Risk indicators for dental caries among preschoolers, school children/adolescents and adults in Nigeria: a scoping review

BACKGROUND

Identifying the dental caries risk factors helps plan interventions. This scoping review mapped the existing literature on dental caries risk indicators for children, adolescents, and adults in Nigeria. It elucidated the commonalities and differences in these populations' behavioral, biological, and social risk indicators, and identified the local government areas in Nigeria where information on dental caries risk indicators are missing.

METHODS

A search of the literature search was performed in July 2023 in PubMed, African Journal Online, Google Scholar, and Cochrane Library [CENTRAL] using a combination of keywords related to dental caries, risk factors, early childhood, children, adults, and Nigeria. Only peer-reviewed full-length articles on risk factors for dental caries in Nigeria published in English were included. Descriptive statistics were used to summarize the study's characteristics and risk indicators for dental caries. The risk indicators for dental caries were categorized into behavioral, biological, and social. Differences and commonalities of the identified behavioral, biological, and social risk indicators for the three populations were identified.

RESULTS

After screening 570 studies, 27 publications for preschoolers, 37 for school children/adolescents, and 17 for adults met the inclusion criteria. For all groups, key social risk indicators were age, gender, socioeconomic, and educational status, biological risk indicators were anthropometric measurements and bacterial counts, and behavioral risks indicators were toothbrushing, snacking, and oral hygiene. Peculiar behavioral, biological, and social risk indicators were identified for each age group. Most studies are clustered in southern Nigeria. In addition, studies in preschoolers was skew to southwestern Nigeria, that of children/adolescents were skewed to Ife Central LGA in Osun State, while that for adults were skewed to Egor LGA in Edo State. Furthermore, participants recruitment was most diverse in Lagos State.

CONCLUSIONS

The shared risk indicators for dental caries can facilitate the development of overarching caries prevention program for the difference age groups in Nigeria. while the age specific risk indicators can inform the development of population specific interventions. This scoping review underscores the importance of a holistic, life course approach to dental caries risk management.

The zinc receptor, ZnR/GPR39, modulates taste sensitivity by regulating ion secretion in mouse salivary gland

Reduced saliva secretion, dry mouth, and loss of taste are debilitating symptoms associated with zinc deficiency. A mechanism for zinc regulation of these processes is lacking. Here, we identified the Zn2+ sensing receptor ZnR/GPR39 as a mediator of ion transport in salivary gland epithelium. By monitoring transport of NH4 +, a surrogate for K+, we revealed that Zn2+ upregulates the Na+/K+ ATPase pump activity in parotid and submandibular salivary gland epithelium from wildtype (WT), but not from ZnR/GPR39 knockout (KO), mice. Since Na+/K+ ATPase activity is crucial for solute transport, we compared saliva composition in WT and ZnR/GPR39 KO mice and found impaired ionic concentration and reduced saliva secretion in ZnR/GPR39 KO mice. Moreover, mice deficient in ZnR/GPR39 exhibited decreased sensitivity to appetitive Na+ concentrations. Altogether, we demonstrate that salivary ZnR/GPR39 activity controls saliva ion composition and secretion, and provides a target for therapeutic approaches for dry mouth and taste disorders.

Effect of nitrogen atmosphere during 3D printing on mechanical properties of orthodontic aligners

The aim of this study was to investigate the effect of low oxygen environment during printing on the mechanical properties of 3D printed aligners. Thirty-six 3D printed rectangular (20 × 20 × 10 mm) specimens were fabricated using the SprintRay Pro 55 printer and equally divided into two groups. Eighteen of them were built under normal atmosphere conditions during printing (CON) and the rest by continuously purging pure (NIT), thereby eliminating the oxygen content. Both groups underwent post-curing in an illuminated chamber. Three samples from each group were analyzed by attenuated total reflection Fourier-transform infrared spectroscopy (ATR-FTIR). The remaining specimens underwent metallographic grinding/polishing followed by nano-indentation testing. The mechanical properties measured were: Martens Hardness (HM), indentation modulus (EIT), and elastic index (ηIT). Statistically significant differences between groups were assessed using Mann-Whitney tests (α = 0.05). Both groups showed identical ATR-FTIR spectra and complete C = C conversion. No statistically significant differences in the parameters tested were seen. The medians (interquartile ranges) were HM CON: 68.0 N/mm2 (65.0-71.0 N/mm2), NIT: 73.0 N/mm2 (67.0-83.0 N/mm2); EIT CON: 1999.0 MPa (1952.0-2154.0 MPa); NIT: 2047.0 MPa (1702.0-2104.0 MPa); ηIT CON: 28.0% (27.2%-29.0%) and NIT: 28.9% (27.1%-31.4%). The results of this study showed that elimination of oxygen during printing does not affect the mechanical properties of 3D printed aligners.

Transforming orthodontic retention: potential of 3D printing and biocompatible material characteristics

This review article delves into the cutting-edge realm of 3D printing and its impact on the fabrication of customised orthodontic retainers, which is an essential utility in the prevention of relapse post orthodontic treatment. This review evaluates the use of biocompatible materials and provides insight into future perspectives and improvements in this field. It highlights the potential of data collecting method and 3D printing to improve orthodontic retainers' fabrication and emphasises the importance of using biocompatible materials for patient safety and efficacy. It also explains cytotoxic qualities of retainer fabrication materials, which are vital for safeguarding the oral health of the patient. The evaluation procedure enables the early diagnosis and correction of any potential difficulties, such as maladjustment or inappropriate fit, allowing for a more effective treatment. It illustrates the breakthroughs and innovations in the field of orthodontics, the advantages of 3D printing over conventional methods, as well as the advantages and disadvantages of various fabrication method. Incorporating 3D printing and review into the production of orthodontic retainers enhances the overall effectiveness and efficiency of patient treatment.

Myths about Oral Health and Associated Factors in Pregnant Women in a Public Hospital in Peru

PURPOSE

To determine oral health myths and associated factors in pregnant women.

MATERIALS AND METHODS

This was a cross-sectional analytical study carried out in an outpatient clinic of a public hospital in Lima, Peru, in a sample of 390 pregnant women (mean age = 30.02 ± 6.32 years) who answered a questionnaire of 61 items, comprising 39 oral health myths, 10 demographic/socioeconomic items, and 12 general health items. Multiple linear regression models were used with Jamovi v.17 at p 0.05.

RESULTS

Oral health myths were prevalent (33.6‒77.6%) and numerous (10 [7‒13] per pregnant woman), with common gestational or maternal beliefs associated with the presence of weakening of enamel/increased risk of caries and gingivitis, infection, or calcium loss; gingival bleeding and dental caries; risks posed by spicy food, medication, radiography, or anesthesia; and intense toothbrushing. Positive predictors of oral health myths were birth in geographical districts outside Lima, previous sexually transmitted disease and pre-eclampsia. Negative predictors were having more children, a higher educational level, better employment status, minimum monthly income, and history of smoking (R2 = 13%; F = 2.37; p 0.001).

CONCLUSION

Pregnant women had a high prevalence of beliefs in a large number of oral health myths associated with birth in the geographical districts outside the capital city, less maternal experience, poorer educational, occupational and economic conditions, and obstetric-gynecological medical history.

Umbrella review: CT of frontal, maxillary and sphenoidal sinuses for sexual dimorphism

PURPOSE

This study aimed to synthesize evidence on the use of computed tomography (CT) for sexual dimorphism based on the frontal (FS), maxillary (MS) and sphenoidal (SS) sinuses.

METHODS

An umbrella review was designed following the Preferred Reporting Items for Overviews of Reviews (PRIOR) and considered the Enhancing the Quality and Transparency of Health Research (EQUATOR) network. The study protocol was registered in Open science framework (OSF, https://doi.org/10.17605/OSF.IO/5XWJU). Systematic reviews and meta-analyses examining FS, MS and SS through CT imaging were included. The search was performed across PubMed, SciELO, LILACS and Open Grey.

RESULTS

Six eligible systematic reviews published between 2021 and 2024 were identified. These reviews analyzed the sinuses for parameters such as height, width, length, area, and volume. The studies predominantly focused on adults with age range spanning 13-97 years. The findings indicated accuracy rates for sexual dimorphism typically ranging between 60 % and 80 %, with MS generally being more dimorphic than the others. Two systematic reviews included meta-analyses, reporting sensitivity and specificity rates for MS of up to 72.3 % and 69 %, respectively. Cone beam CT yielded higher accuracy compared to multislice CT. However, the quality of studies was critically low or moderate based on AMSTAR-2 and ROBIS assessments - highlighting methodological inconsistencies and biases.

CONCLUSION

The studied sinuses were considered adjuvant tools for sexual dimorphism. Better results might come from MS visualized by means of CBCT. Primary studies remain necessary for stronger evidence.

Detection of proximal dental caries in primary teeth with a near-infrared-irradiation-assisted intraoral scanner: an in vitro study

BACKGROUND

The early detection of dental caries is crucial for successful dental care. New intraoral scanners using near-infrared irradiation (NIRI) technology track preventive lesions without ionizing radiation. This study aimed to evaluate the performance of intraoral scanners (IOSs) in detecting proximal caries in primary posterior teeth, compared to conventional methods such as loupes-assisted clinical exams and bitewing (BW) radiography.

METHODS

Fifteen examined tooth surfaces were used to produce a total of 60 scores by a restorative dentistry consultant (RDC). The tooth surfaces were categorized into caries-free (n = 5 × 4 exam methods) and carious (n = 10 × 4 exam methods) subgroups. Artificial caries lesions were created on specified surfaces and mounted on typodont in sets for evaluation using a simplified modified ICDAS visual and BW radiographic examination, DIAGNOcam device, and iTero Element 5D NIRI-assisted IOS. Reference surface scores were recorded. Investigators (RDCs and recent dental graduates (RDGs)) were trained and calibrated. Inter-examiner agreement, agreement with reference, specificity, and sensitivity were checked.

RESULTS

The results showed that the sensitivity and specificity differed between the diagnostic tests. The best agreement of all investigated diagnostic methods with the reference was found using the DIAGNOcam device (ĸ = 0.87) and BW radiography (ĸ = 1.00). High agreement was found for visual examination (by the RDC and RDGs (ĸ ≈ 0.85)) and iTero 5D examination (ĸ = 0.87).

CONCLUSIONS

The iTero Element 5D IOS had lower sensitivity and specificity compared to other methods. The potential use of IOSs with NIRI as a substitute for conventional diagnostic methods in primary teeth shows promise but requires further investigation.

Efficacy of biofilm decontamination methods of dental implant surfaces: A systematic review of in vitro studies

This systematic review examines the decontamination techniques used to clean titanium (Ti) implant surfaces covered with in vitro bacterial biofilms. The selected studies were gathered from the PubMed and Web of Science databases. These include in vitro studies investigating decontamination methods used to clean Ti implant surfaces coated with bacterial biofilms until January 2024. The determined studies were filtered according to the PRISMA guidelines, and the Science in Risk Assessment and Policy (SciRAP) was used to assess the reporting and methodological quality of the included studies. A total of 634 full-length peer-reviewed articles were identified. After excluding duplicate papers between the databases and screening according to the predefined inclusion and exclusion criteria, 13 studies were included. The decontamination methods investigated included mechanical, chemical, and physical methods, either as a single or in a combined approach. Significant variability was observed among the included studies. Combining the mechanical and physical methods with a chemical yielded the most significant reduction in both single- and multiple-species biofilms. The current results do not indicate that any single decontamination technique is more effective than others in eradicating bacterial biofilm from Ti surfaces; the combined approach was more advantageous than the single ones.

Seamless integration: Hybrid intraoral-extraoral scanning techniques redefining articulation in complete-arch implant-supported restorations with rapid digital conversion

Accurate occlusal records are vital for the success of full-arch implant restorations. Traditional methods, relying on impression materials and multiple patient visits, are often time-consuming and prone to errors due to material inconsistencies. The introduction of hybrid intraoral and extraoral scanning techniques marks a significant advancement by offering a fully digital workflow that improves precision, shortens treatment time, and enhances patient comfort. By integrating both scanning approaches, clinicians can achieve greater accuracy, minimizing occlusal vertical dimension discrepancies and optimizing articulation. This article explores how hybrid scanning is transforming full-arch restorations, offering an efficient and simplified solution that benefits both clinicians and patients, while ensuring optimal outcomes.

Polish Version of the Malocclusion Impact Questionnaire (MIQ): Translation, Cross-Cultural Adaptation and Validation

AIM

To translate the malocclusion impact questionnaire (MIQ) into Polish, adapt it for Polish cultural conditions, and validate its usage.

SUBJECTS AND METHODS

The original MIQ was translated into Polish following a seven-stage cross-cultural adaptation protocol. A total of 121 orthodontic patients participated in the study: 21 in the translation and cultural adaptation phase (5 males, 13.4 ± 1.5 years; 16 females, 13.6 ± 1.9 years) and 100 in the validation phase (53 males, 13.1 ± 1.6 years; 47 females, 12.9 ± 1.7 years). Confirmatory factor analysis (CFA) was conducted to confirm the one-dimensional structure of the MIQ_PL. Reliability was assessed using Cronbach's alpha for internal consistency and intraclass correlation coefficients (ICCs) for test-retest reliability, whereas construct validity was evaluated by comparing MIQ_PL scores with responses to global questions 1 and 2 from the MIQ_PL questionnaire and the aesthetic component of the index of orthodontic treatment need (IOTN-AC).

RESULTS

The MIQ_PL was generally well understood by the test group and required only minor adjustments, indicating it is well adapted to the Polish cultural context. The internal consistency, measured by Cronbach's alpha, was 0.68, and the intraclass correlation coefficient for test-retest reliability was 0.75, indicating adequate reliability. Many questionnaire items had a high floor effect. The correlation coefficients between global questions 1 and 2 and the MIQ_PL scores were 0.269 and 0.407, respectively, whereas the correlation between the IOTN-AC and MIQ_PL was 0.235.

CONCLUSIONS

The MIQ_PL is culturally adapted for Polish conditions but demonstrates lower than expected reliability and internal consistency. Further validation in non-clinical settings with a more diverse sample is recommended.

Evaluation of the effectiveness of novel oral hygiene aids in the prevention of gingival diseases in children and adolescents with special healthcare needs - A systematic review and meta-analysis

Background

Due to a lack of manual dexterity, impaired cognitive and general development, and awareness of caregivers, special children are not able to maintain good oral health. This leads to the development of dental plaque, gingival inflammation, and further periodontal diseases. It is, thus, necessary for dentists and caregivers to understand which of oral hygiene aids can be best suited for a child with special healthcare needs. The aim of this review is to evaluate the most efficacious oral healthcare aids in children and adolescents with special healthcare needs.

Materials and Methods

Systematic search was conducted in databases: PubMed, Cochrane, Google Scholar, Scopus, and ProQuest for studies published from January 1, 2000, till December 31, 2023. Randomized trials conducted among children and adolescents with special healthcare needs below 18 years using oral hygiene aids to reduce plaque were included in this review.

Results

A total of 23 articles satisfying eligibility criteria were included in the systematic review and 11 articles for meta-analysis. Meta-analysis was divided into two parts. Novel toothbrushes were more effective than manual toothbrushes with P = 0.01 (SMD: Standard Mean Difference) 95% confidence interval: -4.23 (-7.62, -0.85), I 2 = 99.63%). In chemical oral hygiene aids, chlorhexidine (CHX) spray at concentration of 0.12% was found to be more effective than placebo to control plaque and was not statistically significant.

Conclusion

Current evidence suggests that novel mechanical oral hygiene aids used with CHX spray as an adjunct can be best suited for children and adolescents with special healthcare needs to control plaque.

Elucidation of Factors Affecting Anterior Occlusion in Primary Dentition Based on the Japan Environment and Children's Study

Background/Objectives: Malocclusion in primary dentition affects permanent dentition. However, the factors contributing to malocclusion in the oral cavities of children have not been fully elucidated. We hypothesized that environmental factors affect malocclusion in the primary dentition of the Japanese population and aimed to identify factors associated with anterior occlusion in primary dentition. Methods: The study involved 3793 parent-child pairs from the Miyagi Regional Centre as part of a supplementary survey to the Japan Environment and Children's Study, a cohort study. A questionnaire assessing oral development and environmental factors was administered to parent-child pairs who consented to participate. Parents assessed anterior occlusion when their children were 3.5 years old. Results: The maxillary primary central incisors tended to erupt earlier in the open bite group. Significantly more children in this group were breastfed until 1 year and drank ionic beverages at 1.5 years. In addition, thumb sucking or pacifier use was significantly common at 2 years of age. A correlation was observed between the mother's body mass index (BMI) before and after pregnancy and anterior occlusion. Conclusions: In the open bite group, the occlusion status of the anterior teeth at 3.5 years of age showed distinctive results influenced by the eruption period of the primary anterior teeth, oral habits, intake of sweetened beverages, and maternal BMI. These findings suggest that parental observation could be useful for screening children for malocclusion until the eruption of permanent dentition.

Stainability of 3D-printed resins for denture base and artificial teeth

BACKGROUND

The 3D-printed resins for denture bases and artificial teeth are susceptible to staining from the colorants. The purpose of the study is to evaluate the color stability of 3D-printed denture base and artificial teeth resins submitted to staining by beverages for the simulated periods of 3, 6 and 12 months.

METHODS

Discs (15 × 3 mm) of denture bases resins [Lucitone 550 (n = 50), Cosmos Denture (n = 50) and NextDent Denture 3D+ (n = 50)] and artificial teeth resins [Duralay (n = 50) and Cosmos Temp (n = 50)] were manufactured. A spectrophotometer evaluated color stability after immersion in: instant coffee, cola, tea, red wine and distilled water, simulating periods of 3, 6 and 12 months of consumption. The data (ΔE00) were submitted to Generalized Estimating Equations (GEE) and Bonferroni post-test (α = 0.05). The perceptibility and acceptability thresholds of color change was set at PT/AT: ΔE00 = 1.7/4.1.

RESULTS

The Cosmos Denture resin showed greater color change after immersion in coffee and red wine for most periods at unacceptable levels, in comparison to Lucitone and NextDent. The ΔE00 values for NextDent and Lucitone resins were similar to each other regardless of the beverage and the period evaluated. For artificial teeth resins, Cosmos Temp predominantly reached unacceptable levels of staining in most cases, showing visible color changing due to exposure to instant coffee and red wine. Duralay and Cosmos Temp exhibited a time-dependent discoloration.

CONCLUSIONS

It was concluded that the Cosmos Denture resin presented the greatest changes in color stability in relation to other denture base resins for coffee and red wine. The 3D-printed denture base resin NextDent showed similar behavior of color change in relation to the conventional heat-polymerized denture base resin, irrespective of the beverage and immersion period. The Cosmos Temp artificial teeth resin showed unacceptable color stability compared to Duralay when immersed in coffee and red wine, irrespective of the period.

Trends and Gaps in Clinical Research on Tooth Bleaching: A Bibliometric Analysis of Studies Published From 2001 to 2024

INTRODUCTION

The objective of this bibliometric review is to address the main trends and development in dental whitening throughout the 21st century, as well as to identify knowledge gaps on the subject.

METHOD

A search was conducted in the Web of Science Core Collection database and information was extracted regarding the journal, authors, keywords, year of publication, number of citations, country, continent of the corresponding author. After reading the articles, data such as study design, type of bleaching technique, types of light sources used with the bleaching, occurrence of tooth sensitivity, and tooth color change analysis method were extracted.

RESULTS

The journal with the largest number of publications was "Operative dentistry" (n = 61), and the authors with the most articles were Loguercio AD (n = 82) and Reis A (n = 76). The productions are concentrated in Brazil, with emphasis on the State University Ponta Grossa. Most of the articles are randomized clinical studies that used the in-office bleaching technique with 35% hydrogen peroxide.

CONCLUSION

Our results show that the most recent studies used light sources such as a violet LED during whitening; however, more studies are needed to prove the benefits in relation to color change and reduction of tooth sensitivity.

Properties and Behavior of Additively Manufactured Provisional Fixed Dental Prostheses: A Systematic Review on 3D Printing Orientations Relative to Applied Materials and Postprocessing

OBJECTIVES

This systematic review aimed to assess the influence of printing orientations alone and with other parameters, such as applied material and postprocessing, on the physical-mechanical properties and mechanical behavior of provisional fixed dental prostheses (FDPs).

MATERIALS AND METHODS

A comprehensive search of websites such as PubMed, Scopus, Web of Science, and Cochrane was conducted in July 2024. Adhering to PRISMA 2020 guidelines, the studies that investigated the impact of printing orientations on the physical and mechanical properties were included in this review. The modified CONSORT statement was utilized for the risk of bias assessment. A total of 24 records were included; the main build-up angles were horizontal, oblique, and vertical (0°, 45°, and 90°), and other angles such as 30° and 150° were also reported. The data focused on the impact of orientation on 3D-printed products from different materials, applying various postcuring times and artificial aging. Horizontally printed specimens exhibited significantly superior mechanical properties and behavior compared with other angles, while vertically printed specimens displayed the lowest results. Additionally, the material type, amount, and type of fillers and postcuring had the most substantial impacts; zirconia fillers showed more enhanced strength compared to silica fillers, and the mechanical behavior was enhanced with postcuring time of up to 120 min. Optical properties were more related to the materials and technology applied than to printing directions. Polishing of the products enhances surface quality and removes differences from various orientations. Resin specimens exhibited a high susceptibility to staining, irrespective of printing orientation. Furthermore, aging significantly influenced the mechanical properties, gloss, and surface quality of the specimens.

CONCLUSIONS

To achieve high-quality provisional FDPs, it is essential to select a horizontal orientation. Careful selection of materials is necessary, as well as adherence to optimal printing parameters. 3D-printed resin may not yet be suitable for permanent rehabilitation; however, it is appropriate for short- and long-term temporization.

CLINICAL SIGNIFICANCE

The production of dental parts is shifting to additive manufacturing; it is crucial to understand the impact of various parameters on the physical and mechanical behavior of dental parts, particularly provisional restorations, to ensure their durable clinical service.

Orthodontic Treatment of a Transmigrating Impacted Lower Canine Using a Digitally Designed and 3D-Printed Lingual Appliance Combined with Corticotomy and Laser Therapy-A Case Report

Background: Canines play a vital functional and aesthetic role in human dentition, yet impacted canines, particularly in the mandible, are rare and can lead to functional disorders, such as the absence of canine guidance, while negatively affecting a patient's self-esteem. Transmigration of mandibular canines adds complexity to treatment. One method to reduce the treatment time, especially for impacted teeth, is corticotomy-assisted orthodontic therapy (CAOT). Methods: A 13-year-old patient presented with a horizontally impacted lower right canine, positioned below the roots of the lower incisors, showing transmigration. A digitally designed and 3D-printed lingual appliance was attached to the lower molars with hooks on the lingual side, enabling the application of multi-directional orthodontic forces. CAOT was performed using an Er:YAG laser (LightWalker, Fotona, Ljubljana, Slovenia) at 200 mJ, 12 Hz, 2.4 W, with a pulse duration of 100 µs, and an MSP H14 conical tip (0.6 mm spot diameter). Photobiomodulation (PBM) with a 635 nm diode laser (Lasotronix, Smart ProM, Piaseczno, Poland) was applied at 10 J per point (20 J/cm2) for 100 s per point, with a total energy of 20 J per session to reduce the risk of root resorption, manage pain, and accelerate healing as the tooth was moved into the alveolar ridge. Results: The treatment duration was two and a half years. The lingual appliance with hooks allowed precise traction of the canine, aided by exposure from the lingual side and the attachment of a hook. Gentle forces applied via orthodontic thread gradually moved the canine beneath the oral mucosa. Mid-treatment cone beam computed tomography (CBCT) scans confirmed the absence of root resorption of the lower incisors. A corticotomy, enhanced by laser therapy, was performed before moving the canine into the alveolar ridge. The canine was successfully rotated 180° and positioned without any signs of resorption in the canine or adjacent teeth. Conclusions: The use of a digitally designed and 3D-printed lingual appliance with hooks allowed the precise control of the traction of impacted teeth. When combined with corticotomy and laser therapy, it minimised root resorption risks, reduced pain, accelerated healing, and improved the overall success of the orthodontic treatment.

Functional modification and antibacterial evaluation of orthodontic adhesives with poly (lysine)-derived carbon dots

Fixed appliances used in orthodontic treatment make oral hygiene difficult to maintain, leading to bacterial adhesion around brackets and consequently resulting in white spot lesions (WSLs). After the bracket debonding, the residual adhesive is difficult to remove precisely due to its appearance similar to tooth enamel. In this study, we successfully synthesized small-sized and highly active PL-CDs by one-pot pyrolysis using ε-poly-l-lysine as a precursor. It was incorporated into orthodontic adhesives for multi-function modification. Based on our experimental results, the 3 wt% PL-CDs modified orthodontic adhesive exhibited excellent antibacterial properties and color identifiability. The addition of 3 wt% PL-CDs did not affect the biocompatibility and mechanical properties of the adhesive, and the cell survival rate was up to 80%. Therefore, this study provides a new strategy to solve the two major problems of enamel white spot and adhesive removal in the process of fixed orthodontics, and has important clinical application.

Dimensional accuracy of additive and subtractive manufactured ceramic-reinforced hybrid composite inlays: a CBCT-based in vitro study

The dimensional accuracy of digitally processed inlays is often questioned because of inherent manufacturing inconsistencies associated with computer-aided design and manufacturing (CAD/CAM). This study aimed to compare the absolute marginal discrepancy (AMD), marginal gap (MG), internal gap (IG), and overall discrepancy (OD) of three-dimensional (3D) printed, milled and conventional inlays. Forty resin dies were 3D-printed from a class II mesiococclusodistal preparation on a typodont and randomly distributed into four groups of 10 each. Optical impressions were taken for three groups to fabricate CAD/CAM inlays: Group PVC, 3D printed VarseoSmile Crownplus; Group PVT, 3D printed VarseoSmile TriniQ; and Group MVE, milled using Vita Enamic. For Group CGP (control), CGP was conventionally fabricated using Gradia Plus. These inlays were stabilized on dies and subjected to cone‒beam computed tomography to measure discrepancies in mesiodistal and buccolingual sectional images. All the discrepancies differed significantly among the groups (one-way ANOVA, P > 0.05). The mean OD was significantly greater in the MVE than in the PVT and CGP; the mean AMD and MG were significantly greater in the PVC than in the PVT (Tukey test, P > 0.05). Compared with the other groups, the 3D-printed inlays, especially the VarseoSmile TriniQ, presented a closer marginal and internal fit.

Leptospira biofilms: implications for survival, transmission, and disease management

Leptospirosis is a zoonotic disease caused by Leptospira bacteria, affecting humans and a broad range of wild and domestic animals in diverse epidemiological settings (rural, urban, and wild). The disease's pathogenesis and epidemiology are complex networks not fully elucidated. Epidemiology reflects the One Health integrated approach of environment-animal-human interaction, causing severe illness in humans and animals, with consequent public health burdens. Saprophytic and pathogenic leptospires have been shown to form biofilms in vivo, in vitro, and in environmental samples. Biofilms are characterized by a polymeric matrix that confers protection against hostile environments (both inside and outside of the host), favoring bacterial survival and dissemination. Despite its significance, the role of this bacterial growth mode in leptospiral survival, transmission, and decreased antibiotic susceptibility remains poorly understood and underexplored. Even so, the literature indicates that biofilms might be correlated with lower antimicrobial susceptibility and chronicity in leptospirosis. In this minireview, we discuss the aspects of biofilm formation by Leptospira and their significance for epidemiology and therapeutic management. Understanding the current scenario provides insight into the future prospects for biofilm diagnosis, prevention, and treatment of leptospirosis.

Analysis of Biomarker Levels in Nasopharyngeal Swabs, Serum, and Saliva Across Different Health Conditions

BACKGROUND

Coronavirus disease 2019 (COVID-19) is associated with a wide variety of clinical manifestations.

AIM

This study aims to evaluate the levels of angiotensin-converting enzyme 2 (ACE2), metalloprotease 17 (ADAM17), Interleukin-17A (IL-17A), transmembrane serine protease 2 (TMPRSS2), apelin (AP), and vitamin D (VD) biomarkers in nasopharyngeal swab (NPS), serum, and saliva, as well as the change in their values depending on the health status of individuals.

MATERIAL AND METHODS

The analysis was performed by using enzyme-linked immunosorbent assay (ELISA) methods.

RESULTS

Comparing the levels of the investigated markers in saliva, we found significantly elevated ACE2 values in vaccinated patients, followed by those with severe COVID-19, compared to healthy, previously infected, and mild COVID-19 groups. For TMPRSS2, IL-17A, ADAM-17, and AP, values were significantly higher in all non-healthy groups (previously infected, mild, and severe COVID-19) compared to healthy individuals. Serum levels of VD were consistently low across all five studied groups, suggesting values below normal ranges. Analysis of marker data in saliva, NPS, and serum revealed a positive correlation between NPS and serum and saliva and serum, as well as between saliva and NPS for all studied markers.

CONCLUSIONS

In summary, monitoring changes in biomarkers present in Saliva holds promise as a predictive tool for various diseases. This approach enables the early implementation of preventive measures and protective strategies, potentially improving overall health outcomes.

Effect of Different Luting Methods on the Microtensile Bond Strength of CAD/CAM Resin Blocks

The widespread implementation of new CAD/CAM materials has led to the necessity of establishing an adequate luting protocol. The aim of this study was to evaluate the microtensile bond strength (μTBS) and the film thickness of different luting methods on CAD/CAM resin blocks. Five Brilliant Crios CAD/CAM blocks (Coltene/Whaledent) were sequentially sectioned into two halves, air abraded with 50 µm aluminum oxide, and luted according to five different cementation protocols: Brilliant EverGlow (BEG), Brilliant EverGlow with ultrasound application (BEG-US), preheated Brilliant EverGlow (BEG-H), Brilliant EverGlow Flow (BEGF), and Duo Cem® Trans (DC). Subsequently, the blocks were sectioned to obtain rods, which were then submitted to a microtensile bond strength test (n = 20). The surfaces were examined with optical microscopy to determine the failure mode and the bonding interface was assessed with scanning electron microscope (SEM) analysis. Bond strength values were analyzed using one-way ANOVA and Tukey's post hoc tests (α = 0.05). The bond strength values varied with the different cementation protocols (p < 0.001): BEG (45.48 ± 18.14 MPa), BEG-US (42.15 ± 14.90 MPa), BEG-H (41.23 ± 15.15 MPa), BEGF (58.38 ± 15.65 MPa), and DC (81.07 ± 8.75 MPa). Regarding bond strength, DC presented significantly higher values than all other experimental groups (p < 0.050), whereas all luting methods using BEG presented similar values (p = 0.894). Adhesive failures were the predominant type. On SEM evaluation, all the luting materials presented a tight and homogeneous cement-block interface with variable film thicknesses. In conclusion, among the cementation protocols, the resin cement (DC) rendered the highest bond strength values. SEM analysis revealed that the lowest film thickness was associated with the flowable composite (BEGF).

Investigation of the Influence of Alloying Elements Ni, Cr, Co and Mo on the Crystallization Process, Phase Composition and Corrosion Resistance of AlSi25Cu4Cr and AlSi25Cu5Cr Alloys

To increase the mechanical and improve the operational properties of the AlSi25Cu4Cr and AlSi25Cu5Cr alloys, combinations of the alloying elements Ni, Co and Mo were used. The AlSi25Cu4Cr alloy was additionally alloyed with both Ni and Mo and Ni, Co and Mo, and the AlSi25Cu5Cr alloy was alloyed with Co and Mo in different concentrations. The dental alloys "wiron light" and "wironit" were used to introduce the elements Ni, Co, Mo, as well as additional amounts of Cr into the composition of the base compositions. The thermal analysis recorded a decrease in the liquidus and solidus temperatures of the base alloys, as well as a narrowing of their crystallization temperature range as a result of the added alloying elements. The influence of the used chemical elements on the phase composition of the alloys was established by X-ray diffraction. The elements Cr and Mo do not form secondary strengthening phases but dissolve in the α-solid solution. The results of the corrosion tests conducted in 1 M HCl solution and 1 M H2SO4 solution for 336 h and 504 h show that the elements Ni, Co and Mo improve the corrosion resistance of the alloys.

Three-dimensional analysis of mandibular and condylar growth using artificial intelligence tools: a comparison of twin-block and Frankel II Appliances

BACKGROUND

Analyzing the morphological growth changes upon mandibular advancement between Twin Block (TB) and Functional Regulator II (FR2) in Class II patients involves measuring the condylar and mandibular changes in terms of linear and volumetric measurements, as well as the distances registered after superimposition. Correspondingly, 3D digital assessment with the benefit of artificial intelligence tools was applied, and color-coded distance maps were descriptively interpreted to visualize the direction of growth.

SUBJECTS AND METHODS

Twenty patients aged 9 to 12 years with skeletal Class II malocclusion with overjet (5-9 mm) were enrolled into two groups: Group 1 (TB) and Group 2 (FR2). CBCT radiographs were taken at T0 (prior to treatment) and T1 (at the end of effective treatment; 7-11 months). 3D UX-Net algorithm was used to extract the 3D models and obtain the volumes. Visual Basic software was employed to develop a method for calculating the 3D distances and angles. 3D superimposition methods through Viewbox software were utilized to analyze growth direction following the treatments, using color-coded distance map visualizations.

RESULTS

The average volume increase of the mandible, right and left condyle was 2666.00 ± 1469.16 mm³, 207.70 ± 125.28 mm³, and 216.90 ± 121.65 mm³, respectively, after TB treatment, and 3316.10 ± 1552.29 mm³, 208.90 ± 116.85 mm³, and 193.65 ± 114.25 mm³, respectively, after FR2 treatment. The mean absolute distances (MAD) for the mandible, right, and left condyle from T1 to T0 were in TB group 1.238 ± 0.757 mm, 2.248 ± 0.346 mm, 2.267 ± 0.593 mm, respectively, and in FR2 group 1.417 ± 0.550 mm, 2.616 ± 1.063 mm, 2.475 ± 0.916 mm, respectively. The visualization of color-coded maps revealed a superior-posterior growth direction of the condyle measuring within 3 mm after the treatment.

CONCLUSIONS

Although mandibular and condylar volumes increased in each group when comparing T0 to T1, indicating the efficacy of both appliances in enhancing growth, no clinically or statistically significant differences were observed between the groups in terms of volumetric, linear, and 3D superimposition changes. However, color-coded distance maps demonstrated a consistent pattern of posterior-superior relocation of the condyles in most cases after treatment when comparing T1 to T0, whereas the back of the ramus in more than half of the cases has moved backwards. With no statistical differences between the studied groups.

Effect of polishing systems on the roughness, color, and staining of conventional and bulk-fill resin composites with and without S-PRG filler

OBJECTIVE

To evaluate the effect of polishing systems on the color and roughness of conventional and bulk-fill nanofilled resins, compared to conventional and bulk-fill nano-hybrid resins with S-PRG fillers.

MATERIALS AND METHODS

Discs (n = 12) were fabricated from the following resin composites: conventional nanofilled resin (Filtek Z350 XT, 3 M), bulk-fill nanofilled resin (Filtek One Bulk-Fill, 3 M), conventional nano-hybrid resin with S-PRG fillers (Beautifil II LS, Shofu), and bulk-fill nano-hybrid resin with S-PRG filler (Beautifil Bulk Restorative, Shofu). Polishing was conducted using multi-grit aluminum oxide abrasive discs (Sof-Lex Pop On, 3 M) or a single-grit aluminum oxide tip (OneGloss, Shofu). Roughness (Ra) and color (CIEL*a*b*, ΔEab and ΔE00) were assessed at baseline, post-polishing, and post-coffee staining. Surface micromorphology was analyzed using scanning electron microscopy (SEM).

RESULTS

Roughness increased after polishing with the aluminum oxide tip for all materials (p < 0.0001; Mann-Whitney). Bulk-fill nanofilled resin showed increased roughness, while conventional nano-hybrid resin with S-PRG filler showed decreased roughness after multi-grit disc polishing (p < 0.0001; Mann-Whitney). Coffee staining significantly increased the roughness in resin composites with S-PRG filler (p < 0.0001; Mann-Whitney). All resin composites exhibited reduced L* and b* (p < 0.05; generalized linear mixed models for repeated measures) and increased a* (p < 0.05; Friedman and Nemenyi) values after coffee staining. ΔEab and ΔE00 were significantly higher for bulk-fill nano-hybrid containing S-PRG filler, irrespective of polishing type (p < 0.0001; Friedman and Nemenyi). SEM analysis revealed surface degradation and/or particle loss in resin composites with S-PRG filler (conventional and bulk-fill) post-polishing. Single-grit polishing resulted in greater surface irregularities across all resins.

CONCLUSION

Polishing systems significantly influence resin composite roughness based on their composition, with single-grit polishing causing the highest roughness. Bulk-fill nano-hybrid resin composite with S-PRG filler exhibited the greatest color and roughness changes post-staining.

CLINICAL RELEVANCE

Bulk-fill resin composite with S-PRG filler demonstrated lower color and surface stability. Importantly, these changes were significantly mitigated when polished using a multi-stage polishing system.

TNF-α Activates NF-κB Signalling Pathway in MG-63 Cells on Titanium and Zirconia Implant Surfaces

Dental implant therapy is a widely used clinical procedure for restoring missing teeth in patients. Zirconia implants were introduced as an alternative to titanium implants due to their excellent biocompatibility and esthetic properties. The nuclear factor kappa B (NF-κB) signalling pathway is responsible for multiple aspects of innate and adaptive immune functions and serves as a significant and crucial mediator of inflammatory processes. The dysregulation of NF-κB activation induces pathological processes in multiple diseases. The purpose of this study was to investigate the activation of the NF-κB pathway upon stimulation with tumour necrosis factor (TNF)-α in osteoblast-like cells (MG-63) cultured on zirconia surfaces in comparison to titanium surfaces. Several methods such as immunoblot, immunofluorescence, MTT assay, and flow cytometry were used in this study. We observed that human recombinant TNF-α caused a strong activation of the NF-κB pathway on both zirconia and titanium discs and in wells without any discs. This activation was marked by the upregulation of MHC class I proteins in MG-63 cells grown on both titanium and zirconia discs; however, there was no effect on MHC class II protein expression. In summary, the present study has shown that TNF-α stimulation equally activates the NF-κB pathway in MG-63 cells cultured on both titanium and zirconia surfaces.

Treating White Spot Lesions and Non-Carious Cervical Lesions with Amelogenin Peptide-Based Hydrogel

Peptide-based biomimetic treatments have gained increased attention in the dental field due to their biocompatibility and minimally invasive qualities. These biomimetic approaches can replicate the native architecture of dental tissues, thus contributing to higher success rates and improved longevity of restorations. The aim of this study was first to examine the biocompatibility and stability of an amelogenin peptide-based chitosan hydrogel (P26-CS) against salivary enzymes. Second, we aimed to evaluate its efficacy in biomimetically repairing human dental lesions in situ. White spot lesions (WSLs) in enamel and non-carious cervical lesions (NCCLs) in dentin were artificially created. Chitosan (CS) improved peptide stability, while remineralization of enamel sections with P26-CS was not impeded by salivary enzymes. The peptide was not cytotoxic, irritating, or sensitizing. Fluorescently labeled P26-CS penetrated ~300 μm into the enamel of WSLs and ~100 μm into the dentin of NCCLs. After peptide treatment, quantitative light-induced fluorescence (QLF) and microcomputed tomography (μCT) indicated a gain in mineral density of WSLs. In NCCLs, scanning electron microscopy showed that the dentin was covered by a mineral layer of needle-shaped crystals. Our results show that the repair of artificial WSLs and NCCLs was achieved by P26 peptide-guided remineralization and demonstrate its potential to repair dental lesions.

[Influence of emergence profile designs on the peri-implant tissue in the mandibular molar: A randomized controlled trial]

OBJECTIVE

To compare the influence of different emergence profile of implants in mandibular molar on the peri-implant soft tissue.

METHODS

Forty-four implants were divided into two equal groups by mucosal thickness, ≥2 mm (group A) or < 2 mm (group B), and were randomly included in the test group and the control group. In the control group, the patients were treated by a prosthesis with no transmucosal modifications (subgroups A1 and B1). In groups A1 and B1, the prostheses maintained the original emergence profile of the healing abutment. In the test group, the prostheses were designed based on a width-to-height ratio (W/H) of 1.3 ∶ 1 (subgroups A2 and B2). In group A2, the buccal transmucosal configuration design was slightly concave, and in group B2, the prostheses were designed with convex buccal transmucosal configuration. Assessments were made before delivery of the definitive restoration (T0), one month (T1) and 12 months (T2) after loading. The soft tissue and prosthesis information were obtained by intraoral scan and were converted to digital models. The digital models of different time were superimposed together. Buccal mucosal W/H, emergence angle (EA) and buccal mucosal margin recession (ΔGM) were measured.

RESULTS

One year after loading, the buccal mucosal margin recession in the test group (groups A2 and B2) was significantly lower than that in the control group (groups A1 and B1). The ΔGM in group A2 was significantly lower than that in group A1 (P=0.033), but in groups B1 and B2, it was not significantly different. The W/H in group A2 increased significantly one month after loading, but remained stable at one year. In the A1 group, the W/H changed little from initial to one month, but increased significantly at one year after loading. The W/H in group B2 remained stable from the beginning to one year, while in group B1, it changed little one month after loading, but increased significantly by one year.

CONCLUSION

When the initial mucosal thickness was ≥2 mm, the slightly concave prosthesis designed based on the biological W/H significantly maintained the level of buccal mucosa. When the mucosal thickness was < 2 mm, the slightly convex prosthesis design maintained a more stable W/H over one year.

Photodynamic therapy in non-surgical treatment of periodontitis

Periodontitis is a chronic inflammation disease that, apart from caries, remains the main cause of tooth loss, that lead to a deterioration of the quality of life. Non-surgical treatment is the basic form of periodontal therapy, regardless of the stage of the disease. Novel supportive treatment methods are constantly implemented to improve the effects of non-surgical treatment, including photodynamic therapy that leads to a selective photosensitization of bacteria with the simultaneous participation of a photosensitizer applied into the periodontal pocket. The aim of the study is to evaluate the use of adjunctive photodynamic therapy on clinical and microbiological parameters in the non-surgical treatment of periodontitis. The clinical study involved 30 generally healthy, non-smoking patients. After a periodontal examination standard non-surgical treatment was applied. 6 weeks later a control periodontal clinical examination was performed and then periodontal pockets were subjected to a photodynamic therapy (PDT) using the FotoSan 630 cm Dental lamp with a perio tip and the FotoSan agent CMS Dental medium density photosensitizer. A significant improvement in clinical parameters including BoP (reduction 73,3%, p < 0,05), PD (reduction 1,9 mm, p < 0,05) and CAL (gain 0,6 mm, p < 0,05) and a significant reduction of red complex bacteria after application of PDT compared to SRP alone was observed. The application of supportive photodynamic therapy improve the effectiveness of periodontal non-surgical treatment including clinical parameters and reduction in subgingival bacteria biofilm.

[Analysis of soft tissue healing after keratinized tissue augmentation in reconstructed jaws]

OBJECTIVE

To evaluate the wound healing of recipient and donor sites following keratinized mucosa augmentation (KMA) around implants in reconstructed jaw areas and to compare these outcomes with gingival grafts in native jawbone, so as to provide clinical guidance for postoperative maintenance, and to investigate the impact of clinical experience on the evaluation of KMA postoperative healing through subgroup comparisons.

METHODS

This study included patients who underwent resection of maxillofacial tumors, fibular or iliac flap reconstruction, and implant placement at Peking University Dental Hospital from October 2020 to April 2023. Three months post-implant placement, the patients were referred for KMA procedures. Clinical photographs of the reconstructed area were taken preoperatively, immediately postoperatively, and 3 weeks and 3 months post-surgery. Additionally, photographs of the palatal donor site were obtained preoperatively and 3 weeks later. Wound healing was assessed by four junior and three senior clinicians utilizing the early healing index (EHI), early wound healing score (EHS), and pink esthetic score (PES).And senior clinicians evaluated the healing effect compared with gingival transplantation on natural jawbone using a 10-point scale.

RESULTS

A total of 26 patients with jawbone reconstruction were included, with an average age of (34.2±10.2) years, 11 males (42.3%) and 15 females (57.7%). Among them, 13 cases (50.0%) underwent fibula flap reconstruction, and 13 cases (50.0%) underwent iliac flap reconstruction. The average number of implants per patient was 3.2±0.7. In the recipient area, 3 weeks postoperatively, the EHS was 7.0 (4.0, 9.0), with sub-item scores as follows: Clinical signs of re-epithelialization (CSR) 6.0 (3.0, 6.0), clinical signs of haemostasis (CSH) 1.5 (1.0, 2.0), and clinical signs of inflammation (CSI) 1.0 (0.0, 1.0), indicating that the average appearance of the wound in the recipient area was characterized by generally well-approximated wound edges with minimal fibrin lines and mild erythema and swelling. The EHI for the recipient area was 2.0 (1.5, 2.5), suggesting that the incision was mostly closed with some fibrin lines 3 weeks postoperatively. The long-term healing evaluation system, PES, was 2.5 (2.0, 3.0), with sub-scores for color [1.0 (1.0, 1.5)] and texture [1.5 (1.0, 2.0)], which were slightly different from the reference values.In the palatal donor area, 3 weeks postoperatively, the EHI score was lower at 1.3 (1.0, 2.5), while the EHS score was higher at 8.5 (6.0, 10.0), indicating better soft tissue healing in the donor area compared with the recipient area. Among the clinicians with different levels of experience, the assessment of wound healing revealed that except for the CSI sub-item, where the junior group scored higher than the senior group, all other sub-items showed significantly higher scores in the senior group compared with the junior group. In the EHS evaluation system, the CSH sub-item demonstrated no significant differences between the groups with varying levels of experience. Experienced clinicians' evaluation outcomes of healing effect compared with gum graft on natural alveolar bone was 8.5 (7.5, 9.5), showing high consistency [intraclass correlation coefficient (ICC): 0.892; 95% confidence interval (CI): 0.791－0.949], suggesting slightly suboptimal healing results after KMA surgery.

CONCLUSION

The healing process following KMA in the context of jawbone reconstruction is relatively protracted, emphasizing the necessity for comprehensive postoperative management. Moreover, clinician experience plays a significant role in the assessment of wound healing outcomes for KMA in maxillofacial reconstruction.

The Nutritional Pathway Between Tooth Loss and Healthy Ageing: A Longitudinal Study of Older American Adults

OBJECTIVES

This study examines the mediating role of nutritional intake in the relationship between tooth loss and healthy ageing in older American adults.

METHODS

A secondary data analysis was conducted using the Health and Retirement Study (HRS), a longitudinal survey of American older adults aged 50 years and over. Data from six waves from 2006 to 2016 were used. Nutritional intake was assessed in 2013 using ten essential nutrients, categorised as adequate or inadequate based on national dietary recommendations. Healthy ageing was an aggregate variable composed of freedom from cognitive impairment, freedom from disability, and high physical functioning. Tooth loss was measured as a dichotomous variable (edentate/dentate). Structural equation modelling was used to assess the associations between tooth loss in 2012, nutrition in 2013, and healthy ageing in 2016, accounting for demographic/socioeconomic factors and behaviours.

RESULTS

A total of 3665 participants were included on the analysis. A significant association was found between being dentate in 2012 and nutritional intake in 2013 (coefficient 0.63: 95% CI: 0.62, 0.54, p < 0.001). Healthy ageing in 2016 was significantly influenced by socioeconomic factors in 2006 (coefficient 0.84: 95% CI: 1.38, 1.42, p < 0.001) and nutrition in 2013 (coefficient 0.05: 95% CI: 0.04, 0.05, p < 0.001). Non-Black individuals showed a significant association with healthy ageing.

CONCLUSIONS

The findings underscore the complex interplay of nutrition, socioeconomic status, health behaviours, and oral health in predicting healthy ageing trajectories. This study highlights the importance of oral health to maintaining adequate nutritional intake, which in turn promotes healthy ageing.

Prevalence and associated factors with oral frailty in middle-aged and older hospitalized patients: a cross-sectional study

Background

With the development of the economy and society, people pay more and more attention to oral health. Oral frailty can limit nutritional intake and make an individual physically weak, which is detrimental to people's health. Therefore, it is urgent to identify oral frailty and their associated risk factors. In this study, we aimed to evaluate the oral frailty and its influencing factors in Chinese middle-aged and older hospitalized patients.

Methods

A cross-sectional study was conducted from May 2023 to February 2024 in 2 tertiary hospitals in Wuhu City, Anhui Province, China. The self-designed sociodemographic information, the Oral Frailty Index-8, the 2-item Connor-Davidson resilience scale (CD-RISC-2), the sarcopenia screening questionnaire, and the three-item short literacy survey were used in this study.

Results

A total of 914 middle-aged and older adults patients were recruited. The prevalence of oral frailty was 48.7% (445/914). In the univariate analysis, oral frailty was significantly associated with age, education, place of residence, monthly income, sarcopenia, resilience, and health literacy. Correlation analysis showed that oral frailty was significantly negatively correlated with sarcopenia, resilience, and health literacy. In the binary logistic regression analysis, oral frailty was significantly associated with sarcopenia, and health literacy. Health literacy was a protective factor of oral frailty.

Conclusion

This study aimed to investigate the prevalence of oral frailty and identify the associated influencing factors among middle-aged and older adults patients in Anhui Province, China. This study identified several factors influencing oral frailty in middle-aged and older adults patients. Therefore, the government and relevant departments should implement targeted interventions to improve middle-aged and older adults patients' oral frailty.

The Home Use of Probiotics and Paraprobiotics for the Maintenance of Tongue Eubiosis: A Case Report

Aim: Halitosis is the unpleasant odor emitted from the oral cavity during exhalation and phonation. Using oral care products containing specific probiotics and paraprobiotics, combined with lifestyle changes, this study is aimed at resolving the patient's altered breath odor. Case Report: A 49-year-old male patient suffered from retronasal discharge, bacterial plaque on the back of his tongue, and bad breath. He underwent a professional oral hygiene session, received instructions in proper home oral hygiene techniques, and was advised on appropriate lifestyle changes. The use of oral care products based on probiotics and paraprobiotics was recommended. Sixty days later, the patient was reevaluated and was satisfied with the results, as his tongue had improved significantly, and he no longer experienced any bad sensations in his mouth. Conclusion: Systematic removal of bacterial biofilm and the use of probiotics and paraprobiotics can be useful in the prevention and treatment of halitosis.

'In the dark': parents' lifelong commitment to supporting children with Bardet-Biedl syndrome

Background

Bardet-Biedl syndrome (BBS) is a rare disorder involving a complex combination of eye and kidney diseases, obesity and learning difficulties. To better understand the roles of family caregivers, this study sought to explore parents' experiences of supporting adult children with BBS.

Method

This study included 17 parents of adult children with BBS. Semi-structured interviews were used as the research method. The generated data were interpreted using a reflexive thematic analysis, which employed a phenomenological and hermeneutical approach.

Result

Four themes were identified - namely, worries and expectations for the child's future, advocate and companion, in the power of the health and support system, and sources of support and coping. The findings indicate that the parents' everyday lives are affected in many ways by caring for adult children with BBS.

Conclusion

This study highlights the various roles and responsibilities of parents of adult children with BBS, including advocating for health services and attempting to fill gaps in care and social relationships. Hence, the findings of this study provide valuable insights for health professionals and support systems, helping to identify key areas for future initiatives aimed at better addressing the needs of adults with BBS and their parents.

Salivary Cortisol as a Biomarker for Assessing Fear and Anxiety in Patients with Molar-Incisor Hypomineralization

Background/Objectives: Molar-incisor hypomineralization (MIH) is a prevalent dental condition characterized by hypomineralized enamel affecting the first permanent molars and incisors. It leads to visible enamel opacities, with varying severity. Children with MIH often experience dental hypersensitivity, which can result in increased dental fear and anxiety, complicating dental treatment. Salivary cortisol, a well-established biomarker of stress, has been used to assess stress levels in various pediatric conditions but has not been extensively studied in MIH. This study aimed to assess salivary cortisol levels as a stress biomarker in children with MIH and compare them to those in children without MIH. Methods: Sixty children aged 5-9 years were divided into two groups: 31 with MIH and 29 healthy controls. Salivary cortisol levels were measured using ELISA, and statistical analysis was performed using IBM SPSS software, version 23 The Mann-Whitney test was used for group comparison, and the Kruskal-Wallis test evaluated the correlation between MIH severity and cortisol levels. Results: Children with MIH showed significantly higher mean cortisol levels (2.63 ng/mL) compared to controls (0.96 ng/mL), with a p-value of 0.0001. A progressive increase in cortisol levels was observed with the severity of MIH, with the highest levels recorded in grade 3 (4.38 ng/mL), in contrast to grade 0 (0.95 ng/mL), with a p-value of 0.001. Conclusions: Salivary cortisol levels are significantly higher in children with MIH, suggesting that MIH-related stress may contribute to dental anxiety and hypersensitivity. These findings highlight the importance of stress management in pediatric dental care.

Guided Bone Regeneration Using Carbonated Apatite Granules and L-Lactic Acid/ε-Caprolactone Membranes: A Case Series and Histological Evaluation

Background/Objectives: The newly developed poly L-lactic acid/ε-caprolactone (P(LA/LC)) membrane has recently been proposed as a guided bone regeneration (GBR) procedure in implant treatment. This case series details the clinical, radiographic, and histological results of ridge augmentation using bone graft comprising a P(LA/LC) membrane and carbonated apatite for implant treatment. Methods: Ten patients (15 sites) requiring bone augmentation and implant placement were retrospectively assessed. Simultaneous implant placement (Si) was performed at five sites in three patients. Si immediately following tooth extraction (SiIP) was performed at four sites in four patients. The staged approach (St) was performed at six sites in three patients. In the St-treated cases, hard tissue samples were taken from the implant placement site under patient consent. Results: The mean regenerated bone width for each treatment method was Si, 6.34 ± 2.64 mm (excluding implant diameter, 2.60 ± 2.42); SiIP, 7.55 ± 1.17 mm (excluding implant diameter, 3.90 ± 0.78) and St, 5.57 ± 1.08 mm. The mean regenerated bone width for all the cases was 6.36 ± 1.83 mm (excluding implant diameter, 4.14 ± 1.99). Significant differences were observed between the pre- and post-operative bone width in all the cases and the SiIP group (p < 0.001). All cases were followed up for more than 2 years after attaching the superstructure. No inflammation, shrinkage, or other problems were observed in the hard and soft tissues surrounding the implant. In the histological evaluation, there was no soft tissue ingrowth into the augmented bone, and new bone formation was observed. Conclusions: The use of P(LA/LC) membranes and carbonated apatite as GBR materials in implant treatment resulted in stable and favorable bone augmentation.

Use of virtual simulation for regenerative endodontic training: randomized controlled trial

OBJECTIVES

This study aimed to develop an experimental teaching module based on virtual simulation (VS) to facilitate the instruction of undergraduates in regenerative endodontic procedures (REPs) and to assess its impact on academic outcomes and students' perceptions.

METHODS

A REPs-VS platform with detailed diagnostic thinking, treatment protocol, and outcome evaluation scripts we developed. In total, 123 undergraduates in the fourth year were randomly divided into group A (REPs-VS teaching mode) and group B (traditional teaching mode). The effectiveness was evaluated by theoretical and operational examinations. The perspectives of students were assessed via questionnaires.

RESULTS

The total scores of the theoretical and operational examinations in group A were 82.10 ± 14.50 and 90.65 ± 4.81, respectively, which were significantly higher than the control group. Approximately 98.3% of students in group A agreed that the REPs-VS teaching platform improved their knowledge and skills. Most of the students in both groups unanimously acknowledged that the REPs-VS platform effectively enhanced the course's entertainment value and consequently increased their enthusiasm.

CONCLUSION

The REPs-VS teaching platform established herein is an innovative and practical tool that can enhance the comprehension of REPs among undergraduate students, providing a more robust foundation for clinical practice.

Magnesium-substituted zinc-calcium hydroxyfluorapatite bioceramics for bone tissue engineering

Hydroxyfluorapatite (HFAp) materials possess a structural and compositional similarity to bone tissue and dentin. These bioceramics facilitate various physiological functions, including ion exchange within surface layers. Additionally, magnesium (Mg) serves as a primary substitute for calcium in the biological apatite found in the calcified tissues of mammals, while zinc (Zn) contributes to overall bone quality and exhibits antibacterial properties. Although multiple studies have examined the individual substitution of ions within the hydroxyapatite (HAp) structure, no research to date has investigated the simultaneous substitution of zinc, fluoride, and varying amounts of magnesium in calcium HAp. This study explores the incorporation of magnesium into the structure of zinc-calcium hydroxylfluorapatite. A series of ion-substituted apatites, represented as Ca9.9-xZn0.1Mgx (PO4)6(OH)F with 0 ≤ x ≤ 1, were synthesized. Characterization of the produced samples confirmed that they were monophase apatite, crystallizing in the hexagonal P63/m space group, with only a slight impact on crystallinity due to magnesium doping. Pressure-less sintering of the samples demonstrated that maximum densification, approximately 94%, was achieved at 1200 °C with a sintering dwell of 1 h for the sample with x = 0.1. Furthermore, the Young's and Vickers hardness of this sample reached peak values of 105 and 5.02 GPa, respectively. When immersed in simulated body fluid, the formation of an amorphous CaP which can subsequently be crystallized into crystalline phase on the surface of dense specimens was observed, indicating the ability to bond with bone in a living organism and their potential use as substitutes for failed bone and dentin filling and coating.

Salivary hormones in depression: the future in diagnosis and treatment

Depression is associated with a significant burden on individuals, families, and communities. It leads to impaired social and occupational functioning, increased disability, decreased quality of life, and higher mortality rates, often due to suicide. A recent estimate from the World Health Organization (WHO) states that over 280 million people of all ages suffer from depression, which equals approximately 3.8% of the world population. Despite effective treatments for mental disorders, a dire treatment gap persists. This treatment gap could be reduced by effective and available diagnostic methods that have the potential to aid in depression diagnosis, stratification of patient subgroups, and treatment monitoring. In this regard, salivary hormones have been studied as potential markers for different types and etiologies of depression due to the convenience of non-invasive sample collection and their correlation with certain aspects of mood and mental health. The literature suggests they can help clinicians assess an individual's stress response, hormonal imbalances, and treatment response, leading to more personalized and effective interventions. In this review, we offer an up-to-date look at all studied salivary hormones associated with depression, including Cortisol, Melatonin, Oxytocin, Serotonin, Dehydroepiandrosterone, Testosterone, Progesterone, and Estradiol.

Ion release, cytocompatibility and microbial inhibition of a novel varnish containing fluoride-doped bioactive glass ceramics: an in vitro study

OBJECTIVES

The study aimed to develop and evaluate in vitro a varnish containing fluoride-doped glass ceramics capable of inhibiting oral microorganisms, releasing hydroxyapatite-forming ions, and ensuring biocompatibility.

MATERIALS AND METHODS

For the production of the experimental varnish (VE), composed of hydrogenated rosin, 10% and 20% by weight of glass ceramics with composition S53P4 (CF0) and doped with F- ions (CF5 and CF10) were incorporated. The EVs were characterized by Rheology, Scanning Electron Microscopy (SEM), FTIR, ion release (fluoride and calcium ions), cytotoxicity on VERO cells, and antimicrobial effect on S. mutans, S. aureus and C. albicans and anti-biofilm effect on S. mutans. The data were analyzed by One-Way ANOVA and Kruskal-Wallis test (P = 0.05).

RESULTS

Homogeneous varnishes with good viscosity were obtained. Varnishes with 20% CF demonstrated biocompatibility and minimum inhibitory concentration (MIC) at concentrations lower than 10 mg/mL and 3.12 mg/mL, respectively, except for C. albicans. An anti-biofilm effect on S. mutans was observed for the varnishes with 20% CF. All varnishes with CF released more F- than the commercial varnish, with V20CF10 standing out, which released 4 times more F- ions in a quarter of the time.

CONCLUSIONS

The V20CF10 varnish is a promising material for dental use in the treatment of early caries lesions, due to its biocompatibility, antimicrobial properties, and release of hydroxyapatite-forming ions.

CLINICAL RELEVANCE

The use of a new varnish that combines antimicrobial properties with hydroxyapatite-forming ion release may prevent or halt the progression of dental caries lesions, offering greater efficacy than currently available varnishes.

Accuracy of freehand versus dynamic computer-assisted zygomatic implant placement: An in-vitro study

OBJECTIVE

To compare the accuracy of zygomatic implant placement using a dynamic computer-assisted implant surgery system (D-CAIS) versus the traditional freehand approach.

METHODS

An experimental in vitro study was conducted using 10 stereolithographic models randomized to two groups: D-CAIS (test group) and freehand placement (control group). A single zygomatic implant was placed on each side of the models. The accuracy of implant placement was assessed by superimposing the actual postoperative implant position, obtained via cone-beam computed tomography (CBCT), with the virtual preoperative surgical plan from the preoperative CBCT. Additionally, the operated side and surgery duration were recorded. Descriptive statistics and bivariate analyses were performed to evaluate the data.

RESULTS

The D-CAIS group demonstrated significantly greater accuracy across most outcome variables. Reductions in angular (MD = -5.33°; 95 %CI: -7.37 to -3.29; p < 0.001), coronal global (MD = -2.26 mm; 95 %CI: -2.97 to -1.55; p < 0.001), coronal horizontal 2D (MD = -1.96 mm; 95 %CI: -2.60 to -1.32; p < 0.001) and apical global deviations (MD = -3.37 mm; 95 %CI: -4.36 to -2.38; p < 0.001) were observed. Accuracy in the freehand group varied significantly between operated sides. However, the surgical procedures in the D-CAIS group were significantly longer (MD = 11.90 mins; 95 %CI: 9.37 to 14.44; p < 0.001).

CONCLUSIONS

D-CAIS navigation systems offer significantly greater accuracy in zygomatic implant placement compared to the traditional freehand technique. Additionally, D-CAIS systems may minimize discrepancies in accuracy between operated sides, though their use is associated with an increase in the duration of surgery.

CLINICAL SIGNIFICANCE

D-CAIS navigation systems improve the accuracy of zygomatic implant placement. However, an increase in the duration of surgery is to be expected.

Tongluo Jiedu as an adjuvant therapy for oral cancer

Oral cancer is one of the malignant neoplasms that present major global health challenge. It is the sixth most prevalent type of cancer in the world, with a high incidence and mortality rate. This letter is a review of the study by Yin et al which was published in the World Journal of Clinical Cases (2024). The study evaluated the effect of Tongluo Jiedu as an adjuvant treatment for oral cancer. Over the years, there has been a continuous search for effective and less invasive treatments for oral cancer. This article emphasizes and discusses various therapeutic options currently available, and it highlights that early intervention and multidisciplinary management are crucial for improving outcomes. Traditional Chinese medicine, particularly Tongluo Jiedu, presents potential complementary approach to conventional oral cancer therapies. Future research on Tongluo Jiedu should be focused on validation of its efficacy and safety through large, well-designed clinical trials, as well as better understanding of the molecular mechanisms involved, and optimization of therapeutic combinations. Additionally, continuous education of health professionals is key to the effective and safe integration of this traditional medicine into clinical practice. Continuous research is essential for optimization of therapeutic strategies and for addressing the challenges presented by this neoplasm.

Efficacy of the NOA® mandibular advancement device in the management of obstructive sleep apnea: A cohort study

OBJECTIVES

To evaluate the efficacy, compliance, and side effects of the NOA® device compared to other mandibular advancement devices (MADs) in managing obstructive sleep apnea (OSA).

METHODS

Thirty-three participants using the NOA® device were evaluated based on apnea-hypopnea index (AHI) reduction (criterion I: >50% reduction of AHI or criterion II: residual AHI < 5 events/hour), compliance, temporomandibular disorders (TMDs), and patient-reported side effects. These data were compared to retrospective data of 59 patients receiving a different MAD.

RESULTS

Results showed that the NOA® device was effective in 78.8% (criterion 1) and 90.9% (criterion 2) of cases, requiring less mandibular advancement than other MADs. Participants used the device for an average of 6.94 ± 0.97 hours per night. Significant improvements were noted in morning headaches, sleep bruxism, and nocturnal urination.

CONCLUSIONS

The NOA® device demonstrated high efficacy, improved patient-reported outcomes, and caused no significant side effects or issues. It required less mandibular advancement than other devices and had high patient compliance.

CAD/CAM single prosthesis: A 25 years bibliometric assessment of prosthetic outcomes

Background

Computer-aided design and computer-aided manufacturing (CAD/CAM) single prostheses on teeth or implants are a viable option to restore edentulous spaces, using crowns. However, a comprehensive study that presents an overview of bibliometric factors related to the characteristics of this type of rehabilitation on teeth or implant is still lacking.

Objective

The purpose of this bibliometric study was to assess the review progress of papers in the field of CAD/CAM single prostheses regarding bibliometric parameters of year, framework material, technology, retention, and impression.

Material and methods

Four databases were assessed, and 5 bibliometric parameters were evaluated. An incidence rate ratio (IRR) was applied by using a multiple Poisson regression model (a = .05) to assess the association between single prostheses and each bibliometric parameter.

Results

A 25-year bibliometric research was carried out and 1019 studies were evaluated. Of these, 805 papers met the inclusion criteria. Over time, an upward trend was observed in the publication of articles on CAD/CAM single prostheses. Studies using only additive manufacturing had a higher IRR than papers that used both technologies (P = .016, IRR = 1.286). Aesthetic materials showed a higher IRR compared with studies that used titanium as framework material (P = .012, IRR = 1.258). Cemented prostheses (P < .001, IRR = 2.272) and both retentions systems (P = .005, IRR = 1.436) exhibited a higher IRR compared to screwed design. Scanning (P = .036, IRR = 1.107) had a higher IRR than hybrid method.

Conclusions

The number of studies that reports CAD/CAM single crowns has increased over time. Likewise, as the volume of publications with aesthetic frameworks. Additive manufacturing has been increasingly present in the most publications assessed, as well as the use of intraoral scanners for impressions. Single prostheses cemented retained were most commonly found.

Oral Microbiota and Inflammatory Bowel Diseases: Detection of Emerging Fungal Pathogens and Herpesvirus

Background/Objectives: Ulcerative colitis (UC) and Crohn's disease (CD) are the usual clinical forms of inflammatory bowel disease (IBD). Changes in the oral microbiota, especially the presence of emerging fungi and herpesviruses, have been shown to worsen the clinical aspects of IBD. The aim of this study was to screen for emerging pathogens in the oral yeast microbiota and the presence of herpesvirus in IBD patients. Methods: Oral swabs of seven UC or CD patients were collected. The samples were plated on Sabouraud Dextrose Agar and subcultured on CHROMagar Candida and CHROMagar Candida Plus. Polyphasic taxonomy was applied and identified using molecular tools, such as MALDI-TOF MS and ITS partial sequencing. Multiplex qPCR was used to identify the herpesvirus. Results: The mean age was 38.67 ± 14.06 years, 57.14% were female, and two had diabetes. The CD patients presented with Rhodotorula mucilaginosa, Candida orthopsilosis and Kodamaea jinghongensis, while the UC patients presented with Cutaneotrichosporon dermatis, Candida glabrata, Candida lusitanea and Candida tropicalis. Two UC individuals had at least one herpesvirus. In the first individual, a co-detection of Herpes Simplex Virus 1 (HSV-1) and C. lusitaniae was observed. The second presented with co-infections of Epstein-Barr virus (EBV), Human Herpesvirus 7 (HHV-7) and C. tropicalis. Conclusions: We identified rarely described yeasts and co-infections in IBD patients, highlighting the need to identify emerging pathogens in the oral microbiota, as they may contribute to opportunistic infections.

Digital workflow for fabricating a nasal apex-columella prosthesis with an integrated custom nasal stent

This clinical report details the management of an 11-year-old child with significant nasal trauma from a dog bite who required esthetic and functional rehabilitation. Initial treatment included surgical debridement and wound stabilization, followed by a nasal stent to maintain airway patency and prevent soft tissue contracture. A digital workflow incorporating facial scanning, computer-aided design, and 3-dimensional (3D) printing was used to fabricate a custom nasal stent. This approach ensured precise anatomic adaptation and enhanced esthetics through digital sculpting of the nasal apex and columella. The 3D printed stent demonstrated excellent clinical fit, improving both functional and esthetic outcomes. This clinical report emphasizes the benefits of digital workflows and 3D printing in pediatric nasal stent fabrication, providing rapid production and better results compared with traditional methods.

In vitro evaluation and comparison of the abrasive capacity of zirconia whitening toothpaste at different concentrations on the radicular dentin surface of human teeth

Background

Marketed toothpastes vary in the extent to how much abrasive wear they cause to dentin. New abrasive particles in a dentifrice should be evaluated since there they can be at risk of abrasion to dentin and root surfaces.

Aim

The aim of this in vitro study was to evaluate abrasive dentin wear and surface roughness after brushing with whitening toothpaste containing zirconia at four different concentrations.

Material and method

This study tested 40 extracted human teeth. After crown removal, root dentin samples were randomly divided into four experimental groups based on zirconia toothpaste concentration: Group A (10 samples) brushed for 5 min with 0.5 % zirconia toothpaste, Group B (10 samples) with 1 %, Group C (10 samples) with 2 %, and the last 10 samples with 5 %.Before brushing, specimens were weighed three times using a precision analytical scale and measured with a Profile Projector. After completing the brushing cycles, surface roughness was measured to evaluate the differences after brushing.

Results

The Kruskal-Wallis test showed no significant difference in the weight of samples at 0.5 %, 1 %, and 2 % toothpaste concentrations. However, at the 5 % toothpaste concentration, there was a significant difference in sample weight measurements (P < 0.05). The mean roughness difference in the three lower concentrations indicated no significant statistical difference, but with the 5 % toothpaste, there was an increase in average dentin roughness (P < 0.05).

Conclusion

Results showed that percentage ≤2.0 % of zirconium powder added in a toothpaste, can lead to dentin minimal wear and better roughness by polishing effect. Toothpaste containing 5 % zirconia showed an abrasive effect on dentin and increased surface roughness.

CT based 3D radiomic and clinical airway examination model for evaluating mask ventilation in oral and maxillofacial surgery patients

The objective of this study is to develop a model that incorporates clinical measurements with 3D radiomic signatures extracted from CT images of oral and maxillofacial surgery patients to evaluate mask ventilation. A prospective cohort trial was conducted to enroll patients scheduled for oral and maxillofacial surgery. After obtaining informed consent, clinical measurements and head and neck CT images were collected. The anesthesiologist who managed the airway graded the mask ventilation. Difficult mask ventilation was defined as mask ventilation that required assistance or the use of an oral airway or other adjuvant by the anesthesiologist. For radiomics analysis, 3D airway segmentation was extracted and calculated 3D radiomic signatures and corresponding radiological features. Subsequently, features in the clinical measurements model and radiomic signatures model were determined using the least absolute shrinkage and selection operator (LASSO) classifier. A mixed model was developed that incorporated both radiomic signature features and clinical measurement features. A total of 716 patients were enrolled in the study. The mixed model combined the five 3D radiomic signatures and six clinical measurements, and was found to have the highest predictive accuracy. In the validation group, the mixed group had an area under the curve (AUC) of 0.851, which was higher than the AUC of 0.812 in the clinical measurements model and 0.827 in the radiomic signatures model. This study developed a mixed model that combines 3D radiomic signatures and clinical measurements. Its application in clinical practice can assist in identifying patients at risk of experiencing difficult mask ventilation during oral and maxillofacial surgeries.

The Microbiological Background of Medication-Related Osteonecrosis of the Jaw (MRONJ): Clinical Evidence Based on Traditional Culture and Molecular Biological Detection Methods

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a common adverse event following antiresorptive treatment, leading to chronic inflammation and exposed, necrotic bone surfaces in the jawbone. There is an increasing recognition of the role of compositional changes in the colonizing members of the oral microbiota implicated in triggering and/or maintaining MRONJ. The aim of our study was to characterize the culturable and non-culturable microbiota-with particular focus on Actinomyces spp. and Actinomyces-like organisms (ALOs)-from surgically removed bone samples of MRONJ patients and healthy control subjects. Methods: n = 35 patients (median age: 70 years) in various stages of MRONJ, with a history of receiving oral or intravenous antiresorptive treatment were included in the study. The controls (n = 35; median age: 35 years) consisted of otherwise healthy individuals undergoing tooth extraction. Traditional, quantitative, aerobic, and anaerobic culture, and Actinomyces-specific PCR was performed for all bone samples from patients and controls, while microbiome analyses-based on 16S rRNA sequencing-were carried out in 5-5 randomly selected samples. Mann-Whitney U test, Wilcoxon rank sum test (alpha diversity), and PERMANOVA analysis (beta diversity) were performed. Results: In MRONJ samples, 185 anaerobic isolates, corresponding to 65 different species were identified (vs. 72 isolates, corresponding to 27 different species in the control group). The detection of Actinomyces spp. and ALOs was more common in MRONJ bone samples, based on traditional culture (65.7% vs. 17.1%; p < 0.001) and PCR (82.9% vs. 37.1%; p < 0.001), respectively. The isolation of Fusobacterium spp. (22 vs. 7; p = 0.001), Prevotella spp. (22 vs. 6; p = 0.034), and Gram-positive anaerobic cocci (GPAC) (30 vs. 9; p = 0.016) was significantly more common in MRONJ patient samples. The microbiota of the controls' bone samples were characterized by a considerable dominance of Streptococcus spp. and Veillonella spp, while the bacterial abundance rates were substantially more heterogeneous in MRONJ bone samples. Notable differences were not observed among the samples related to the abundance of Actinomyces in the bone microbiota. Conclusions: According to the "infection hypothesis", alterations in the oral microbiome-with Actinomyces and ALOs being the most relevant-may play a key role in the development, aggravation, and progression of MRONJ. The timely detection of Actinomyces in necrotic bone is crucial, as it has important therapeutic implications.

Gingival phenotype prevalence of lower incisors and associated risk indicators in the French dental student population: a cross-sectional study

OBJECTIVES

To investigate the prevalence of the gingival phenotype in the mandibular incisor area and the associated risk indicators.

MATERIALS AND METHODS

This cross-sectional study involved clinical examination to record main periodontal characteristics (gingival phenotypes) at the tooth level. Then, a phenotype at the subject level was defined as fragile (at least one thin phenotype on one of the four incisors) versus resistant (no thin phenotype on the four incisors). Furthermore, orthodontic parameters were assessed based on photographic examination. Two blinded periodontists and two blinded orthodontists were involved in the data collection. Univariate and multivariate logistic regression models were implemented.

RESULTS

A total of 119 students were included, encompassing 476 incisors. The prevalence of gingival phenotypes at the tooth level was as follows: thin/high (63.9%), thick/high (36.3%), thin/reduced (5.9%), and thick/reduced (0.2%). At the subject level, the fragile phenotype predominated (81.5%) and showed a significant correlation with the visibility of roots prominence (OR = 4.09, 95% CI: 1.47-11.41, p = 0.007).

CONCLUSIONS

Considering the conditions of this study, in the mandibular incisor area, the thin/high gingival phenotype exhibited the highest prevalence at the tooth level. At the subject level, the presence of visible roots prominence was identified as the only significant risk indicator associated with the fragile phenotype.

CLINICAL RELEVANCE

General practitioners, periodontists and orthodontists should consider the mandibular incisor sector as a vulnerable area. Categorizing the overall gingival phénotype into 4 types improves the diagnostic approach and allows better identification of high-risk phenotypes, especially in cases requiring multidisciplinary management.

CLINICALTRIAL

GOV RECORD

Number NCT05813444.

Artificial intelligence-produced radiographic enhancements in dental clinical care: provider and patient perspectives

Introduction

Artificial intelligence (AI)-based software can be used with dental radiographs to facilitate dental providers' diagnoses and to educate patients about their oral health conditions. The goal of this study was to survey dental providers and patients about the use of AI-enhanced radiographs in the diagnostic and patient education processes.

Methods

Within their Community Collaborative Practice model, Apple Tree Dental in Minnesota implemented the use of an AI software platform that annotates carious lesions and periodontal measurements on dental radiographs. Before and after implementation of this software, providers (dentists, dental hygienists, dental therapists, and dental assistants) were surveyed about what benefits and challenges they anticipated and experienced in using the AI software. A small-scale study of patients who viewed AI-generated annotations on their own radiographs examined patient perspectives on the use of this software.

Results

Dental therapists reported using the software most often, with 57.2% using the software at least 50% of their clinical time; 79% of dental assistants reported using the software 25% of the time or less. While the majority of providers (n = 70 for Survey I; n = 53 for Survey II) said that AI enhancements would help facilitate patient education efforts, providers' confidence in the ability of the AI software to improve diagnosis of dental caries and periodontal disease and its ability to improve the efficiency of their work was mixed. Patients (n = 25) found reviewing the AI-produced visual aids used by their dental provider to be helpful in understanding their oral health, and a large proportion (92%) said they planned to follow through on recommended treatment.

Discussion

While provider and patient perceptions of the use of AI software in dental care were positive overall, attitudes among providers were mixed regarding its effectiveness in diagnosing dental disease and improving work efficiency. More research is needed to determine whether use of AI software in clinical dental practice produces changes in treatment recommendations by providers or in patient adherence to these recommendations.