Association between salivary /microbiological parameters, oral health and eating habits in young athletes

BACKGROUND

Athletes' oral health can impact overall well-being and sports performance. This study aimed to evaluate the interactions between eating habits and oral health of 120 young athletes as compared to 30 age-matched individuals not practicing sports based on a questionnaire and the analysis of saliva.

METHODS

One hundred twenty subjects practicing various sports activities (test group) and 30 subjects not practicing sports (control group) were selected. A self-administered questionnaire was used to obtain personal data, hours and frequency of weekly training, complete pathological history, history of hard and soft tissues of the oral cavity, family history, and oral hygiene practices. The eating habits of the young participants were analyzed by investigating the number of daily meals; use and frequency in sports practice of supplements/energy drinks, fruit/juices, snacks, chocolate; daily diet; and differences between usual diet and pre-competition diet. At baseline (T0), each participant was clinically assessed for the determination of the number of decayed, missing, and filled teeth (DMFT), Silness & Löe Plaque Index (PI), and the Löe & Silness Gingival Index (GI) and qualitative analysis for the presence/absence of stains and dental erosions. At T0, before (T1) and after training sessions (T2), saliva was collected to determine resting pH, Streptococcus mutans, and Lactobacillus spp counts.

RESULTS

Test groups were trained more than 2 h, 5 times a week. Soccer players and skiers had a high percentage of caries; water polo players demonstrated the highest percentage of erosions and dental stains. Salivary resting pH showed statistically different values in three different observations between the groups. S. mutans was harbored by 60% of soccer and 70% of water polo players, while Lactobacillus spp in 43.33% of the swimmers and soccer players. Combining all the 56 variables including the clinical examination, self-reported parameters, and salivary analysis, we have identified water polo players as a distinct at-risk group for developing dental defects, expressed as an aggregate disease score. In particular, we have found that energy snacks/chocolate intake is strongly associated with ratio of S. mutans/Lactobacillus spp and that S. mutans is linked to dental defects (R = 0.88). Linear regression analysis indicates that energy snacks/chocolate intake in the study population represents a strong driver for oral dysbiosis and dental disease.

CONCLUSIONS

Our study clearly shows that athletes should follow a balanced diet that not only satisfies their nutritional needs but also avoids oral dysbiosis and subsequent dental damage.

Porphyromonas gulae and canine periodontal disease: Current understanding and future directions

Porphyromonas gulae has emerged as a notable pathogen in canine periodontal disease, akin to Porphyromonas gingivalis in human periodontitis. This review examines the initial isolation, phylogenetic analysis, habitat, host range, relationships with host health status and age, and key pathogenic determinants, including fimbriae, proteases, citrullinating enzyme, and lipopolysaccharide. Control strategies discussed include polyphosphate to disrupt haeme/iron utilization, clindamycin with interferon alpha to reduce bacterial load and enhance the immune response, and a protease inhibitor. Further research is needed to understand strain-level diversity of virulence factors and interactions between P. gulae and other oral bacteria, particularly Fusobacterium nucleatum, a common pathogen in both dogs and humans. The potential for interspecies transmission between dogs and humans warrants further research into these interactions. Extensive in vivo studies across various breeds are crucial to validate the effectiveness of proposed treatment strategies. This review emphasizes P. gulae's role in periodontal health and disease, setting the stage for future research and improved management of canine periodontal disease.

Magnification: The game changer in dentistry

During dental examinations and treatments, many dentists are using magnification to improve their vision. The dental operating microscope serves as the most effective tool for this purpose, enhancing the quality, longevity, and outcome of clinical work. This review will explore the latest research and data on the importance of magnification devices in dentistry, including diagnostic methods, treatment options and ergonomics in specialities such as restorative dentistry, endodontics, pedodontics, periodontics, and prosthodontics. This review aims to provide insights into the optimal magnification for different clinical situations, the specific benefits of dental operating microscopes for each dental branch, and their limitations.

Biomaterials and therapeutic strategies designed for tooth extraction socket healing

Tooth extraction is the most commonly performed oral surgical procedure, with a wide range of clinical indications. The oral cavity is a complex microenvironment, influenced by oral movements, salivary flow, and bacterial biofilms. These factors can contribute to delayed socket healing and the onset of post-extraction complications, which can burden patients' esthetic and functional rehabilitation. Achieving effective extraction socket healing requires a multidisciplinary approach. Recent advancements in materials science and bioengineering have paved the way for developing novel strategies. This review outlines the fundamental healing processes and cellular-molecular interactions involved in the healing of extraction sockets. It then delves into the current landscape of biomaterials for socket healing, highlighting emerging strategies and potential targets that could transform the treatment paradigm. Building upon this foundation, this review also presents future directions and identifies challenges associated with the clinical application of biomaterials for extraction socket healing.

The Effect of Angulation and Scan Body Position on Scans for Implant-Treated Edentulism: A Clinical Simulation Study

INTRODUCTION

The acquisition of digital impressions has become an integral part of clinical dentistry. The purpose of the present clinical simulation study was to evaluate the accuracy of digital impressions for maxillary full-arch implant-supported prostheses using two modern intraoral scanners with different acquisition technologies.

MATERIAL AND METHODS

Two models of edentulous maxilla, with six implants at positions #16,14,12,22,24,26 (FDI World Dental Federation System, ISO 3950) or #3,5,7,10,12,14 (Universal Numbering system) were digitally designed, and 3D-printed in resin material (Asiga DentaMODEL, Australia). In the first scenario, all implants were parallelized, while in the second, implants #12/#7 and #22/#10 had a 20° angulation buccally, while implants #16/#3 and #26/#14 20° angulation distally. The models were scanned with two different intraoral scanners, Trios3 (3Shape, Denmark) and CS3600 (Carestream Dental, USA). Linear (x, y, z axes-top point) and angular deviations (x, y, z axes-Δφ) were assessed. Statistical analysis was performed using Kolmogorov-Smirnov tests (significance at p < 0.05).

RESULTS

Implant angulation showed a significant impact on accuracy, while the two scanners showed statistically significant differences. CS3600 demonstrated superior trueness, while Trios3 superior precision in both clinical scenarios. In the first clinical scenario a predominant occurrence of angular deviations was observed, while in the second scenario both angular and linear deviations were recorded. Scan body position also influenced scanning outcomes, with the last scan body captured demonstrating higher deviations.

CONCLUSION

Both scanners provided acceptable accuracy in the acquisition of digital impressions. Implant angulation and scan body position significantly affected trueness and precision. Clinicians should carefully consider implant angulations in full-arch implant restorations, as well as the scanning protocol.

Exploring the potential of reconstructed human epithelial tissue models for safety assessment of intraoral medical devices

Medical devices are integral to a wide array of medical interventions and are increasingly utilized in both clinical and home settings. Within the oral cavity, intraoral medical devices are employed for various applications, to improve quality of life and maintain oral health and hygiene. However, the dynamic and complex environment of the oral cavity, characterized by the influence of factors, such as saliva composition, fluctuating pH, and microbial flora presents a challenge to ensure the safety of end-users. In this paper, we investigate the feasibility of utilization of 3D reconstructed human tissue models for the assessment of biocompatibility of intraoral medical devices. Building upon experiences drawn from the development and validation of ISO 10993-23 and from the development of a protocol for ocular irritation and photo-irritation, we suggest a new protocol for buccal mucosa irritation testing. The methodology is based on the viability assessment and analysis of cytokine release into media. By addressing intraoral medical devices biocompatibility testing, we aim to contribute to the advancement of biocompatibility assessment methodologies and increase the applicability of ISO 10993-23.

Racial Disparities in Access to Preventive Dental Services in Pediatric Population: A Secondary Data Analysis

BACKGROUND AND OBJECTIVES

Though preventive measures are available to alleviate the burden of dental caries, there remain racial disparities in the utilization of preventative dental care. Our objectives were to determine whether racial disparities persisted in receiving preventive oral procedures between (1) Black children and white children; and (2) Hispanic children and white children.

METHODS

We used pooled Medical Expenditure Panel Survey data in the United States from 2018 to 2021. The key outcome variable involved the use of preventive dental services (ie, examination, x-rays, cleaning, dental sealant fitting, and fluoride treatment), while the main predictor variable involved race (ie, whether they were white, Black, or Hispanic children).

RESULTS

Controlling for covariates, there was no statistical significance in the odds of Hispanic and white children in receiving x-rays, sealants, and fluoride treatment ( P < .001). Black children had significantly lower odds of receiving oral examination, x-rays, and fluoride treatment than their white counterparts ( P < .01).

CONCLUSIONS

This study highlights the massive strides made in the utilization of preventive dental services by Hispanic children in the United States along with the persisting disparities largely present for Black children; however, further studies are needed focusing on structural, sociocultural, and factors contributing to these disparities.

Effect of beam divergence on the irradiance from dental light curing units

OBJECTIVE

This study measured the beam divergence angle and light output from dental light curing units (LCUs). Twenty LCUs were assessed using a laboratory-grade wide beam imager to determine the relationship between the beam divergence on the irradiance as a function of distance from the light tip.

METHODS

The irradiance (mW/cm2) and beam divergence angles (°) at 5, and 10 mm from the tips of 18 Light-Emitting Diode (LEDs), 1 Quartz-Tungsten-Halogen (QTH), and 1 Laser diode LCU.

RESULTS

There were significant differences in the power, irradiance, and emission spectra from the 20 LCUs. At 10 mm from the LCU tip, the irradiance delivered by one LCU decreased by approximately 85.7 %, whereas this decrease was as low as 5.6 % for a different LCU. There was a positive correlation between the divergence angle reported by the wide beam imager and the reduction in irradiance. The laser diode LCU had the least beam divergence and the smallest decrease in irradiance as the distance increased. In contrast, the QTH LCU with the turbo light guide had the greatest beam divergence and the greatest reduction in irradiance as the distance increased. 50 % of the LCUs tested would require exposure times longer than 20 s to deliver 10 J/cm2 at the 10 mm distance.

SIGNIFICANCE

The wide beam imager is a useful tool for measuring the beam divergence from LCUs and predicting the effect of distance on their irradiance. At 10 mm, some LCUs may require a fivefold increase in the exposure time to deliver the same energy they deliver at 0 mm from the tip of the LCU.

Dydrogesterone alleviates periodontitis in perimenopausal women undergoing periodontal therapy by decreasing inflammation and mediating oral microbiota

OBJECTIVE

Dydrogesterone (DG), a synthetic isomer of progesterone, plays a potential regulatory role in the periodontal environment. The aim of this study was to investigate the potential effects of DG on periodontitis under periodontal therapy (PT) and the underlying mechanisms related to oral microbiota.

METHODS

As a cohort study, perimenopausal women with periodontitis and abnormal uterine bleeding associated with ovulatory dysfunction were screened. A total of 30 women received PT (PT group) and 30 women received PT and oral DG 10 mg twice/day for 10 days/month (PT + DG group). At baseline and 3 months after treatment, pocket probing depth (PPD), bleeding index (BI), bleeding on probing (BOP), plaque index, CRP, IL-6, and TNF-α were measured. Additionally, 16S rDNA sequencing was performed to determine the characteristics of oral microbiota, mainly in terms of abundance, diversity, composition, and community structure.

RESULTS

Three months after treatment, the levels of PPD, BI, and BOP, as well as the levels of CRP, IL-6, and TNF-α in gingival crevicular fluid were significantly lower in the PT + DG group than those in the PT group. After treatment, a relatively lower microbial abundance, and some differences in microbial composition were revealed between the PT and PT + DG groups. At the genus level, significantly fewer Escherichia-Shigella, Porphyromonas, and Absconditabacteriales (SR1), and more Lactobacillus, Gordonia, Bifidobacterium, and Oribacterium were found in the PT group than in the PT + DG group.

CONCLUSIONS

DG enhances the effect of PT on inhibiting inflammatory response in women with periodontitis by mediating oral microbiota.

Prognostic factors affecting probing depth reduction following non‑surgical periodontal therapy in patients with periodontitis: A linear mixed‑effects model analysis

The present study aimed to elucidate the prognostic factors affecting the probing depth (PD) reduction following the non-surgical periodontal treatment of patients with periodontitis using a linear mixed-effects model. A retrospective analysis was performed on 455 patients who met the specific inclusion criteria. Data were gathered from 3-month re-evaluation records in the electronic periodontal charting system at the Department of Periodontology, School and Hospital of Stomatology at Tianjin Medical University between December 2021 and January 2022. Descriptive statistics were used to assess the changes in PD and certain baseline characteristics of the patients. A three-level nested random-effects mixed-effect model (patient/tooth/site) was used to evaluate the prognostic factors for PD reduction. Variance decomposition was conducted to analyze PD reduction across different nested levels. P<0.05 was considered to indicate a statistically significant difference. The overall mean PD reductions at the patient level for all sites were 0.88 mm. Patients diagnosed with Grade C periodontitis exhibited a greater PD reduction compared with those with Grade B periodontitis (0.96 vs. 0.76 mm; P<0.001). The multivariable coefficient for patients with Grade C periodontitis was 0.20 (95% confidence interval, 0.08-0.33; P<0.001). Random-effects analysis demonstrated that the variability in PD reduction was 59.4, 39.1 and 73.8% at the patient, tooth and site levels, respectively. Grade C periodontitis had the most substantial importance on the effect of PD reduction following NSPT. This reduction in PD could primarily be explained at both the site and patient levels.

Your Teeth, You Are in Control: A Process Evaluation of the Implementation of a Cognitive Behavioural Therapy Intervention for Reducing Child Dental Anxiety

AIM

To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) intervention, 'Your teeth, you are in control' (YTYAIC), in the CALM trial.

METHODS

Semi-structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT.

RESULTS

Thirty-seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR.

CONCLUSIONS

This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts.

TRIAL REGISTRATION

This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).

Experimental bilayer zirconia systems after aging: Mechanical, optical, and microstructural characterization

OBJECTIVES

To characterize two experimental zirconia bilayer materials compared to their monolithic controls, before and after hydrothermal aging.

METHODS

Commercial zirconia powders were utilized to fabricate two bilayer materials: 3Y-TZP+ 5Y-PSZ (3Y+5Y/BI) and 4Y-PSZ+ 5Y-PSZ (4Y+5Y/BI), alongside control groups 3Y-TZP (3Y/C), 4Y-PSZ (4Y/C), and 5Y-PSZ (5Y/C). Compacted specimens were sintered (1550 °C- 2 h, 3 °C/min), and half of them underwent hydrothermal aging (134 °C-20h, 2.2 bar). Characterizations were performed through scanning-electron microscopy (SEM), X-ray diffraction (XRD), Raman spectroscopy, reflectance tests and biaxial flexural strength test (ISO:6872). Weibull statistics were applied to determine the characteristic strength and Weibull modulus. Grain size and optical properties were analyzed using two-way ANOVA followed by the Tukey test.

RESULTS

Degradation regions and monoclinic phase were observed at aged 3Y-TZP and 4Y-PSZ surfaces. Significant differences were observed in the evaluation of optical properties between the bilayer and control groups. The bilayer materials presented intermediate characteristic strength values compared to their controls and aging significantly increased the strength of some groups.

SIGNIFICANCE

Experimental bilayer materials presented lower mechanical properties than monolithic controls, 3Y/C and 4Y/C. Hydrothermal aging increased the characteristic strength of bilayered and monolithic controls, except for 5Y-PSZ. Both experimental bilayer systems, as well as monolithic controls, met the ISO 6872:2015 requirements for single-unit crowns (100 MPa), 3-unit fixed dental prostheses (FDPs) up to premolars (300 MPa), and 3-unit FDPs involving molars (500 MPa). However, for FDPs with four or more units, only monolithic 3Y-TZP and 4Y-PSZ, and bilayered 3Y+5Y met the required minimum flexural strength (≥800 MPa).

Psychosocial Determinants of Poor Dental Attendance Among Young Mexican-Identifying Adults in California

OBJECTIVE

Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance.

METHODS

Survey data from 333 Mexican-identifying adults in California aged 21-40-year were analysed. Poor dental attendance was a composite of time since last dental visit and reason for visit. Responses of 'more than 1 year ago' for last dental visit, or 'something was wrong, bothering or hurting/emergency dental problem' as the reason for last dental visit were categorised as poor dental attendance. Psychosocial determinants including dental anxiety assessed using the Modified Dental Anxiety Scale, participant reported quality of provider interactions, and perceived social support were assessed. Logistic regression analyses examined associations after accounting for covariates.

RESULTS

Over half (58%) had poor dental attendance. Among those with poor dental attendance, 22% had high dental anxiety, 41% perceived low quality of dental explanation, and 48% reported provider occasionally/never checked patient understanding. Participants with high anxiety had twice the odds of poor dental attendance (OR = 2.07, 95% CI = 1.01-4.22) than those with low dental anxiety. Additionally, those reporting that providers did not explain oral health status or treatments well had two times higher odds of poor dental attendance than those reporting adequate explanation (OR = 2.06, 95% CI = 1.11-3.83). Checking patient understanding or perceived social support was not significantly associated with dental attendance.

CONCLUSION

Dental anxiety and poor provider interactions affect use of dental services. Interventions targeting dental staff should prioritise enhancing communication skills and checking patient understanding to improve their dental attendance.

ZygoPlanner: A three-stage graphics-based framework for optimal preoperative planning of zygomatic implant placement

Zygomatic implant surgery is an essential treatment option of oral rehabilitation for patients with severe maxillary defect, and preoperative planning is an important approach to enhance the surgical outcomes. However, the current planning still heavily relies on manual interventions, which is labor-intensive, experience-dependent, and poorly reproducible. Therefore, we propose ZygoPlanner, a pioneering efficient preoperative planning framework for zygomatic implantation, which may be the first solution that seamlessly involves the positioning of zygomatic bones, the generation of alternative paths, and the computation of optimal implantation paths. To efficiently achieve robust planning, we developed a graphics-based interpretable method for zygomatic bone positioning leveraging the shape prior knowledge. Meanwhile, a surface-faithful point cloud filling algorithm that works for concave geometries was proposed to populate dense points within the zygomatic bones, facilitating generation of alternative paths. Finally, we innovatively realized a graphical representation of the medical bone-to-implant contact to obtain the optimal results under multiple constraints. Clinical experiments confirmed the superiority of our framework across different scenarios. The source code is available at https://github.com/Haitao-Lee/auto_zygomatic_implantation.

Knowledge, assessment and treatment of molar incisor hypomineralisation (MIH) among German dentists

OBJECTIVES

This study investigated the knowledge, perceptions, and clinical practices of German dentists regarding molar incisor hypomineralisation (MIH), a significant issue in paediatric dentistry. To date, no study has examined the knowledge and experience of German dentists with MIH.

SUBJECTS AND METHODS

A digital questionnaire comprising 25 items was designed to assess German dentists' understanding of MIH. The questionnaire was available online via Survio.de from March to June 2023. The responses were entered anonymously into an Excel spreadsheet and analysed using SPSS 29.0.

RESULTS

625 dentists were surveyed, and 517 questionnaires were evaluated. 99.2% of respondents treated patients with MIH, and 92.5% considered it a significant clinical problem. Commonly observed clinical presentations included yellow/brown defects (81%), enamel loss (46%) and white defects (36.4%). 68.6% of respondents noted an increase in MIH prevalence. Treatment barriers included child behaviour (44.7%), difficulties with local anaesthesia (22.7%), and extended treatment duration (15.3%). Most dentists (77.8%) expressed a desire for further training on MIH.

CONCLUSIONS

The data indicated that dentists' MIH management was influenced by specialisation and diagnostic confidence. Despite basic knowledge and experience, many respondents expressed a need for further education. Age-related biases and limited awareness of new techniques highlight the need for further research.

CLINICAL RELEVANCE

Dentists must receive comprehensive training to enable them to diagnose and treat patients promptly. This should include the development of updated courses, which should be aligned with international guidelines.

Primary implant stability of two implant macro-designs in different alveolar ridge morphologies: an in vitro study

PURPOSE

The primary aim of this in vitro study was to investigate the primary implant stability obtained in immediate and late implant placement scenarios. Secondary aims evaluated the effect of two distinct implant macro-designs and examined the correlation between resonance frequency analysis (RFA) and final insertion torque.

METHODS

Partially edentulous maxillary models including six single sites simulating extraction sockets and healed alveolar ridges were used. Virtual implant planning facilitated static computer-assisted implant placement of bone level implants with either a shallow-threaded and cylindrical (BL), or deep-threaded and tapered implant macro-design (BLX). The insertion torque was continuously measured during implant placement, and RFA was performed after final implant positioning.

RESULTS

One-hundred and forty-four implants were equally distributed to two alveolar ridge morphologies and implant designs. Higher final insertion torque and RFA values were observed for implants placed in healed ridges compared to extraction sockets (40.8 ± 13.5 vs. 20.6 ± 8.4 Ncm, and RFA 70.7 ± 2.8 vs. 59.6 ± 6.5, both p < 0.001), and for BL implants compared to BLX implants (35.7 ± 13.0 vs. 25.7 ± 8.9 Ncm, and RFA 66.7 ± 4.4 vs. 63.6 ± 4.9, both p < 0.001). Insertion torque and mean RFA values positively correlated (r = 0.742; p < 0.001).

CONCLUSION

Primary implant stability is significantly affected by the alveolar ridge morphology and the implant macro-design, demonstrating higher values in healed sites and shallow-threaded, cylindrical implants. Therefore, a tailored selection of the implant design depending on the implant placement and loading protocol is recommended.

A comparative study of irrigation techniques and the development of a self-serve training model for ophthalmology residents

BACKGROUND

Lacrimal irrigation is a fundamental skill for diagnosing and managing lacrimal diseases. This study evaluates two lacrimal irrigation techniques and introduces a haptic-visual integrated self-serve training model to enhance skill acquisition among novice ophthalmology residents.

METHODS

Ninety-two ophthalmology residents were randomized into Group A (n = 47) and Group B (n = 45). Both groups completed an 8-hour training program comprising theoretical instruction, demonstrations, and hands-on practice. Group A provided feedback to refine the training model, which was subsequently implemented in Group B1 (n = 23), while Group B2 (n = 22) served as the control. Outcomes were assessed through skill evaluations and post-training questionnaires measuring confidence scores and perceived efficacy.

RESULTS

In Group A, 70.2% of participants preferred Technique 1 for its perceived ease of use, while 29.8% favored Technique 2 for pressurized irrigation scenarios (p < 0.05). Key barriers to proficiency included the absence of suitable training models (63.8%) and psychological anxiety (25.5%). In Group B, participants using the training model (Group B1) demonstrated significantly higher confidence scores compared to Group B2 (8.4 ± 1.2 vs. 6.1 ± 1.5, p < 0.05). Although skill assessment scores showed a positive trend in Group B1 (80.7 ± 8.3 vs. 76.8 ± 9.1), the difference was not statistically significant (p > 0.05).

CONCLUSION

Both lacrimal irrigation techniques are equally accessible to novices, with Technique 2 offering advantages in pressurized irrigation. The self-serve training model significantly enhances procedural confidence and addresses critical training barriers, including resource limitations and psychological safety. Future studies should validate these findings in larger cohorts and refine the model to incorporate enhanced simulation techniques and dynamic physiological feedback.

An exploration of the ocular mysteries linking nanoparticles to the patho-therapeutic effects against keratitis

Microbial keratitis, a sight-threatening corneal infection, remains a significant global health concern. Conventional therapies using antimicrobial agents often suffers from limitations such as poor drug penetration, side effects, and occurrence of drug resistance, with poor prognosis. Novel treatment techniques, with their unique properties and targeted delivery capabilities, offers a promising solution to overcome these challenges. This review delves into timely update of the state-of-the-art advance therapeutics for keratitis treatment. The diverse microbial origins of keratitis, including viral, bacterial, and fungal infections, exploring their complex pathogenic mechanisms, followed by the drug resistance mechanisms in keratitis pathogens are reviewed briefly. Importantly, the emerging therapeutic techniques for keratitis treatment including piezodynamic therapy, photothermal therapy, photodynamic therapy, nanoenzyme therapy, and metal ion therapy are summarized in this review showcasing their potential to overcome the limitations of traditional treatments. The challenges and future directions for advance therapies and nanotechnology-based approaches are discussed, focusing on safety, targeting strategies, drug resistance, and combination therapies. This review aims to inspire researchers to revolutionize and accelerate the development of functional materials using different therapies for keratitis treatment.

Oral health in adolescents: periodontal inflammatory biomarkers during orthodontic clear aligner therapy

OBJECTIVES

This prospective study aimed to evaluate periodontal inflammation in adolescents undergoing orthodontic treatment with clear aligners (Invisalign® Teen, Align Technology, San Jose, CA, USA). Key objectives included assessing the presence of 11 periodontitis-associated marker bacteria, active matrix metalloproteinase-8 concentrations in sulcular fluid, and the influence of IL-1 polymorphism genotypes on periodontal health.

MATERIALS AND METHODS

Fifty adolescent patients (13.3 ± 1.8 years) with mixed and permanent dentition participated. Gingival crevicular fluid samples were analyzed at multiple time points: before, during, and one year after aligner treatment. Periodontal health was assessed using the Gingivitis Index and the Modified Quigley-Hein Index. Genotypic analysis of IL-1 polymorphism was also performed. Statistical analyses included mixed linear models and generalized linear models to explore correlations.

RESULTS

All combinations of IL-1 polymorphism genotypes were found in the sample. No significant increase in periodontal inflammation or aMMP-8 concentrations was observed over the treatment period. Marker bacteria from the red and orange-associated complexes remained at low levels, while significant changes occurred in the orange and green complexes, particularly Capnocytophaga spp. (p = 0.0042) and Fusobacterium spp. (p = 0.0365). GI correlated significantly with aMMP-8 levels (p = 0.0017), but no genotype effect on GI was observed. MQH showed associations with pathogens from the orange and green complexes, including Capnocytophaga spp. and Fusobacterium spp.

CONCLUSIONS

Clear aligner treatment in adolescents, including those with an unfavorable genotype, does not increase periodontal inflammation when accompanied by good oral hygiene.

CLINICAL RELEVANCE

Regular periodontal monitoring and hygiene reinforcement is important during orthodontic treatment, especially in adolescent patients.

Advanced progress of adipose-derived stem cells-related biomaterials in maxillofacial regeneration

The tissue injury in maxillofacial region affects patients' physical function and specific mental health. This decade, utilizing regenerative medicine to achieve tissue regeneration has been proved a hopeful direction. Seed cells play a vital role in regeneration strategy. Among various kinds of stem cells that effectively to regenerate the soft and hard tissue of maxillofacial region, adipose-derived stem cells (ADSCs) have gained increasing interests of researchers due to their abundant sources, easy availability and multi-differentiation potentials in recent decades. Thus, this review focuses on the advances of ADSCs-based biomaterial in maxillofacial regeneration from the progress and strategies perspective. It is structured as introducing the properties of ADSCs, biomaterials (polymers, ceramics and metals) within ADSCs and the latest applications of ADSCs in maxillofacial regeneration, including temporomandibular joint (TMJ), bone, periodontal tissue, tooth, nerve as well as cosmetic field. In order to further facilitate ADSCs-based therapies as an emerging platform for regenerative medicine, this review also emphasized current challenges in translating ADSC-based therapies into clinical application and dissussed the strategies to solve these obstacles.

Effects of ozone therapy as an adjuvant in the treatment of periodontitis: a systematic review and meta-analysis

BACKGROUND

Chronic periodontitis is an infectious disease initiated by plaque, which affects chewing and even general health. Ozone therapy, as a complementary means in the treatment of chronic periodontitis, numerous clinical trials have been conducted. We conducted this review to evaluate the effect of the ozone use accompanied by scaling and root planning (SRP) in periodontal treatment.

METHODS

Randomized controlled trials investigating the use of ozone therapy in chronic periodontitis. The search was carried out across PubMed, Cochrane Central Register of Controlled Trials, and EMBASE databases with the search period extending to July 2024. The quality of the identified studies was evaluated using the Cochrane Collaboration's Risk of Bias tool. The results were presented as weighted mean differences (WMD) with corresponding 95% confidence intervals (95% CI). Heterogeneity among the studies was assessed using the I2 test. Data analysis was performed using RevMan 5.4 and Stata 16.0.

RESULTS

Thirteen articles meeting the inclusion criteria. The meta-analysis revealed statistically significant differences in probing depth (PD) and gingival index (GI) reduction between ozone-assisted nonsurgical periodontal treatment and placebo-assisted treatment in patients with chronic periodontitis (P < 0.05). However, no significant differences were observed in clinical parameters such as bleeding on probing (BOP) percentage, plaque index (PI), and clinical attachment level (CAL) (P > 0.05).

CONCLUSION

Ozone therapy combined with SRP is superior to SRP alone in improving PD and GI indexes in patients with periodontitis, without increasing adverse reactions, and the effect is worthy of recognition. The research evidence indicates that ozone therapy in patients with chronic periodontitis has a positive effect.

An analysis of initial force and moment delivery of different aligner materials

OBJECTIVES

The aim of this study was to clarify the applied initial forces and moments by different aligners of various materials and manufacturing methods.

METHODS

The finite-element-method was used to analyze the forces and moments generated by the aligners on a maloccluded tooth. Plaster models of dental arches with a mesiorotated tooth 11 were fabricated, digitized and virtually analyzed. Four types of aligners with various layer thicknesses were selected: two splints with novel shape memory properties: a printable aligner made of the resin Tera Harz TC-85 DAC (Graphy Inc., South Korea) and a self-manufactured aligner consisting of the components polypropylene carbonate and thermoplastic polyurethane. The other two aligners were conventional, thermoformable aligners: CA® Pro Clear Aligner (Scheu Dental GmbH, Germany) and Erkodur-al (Erkodent Erich Kopp GmbH, Germany).

RESULTS

The force and moment analyses showed that the thermoformable CA® Pro Clear Aligner exhibited the highest values. The thermoformed Erkodur-al aligner showed the lowest force loads for all layer thicknesses. The Graphy printed splint showed similar results compared to Erkodur-al at layer thicknesses of 0.40 mm and 0.50 mm.

CONCLUSIONS

To avoid periodontal overloading, aligners with lower force and moment delivery should be chosen for this type of tooth movement.

Ginsenoside Rg1 regulating inflammatory response and bone-remodeling through Keap1/Nrf2 signaling pathway in rats with periodontitis

Periodontitis is a chronic inflammatory disease arising from local microorganisms and the host's own aberrant immune regulation. Ginsenoside Rg1(GS-Rg1) is an active extract of ginseng known for its anti-inflammatory and osteogenesis effects. However, GS-Rg1 has not been shown to treat periodontitis and its exact mechanism remains elucidated. Orthodontic wires inoculated with Porphyromonas gingivalis were wrapped around the gingiva of the first molar in rats to induce periodontitis. Inflammatory factor secretion was analyzed using RT-PCR and immunohistochemistry. The number of osteoclasts and secretion of osteogenic factors were analyzed using TRAP staining and immunofluorescence. The destruction of periodontal tissues was evaluated using Micro-CT and H&E staining. Keap1/Nrf2 pathway protein expression was analyzed using Western-Blot and RT-PCR. Applying GS-Rg1 significantly reduced the secretion of inflammatory factors IL-6 and increased the secretion of transforming growth factor TGF-β1. Additionally, GS-Rg1 decreased osteoclast numbers and increased RUNX2 and OCN expression. Furthermore, GS-Rg1 was found to enhance the expression of the related protein Nrf2 while reducing Keap1 expression. GS-Rg1 may effectively alleviate periodontitis through the Keap1/Nrf2 pathway. In conclusion, our study provided the first preclinical evidence to support GS-Rg1 as a potential therapeutic agent for treating periodontitis.

From morphology to single-cell molecules: high-resolution 3D histology in biomedicine

High-resolution three-dimensional (3D) tissue analysis has emerged as a transformative innovation in the life sciences, providing detailed insights into the spatial organization and molecular composition of biological tissues. This review begins by tracing the historical milestones that have shaped the development of high-resolution 3D histology, highlighting key breakthroughs that have facilitated the advancement of current technologies. We then systematically categorize the various families of high-resolution 3D histology techniques, discussing their core principles, capabilities, and inherent limitations. These 3D histology techniques include microscopy imaging, tomographic approaches, single-cell and spatial omics, computational methods and 3D tissue reconstruction (e.g. 3D cultures and spheroids). Additionally, we explore a wide range of applications for single-cell 3D histology, demonstrating how single-cell and spatial technologies are being utilized in the fields such as oncology, cardiology, neuroscience, immunology, developmental biology and regenerative medicine. Despite the remarkable progress made in recent years, the field still faces significant challenges, including high barriers to entry, issues with data robustness, ambiguous best practices for experimental design, and a lack of standardization across methodologies. This review offers a thorough analysis of these challenges and presents recommendations to surmount them, with the overarching goal of nurturing ongoing innovation and broader integration of cellular 3D tissue analysis in both biology research and clinical practice.

Lower lip changes after overjet reduction with and without mandibular incisor retraction

INTRODUCTION

Four (2 maxillary + 2 mandibular) premolar (4P) and 2 maxillary premolar (U4) extractions are commonly employed for Class II malocclusion with excessive overjet. Although upper lip changes have been widely investigated, lower lip changes remain unclear. The soft-tissue responses after maxillary and mandibular incisor movements in each protocol were investigated.

METHODS

A total of 90 pretreatment and posttreatment lateral cephalograms were digitized and allocated to 3 groups (n = 30 each) according to the initial overjet and treatment: normal overjet with 4P (NJ-4P), excessive overjet with 4P (EJ-4P), and excessive overjet with U4 (EJ-U4). The cephalometric parameters were compared, and the lip-to-incisor change ratios (upper lip-maxillary incisor, lower lip-mandibular incisor, and lower lip-maxillary incisor) were determined.

RESULTS

Soft-tissue parameters revealing significant changes among the groups included upper lip and lower lip positions, mentolabial area, and vermilion lip thickness. Significant differences were observed between NJ-4P/EJ-U4 for lower lip-mandibular incisor ratio and between NJ-4P/EJ-U4 and NJ-4P/EJ-4P for lower lip-maxillary incisor ratio but not for upper lip-maxillary incisor ratio.

CONCLUSIONS

Reduction in upper lip protrusion was smaller, whereas that in lower lip protrusion was greater after maxillary incisor and mandibular incisor retraction, respectively, in patients with excessive overjet and skeletal Class II malocclusion undergoing the 4P extraction than in those with normal overjet. Moreover, a reduction in lower lip protrusion can be expected with minimal retraction of the mandibular incisors in patients undergoing U4 extraction. The potential impact of the maxillary incisors on the lower lip, especially in excessive overjet malocclusion, should be noted during clinical examination.

The Burden of Care for Cervical Necrotizing Fasciitis in a Resource-constrained Setting

Necrotizing fasciitis (NF) is a soft tissue infection that is primarily characterized by fast spread along the fascial planes and adjacent cutaneous tissues. Cervico-facial necrotizing fasciitis (CNF) usually presents with severe intense pain with a polymicrobial odontogenic source. Early diagnosis with aggressive management, usually involving appropriate antibiotic selection, surgical debridement, and wound care, is key to achieving a good outcome. Management of CNF requires a multidisciplinary approach and poses several challenges in resource-constrained settings, especially in developing countries. This problem is further compounded by the late presentation and uncontrolled and indiscriminate use of herbal medications in the tropics. A 65-year-old Ghanaian woman with no known comorbidity reported to the Accident and Emergency Unit of Sunyani Teaching Hospital with a chief complaint of recurrent toothache for two years and left facial swelling of 1-week duration. On physical examination, she was chronically ill, febrile (39.5 °C), and anicteric but not pale. There was a soft, fluctuant, tender swelling involving both submandibular and submental areas with increased local temperature. The swelling also extended to the anterior cervical and anterior chest walls, which were overlaid with necrotic skin. Overlying such diseased skin was also prevalent over the mammary glands. Following the clinical diagnosis of NF spread, debridement was performed, and appropriate antibiotic therapy with daily wound care management was instituted. This continued until the patient's general condition improved, and good wound healing with the formation of granulation tissue was observed. The patient was subsequently referred to a tertiary facility for skin graft. Early presentation, prompt diagnosis, and aggressive surgical and medical care are key in achieving good outcomes of NF in resource-constrained developing nations.

Illuminating the path: the role of photodynamic therapy in comprehensive periodontal treatment

OBJECTIVES

Evaluating photodynamic therapy's efficacy and suitability for treating periodontal disease is the main goal of this review. What are the best conditions for using photodynamic therapy, and how can it improve conventional periodontal treatments?.

MATERIALS AND METHODS

A comprehensive literature search has been conducted to identify peer-reviewed research published up until August 2024. This search utilized reputable databases, including PubMed, Scopus, and Google Scholar, ensuring a robust selection of relevant studies. Selected studies were meticulously analyzed to their methodologies, types of photosensitizers employed, light intensity levels applied, as well as the resultant clinical outcomes observed. Additionally, a comparative analysis has been performed between photodynamic therapy and traditional periodontal therapy as documented in numerous clinical studies.

RESULTS

Results show that photodynamic therapy considerably lowers the number of microorganisms present in periodontal pockets, which in turn reduces inflammation and improves healing responses. According to studies, photodynamic therapy is an efficient way to break up the biofilms that of harmful bacteria that cause periodontal disease produce.

CONCLUSIONS

Photodynamic therapy is an intriguing alternative treatment option for periodontal disease. Because photodynamic therapy reduces biofilm resistance, improves blood flow, and promotes healing through anti-inflammatory effects, it may yield better clinical results when used in conjunction with conventional periodontal therapies. More research is required to create consistent guidelines for light dosage and photosensitizer selection in order to maximize therapeutic outcomes.

Utilization of caries risk assessment tools within the underserved population: a scoping review

OBJECTIVES

Caries Risk Assessment (CRA) tools can be utilised to assess caries risk levels within underserved individuals to provide risk-based caries management. With no previous review mapping the evidence of CRA tools in underserved populations, a scoping review was conducted to provide a comprehensive view of the current literature and the utilisation of CRA tools in underserved populations. The main objectives of this review are as follows: (1) to comprehensively review CRA tools utilised, and (2) to highlight the important findings indicating the oral health status of underserved population subgroups.

METHODS

A systematic search was performed using MEDLINE, EMBASE, Scopus, Google Scholar, and Dissertations & Theses Global (ProQuest). All relevant English-language papers published between January 2004 to June 2024 were identified. Retrieved references were imported and underwent 2-stage screening. The type of CRA tool was extracted as the primary outcome and oral health status of underserved subgroups were extracted as the secondary outcome.

RESULTS

A total of 26 studies and nine different CRA tools were identified. Included studies examined caries risk in low-income families, people with disabilities, Indigenous peoples, refugees, veterans, and rural communities. Most studies indicated moderate to high caries risk and significant unmet oral health needs in underserved populations.

CONCLUSIONS

The underserved populations experience elevated caries risk and poor oral health status that require the attention of policymakers and practitioners. Significant heterogeneity across the utilised CRA tools was identified. Future research focusing on developing a standardised and appropriately validated CRA tool that can be utilised is necessary.

Inducing phospholipase A2 and cyclooxygenase-2 expression and prostaglandins' production of human dental pulp cells by activation of NOD receptor and its downstream signaling

Dental caries with invasion and infection by microorganisms may induce pulpitis and intolerable pain. L-Ala-γ-D-Glu-mDAP (TriDAP) is a DAP-comprising muramyl tripeptide and a peptidoglycan degradation product found in gram-negative pulpal pathogens. TriDAP activates nucleotide-binding oligomerization domain1/2 (NOD1/NOD2) and induces tissue inflammatory responses. This study aimed to test whether TriDAP stimulates cytosolic phospholipase A2 (cPLA2), cyclooxygenase-2 (COX-2), and prostanoid production in human dental pulp cells (HDPCs) and their inhibition by signal transduction inhibitors, melatonin, and eugenol. We found that TriDAP stimulated cPLA2 and COX-2 expression as well as prostaglandin E2 (PGE2) and PGF2α secretion in HDPCs. TriDAP activated TAK1, MEK/ERK, and p38 signaling. COX-2 expression, PGE2, and PGF2α production induced by TriDAP were prevented by 5Z-7oxozeaenol, SB203580, and U0126. Moreover ASB14780 (a cPLA2 inhibitor) and the clinical drugs melatonin and eugenol suppressed TriDAP- and Poly(I:C)-stimulated PGE2 and PGF2α production. These results indicate that NOD activation in HDPCs may stimulate COX-2 expression and prostaglandin production, which are crucial in pulpal inflammatory and repair responses. The effects of TriDAP and Poly(I:C) were associated with TAK1, p38, MEK/ERK, and cPLA2 in pulpal inflammation. PLA2 inhibitors, melatonin, and eugenol can be used to control pulpal inflammation associated with NOD1/2 and TLR3 activation.

Effect of probiotic toothpaste and regular toothpaste on gingival health and plaque levels of adult orthodontic patients - An open label randomized controlled trial

INTRODUCTION

Probiotics are living micro-organisms that are likely to influence oral health by modulating the oral microbiota and offer a promising preventive approach to gum and dental disease. This approach is particularly relevant for orthodontic patients, who are more susceptible to gingival inflammation and plaque accumulation. The aim of this randomized controlled study was to compare the effects of a probiotic toothpaste versus a regular toothpaste on gingival health and plaque levels in orthodontic patients.

METHODS

Participants were recruited between 4 June 2024 and 15 July 2024, and were aged between 18 and 50years. They did not suffer from mental/physical disabilities, craniofacial disorders, enamel/tooth dysplasia and were not taking medication affecting plaque build-up. Participants were randomized in two groups using a computer programme and sealed envelopes: the group A (control) used an ordinary toothpaste (Colgate) twice a day for four weeks, the group B used a probiotic toothpaste containing Lactobacillus paracasei twice a day for four weeks. Standard oral hygiene instructions were given to all participants. The primary outcome was the mean change in gingival bleeding index (GBI) and plaque index (PI) over four weeks. This was an open-label trial. Only the evaluator was blinded and the evaluation criteria were objective.

RESULTS

Forty-four participants, 22 in each group, were finally included and analysed. After the intervention, the probiotic group had a significantly lower median gingival score [0.12 (IQR 0.09, 0.16)] than the control group [0.15 (IQR 0.10, 0.18)], with a p-value of 0.041 (95% CI: 0.009-0.18). However, there was no significant difference in plaque scores between the two groups [Probiotic: 20.0 (IQR 18.0, 21.0) vs. control: 21.0 (IQR 19.0, 22.0), P=0.15]. No significant adverse events or side effects were reported.

CONCLUSION

Under the conditions of this trial, the probiotic toothpaste only significantly improved the gingival bleeding index in orthodontic patients compared to regular toothpaste.

TRIAL REGISTRATION

ClinicalTrial.gov (NCT06473792).

Molecular analysis of HPV16 and HPV18 oncogenes in oral squamous cell carcinoma: Structural, transcriptomic and in vitro insights

The present study investigated the involvement of human papillomavirus (HPV)16 and HPV18 in oropharyngeal malignancies in order to understand the oncogenic mechanisms, and to identify biomarkers for early detection and treatment targets. Given the rising incidence of HPV-associated cancer, particularly in India, this holds significance in elucidating the molecular basis of these diseases. Structural validation of HPV16 and 18 oncoproteins E6 and E7 was conducted using computational tools, while gene expression profiles related to oral squamous cell carcinoma (OSCC) were analyzed to assess differential expression. The presence of HPV in patient tissue sections was examined using reverse transcription-PCR. The present study revealed the interactions of HPV16 and 18 E6/E7 oncoproteins, highlighting their role in cancer progression by targeting key tumor suppressors, such as p53 and retinoblastoma protein. Further analysis demonstrated the involvement of HPV16 and 18 E6/E7 oncoproteins in cancer pathways, signaling and telomere regulation, which supports the development of future targeted therapies. HPV16 and 18 E6/E7 represent promising therapeutic targets in OSCC, and provide further insights into potential diagnostic and treatment avenues. The present study contributes to the current understanding of HPV-associated cancer and innovative strategies in disease management.

Orthodontic extrusion with fixed appliances for treatment of intrusive luxation injuries: A prospective study of 28 permanent maxillary incisors

BACKGROUND

Limited evidence exists on the treatment options of tooth repositioning after intrusive luxation.

AIM

The study aimed to investigate the outcomes and complications of orthodontic extrusion in treating intruded maxillary permanent incisors.

DESIGN

A prospective study was conducted involving 28 intruded maxillary permanent incisors treated with orthodontic extrusion, compared with a retrospective control group of 29 teeth that underwent spontaneous re-eruption. The success rate of tooth repositioning, as well as pulp condition, periodontal healing, and root development were assessed and compared.

RESULTS

The success rate of orthodontic extrusion was 96.4%, excluding one tooth that was ankylosed before treatment. There were no significant differences in pulp condition between the orthodontic extrusion and control groups for teeth with immature root development. Teeth with mature root development in the orthodontic group, however, showed a significantly higher rate of pulp necrosis (100%, p < .05). Periodontal healing outcomes were similar across both groups, regardless of the maturity of root development. The root length continued increasing during orthodontic extrusion treatment.

CONCLUSIONS

Orthodontic extrusion treatment could effectively reposition moderately to severely intrusive permanent incisors, without increasing the risk of complications compared with spontaneous re-eruption.

Integrating artificial intelligence with smartphone-based imaging for cancer detection in vivo

Cancer is a major global health challenge, accounting for nearly one in six deaths worldwide. Early diagnosis significantly improves survival rates and patient outcomes, yet in resource-limited settings, the scarcity of medical resources often leads to late-stage diagnosis. Integrating artificial intelligence (AI) with smartphone-based imaging systems offers a promising solution by providing portable, cost-effective, and widely accessible tools for early cancer detection. This paper introduces advanced smartphone-based imaging systems that utilize various imaging modalities for in vivo detection of different cancer types and highlights the advancements of AI for in vivo cancer detection in smartphone-based imaging. However, these compact smartphone systems face challenges like low imaging quality and restricted computing power. The use of advanced AI algorithms to address the optical and computational limitations of smartphone-based imaging systems provides promising solutions. AI-based cancer detection also faces challenges. Transparency and reliability are critical factors in gaining the trust and acceptance of AI algorithms for clinical application, explainable and uncertainty-aware AI breaks the black box and will shape the future AI development in early cancer detection. The challenges and solutions for improving AI accuracy, transparency, and reliability are general issues in AI applications, the AI technologies, limitations, and potentials discussed in this paper are applicable to a wide range of biomedical imaging diagnostics beyond smartphones or cancer-specific applications. Smartphone-based multimodal imaging systems and deep learning algorithms for multimodal data analysis are also growing trends, as this approach can provide comprehensive information about the tissue being examined. Future opportunities and perspectives of AI-integrated smartphone imaging systems will be to make cutting-edge diagnostic tools more affordable and accessible, ultimately enabling early cancer detection for a broader population.

Association between molar-incisor hypomineralisation and dental anomalies

BACKGROUND

Common etiological factors have been reported in the development of molar-incisor hypomineralisation (MIH) and dental anomalies (DA).

AIM

To assess the association between MIH and DAs.

DESIGN

A cross-sectional study was performed to evaluate the presence of MIH and other six DAs in a sample of 415 pretreatment records from patients aged 9-18 years. Statistical analyses were performed using the chi-squared and Fisher's exact tests, and logistic regressions.

RESULTS

There was statistically significant association between the prevalence of DAs and MIH (CI: 1.43-2.43, φ-coefficient: 0.204, PR: 1.87). Higher percentage of tooth agenesis (CI: 1.37-1.68, φ-coefficient: 0.271, PR: 1.50), maxillary premolar agenesis (CI: 1.70-3.65, φ-coefficient: 0.125, PR: 2.49), mandibular second premolar agenesis (CI: 1.68-3.16, φ-coefficient: 0.172, PR: 2.30) and distoangulation of the mandibular second premolars (CI: 1.31-3.47, φ-coefficient: 0.103, PR: 2.13) was observed among children who had MIH-affected teeth. Individuals with MIH had a 2.95 times greater chance of having DAs (R2 = .153). The number of patients with DAs was higher when the first molar showed severe defects (OR = 4.47; R2 = .149).

CONCLUSION

There is a weak association between MIH and DAs. Patients with severe MIH lesions have a slightly higher risk of presenting DAs.

Current landscape and future directions of therapeutic approaches for adenoid cystic carcinoma of the salivary glands (Review)

Adenoid cystic carcinoma (ACC) of the salivary glands is the second most common type of salivary gland cancer, and is characterized by a poor prognosis and an unclear pathology. The incidence of ACC is rare, as it accounts for 10-15% of all salivary gland tumors and affects mainly patients aged between 50 and 60 years. The annual incidence rate is estimated to be ~4.5 cases per 100,000 individuals. Due to its rarity and the use of contaminated cell lines in previous investigations, the precise etiological factors underlying ACC remain poorly understood. Current treatment modalities, typically involving surgery with or without postoperative radiotherapy, often prove unsatisfactory due to the potential for local recurrence and delayed distant metastases, which may manifest 3-5 years after treatment and constitute the primary failure of existing therapeutic approaches. The indolent growth pattern, along with perineural and perivascular invasion, is potentially responsible for the delayed onset of metastases. No effective systemic therapy has been established so far. Therefore, the management of ACC represents a significant therapeutic challenge. Exploring the molecular characteristics of ACC, including the reasons behind its propensity for perineural invasion and its potential correlation with the immune system, offers promising strategies for managing ACC and could open up novel pathways for future therapeutic interventions. Currently, the use of immunotherapy in ACC treatment has shown limited effectiveness. While the exact mechanism underlying the lack of response to immunotherapy in ACC remains unknown, the low levels of tumor-infiltrating lymphocytes in these tumors may contribute to this resistance. Therefore, identifying novel targets to enhance the immune response against tumor cells is essential. The present review provides an update on clinical studies and explores novel therapeutic targets that could be effective in the therapeutic management of ACC.

Periodontal, occlusal, and aesthetic outcomes of missing maxillary lateral incisor replacement: A systematic review and network meta-analysis

INTRODUCTION

The aim of this systematic review was to determine the best treatment alternatives for patients with maxillary lateral incisor agenesis (MLIA) by comparing orthodontic space closure, implant and tooth supported dental prostheses by assessing studies that evaluated their periodontal, occlusal (function) and aesthetic results.

METHODS

The present systematic review was reported according to the indications of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) incorporating network meta-analysis, and the protocol was registered with PROSPERO (CRD42023487245). The PRISMA systematic search, without restriction on language or initial date, was carried out using electronic databases: MEDLINE (PubMed), Scopus and central register of controlled trials. To assess the aesthetic effects of the different treatment methods, an arm-based network meta-analysis was carried out.

RESULTS

The systematic search initially produced 1177 studies. At the end 10 studies met the inclusion criteria. These studies used various methods of treatment for maxillary lateral incisor agenesis including orthodontic space closure, implant-supported and tooth-supported dental prostheses. Data were extracted from the articles selected, and a network meta-analysis was carried out.

CONCLUSIONS

Within the limits of this network meta-analysis, no significant difference was found regarding the aesthetic results between orthodontic space closure or dental implant. Tooth-supported dental prostheses for MLIA reported worse scores in the periodontal indexes than orthodontic space closure treatment but the impact of orthodontic and prosthetic treatment on periodontal health remained contentious. Furthermore, no signs of TMJ dysfunction were observed in patients treated with either orthodontic space closure or prosthetic replacement.

Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability

BACKGROUND

Open Bankart repair and Latarjet stabilization are 2 widely used surgical procedures in the treatment of shoulder instability in contact athletes. This study evaluates the outcomes of bone block arthroscopic procedures, performed with a xenograft, in combination with Bankart repair and selective subscapularis augmentation for contact athletes with recurrent anterior shoulder instability.

METHODS

We retrospectively assessed contact athletes who underwent arthroscopic bone block with xenograft and Bankart repair with selective augmentation of the subscapularis for recurrent anterior shoulder instability between January 2017 and December 2021. Shoulders with posterior instability or multidirectional instability were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score, Western Ontario Shoulder Instability index [WOSI] score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form ASES score) were assessed. A computed tomography scan at 2-year follow-up was performed to assess the status of bone block integration, its displacement and restoration of glenoid surface.

RESULTS

Sixteen patients with a mean age of 24 years were included in the study. None of the patients treated with arthroscopic bone block and subscapularis augmentation presented new dislocation episodes. An increase in preoperative scores was observed at the last follow-up; in particular, the ASES, Rowe, and WOSI scores increased from 69 ± 7, 31 ± 9, and 1235 ± 46, respectively, to 96.1 ± 3.2, 94 ± 6, and 119 ± 51. All athletes returned to sporting activity at or near the same level as presurgery. The glenoid bone surface increase from 83% to 116% at the last follow-up.

CONCLUSION

Bone block treatment with xenograft combined with Bankart repair and arthroscopic subscapularis augmentation procedures has been shown to be effective in treating instability in contact athletes with significant glenoid deficit. All athletes returned to athletic activity at a level similar to the preintervention period.

Perceptions of mothers of preschool children towards oral health services - a qualitative study

BACKGROUND

Poor oral health, especially dental caries in early childhood is a major public health concern. Parental oral health knowledge, behavior, and perceptions are important elements in determining the child's oral health status. The aim of the study was to investigate the perceptions of mothers of preschool children in Qatar towards their children's oral health and their experiences with oral health services provided to children.

METHODS

The study is based on qualitative methods using focus groups. Purposive sampling was used to recruit mothers of preschool children at two kindergartens in the city of Doha, Qatar. The focus group consisted of a series of open-ended questions about the oral health of children and the opinion of mothers towards the current oral health services provided in the country. An inductive thematic content analysis at the statement level approach was used to analyze the qualitative data.

RESULTS

Twelve mothers between the ages of 20 and 41 years old from two kindergartens participated in two separate focus groups. The average number of children per mother was 5 with 45 months being the mean age of children. Several themes emerged from analyzing the data retrieved from the discussion with mothers. For oral health knowledge, mothers demonstrated a different level of oral health knowledge, from good to poor. As for experiences with health services, recognized the value of oral health services in Qatar but expressed difficulties in access to oral health services for their children with almost all having had some negative experiences. Regarding the anticipated role of mothers in the oral health of their children, mothers were very positive about their potential role in supporting their children's oral health. The mothers also gave recommendations to improve oral health services for young children.

CONCLUSION

Mothers showed positive attitudes towards the oral health of their children and they recognized the importance of a good oral health care system.

Factors associated with tooth loss in patients with stages 3 and 4 periodontitis: a short-term retrospective evaluation of patients

This retrospective study analyzed factors associated with tooth loss in patients with stages 3 and 4 periodontitis undergoing non-surgical periodontal therapy. Data from 84 patients treated at Griffith University Periodontal Clinic (2019-2022) were examined, focusing on patient factors such as smoking status, osteoporosis, and age, alongside tooth loss variables. The logistic regression analysis revealed that patients with stage 4 periodontitis had a significantly higher likelihood of tooth loss compared to those with stage 3 (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.13-4.84). Smoking was also identified as a significant risk factor, with smokers showing an OR of 1.69 (95% CI 1.4-3.9) for tooth loss. While no statistically significant relationships were observed for other variables (p > 0.05), patients under 40 years and over 71 years with stage 4 periodontitis exhibited notable tooth loss outcomes (p = 0.003 and p = 0.034, respectively). These findings emphasize the importance of integrating smoking cessation programs into periodontal care and tailoring treatment strategies for high-risk groups. Further longitudinal studies with comprehensive data collection are recommended to enhance the understanding of tooth loss predictors in advanced periodontitis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-025-04217-5.

Clinical, Radiological, and Histomorphometric Comparison of the Use of Deproteinized Bovine Bone Mineral and Titanium-Prepared Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Split-Mouth Randomized Controlled Clinical Study

BACKGROUND

Maxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA.

PURPOSE

This study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique.

STUDY DESIGN, SETTING, SAMPLE

This randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded.

PREDICTOR VARIABLE

The predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA.

MAIN OUTCOME VARIABLES

The primary outcome was the histomorphometric evaluation of the percentage of new bone between the 2 groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain, bone density (BD), and graft volume (GV) on cone-beam computed tomography 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA.

COVARIATES

Age, sex, periodontitis susceptibility, and smoking status were treated as covariates.

ANALYSES

The Wilcoxon signed-rank test was used for bivariate comparisons between 2 groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A P value ≤ .05 was considered statistically significant.

RESULTS

The sample was composed of 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) males and 2 (20%) females with a mean age of 51.30 (9.06) year. The percentage of new bone was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (P = .074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 hounsfield unit in the T-PRF group and 14.25 ± 1.65 mm, 1,519.39 ± 432.61 mm3, and 492.77 ± 117.35 hounsfield unit in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (P = .01 and P = .00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 implant stability quotient (ISQ) and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (P = .41 and P = .33).

CONCLUSION AND RELEVANCE

Although T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084).

Effects of FGF-related gene polymorphisms on cerebral infarction in patients treated with direct oral anticoagulants

BACKGROUND

The development of cerebral infarction is multifactorial, including both environmental and genetic factors. This study assessed the association between fibroblast growth factor (FGF)-related gene polymorphisms and the incidence of cerebral infarction among patients on direct oral anticoagulants (DOACs).

METHODS

Patients over 18 years old with atrial fibrillation who were receiving DOACs for cerebral infarction prevention at Ewha Womans University Mokdong Hospital and Ewha Womans University Seoul Hospital were enrolled in this analysis. Twenty-one single nucleotide polymorphisms (SNPs) from FGF1, FGF2, and FGFR1 were examined. In multivariable logistic regression analysis, three models (Model I: demographic factors only, Model II: demographic factors and genetic factors, and Model III: genetic factors and the CHA2DS2-VASc score) were constructed to identify the risk factors related to cerebral infarction.

RESULTS

Among the 536 candidate patients, 21 (3.9 %) experienced cerebral infarction while taking DOACs. From Model I and Model II, age ≥ 75 years and previous thromboembolic event history increased the risk of cerebral infarction. For genetic factors in Model II and III, FGF1 rs1596776 GG, FGFR1 rs6996321 AA, and FGFR1 rs7012413 TT genotypes were associated with a higher risk of cerebral infarction. The area under the receiver operating curve increased from 0.747 (Model I) to 0.822 (Model II) by adding genetic factors, demonstrating better model performance.

CONCLUSIONS

This study uncovered the association between FGF-related gene polymorphisms and cerebral infarction among patients with atrial fibrillation undergoing DOAC therapy.

Effect of an experimental pregabalin gel on dental sensitivity and color change after bleaching with 35% hydrogen peroxide: a randomized clinical trial

OBJECTIVE

This clinical study evaluated an experimental pregabalin (PG) gel in reducing dental sensitivity (DS) and color change after dental bleaching.

MATERIALS AND METHODS

Seventy-five volunteers were selected and randomized into three groups: GPG (10% pregabalin gel), GKF (5% potassium nitrate and 2% sodium fluoride), and GP (placebo gel). Prior to the bleaching treatment, GPG and GKF received applications of the respective desensitizing gels for 10 min. The GP group received an application of placebo gel, similar to the other groups. The bleaching was performed with 35% hydrogen peroxide in 3 sessions, with a 7-day interval between sessions. Post-bleaching DS was assessed using the visual analog scale (VAS) over 21 days of follow-up. Color Assessment (ΔE00, ΔWID, and ΔEab) and luminosity (L) were measured at baseline (T0) and 7 days after the third session (T1). Friedman, Kruskal-Wallis, one-way ANOVA, and Tukey tests were used, with α = 5%.

RESULTS

Intergroup analysis showed that on the 1st, 8th, and 15th days, DS was higher for GP (p < 0.006; p = 0.004; p < 0.001) and did not differ between GKF and GPG (p = 0.203; p = 0.178; p = 0.09). In the intragroup analysis, GP showed a significant increase in DS on the 15th day (p < 0.001).

CONCLUSIONS

The experimental 10% pregabalin gel reduced dental sensitivity and did not interfere with bleaching results.

CLINICAL SIGNIFICANCE

The topical application of 10% pregabalin gels and NKF was effective in reducing tooth sensitivity 24 hoursafter whitening with 35% hydrogen peroxide.

TRIAL REGISTRATION

ClinicalTrials.gov trial registry with the identifier NCT06180707.

Efficacy and safety of peroxide-based mouthrinse on whitening treatment: A randomized controlled clinical trial

OBJECTIVES

This randomized controlled clinical trial evaluated the efficacy and safety of peroxide-based mouthrinse on whitening treatment. The patient's satisfaction and treatment longevity were also assessed.

MATERIAL AND METHODS

Participants (N = 45) were randomly allocated to three different groups: WM (Whitening mouthrinse - 2.5% hydrogen peroxide); PM (Placebo mouthrinse - 0% hydrogen peroxide); and WG (Whitening gel - 10% carbamide peroxide). The treatment was performed twice daily for 30 s over 90 days for WM and PM and once daily for 2 h over 14 days for WG. Tooth color was evaluated with shade guides (ΔSGU) and with a spectrophotometer (ΔE00 and WID) after 14, 30, 60, 90, 120 days, and 2 years. Tooth sensitivity, gingival condition, and patient satisfaction were also evaluated.

RESULTS

WG resulted in the highest color change over time for visual (ΔSGU) and objective (ΔE00 and WID) analyses. With WM, significant visual color alteration was detected in the 60-day assessment compared with PM. After 2 years, no color rebound was observed for the treatments. A very low intensity of sensitivity was found for WM and WG. No gingival irritation was detected. All the participants were satisfied with the whitening treatment outcomes.

CONCLUSIONS

The peroxide-based mouthrinse effectively changed tooth color, with relevant effect detected after 60 days of use. However, the whitening result obtained with the conventional carbamide peroxide gel treatment was more pronounced. No relevant adverse effects were observed, and the outcomes were maintained for 2 years.

CLINICAL SIGNIFICANCE

Peroxide-based mouthrinse is an effective alternative whitening treatment, although it promotes less color change compared with the conventional at-home technique without inducing significant adverse effects. Patients should be warned about the prolonged treatment and the need for compliance.

Randomised clinical trial to compare the efficacy of dental whitening with 37.5 % Hydrogen Peroxide gel and 6 % Hydrogen Peroxide whitening strips

OBJECTIVE

to evaluate the efficacy and chromatic stability after 4weeks, in all three thirds of the central incisor of two whitening treatments: in-office 37.5 % hydrogen peroxide (HP) treatment alone, and 37.5 % in-office HP followed by use of 6 % HP whitening strips (WS).

METHODS

60 participants were randomly divided into two groups of 30. Group 1 was treated solely with in-office 37.5 % HP. Group 2 followed the same in-office 37.5 % HP protocol, followed by WS over 2 weeks. The CIELAB colour were measured before and after every treatment stage. Colour differences were quantified and compared to the perceptibility thresholds.

RESULTS

In-office 37.5 % HP treatment created a statistically significant increase in the L* coordinate and a statistically significant decrease in the a* and b* coordinates, resulting in perceptible colour changes in over 80 % of participants in all thirds of the tooth. In the group that used WS, the increase in L* and the decrease in a* and b* were maintained in the cervical and middle thirds after 4 weeks, whereas only the decrease in b* was maintained in the incisal third. In the group that did not use WS, the decrease in a* and b* was maintained in all thirds of the tooth after 4 weeks, but the increase in lightness was lost.

CONCLUSIONS

The use of WS helped maintain that increase in lightness over 4 weeks. The decrease in the a* and b* coordinates caused by the 37.5 % HP treatment persisted after 4 weeks, whether WS were used or not. All the colour changes evaluated were perceptible in over 70 % of participants.

CLINICAL SIGNIFICANCE

In-office treatment with 37.5 % HP increases lightness and decreases the quantity of yellow and red immediately but, if WS are not used, the impact on lightness is lost after 4 weeks. WS are a valid and effective treatment option in combination with in-office treatments to temporally extend the clinical treatment's whitening effect.

Light-curing of restorative composite through milled and 3D-printed full-contour zirconia for adhesive luting

OBJECTIVES

To evaluate the effect of different zirconia compositions and manufacturing processes on the light irradiance (LI), to measure the degree of conversion (DC) of solely light-curing restorative composite underneath these zirconia grades and to evaluate the respective zirconia microstructures.

METHODS

Six dental zirconia grades (GC HT, GC UHT [GC]; Katana HT, Katana UTML [Kuraray Noritake]; Lava Esthetic, Lava Plus [3 M Oral Care]) were cut and sintered per manufacturer instructions. One 3D-printed zirconia grade (XJet [XJET]) was prepared according to previous research. Zirconia plates were ground to four thicknesses (0.5, 1.0, 1.5, 3.0 mm). The LI through these zirconias was measured using light spectrometry using two light-curing units (Demi Plus [Kerr], Bluephase G4 [Ivoclar]). Restorative composite (Clearfil AP-X [Kuraray Noritake]) was light-cured through the zirconia plates and the DC was determined by micro-Raman spectrometry 5 min, 24 h and 1 w after light-curing. Statistical analysis of LI and DC data involved linear mixed-effects modelling and multi-way ANOVA. Microstructural analysis of zirconia was performed by scanning electron microscopy.

RESULTS

Zirconia type and thickness, and LCU had a significant effect on LI (p < .0001). DC significantly increased over time (p < .0001) and was not influenced by curing-light attenuation if LI reached at least 40 mW/cm². Increased yttria content resulted in an increased zirconia grain size.

SIGNIFICANCE

Despite significant light attenuation, DC of composite light-cured through zirconia at almost all thicknesses, approached DC measured without zirconia interposition for five out of seven zirconia grades. Additionally, the manufacturing process did not seem to influence LI or DC.

Exosome-based miRNA delivery: Transforming cancer treatment with mesenchymal stem cells

Recently, increasing interest has been in utilizing mesenchymal stem cell-derived extracellular vesicles (MSC-EVs), especially exosomes, as nanocarriers for miRNA delivery in cancer treatment. Due to such characteristics, nanocarriers are specific: biocompatible, low immunogenicity, and capable of spontaneous tumor accumulation. MSC-EVs were loaded with therapeutic miRNAs and minimized their susceptibility to degradation by protecting the miRNA from accessibility to degrading enzymes and providing targeted delivery of the miRNAs to the tumor cells to modulate oncogenic pathways. In vitro and in vivo experiments suggest that MSC-EVs loaded with miRNAs may inhibit tumor growth, prevent metastasis, and increase the effectiveness of chemotherapy and radiotherapy. However, these improvements present difficulties such as isolation, scalability, and stability of delivered miRNA during storage. Furthermore, the issues related to off-target effects, as well as immunogenicity, can be a focus. The mechanisms of miRNA loading into MSC-EVs, as well as their targeting efficiency and therapeutic potential, can be outlined in this manuscript. For the final part of the manuscript, the current advances in MSC-EV engineering and potential strategies for clinical application have been described. The findings of MSC-EVs imply that they present MSC-EVs as a second-generation tool for precise oncology.

Oral Health Care: A Systematic Review of Clinical Practice Guidelines

Maintaining good oral hygiene is essential for preventing and managing oral health problems. This systematic review aimed to identify and assess clinical practice guidelines on oral hygiene, focusing on quality and key areas. A comprehensive search was conducted in PubMed, CINAHL, Scopus, Cochrane, and organizational websites. Guidelines from health organizations that focused on oral health, hygiene education, and disease prevention were included. Guidelines based on expert opinions and those focusing on specific pathologies were excluded. The AGREE II tool was used to evaluate quality, and a narrative synthesis summarized recommendations across pediatric, adult, and senior age groups. Nine studies were reviewed. Results showed that electric toothbrushes do not significantly outperform manual ones in preventing cavities, though they may reduce plaque. Fluoride toothpaste is less effective if followed by rinsing with water. For adults, mouthwashes with chlorhexidine or sodium fluoride are recommended. Checkups every six months are advised for healthy children and adults. Proper denture care is also emphasized. Regular updates to oral care guidelines are necessary, as oral health affects essential functions and social well-being.

Physicochemical and functional properties of a novel clodronate-containing chelating gel: A comparative in vitro study

AIM

All commercial chelating gels contain EDTA which reacts chemically with sodium hypochlorite (NaOCl). This research aimed to develop a non-EDTA clodronate gel and to measure physicochemical and functional gel properties of the novel and commercial gels.

METHODOLOGY

A 1.37 M clodronate gel was made by combining polyethylene glycol (PEG) 400 and tetrasodium clodronate. File-Eze™, Glyde™, Odontoprep®, RC-Prep®, SlickGel™ ES and the clodronate gel were tested in pH, density and viscosity experiments. pH: A pH meter was used at 23°C. Viscosity: A rheometer recorded viscosity at a shear rate of 10/s at 35°C. Free available chlorine (FAC): NaOCl reactivity with the clodronate gel was compared to a 4% NaOCl control by measuring FAC with iodometric titration. Tissue Dissolution: File-Eze, Glyde, RC-Prep and clodronate gel mixtures with 4% NaOCl, PBS (phosphate buffered saline) (negative control) and 4% NaOCl (positive control) were tested. Percentage weight losses of porcine palatal mucosa were recorded over 5 min at 35°C. Smear Layer Removal (SLR): Scanning electron micrography and ImageJ software assessed the SLR ability of File-Eze, Glyde, RC-Prep, clodronate gel, PBS (negative control) and 15% EDTA (positive control) by calculating the area fraction percentage of the image occupied by open dentinal tubules (AF%).

RESULTS

pH: Values ranged from 5.78 ± 0.09 (RC-Prep) to 11.34 ± 0.05 (clodronate gel). Viscosity: Ranges were 6390 ± 290 (File-Eze) to 714 ± 50 mPa.s (Odontoprep). FAC: The clodronate gel differed significantly from 4% NaOCl (p < 0.0001, two-way anova, Šídák's tests), albeit with small absolute differences. Tissue Dissolution: All gel-NaOCl mixtures, except for clodronate gel-NaOCl, differed significantly to 4% NaOCl (p < 0.0001, one-way AVOVA, Tukey's multiple comparisons test). Weight losses were: 4% NaOCl, 30.0 ± 3.7%; clodronate gel-4% NaOCl, 29.2 ± 3.5%; whilst other gel-4% NaOCl mixtures ranged from 2.8 ± 2.0% to -0.6 ± 4.5% and PBS was -0.13 ± 3.3%. SLR Ability: Median AF%s were: 15% EDTA-9.7%; File-Eze-8.7%; clodronate gel-5.8%; Glyde-2.5%; RC-Prep-2.2%; PBS-0.22%. All gels differed to 15% EDTA (p < 0.0001, Kruskal-Wallis, Dunn's tests) except File-Eze.

CONCLUSIONS

The gels varied in physical properties, but none of them both dissolved organic tissue in NaOCl mixtures and removed smear layer well. Thus, none of the gels tested possessed all functional properties required of a chelating gel for glide path creation.

Efficacy of combining soluble calcium and pyrophosphate with sodium fluoride in inhibiting enamel caries progression: An in vitro study

OBJECTIVE

This study aimed to compare the effects of a combination of sodium fluoride, soluble calcium, and pyrophosphate (FCaP) versus fluoride alone in inhibiting enamel caries progression.

DESIGN

Different FCaP solutions were prepared, and two were selected for testing (FCaP-1: F = 76 mmol/L, Ca = 7.6 mmol/L, P = 7.6 mmol/L, FCaP-5: F = 76 mmol/L, Ca = 23 mmol/L, P = 23 mmol/L). Fluoride solution (F = 76 mmol/L) was used as a control. Fluoride and calcium bioavailability in the solutions were measured, and NMR analysis was used to identify fluorine-containing complexes. Sound bovine enamel samples (n = 24 / group) underwent a 4-day pH cycling protocol followed by an additional 3 days of demineralization. Micro-hardness testing and fluoride concentration measurements were performed.

RESULTS

FCaP-1 and FCaP-5 demonstrated nearly 100 % fluoride and calcium bioavailability. NMR analysis confirmed the formation of fluorine-containing complex. Enamel treated with FCaP-5 exhibited significantly less reduction in subsurface hardness after pH cycling and additional demineralization compared to fluoride alone. Interestingly, fluoride concentration and acid resistance on enamel surfaces treated with FCaP-5 was lower than with fluoride alone (Steel's multiple comparison test, p < 0.05).

CONCLUSIONS

FCaP effectively inhibits caries progression in subsurface enamel layers under pH cycling conditions by providing bioavailable calcium, indicating that FCaP increases the effectiveness of fluoride in caries management. FCaP may be a valuable addition to clinical practice, particularly for improving the effectiveness of fluoride-containing oral care products in individuals with low salivary calcium levels.