodontitis and dental caries, are outcomes of bacterial infection. However, recently and especially after the emergence of coronavirus disease 2019, there is a growing tendency toward including viruses also into the scope of oral microbiome investigations. The global high prevalence of periodontitis and viral infections may point out to a concomitant or synergistic effect between the two. Although the exact nature of the mechanism still is not clearly understood, this could be speculated through the manipulation of the immune system by viruses; hence facilitating the furthermore colonization of the oral tissues by bacteria. This review provides an extensive and detailed update on the role of the most common viruses including herpes family (herpes simplex, varicella-zoster, Epstein-Barr, cytomegalovirus), Human papillomaviruses, Human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 in the initiation, progression and prognosis of periodontitis.

Success rate and factors affecting stability of infrazygomatic miniscrew implants: a systematic review and meta-analysis

BACKGROUND

The infrazygomatic miniscrew implants (IZC-MSI) serve as innovative temporary anchorage devices placed parallel to the roots of molars in the infrazygomatic crest region, leveraging their extra-radicular location to support the en masse distalization and intrusion of the maxillary dentition. The efficacy and stability of these screws are crucial for their application in contemporary orthodontic practices.

OBJECTIVES

This systematic review aimed to estimate the success rate and factors affecting the stability of IZC-MSI.

SEARCH METHODS

An electronic search was conducted on 7 February 2024 across the following databases: PubMed, Scopus, EMBASE, and Cochrane databases without any restriction on language and time of publication.

SELECTION CRITERIA

The review included clinical trials (both randomized and non-randomized) and retrospective cohort studies that utilized infrazygomatic miniscrew anchorage for orthodontic tooth movement in human participants.

DATA COLLECTION AND ANALYSIS

The proportion of success rate was calculated and factors affecting stability (patient and implant-related factors) such as age, sex, implant position, and loading characteristics were subjected to subgroup analysis and meta-regression. The quality assessment of studies was done using the Cochrane risk-of-bias tools for randomized (RoB 2.0) and non-randomized trials (ROBINS-I).

RESULTS

Fourteen studies (n = 1683 IZC-MSI) were included in the meta-analysis revealing a 92% success rate of IZC-MSI (C.I. 87%-95%; prediction interval: 66%-99%; I2 = 80%). Studies with sample size > 100 presented a 94% success rate (C.I. 91%-96%; I2 = 63%) and moderate heterogeneity. Meta-regression analysis revealed no significant relation between age and success rate. Significant heterogeneity was observed in the subgroup analysis of host-, implant- and other related risk factors affecting stability and limited correlation was found. The risk-of-bias assessment revealed high risk in five, moderate in five, and low in four studies.

CONCLUSIONS

IZC-MSI have shown a good success rate for their clinical application. Although some factors appear to influence IZC-MSI stability, the majority of them necessitate additional investigation due to the low quality of evidence. Furthermore, high-quality studies are needed to confirm the results of this meta-analysis and address other important factors such as operator's experience, insertion torque, and sinus penetration that could not be analysed due to limited data.

REGISTRATION

CRD42024469048.

Giant Angina Bullosa Hemorrhagica of Hard Palate: A Case Report

Angina Bullosa Hemorrhagica is characterized with rapid appearance of soft, blood-filled blisters on the mucosa of oral cavity and oropharynx. It is a benign condition, and is not associated with any systemic hematological disorder. No etiological factors have been identified and there are no established guidelines for its management. The current case report describes the sudden appearance of large, bluish, soft lesion on the soft palate which was managed with incision and drainage, and healed completely over the next three weeks.

Oral lichen planus-like lesions in skin of color: a review

In dermatology, lichenoid describes lesions with a violaceous hue that is a clinical reflection of basal cell damage in the epithelium and dense mononuclear infiltrate in the sub-epithelium. The violaceous color results from pigment incontinence due to basal cell damage and the Tyndall effect. Although classically described in lichen planus, a lichenoid hue is noted in the oral mucosa in several other disorders that often lead to diagnostic dilemmas. Early and accurate diagnosis is important for the appropriate management of the underlying condition and prognostication. Dermatologists play a central role in managing such patients since, apart from the oral mucosa findings, the cutaneous features also help to significantly differentiate various conditions. Mimickers of oral lichen planus include nicotine stomatitis, oral submucous fibrosis, oral lichenoid lesions, mucosal discoid lupus erythematosus, pemphigus vulgaris, paraneoplastic pemphigus, mucous membrane pemphigoid, fixed drug eruption, plasma cell cheilitis/gingivitis, and erythema multiforme. While a detailed history and clinical examination can help reach a diagnosis in most cases, histopathology, immunofluorescence, and other relevant investigations help establish the diagnosis.

Bone Regeneration with Dental Pulp Stem Cells in an Experimental Model

BACKGROUND/OBJECTIVES

The therapeutic approach to bone mass loss and bone's limited self-regeneration is a major focus of research, emphasizing new biomaterials and cell therapy. Tissue bioengineering emerges as a potential alternative to conventional treatments. In this study, an experimental model of a critical bone lesion in rats was used to investigate bone regeneration by treating the defect with biomaterials Evolution® and Gen-Os® (OsteoBiol®, Turín, Italy), with or without mesenchymal stromal cells from dental pulp (DP-MSCs).

METHODS

Forty-six adult male Wistar rats were subjected to a 5-mm critical bone defect in the right mandible, which does not regenerate without intervention. The rats were randomly assigned to a Simulated Group, Control Group, or two Study Groups (using Evolution®, Gen-Os®, and DP-MSCs). The specimens were euthanized at three or six months, and radiological, histological, and ELISA tests were conducted to assess bone regeneration.

RESULTS

The radiological results showed that the DP-MSC group achieved uniform radiopacity and continuity in the bone edge, with near-complete structural defect restitution. Histologically, full bone regeneration was observed, with well-organized, vascularized lamellar bone and no lesion edges. These findings were supported by increases in endoglin, transforming growth factor-beta 1 (TGF-β1), protocollagen, parathormone, and calcitonin, indicating a conducive environment for bone regeneration.

CONCLUSIONS

The use of DP-MSCs combined with biomaterials with appropriate three-dimensional matrices is a promising therapeutic option for further exploration.

Obstructive Salivary Gland Disorders - A Malaysian Patient Series

Introduction  Obstructive salivary gland disease is a frequently encountered clinical entity that can present to various health practitioners. Obstructive sialadenitis can lead to recurrent infections and debilitating quality-of-life issues. Objective  There is a paucity of published data regarding obstructive salivary disorders among the multiracial Asian population. The present study aimed to determine the demographic pattern and risk factors of obstructive salivary gland disorders with the goal of better management of this condition. Methods  A retrospective cross-sectional study was conducted at a tertiary institution over a period of 5 years. Results  A total of 256 (9.84 for every 1,000) patients were found to have salivary disorders, 10% of who were diagnosed to have obstructive disorder. Among the obstructive salivary disorders, 76% had sialolithiasis, 19% had recurrent parotitis, and 1 patient had chronic sialadenitis. We observed a small female preponderance for obstructive salivary disorders. This study revealed that smoking is a significant risk factor ( p  = 0.041; prevalence ratio = 2.54, 95% confidence interval 1.12-5.78), and smokers were 2.5 times more likely to develop obstructive salivary disorders. There was no statistical correlation between the prevalence and other risk factors like infection, dehydration, intake of medications, history of diabetes mellitus, radiotherapy, and autoimmune disorders. Conclusion  Our study results demonstrated that the prevalence of obstructive salivary gland disorders was 0.1%. This study provided a better understanding of the prevalence and risk factors of obstructive salivary disorders, which facilitate timely management and improves quality of life.

Analysis of the pH levels in energy and pre-workout beverages and frequency of consumption: a cross-sectional study

BACKGROUND

Erosive tooth wear is an increasingly common pathology in the youth population. It refers to the chronic, localized, painless loss of dental hard tissues caused by non-bacterial acids, often originating from external sources like acidic beverages. Energy drink consumption is on the rise, frequently preceding physical exercise to enhance perceived energy levels. However, there are other types of beverages that also provide energy, such as pre-workout drinks, classified as sports drinks. The main objective of this research study has been conducted with the purpose of analyzing the pH of energy drinks and pre-workout beverages, and studying the frequency of consumption of such beverages in amateur athletes who practice sports.

METHODS

A total of 67 beverages were examined, comprising 43 energy drinks and 24 sports supplementation beverages, also known as pre-workout or pre-training beverages. The participants were given a survey to complete. They were asked to respond whether they consumed any type of pre-workout or energy drink, and they were also asked about the timing of consumption.

RESULTS

The findings indicated an average pH of 3.3 among the studied beverages, indicating a pH below the critical threshold. Out of the 113 participants, 51% reported taking some form of supplementation.

CONCLUSIONS

Consequently, it was concluded that most of the analyzed beverages recorded pH values low enough to classify them as erosive, posing a threat to enamel surface. When analyzing the frequency of consumption of energy drinks and pre-workout beverages in amateur athletes, we observed that most participants aged 29 years or younger took supplements 3 to 5 times a week, while the older age groups more frequently took supplements 1 to 2 times a week.

Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches

Background/Objectives: Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP's pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP. Results: OLP's pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed. Conclusions: Regular screenings and biopsies are essential due to OLP's likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens.

Synergetic impact of MgO on PMMA-ZrO2 hybrid composites: Evaluation of structural, morphological and improved mechanical behavior for dental applications

This work aims to demonstrate the effect of ZrO2 and MgO inclusion into the Poly(methyl methacrylate) (PMMA). To fabricate novel hybrid composites via heat cure method, various composites (PZM2, PZM4 and PZM6) were synthesized in the system [(95-x) PMMA + 5 ZrO2 + x MgO] (x = 2, 4, and 6) respectively. Density of the prepared composites were determined and varying between 1.035-1.152 g/cm3. X-ray Diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) followed by EDAX and mechanical testing were performed to evaluate the fabricated composite properties. Moreover, to explore the structure of the fabricated composites the 13 C CP-MAS SSNMR and 1 H-13 C Phase-Modulated Lee Goldberg (PMLG) HETCOR Spectrum were recorded which clarify chemical shifting and motional dynamics of the composites. Mechanical tests were performed by UTM and the obtained parameters such as compressive strength, Young's modulus, fracture toughness, brittleness coefficient, flexural strength and flexural modulus are found to be in the range of 91-100 MPa, 0.48-0.51 GPa, 9.122-9.705 MPa.m1/2, 0.66-0.815, 51.03-42.78 MPa and 499-663 MPa respectively. Some more mechanical parameters such as proportional limit, elastic limit, failure strength, modulus of resilience and modulus of toughness were also calculated. Furthermore, tribological properties were also determined and the coefficient of friction (COF) was decreased by 17.4 % and 38 % for composite PZM6 at 20 N and 40 N as compared to the composite PZM2 and the lowest wear volume of 1.55 mm3 was observed for PZM2, whereas the maximum volume loss of 5.64 mm3 is observed for composite PZM6. To check out the biocompatibility, cytotoxicity and genotoxicity of the fabricated composites the Trypan-blue assay was also performed for PZM2 and PZM6 composites. Dissection on the gut of larvae was also performed on the both composites followed by DAPI and DCFH-DA staining. Therefore, these synthesized samples can be used for the fabrication of denture materials.

Impact of acidic beverages on composition and surface characteristics of human teeth: scanning electron microscopic, stereomicroscopic and energy dispersive x-ray analyses

OBJECTIVES

The objective of this study was to evaluate the effect of acidic beverages on the surface topography and elemental composition of human teeth.

METHODS

A total of five highly acidic beverages (Red Bull, Pepsi, Apple Cidra, Tang Mosambi, and Tang Orange) were investigated. The tooth specimens of experimental groups were submerged in each beverage and incubated at 37 °C for 7 days, whereas, the tooth specimens of control groups were placed in distilled water. Afterwards, tooth specimens were analyzed using scanning electron microscopic (SEM), stereomicroscopic, and energy dispersive x-ray (EDX) techniques.

RESULTS

All experimental groups revealed a decline in the tooth elements compared to controls, however, such decline was not statistically significant. Nevertheless, comparing the experimental groups, the Red Bull beverage caused a marked reduction in the percentage of both calcium and phosphorus elements compared to the Pepsi, Apple Cidra, Tang Mosambi, and Tang Orange beverages but it was insignificant as well in contrast to its control counterpart. All five acidic beverages demonstrated erosive potential under SEM analysis; however, each group of specimens showed a diverse amount of demineralization. In addition, all experimental groups exhibited significant discoloration of tooth specimens compared to their respective control counterparts.

CONCLUSIONS

Within the limitations of study, all five acidic beverages demonstrated erosive potential in the simulated in vitro conditions under SEM analysis; however, each group of specimens exhibited a different extent of demineralization. In addition, the overall effect of all beverages was insignificant under EDX analysis as no substantial difference was revealed between the elemental composition of experimental and control group specimens.

Salivary Histamine Levels in Patients with Oral Lichen Planus Lesions

Background and Objectives: An oral lichen planus (OLP) chronic lesion refers to a group of oral potentially malignant disorders (OPMDs) that still lack a proper understanding from the point of view of relevant biomarkers for diagnostics and prognosis. The aim of the study was to assess the salivary histamine levels in patients with oral lichen planus lesions. Materials and Methods: The study included a group of 76 patients with oral lichen planus. General diseases and medication taken, smoking habits, severity of pain assessed using a visual analogue scale (VAS), oral hygiene status, and duration of OLP were evaluated. ELISA diagnostics for histamines in saliva levels were assessed. Results: The histamine levels in the OLP group were higher (0.468) in comparison with the control group (0.056), without a statistically significant value p = 0.090 (Mann-Whitney U Test). The median age of 76 OLP patients was 63 years (min 22.0-max. 81), with the biological sex being 80.3% females and 15 19.7% males. The average duration of OLP lesion presence was 29.4 months (SD 37.1) and the median value was 14.5 months. The median of the VAS was 3.0. OLP assessment in accordance with the Malhotra methodology showed the highest frequency-30.3% for only two of the point areas involved and 17.1% for three points. Clinical assessment of the different OLP grades, severity, and oral site involvement and the VAS in correlation with histamine salivary levels showed a lack of statistical significance in the investigated population. Conclusions: Undertaking further research could provide further possibilities for searching for general factors in OLP development.

Oral Lichen Planus and Its Therapeutic Approaches: A Case Report

Lichen planus, a chronic inflammatory skin disorder, presents with pruritic, polygonal, and flat-topped papules and plaques. It encompasses not only the skin but also mucous membranes, nails, and hair follicles. Diagnosis relies on all the clinical and biopsy reports. The etiology of oral lichen planus (OLP) is multifactorial, with genetic, immunological, and environmental factors playing significant roles. Frequently utilized therapies encompass topical corticosteroids, calcineurin inhibitors, and systemic immunomodulatory medications. Management should be tailored to disease severity and the specific site of involvement. Lichen planus can present in papular, hypertrophic, atrophic, erosive, or erythematous forms. In this report, we present a case of a 28-year-old male patient who presented with bilateral white striations on the buccal mucosa and an erythematous lesion on the right buccal mucosa causing significant discomfort. The patient was treated with corticosteroids, resulting in marked symptomatic relief and partial lesion regression over a follow-up period of six months. This case underscores the importance of early diagnosis and tailored therapeutic strategies in managing OLP to improve patient outcomes.

The Orthodontic Mini-Implants Failures Based on Patient Outcomes: Systematic Review

Anchorage is a challenge and essential issue for an orthodontist in determining the success of orthodontic treatment. Orthodontic anchorage is defined as resistance to unwanted tooth movement. Mini-implant is one of the devices that can be used as an anchor in orthodontic treatment. Many cases have reported successful treatment using mini-implant, but there are cases where mini-implants may fail. Failure of mini-implants can affect orthodontic treatment, and it is known that several factors may lead to mini-implant loss in orthodontic treatment. This systematic review aimed to determine the factors influencing mini-implant failure in orthodontic treatment. Articles were selected from electronic databases (PubMed, Google Scholar, The Cochrane Library, ScienceDirect) from January 2015 until 2023 according to the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) under the PEOS (Population-Exposure-Outcome-StudyType) framework questions for systematic review. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022337684). All data collected were in English, and filtering was done by eliminating duplicate data, meta-analysis, case reports, case series, mini-reviews, and animal studies. The analysis was further divided into three groups, that is, patient-related, implant-related, and operator-related and operator-related (A graphical abstract provided as a Supplementary information [available in the online version]). Twenty-one articles were identified according to the inclusion criteria in the form of retrospective, prospective, in vivo, and randomized controlled trial studies. Mini-implant failures due to patient-related showed six etiological factors, failures due to implant-related had eight etiological factors, and only one factor was operator-related, which may lead to mini-implant failure. The data was extracted without a computerized system and only in English. Mini-implant failure can be caused by many factors; we could not accuse one major factor as a cause. However, the quality or condition of the bones and oral hygiene are factors that play a significant role in obtaining the stability of implants. Mini-implant failure is highly influenced by poor oral hygiene and peri-implant inflammation. Comprehensive diagnostic prior to mini-implant insertion should be appropriately considered. This systematic review describes several factors that can influence mini-implant failure, divided into three groups: patient-related, implant-related, and operator-related (A graphical abstract provided as a Supplementary information [available in the online version]).

Klippel-Feil Syndrome With Isolated Facial Dysmorphism: A Clinical Conundrum With Resemblance to Adenoid Facies

Klippel-Feil syndrome (KFS) is a triad comprising cervical spine fusion, a low posterior hairline, and constrained neck movement. This triad is not universally present. The most frequent accompaniment is Sprengel's scapula deformity. According to the Feil classification, Class 1 (C1) is an immense fusion of many cervical vertebrae, Class 2 (C2) is a fusion of one or two vertebrae only, and Class 3 (C3) is coupled with thoracic and lumbar spinal vertebral fusion in addition to the fusion of the cervical vertebrae. Clarke's categorization of KFS includes other associated anomalies. The different classification systems for KFS have been made by the different specialists to whom patients may present, which include orthopedic surgeons, neurosurgeons, orthodontists, faciomaxillary surgeons, cardiologists, and pediatricians. This anomaly being rare and the lack of universally accepted classification may lead to confusion regarding the identification of the syndrome, especially the Clarke Type 3 with isolated facial dysmorphism may go undiagnosed. We report a case with KFS-Clarke Type 3 with isolated facial dysmorphism and Feil Type 2 with the fusion of C2-C3 cervical vertebrae, detected as an incidental radiologic finding, and initial impression of adenoid facies. Hence, this case also highlights the contrasting features between the facial dysmorphism of Clarke Type 3 KFS and adenoid facies.

A New Scoring System of Oral Lichen Planus

Lichen planus (LP) is a chronic, immune-mediated mucocutaneous disorder increasingly becoming common in the general population with female predominance. Clinically, there are different forms of lichen planus with the presence of the main characteristic feature of Wickham striae. Literature, to date, is abundant with various scoring systems of oral lichen planus, and among them, the most commonly followed scoring system was the one proposed by the Thongprasom system because of its simplicity and ease of application.

Aim

The aim of the present study is to critically review all the disease scoring systems on oral lichen planus (OLP) that have been reported in the literature during the past decades. A systematic literature search was performed using PUBMED, MEDLINE, EMBASE, and COCHRANE Library with language restriction to English. The search was carried out incorporating the published literature from 1980 to 2020 using the MeSH (medical subject heading) terms. A literature search was done using keywords: Staging, Grading, Oral lichen planus, Diagnostic, and Therapeutic. Out of 25 publications, related to search strategy, 22 full articles, which were related to the disease scoring system for oral lichen planus, were acquired for further inspection. Out of the 22 articles, 15 articles met the inclusion criteria. The data was collected and a brief summary of the studies regarding the different disease scoring systems for oral lichen planus was explained. Taking into consideration, the parameters were not included in the previous disease scoring system. A new proposal encompassing a scoring system for oral lichen planus considering the missing parameters along with an amalgamation of histopathological criteria of dysplasia is presented. It also proposes to grade and stage the lesions and recommend appropriate therapy for each of such lesions.

Assessment of Clinical and Patient-Centered Outcomes in Nonsurgical Periodontal Therapy

Aim  The study was conducted to assess the clinical and patient-centered outcomes among the patients who had undergone nonsurgical periodontal therapy (NSPT). Methodology The participants for this study were 40 individuals with generalized chronic periodontitis. Numerous clinical parameters including clinical attachment level (CAL), probing pocket depth (PPD), plaque index (PI), and gingival index (GI) were evaluated along with the administration of a customized questionnaire before and after three months of therapy to evaluate patient-centered outcomes. Results Clinical parameters showed significant (p < 0.05) improvement post-NSPT. There was 100% satisfaction in few patient-centered outcomes such as bleeding gums, bad breath, food entrapment, and mobility. Conclusion A significant improvement in the clinical parameters does not guarantee improvement in patient-centered outcomes. Achieving the improvement in patient-centered outcomes can improve the overall quality of life (QOL), marking this a holistic treatment.

Application of dental pulp stem cells for bone regeneration

Bone defects resulting from severe trauma, tumors, inflammation, and other factors are increasingly prevalent. Stem cell-based therapies have emerged as a promising alternative. Dental pulp stem cells (DPSCs), sourced from dental pulp, have garnered significant attention owing to their ready accessibility and minimal collection-associated risks. Ongoing investigations into DPSCs have revealed their potential to undergo osteogenic differentiation and their capacity to secrete a diverse array of ontogenetic components, such as extracellular vesicles and cell lysates. This comprehensive review article aims to provide an in-depth analysis of DPSCs and their secretory components, emphasizing extraction techniques and utilization while elucidating the intricate mechanisms governing bone regeneration. Furthermore, we explore the merits and demerits of cell and cell-free therapeutic modalities, as well as discuss the potential prospects, opportunities, and inherent challenges associated with DPSC therapy and cell-free therapies in the context of bone regeneration.

Materials and Methods for All-Ceramic Dental Restorations Using Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) Technologies-A Brief Review

The materials used in dentistry for the fabrication of all-ceramic restorations have undergone great and rapid developments over the last two decades. Among the most common ceramic materials in dentistry are those based on zirconium and lithium disilicate. Due to the properties of these materials, they are in great demand in the field of dental restoration production. Thus, dental restorations that will use those materials are commonly machined in CAD/CAM systems, which offer the possibility of manufacturing all-ceramic dental restorations in a very short period of time. This article reviews the modern materials in the field of all-ceramic dental restorations, their manufacturing processes, as well as what determines which ceramic materials are used for the production of CAD/CAM blanks and their production technology.

The Combined Effects on Human Dental Pulp Stem Cells of Fast-Set or Premixed Hydraulic Calcium Silicate Cements and Secretome Regarding Biocompatibility and Osteogenic Differentiation

An important part of regenerative endodontic procedures involving immature permanent teeth is the regeneration of the pulp-dentin complex with continuous root development. Hydraulic calcium silicate cements (HCSCs) are introduced for the pulpal treatment of immature permanent teeth. The stem-cell-derived secretome recently has been applied for the treatment of various damaged tissues. Here, we evaluated the biocompatibility and osteogenic differentiation of HCSCs combined with secretome on human dental pulp stem cells. In the Cell Counting Kit-8 test and wound healing assays, significantly higher cell viability was observed with secretome application. In alkaline phosphatase analysis, the activity was significantly higher with secretome application in all groups, except for RetroMTA on day 2 and Endocem MTA Premixed on day 4. In an Alizarin Red S staining analysis, all groups with secretome application had significantly higher staining values. Quantitative real-time polymerase chain reaction results showed that the day 7 expression of OSX significantly increased with secretome application in all groups. SMAD1 and DSPP expression also increased significantly with secretome addition in all groups except for Biodentine. In conclusion, HCSCs showed favorable biocompatibility and osteogenic ability and are predicted to demonstrate greater synergy with the addition of secretome during regenerative endodontic procedures involving immature permanent teeth.

Herpesviruses and SARS-CoV-2: Viral Association with Oral Inflammatory Diseases

The oral cavity is a niche for diverse microbes, including viruses. Members of the Herpesviridae family, comprised of dsDNA viruses, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an ssRNA virus, are among the most prevalent viruses infecting the oral cavity, and they exhibit clinical manifestations unique to oral tissues. Viral infection of oral mucosal epithelia triggers an immune response that results in prolonged inflammation. The clinical and systemic disease manifestations of HHV have been researched extensively, and several recent studies have illuminated the relationship between HHV and oral inflammatory diseases. Burgeoning evidence suggests the oral manifestation of SARS-CoV-2 infection includes xerostomia, dysgeusia, periodontal disease, mucositis, and opportunistic viral and bacterial infections, collectively described as oral post-acute sequelae of COVID-19 (PASC). These diverse sequelae could be a result of intensified immune responses initially due to the copious production of proinflammatory cytokines: the so-called "cytokine storm syndrome", facilitating widespread oral and non-oral tissue damage. This review explores the interplay between HHV, SARS-CoV-2, and oral inflammatory diseases such as periodontitis, endodontic disease, and peri-implantitis. Additionally, the review discusses proper diagnostic techniques for identifying viral infection and how viral diagnostics can lead to improved overall patient health.

Variations of oral anatomy and common oral lesions

Several topics related to the oral cavity are briefly addressed in this article, from anatomical variations that, when recognized, avoid unnecessary investigations, to diseases that affect exclusively the mouth, mucocutaneous diseases, as well as oral manifestations of systemic diseases. A complete clinical examination comprises the examination of the mouth, and this approach facilitates clinical practice, shortening the path to diagnosis in the outpatient clinic as well as with in-hospital patients. The objective of this article is to encourage the examination of the oral cavity as a useful tool in medical practice, helping to recognize diseases in this location.

Zirconia Ceramics

Zirconia ceramics have become popular among other dental ceramics thanks to their biological, mechanical, optical, and aesthetic properties. CAD/CAM (computer-aided design/ computer-aided manufacturing) technology improvement has played a vital role in the increased popularity of zirconia ceramics; easy computer manipulation significantly expanded the possibility of using different types of restorations. Zirconia ceramics have a broad spectrum of indications in prosthetic dentistry, from simple restorations to complex structures supported by dental implants. A good orientation in the classification, features, and manipulation of zirconia ceramics is the main key to success.

Total Antioxidant Capacity of Saliva and Its Correlation with pH Levels among Dental Students under Different Stressful Conditions

(1) Background: This cross-sectional study conducted at the Faculty of Dental Medicine, Timisoara, Romania, between December 2022 and February 2023 aims to assess salivary total antioxidant capacity and pH levels in dental students experiencing non-stressful and stressful situations and explore potential correlations between these factors. (2) Methods: Saliva samples were collected during two different periods: before an Oral Health course and before the Oral Health exam, under stressful conditions. Ethical principles were followed, and informed consent was obtained. Data on age, gender, health status, drug use, smoking habits, and anxiety levels were recorded. Saliva was collected using the draining method and pH was measured using indicator paper strips. Total antioxidant capacity (TAC) was determined using a commercial assay kit. Statistical analysis involved descriptive statistics, Student's t-test to compare pH and TAC between study groups, and Pearson's correlation coefficient to analyze the correlation between salivary pH and TAC within each group, with p < 0.05 indicating significance. (3) Results: This study involved 80 participants, comprising 26 males and 54 females, all enrolled in the 5th year of the Oral Health course, with ages ranging from 20 to 53 and a mean age of 23.62 (±4.19) years. Pearson's correlation results show a statistically significant negative relationship between the STAI test and TAC during the stress-free period (-0.02 **, N = 80, p < 0.01). (4) Conclusions: There are variations in saliva's antioxidant capacity in response to different stress conditions. Dental students experienced a higher level of stress before academic assessments compared to the non-stress period during the course.

Effect of Low pH Dietary Supplements on Discoloration of Resin Composites

AIM

This study aimed to evaluate the impact of the consumption of low pH dietary supplements on the color stability of different resin composites.

MATERIALS AND METHODS

Three different restorative materials were used for this in vitro study: Filtek One Bulk-Fill (FOB), Filtek Z550 (Z550), and Fill-Up (FUP). Samples fabricated from each composite group were divided into four subgroups, and color measurements were performed at baseline. The control subgroup was stored in distilled water, and the other three subgroups were immersed in acidic dietary supplement solutions (Redoxon, Supradyn, and Voonka Collagen Shake) for 2 minutes daily for 28 days. Color measurements were obtained using a digital spectrophotometer. Color change values (ΔE1) were calculated after each color measurement. Next, all samples were immersed in a coffee solution for 7 days and repeat color measurements were taken to determine ΔE2 values. The study groups were compared using the Kruskal-Wallis test (α =0.05).

RESULTS

ΔE1 values were significantly different among the groups (P < 0.05). While Voonka Collagen Shake produced the greatest discoloration in FOB (1.67 ± 1.08) and Filtek Z550 (3.59 ± 1.90) materials, Fill-Up showed the highest discoloration (3.14 ± 0.37) with Supradyn. Analysis of ΔE2 values demonstrated a significant difference only for the Filtek Z550-Redoxon group versus the control group (P < 0.05).

CONCLUSION

Acidic dietary supplements not only produce color alterations in resin composites but also reduce the staining resistance of the composite further, depending on the type of composite and dietary supplement. Consumption of staining food after taking Redoxon effervescent tablets produces greater discoloration in Filtek Z550 restorations compared with other restorative materials.

Systemic non-steroidal immunomodulators for oral lichen planus treatment-a scoping review

OBJECTIVE

The aim of this scoping review was to evaluate the efficacy and safety of the use of systemic nonsteroidal immunomodulators (SNSI) for oral lichen planus (OLP) treatment.

MATERIALS AND METHODS

This review was conducted according to PRISMA-ScR guidelines and registered at PROSPERO (CRD42021243524). Consulted databases were Pubmed, Embase, Scopus, and Web of Science. The inclusion criteria was as follows: clinical trials, case series, prospective, and retrospective studies conducted with participants presenting OLP of any sex and age.

RESULTS

Thirty-two studies were selected, assessing 9 different SNSI: methotrexate, dapsone, levamisole, hydroxychloroquine, thalidomide, metronidazole, azathioprine, mycophenolate mofetil, and colchicine. Methotrexate and dapsone were the drugs with the best evidence among the options included, regarding number and quality of studies. Methotrexate resulted in significant improvement in the clinical condition and remission of symptoms, ranging between 63 and 93% of cases. Dapsone presented a similar effect to the use of topical corticosteroids and tacrolimus CONCLUSION: Among SNSI therapeutic options, methotrexate, and dapsone showed promising efficacy and safety. However, large-scale randomized clinical trials are still needed.

CLINICAL RELEVANCE

SNSI have been used in the treatment of recalcitrant OLP; however, so far, it is not clear which are the best options. This scoping review highlights the potential use of methotrexate and dapsone.

Assessing the effect of piezoelectric ultrasonic scaler tip wear on root surface roughness under influence of various working parameters: A profilometric and atomic force microscopic study

Background

Assessing the effect of scaler tip wear on the root surface roughness using piezoelectric ultrasonic scaling device under influence of various working parameters, i.e. power setting, lateral force, and instrumentation time.

Materials and Methods

An experimental study was conducted using 160 single-rooted tooth samples divided into two groups of new (n = 80) and worn tips (n = 80). Samples were prepared to examine the root surface roughness after being instrumented by new and worn piezoelectric ultrasonic tips (8 new/8 worn) at different parameters. The erosion ratio (ER) of the new/worn tip was examined under an atomic force microscope and roughness over root surface was measured by a contact surface profilometer. One-way analysis of variance test, post hoc Tukey's test, and independent t-test were used for intragroup, pair-wise multiple comparisons and intergroup comparison of average roughness (Ra) value.

Results

A statistically significant difference was found between the ER of new and worn scaler tips (P < 0.001). Intragroup comparison between subgroups 1 and 8 showed a higher Ra value in both the groups (P < 0.005). There was a significantly higher Ra value of worn tips compared to new tips (P < 0.05). Significantly higher mean Ra value was shown when lateral force changed from 50 g to 100 g (P < 0.005).

Conclusions

Increasing value of power setting, lateral force, and instrumentation time caused more surface roughness in worn-out scaler tips compared to new scaler tips. Lateral force and instrumentation time proved to be a major factor influencing surface roughness.

Contemporary treatment techniques for excessive gingival display caused by altered passive eruption or lip hypermobility

OBJECTIVES

Excessive gingival display (EGD), also known as gummy smile, has various causes, including altered passive eruption (APE) and hypermobile upper lip (HUL). This state-of-the art narrative review explores current concepts regarding soft tissue EGD etiologies and the contemporary modalities available for APE or HUL treatment.

DATA, SOURCES, STUDY SELECTION

Literature search was conducted for a narrative review on the etiology, diagnosis, and treatment of EGD caused by APE and HUL. Searching for articles was carried out in PubMed and Google Scholar. Published articles, including case reports, case series, observational and interventional clinical trials, and critical appraisals of the literature (e.g., systematic reviews) on the etiology, diagnosis, and treatment of EGD caused by APE and HUL were retrieved and reviewed. Particular focus was placed on novel treatment modalities introduced in the last five years.

CONCLUSIONS

Recent research evidence indicates that APE and HUL are the two major soft tissue-based EGD etiologies. Aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) are the established surgical treatment modalities for APE and HUL, respectively. The last few years have seen the introduction of new techniques for APE and HUL management, an expansion of the available ACL and LRS technique variations, and additional evidence further supporting the effectiveness of these two procedures. Several of the recently introduced approaches offer unique, innovative, and potentially impactful concepts. However, for many of these newly described treatments the available evidence is limited to case reports and the exact indications remain to be adequately defined.

CLINICAL SIGNIFICANCE

Altered passive eruption and hypermobile upper lip are the common soft tissue causes of gummy smile and can be successfully managed through aesthetic crown lengthening and lip repositioning surgery, respectively. A wide range of newly introduced approaches promises to further facilitate gummy smile treatment and improve outcomes.

A retrospective study of nonneoplastic and neoplastic disorders of the salivary glands

The spectrum of major and minor salivary gland disorders varies widely. Epidemiological data on some injury categories are rare and often not up-to-date. This study aims to analyze epidemiological data using clinical, paraclinical, and histopathological parameters. Study was carried out for 5 years on the nonneoplastic and tumoral pathology of the salivary glands. Data were statistically analyzed using the appropriate parameters. Data analysis according to the biological behavior of the lesions revealed great heterogeneity. Statistically significant correlations were observed between the type of injury, age (P = .002) and gender (0.033). The environment of origin of the patients as well as the comorbidities reflected in most cases the nature of the process. Associations were also observed between the biological behavior of the lesions and the hemicranial topography (P = .019), the type of salivary gland (P = .024), and the surgical technique used (P < .001). Most cases were identified in the major salivary glands, often in the parotid. The most common diseases are represented by nonspecific chronic sialadenitis (nonneoplastic lesion), pleomorphic adenoma and Warthin tumor (benign tumors), mucoepidermoid carcinoma (malignant tumor), and squamous carcinoma (secondary tumor). They presented axial diameters between 2 to 95 mm. The most used curative technique was subtotal excision with facial nerve preservation. In conclusion, the study highlighted the main epidemiological aspects of salivary gland disorders. Some data agree with the specialty literature, and particular aspects are also observed. Therefore, this research is useful both in the medical and research fields.

The Effect of Calcium hydroxide, Glass Ionomer and light cured resin modified calcium silicate on viability, proliferation and differentiation of stem cells from human exfoliated deciduous teeth

BACKGROUND

Vital pulp therapy, based on the use of stem cells, has promising research and therapeutic applications in dentistry. It is essential to understand the direct effect of capping materials on the dental pulp stem cells of primary teeth, which contribute to the healing powers of the tooth. The aim of this study is to evaluate the effect of different capping materials (Calcium Hydroxide (DyCal®) - Glass Ionomer (Fuji IX®) and light-cured resin modified calcium silicate (TheraCal LC®)) on the viability, proliferation, and differentiation of stem cells from human exfoliated deciduous teeth (SHEDs).

METHODS

SHEDs were isolated from extracted primary teeth, then divided into four groups and each of the capping materials were applied to the stem cells as follows: group I the controls, group II with Ca(OH)2, group III with the GIC, and group IV with the Theracal LC. For all groups assessment of viability and proliferation rate was done using the MTT cell proliferation assay. Also, Differentiation was evaluated by measuring the gene expression of Alkaline phosphatase enzyme activity (ALP) and Dentin matrix protein-1 (DMP1) through quantitative real-time PCR. Morphological assessment was conducted using Alizarin Red S staining. All evaluations were performed after 7 and 14 days of culture.

RESULTS

TheraCal LC showed the highest values of proliferation, which was significant only compared to the control group after 2 weeks (p = 0.012). After one week, TheraCal LC showed the highest significant values of ALP and DMP1 compared to all other groups (p < 0.001).

CONCLUSION

The three materials under study are biocompatible, maintain viability, and stimulate the proliferation and differentiation of SHEDs. However, TheraCal LC allows better proliferation of SHEDs than Dycal Ca(OH)2 and Fuji IX GIC.

Zirconia Facts and Perspectives for Biomaterials in Dental Implantology

Dental implantology has witnessed remarkable advancements in recent years, and zirconia has emerged as a prominent biomaterial for dental implant applications. This review explores the multifaceted aspects of zirconia, focusing on its properties, processing methods, biocompatibility, mechanical performance, and clinical applications. Over the past few decades, the most popular choice of material for dental implantology has been titanium which has been found to have the highest success rate of implant treatment. However, recently, it has been observed that zirconia might replace titanium and eventually emerge as one of the gold-standard materials of dental implants. Analysis of biomechanical sciences and biomaterial sciences provides an opportunity for the refinement of design and material notions for surgical implants. However, the most important aspect and prime concern is how tissue at the implant site responds to biomechanical disturbances caused by foreign materials. The literature revealed that zirconia has certain characteristics that make it an excellent material for implants, including biocompatibility and osseointegration which depicts positive soft tissue response with low plaque affinity as well as aesthetics owing to light transmission and color. Additionally, this review discusses the current challenges and prospects of zirconia in dental implantology as well as aims to provide dental professionals and researchers with a comprehensive understanding of zirconia's potential as a biomaterial in dental implantology. The present overview of available literature intends to highlight and explore the biological characteristics of zirconia for applications in dental implantology. However, research is urgently required to fill in gaps over time for clinical assessments of all zirconia implants, consequently, the implementation of hybrid systems (a titanium screw with a zirconia collar) has recently been suggested.

Comparing the Effectiveness of Low-Level Laser Therapy and Topical Steroid Therapy Combination Regimen With Routine Topical Steroid Therapy in the Management of Oral Lichen Planus Symptomatic Patients

BACKGROUND

For symptomatic oral lichen planus (OLP), a wide range of therapeutic approaches have been suggested. To minimize discomfort and symptoms among individuals with symptomatic OLP, extensive therapy is frequently needed. Therefore, finding a new therapeutic approach that may effectively manage OLP's symptoms and signs while having few adverse effects continues to be a difficult task. Recently, low-level laser therapy (LLLT) has become a popular alternative therapy option for OLP with no serious side effects.

AIM

The present research was designed to compare the effectiveness of a combination regimen of LLLT in addition to topical steroids with routine topical steroid therapy separately in order to manage patients with bothersome OLP with an extended period of follow-up.

MATERIALS AND METHODS

In our trial, 60 patients were chosen and given sequential numbers as they signed up to take part. The participants were divided randomly into two categories: category A (LLLT plus topical steroids) and category B (only topical steroids). The data were entered into the aforementioned prepared case template after receiving informed consent. The aforementioned prepared case template included the following criteria for evaluating the result of the treatment: pain, recurrence, burning sensation, clinical remission, and size of the lesion. Applying the visual analog scale (VAS), pain, as well as burning sensations, were assessed in both categories. With the aid of the Electronic Digital Vernier Caliper (Mitutoyo, China), these individuals were assessed for the dimension of the lesion.

RESULTS

The pain score on day 21 of intervention in category A was 2.5, while it was 4.63 in category B. The difference in findings was significant statistically at day 21 (p = 0.0032). The pain score on day 28 of intervention in category A was 1.3, while it was 3.0 in category B. The difference in findings was significant statistically at day 28 (p = 0.003). The pain score was greater in the control category as compared to the intervention category. The burning sensation score on day 21 of intervention in category A was 2.5, while it was 4.5 in category B. The difference in findings was significant statistically (p = 0.0024). The burning sensation score at the follow-up phase on day 45 of intervention in category A was 1.1, while it was 3.4 in category B. The difference in findings was significant statistically (p = 0.002).

CONCLUSION

Newer therapeutic techniques are becoming accessible to oral specialists for controlling oral mucosal disorders as a result of evolving dental trends. The gold standard for treating people with symptomatic OLP continues to be topical corticosteroids. The therapeutic advantages of topical corticosteroids, however, are considerably outweighed by their complementary effect when paired with newer treatment methods like LLLT.

Effect of Cement Type on Fracture Resistance and Mode of Failure of Monolith vs Bilayered Zirconia Single Crowns

AIM

To compare the fracture resistance and the mode of failure between monolith second-generation zirconia and bilayered first-generation zirconia single crowns cemented by resin cement and glass ionomer cement (GIC).

MATERIALS AND METHODS

A total of 36 maxillary first premolar crowns (5 mm in length × 4 mm in cervical diameter, with a base of 6 mm) were computer-aided design-computer-aided manufacturing (CAD-CAM) milled. They were divided into the following two groups (n = 18) according to the fabrication techniques: Group M - monolith zirconia crown (1-mm axial thickness and 2-mm occlusal thickness) and group B - bilayer zirconia crown (0.5-mm axial thickness and 1-mm occlusal thickness). Each group was further subdivided into the following two subgroups (n = 9) according to the cement used: Subgroup G - cemented using GIC; subgroup R - cemented using resin cement. All crowns were cemented to their corresponding resin dies and stored in distilled water for 72 hours. Each specimen was mounted to the lower member of the universal testing machine with a load cell of 5 kN and a crosshead speed of 0.5 mm/minute. Failure modes were analyzed for fractured parts using scanning electron microscopy (SEM).

RESULTS

Subgroup MR recorded the highest fracture resistance mean value (3616 ± 347.2 N) while the BG subgroup recorded the statistically significant lowest fracture resistance mean value (1728.7 ± 115.3 N). One-way analysis of variance (ANOVA) followed by pairwise Tukey's post hoc tests revealed a statistically significant difference (p = 0.0001) between groups M and B. One-way ANOVA followed by pairwise Tukey's post hoc tests also showed a statistically significant difference (p = 0.0297) between the types of cement used (subgroups G and R).

CONCLUSION

Monolith zirconia crowns had better mean fracture resistance than bilayered zirconia crowns. Resin cement improved the fracture resistance compared to GIC. Monolith zirconia crowns showed bulk fracture while bilayered zirconia crowns showed chipping fracture.

CLINICAL SIGNIFICANCE

Monolith zirconia crowns present a good prosthetic alternative overcoming the veneer chipping drawback of bilayered zirconia crowns. In addition, resin cement could increase the fracture resistance of zirconia crowns.

Unraveling the impact of primary immunodeficiency disorders on the microbiota of dental caries in children through 16S rRNA gene-based metagenomic analysis

Background/aim

Dental caries is a frequently occurring and multifactorial chronic disease in children resulting from the interaction of cariogenic bacteria and host susceptibility. The aim of this study was to elucidate the impacts of primary immunodeficiency disorders (PIDs) on microbiota of dental caries in children by 16S rRNA gene-based metagenomic analysis.

Materials and methods

Enrolled in this study were 15 children with primary PID with caries (PID group) and 15 healthy children with caries as a control (CG). The DMFT index, saliva flow rate, and buffering capacity of each participant were assessed before the metagenomic analyses were conducted. For taxonomic profiling, the reads were obtained by high-throughput sequencing of the V3-V4 hypervariable region of 16S rRNA.

Results

The DMFT score, saliva flow rate, and buffering capacity of the groups were similar. The flow rate and buffering capacity had no correlation with the number of species with 95% confidence. The metagenomic analysis resulted in the identification of 2440 bacterial species in all of the samples. Among the 50 most prevalent species present at ≥1% relative abundance, Prevotella melaninogenica and Prevotella salivae were differentially more abundant in the PID group. The PID group and CG showed similar species richness and evenness, but 4 of the 5 samples with the highest Shannon-Weiner and Inverse Simpson indices belonged to the PID group. The Spearman test results for correlation of the species in the PID subgroups showed that Prevotella oris had a positively correlated relationship with both Scardovia wiggsiae and Saccharibacteria genera incertae sedis.

Conclusion

This study provided insight into the caries microbiota of children with immunodeficiency diseases. Differentially abundant species, novel bacterial associations, and unique bacterial species were disclosed in the PID samples, indicating the role of the immune system in altering the caries microbiota. The prominent bacterial species and associations in the PID group should be suspected in regard to their link with present or future diseases.

Current classification of zirconia in dentistry: an updated review

Zirconia, a crystalline oxide of zirconium, holds good mechanical, optical, and biological properties. The metal-free restorations, mostly consisting of all-ceramic/zirconia restorations, are becoming popular restorative materials in restorative and prosthetic dentistry choices for aesthetic and biological reasons. Dental zirconia has increased over the past years producing wide varieties of zirconia for prosthetic restorations in dentistry. At present, literature is lacking on the recent zirconia biomaterials in dentistry. Currently, no article has the latest information on the various zirconia biomaterials in dentistry. Hence, the aim of this article is to present an overview of recent dental zirconia biomaterials and tends to classify the recent zirconia biomaterials in dentistry. This article is useful for dentists, dental technicians, prosthodontists, academicians, and researchers in the field of dental zirconia.

Azathioprine induced acute sialadenitis: A case report

Key clinical message

Patients presenting with acute sialadenitis need careful review of their medications. Azathioprine is one of such drugs, which can rarely induce acute sialadenitis. Prompt discontinuation of the medication leads to reversal of the patient condition.

Abstract

Acute sialadenitis is one of the rare adverse effects of azathioprine. We report a case of acute submandibular sialadenitis following initiation of azathioprine which resolved upon discontinuation of the drug.

Single-cell immune profiling reveals immune responses in oral lichen planus

Introduction

Oral lichen planus (OLP) is a common chronic inflammatory disorder of the oral mucosa with an unclear etiology. Several types of immune cells are involved in the pathogenesis of OLP.

Methods

We used single-cell RNA sequencing and immune repertoire sequencing to characterize the mucosal immune microenvironment of OLP. The presence of tissue-resident memory CD8+ T cells are validated by multiplex immunofluorescence.

Results

We generated a transcriptome atlas from four OLP biopsy samples and their paired peripheral blood mononuclear cells (PBMCs), and compared them with two healthy tissues and three healthy PBMCs samples. Our analysis revealed activated tissue-resident memory CD8+ T cells in OLP tissues. T cell receptor repertoires displayed apperant clonal expansion and preferrential gene pairing in OLP patients. Additionally, obvious BCR clonal expansion was observed in OLP lesions. Plasmacytoid dendritic cells, a subtype that can promote dendritic cell maturation and enhance lymphocyte cytotoxicity, were identified in OLP. Conventional dendritic cells and macrophages are also found to exhibit pro-inflammatory activity in OLP. Cell-cell communication analysis reveals that fibroblasts might promote the recruitment and extravasation of immune cells into connective tissue.

Discussion

Our study provides insights into the immune ecosystem of OLP, serving as a valuable resource for precision diagnosis and therapy of OLP.

Comparative proteomics analysis of transforming growth factor-beta1-overexpressed human dental pulp stem cell-derived secretome on CD44-mediated fibroblast activation via canonical smad signal pathway

PURPOSE

The aim of this study investigates whether the secretome collected from human dental pulp stem cells (hDPSCs) transfected with transforming growth factor-beta1 (TGF-β1) is related to CD44 expression of fibroblasts and canonical smad signaling pathway via proteomic analyzes.

MATERIALS AND METHODS

In order to obtain secretome, hDPSCs were conditioned with serum-free alpha-MEM in an incubator containing 37°C, 5% CO₂, and humidity for 18-24 h. Proteins in control and TGF-β1 secretome were analyzed by tandem mass spectrometry-based shotgun proteomic method. Bioinformatic evaluations were completed via Ingenuity Pathway Analysis (IPA, QIAGEN) software. CD44 expressions in fibroblasts were evaluated by real time-PCR, western blot, and immunofluorescent staining. The relationship of canonical smad pathway and CD44 was analyzed by western blot and LC-MS/MS. Cell cycle, proliferation and wound healing tests were performed in the secretome groups.

RESULTS

Venn diagram was showed 174 common proteins were identified from each group. In the control secretome 140 unique proteins were identified and 66 entries were exclusive for TGF-β1 secretome. CD44 gene and protein expressions were increased in fibroblasts treated with TGF-β1 secretome. Relationship between targeted protein data showed that activation of the canonical TGF-β1/Smad pathway was up-regulated CD44 expression in fibroblasts. The canonical smad pathway-mediated upregulation of CD44 may increase the mitotic activity, proliferation, and wound healing potential in fibroblasts.

CONCLUSION

While TGF-β1-transfected hDPSC secretome may be a potential therapeutic candidate in regenerative connective tissue therapies as it induces fibroblast activation, anti-TGF-β1-based therapies would be considered in histopathological conditions such as pulmonary fibrosis or hepatic fibrosis.

Effects of Smokeless Tobacco on Color Stability and Surface Roughness of 3D-Printed, CAD/CAM-Milled, and Conventional Denture Base Materials: An In Vitro Study

Tobacco consumption in its different forms can affect the optical and surface properties of dental materials that are used in the oral cavity. Thus, the present study was conducted to evaluate the effects of two commercially available smokeless tobacco products on the color stability and surface roughness of denture base resins that were fabricated using three different techniques (CAD/CAM milling, 3D printing, and conventional heat polymerization). A total of 126 denture base resin specimens were fabricated using the three different manufacturing techniques (n = 42 each). Specimens from each group were further subdivided into three subgroups (n = 14 each) and immersed in three different immersion media (a khaini suspension, a tabbaq suspension, and artificial saliva). The differences in color and surface roughness were assessed according to data that were collected and statistically analyzed using SPSS version 24.0. The tabbaq smokeless tobacco was found to cause greatest changes in color and surface roughness; the effect was observed to be highest in the 3D-printed specimens followed by the conventional heat-polymerized and CAD/CAM milled specimens. The mean changes in color and surface roughness were the highest for the tabbaq smokeless tobacco followed by the khaini smokeless tobacco and the artificial saliva. Statistically significant (p-value < 0.05) differences were observed among all techniques and suspensions. We concluded that the mean changes in color and surface roughness were significantly higher for the 3D-printed dentures compared to the conventional heat-polymerized and CAD/CAM-milled dentures. Thus, the results of the present study strengthened the concept that tobacco in any form can lead to changes in the color and surface roughness of denture base materials.

SPECT/CT-based dosimetry of salivary glands and iodine-avid lesions following 131I therapy

Objective

The purpose was to provide uptake and radiation dose estimates to salivary glands (SG) and pathologic lesions following radioiodine therapy (RIT) of differentiated thyroid cancer patients (DTC).

Methods

A group of DTC patients (n = 25) undergoing ¹³¹I therapy joined this study with varying amounts of therapeutic activity. Sequential SPECT/CT scans were acquired at 4 ± 2, 24 ± 2, and 168 ± 3 h following administration of 3497-9250 MBq 131I. An earlier experiment with Acrylic glass body phantom (PET Phantom NEMA 2012 / IEC 2008) was conducted for system calibration including scatter, partial volume effect and count loss correction. Dose calculation was made via IDAC-Dose 2.1 code.

Results

The absorbed dose to parotid glands was 0.04-0.97 Gy/GBq (median: 0.26 Gy/GBq). The median absorbed dose to submandibular glands was 0.14 Gy/GBq (0.05 to 0.56 Gy/GBq). The absorbed dose to thyroid residues was from 0.55 to 399.5 Gy/GBq (median: 21.8 Gy/GBq), and that to distal lesions ranged from 0.78 to 28.0 Gy/GBq (median: 3.12 Gy/GBq). 41% of the thyroid residues received dose > 80 Gy, 18% between 70-80 Gy, 18% between 40-70 Gy, and 23% has dose < 40 Gy. In contrast, 18% of the metastases exhibited a dose > 80 Gy, 9% between 40-60 Gy, and the dose to the vast majority of lesions (64%) was < 40 Gy.

Conclusion

It was inferred that dose estimation after RIT with SPECT/CT is feasible to apply, together with good agreement with published ¹²⁴I PET/CT dose estimates. A broad and sub-effective dose range was estimated for thyroid residues and distal lesions. Moreover, the current methodology might be useful for establishing a dose-effect relationship and radiation-induced salivary glands damage after RIT.

Effects of non-steroidal anti-inflammatory drug (ibuprofen) in low and high dose on stemness and biological characteristics of human dental pulp-derived mesenchymal stem cells

PURPOSE

The effect of ibuprofen, an NSAID, on biological characteristics such as proliferation, viability, DNA damage and cell cycle in dental pulp derived stem cells (DPSCs) can be important for regenerative medicine. Our aim is to investigate how low and high doses of ibuprofen affect stem cell characteristics in DPSCs.

MATERIALS AND METHODS

DPSCs were isolated from human teeth and characterized by flow cytometry and differentiation tests. Low dose (0.1 mmol/L) and high dose (3 mmol/L) ibuprofen were administered to DPSCs. Surface markers between groups were analyzed by immunofluorescence staining. Membrane depolarization, DNA damage, viability and cell cycle analysis were performed between groups using biological activity test kits. Cellular proliferation was measured by the MTT and cell count kit. Statistical analyzes were performed using GraphPad Prism software.

RESULTS

High dose ibuprofen significantly increased CD44 and CD73 expression in DPSCs. High-dose ibuprofen significantly reduced mitochondrial membrane depolarization in DPSCs. It was determined that DNA damage in DPSCs decreased significantly with high dose ibuprofen. Parallel to this, cell viability increased significantly in the ibuprofen applied groups. High-dose ibuprofen was found to increase mitotic activity in DPSCs. Proliferation in DPSCs increased in parallel with the increase in mitosis stage because of high-dose ibuprofen administration compared to the control and low-dose ibuprofen groups. Our proliferation findings appeared to support cell cycle analyses.

CONCLUSION

High dose ibuprofen improved the immunophenotypes and biological activities of DPSCs. The combination of ibuprofen in the use of DPSCs in regenerative medicine can make stem cell therapy more effective.

Osteoblast Response of Additively Manufactured Zirconia and Alumina-Toughened Zirconia

Zirconia ceramics have been widely used in dentistry. Herein, we assess the surface morphology, surface texture, and osteoblast response of additively manufactured zirconia and alumina-toughened zirconia (ATZ) in comparison with titanium. The surface roughness, contact angle, and surface microstructure of titanium sandblasted with large-grit alumina and subsequently acid-etched using 18% HCl and 49% H₂SO₄ (SLA-titanium), uniaxially pressed zirconia (UP zirconia), additively manufactured zirconia (AM zirconia), and additively manufactured ATZ (AM ATZ) were investigated. Moreover, the cell viability, alkaline phosphatase (ALP) activity, and gene expression of type I collagen on these materials were evaluated. The data were statistically analyzed using one-way ANOVA with Tukey's post hoc test. SLA-titanium showed the highest surface roughness and contact angle. The other three materials showed comparable surface roughness and contact angles. Micro- and nanoroughness were observed on the surface of SLA-titanium. UP zirconia and AM zirconia had similar surface morphologies. The cell viability, ALP activity, and gene expression of type I collagen on AM zirconia were comparable to or better than those on SLA-titanium. Our results indicate that AM zirconia is a promising material for zirconia dental implants.