Timing of keratinized mucosa augmentation and peri-implant outcomes: A systematic review and meta-analysis

PURPOSE

This study aimed to compare different surgical timings for keratinized mucosa (KM) augmentation and assess the impact on peri-implant parameters stability.

METHODS

Electronic searches were conducted through MEDLINE (via PubMed), Scopus, Embase, and Web of Science up to June 13, 2024, which was completed with a manual search. The inclusion criteria focused on randomized and non-randomized human clinical studies that assessed outcomes of KM augmentation, with at least 3-months follow-up. The analysis included changes in KM width over time and several secondary outcomes.

RESULTS

Twenty-five studies satisfied the inclusion criteria. The studies included 855 patients and 1588 implants. The KM width significantly increased after surgery, regardless of the time or method of intervention (MD: 5.17, 95% CI: 4.59, 5.75, p<0.001). The second-stage surgery, particularly with the use of autogenous graft, indicated the lowest reduction in KM width up to 3 months after surgery, while a significant shrinkage was found when the augmentation was performed post-restoratively.

CONCLUSION

The evidence suggests that second-stage surgery is acceptable for KM augmentation, whereas the post-restorative phase is generally not the primary option. In cases where suboptimal soft tissue conditions are detected, it is advisable to either undertake KM augmentation or refer the patient for additional assessment before proceeding with the delivery of the restoration. Due to limited data, it is not possible to come to a definitive conclusion about the other surgical phases.

Periodontal Disease and Age-Related Maculopathy: A Case Report

Age-related macular degeneration (AMD) is a leading cause of significant vision impairment in individuals aged 50 and older, primarily impacting central vision. This study seeks to investigate potential associations between periodontal disease and age-related maculopathy in the analyzed clinical case. A male subject of 66 years old, with age-related degenerative maculopathy and severe periodontal disease, was evaluated and treated. After an initial phase of non-surgical causal periodontal therapy, the periodontal indices were re-evaluated. In addition, the extraction of hopeless teeth replaced by dental implants was performed. A retinal topography was used to assess possible regression of the pathology, and proper anti-VEGF therapy was administered. The results showed a regression of periodontal disease and an improvement of the degenerative maculopathy. These preliminary results, even if encouraging, should be supported by larger prospective trials.

Xerostomia and associated factors among adults with HIV on HAART attending voluntary counseling and testing (VCT) clinics in Dar Es Salaam

BACKGROUND

Adequate saliva quantity and quality are necessary for proper oral function and protection. Xerostomia, or dry mouth, is a common complaint among people living with HIV (PLHIV) which increases their risk of acquiring oral diseases. This study aimed to assess the magnitude of xerostomia and the associated factors in this group of patients.

METHODS

A descriptive cross-sectional hospital-based study was conducted among 420 PLHIV on highly active antiretroviral therapy (HAART) aged 18 years and above. Informed consent was obtained from the participants during data collection. The xerostomia was assessed using a questionnaire. Pearson's χ2 test was used to correlate independent (sociodemographic factors, oral health-related, and HIV-related factors) and dependent variables (xerostomia). Univariate and adjusted multinomial logistic regression were used to determine the odds ratio (OR) of xerostomia.

RESULTS

Xerostomia was observed in 36.3% of the respondents. The chi-square test showed a significantly higher proportion of xerostomia among the unemployed (p = 0.014), those who were HIV diagnosed up to five years (p = 0.014), and those having CD4+ counts ≥ 500 cells/ mm³ (p = 0.03). In multivariate analysis, higher odds of having xerostomia were found among participants with higher viral load (OR = 2.6; CI = 1.07-6.3), whereas lower odds were found among self-employed participants (OR = 0.48; CI = 0.28-0.82) and employed participants (OR = 0.52; CI = 0.27-0.98).

CONCLUSION

The prevalence of xerostomia is moderately high among PLHIV. Higher viral load and unemployment were the associated factors with xerostomia. Low CD4+ counts, duration of HAART use, and HAART regime were not associated with xerostomia.

A Descriptive and Correlational Study Assessing the Integration of Digital Health into Brazil's Dentistry Master's Degree Programs

Dental education faces a significant challenge in preparing future professionals for a world increasingly driven by Digital Health (DH) innovations. However, it is not known whether or how DH content is being included in the training of future dental teachers in Brazil. This study aimed to evaluate the extent of DH content integration in Brazilian Dentistry Master's programs. From April to June 2023, data from the Sucupira platform and institutional websites were utilized to evaluate all Dentistry Master's programs in Brazil. Statistical analysis assessed the impacts of five factors: geographical location, program type, administrative category, program score, and association with a Teledentistry unit on offering up-to-date content. Out of 92 identified programs, 77 had available documents for analysis. A total of 2,161 courses were found, 1,523 with detailed information. DH curricular content was found in 4 courses. No relationship was observed between the offering of DH and factors like program type (professional or academic) (p = 1.00), university administrative category (public or private) (p = .144), region (p = .638), program quality rating (p = .792), or association with a Teledentistry unit (p = 1.00). These findings highlight a concerning gap in the incorporation of DH-related content into Brazil's dentistry master's programs, underscoring the need to address this deficiency.

Implementation of Motivational Interviewing Training in Dental Education and Research-A Scoping Review

PURPOSE/OBJECTIVES

Motivational interviewing (MI) is an evidence-based counseling approach that enhances behavior change by strengthening an individual's motivation. While MI research in dental education is growing, the scope of MI training programs has not been systematically examined. This review assesses the implementation of MI training in dentistry.

METHODOLOGY

A scoping review followed the PRISMA-ScR checklist and JBI manual for evidence synthesis. A systematic search (May 2023) using MeSH terms, keywords, and operators was conducted in Medline (Ovid), Embase (Ovid), CINAHL, PsycINFO (Ovid), Web of Science, and ProQuest. Articles were screened via Covidence, and data were extracted based on variables informed by the DoCTRINE framework.

RESULTS

Of 17 studies, 70.6% were US-based, and 64.7% were published after 2010. MI training targeted dental hygiene and dentistry students (47% each) through lectures, role-play, e-learning, and workshops. Evaluations used pre-post questionnaires, recorded interactions, and tools like MITI, MISC, and OSCE. Training duration varied from single sessions (11.7%) to longitudinal programs (82.3%), enhancing students' confidence, communication, and public health readiness. However, skill retention required ongoing reinforcement. Barriers included time constraints, patient resistance, and limited faculty support. High-quality reporting (DoCTRINE score) was observed in 47% of studies.

CONCLUSION

MI training enhances dental students' communication and patient-centered care. Long-term skill retention requires continued practice, and hybrid instructional strategies can improve scalability. Faculty competency and structured longitudinal training are crucial for effective MI implementation.

Vitamin D receptor upregulation promotes ferroptosis-related salivary hyposecretion caused by Sod1 knockout in female mice

Oxidative stress is a key factor in reducing salivary flow and damaging salivary gland tissues, and females are more likely to experience saliva hyposecretion than males, with the underlying mechanism not elucidated. To investigate the potential link between salivary gland function and systemic oxidative stress, we employed a superoxide dismutase 1 gene (Sod1) knockout (SKO) mouse model to simulate elevated endogenous oxidative stress. Concurrent with increased endogenous reactive oxygen species (ROS) levels, we observed reduced salivary production, increased vitamin D receptor (VDR) expression, and altered gene expression profiles associated with ferroptosis, inflammation, and circadian regulation. These changes were specifically detected in female SKO mice but not in their male counterparts. In A253 salivary gland epithelial cells, exposure to 4-nitroquinoline N-oxide (4NQO), a superoxide inducer, led to the expression changes of ferroptosis-related genes and VDR. Overexpressed VDR enhanced the expression of transferrin receptor (TFRC) by targeting its predicted gene promoter, which stimulates ferroptosis. Ferroptosis occurs in the salivary glands of female SKO mice, contributing to impaired salivary secretion. Our findings underscore the potential role of VDR upregulation in reducing salivary secretion by modulating ferroptosis pathways and offer a promising avenue for future research to develop therapeutic strategies for preventing dry mouth and salivary gland dysfunction associated with oxidative stress and aging.

Comparison of fracture resistance of implant-supported fixed prothesis substructure materials with different cross-sectional geometry

BACKGROUND

The aim of this study was to compare fracture resistance after thermomechanical ageing of prosthetic substructure materials with different connector designs.

METHODS

Three different prosthetic substructure materials were used in this study: (1) GroupZir: (Zirconia, Fusion ceram, Turkey), (2)GroupPEEK (PEEK, Whitepeaks, CopraPeek, Essen, Germany), (3)GroupFRC (Fibre-reinforced composite, Trinia, Bicon Implant, Rep. of Ireland). A total of 72 implant-supported prosthesis triangular, square, and oval connector designs were created between 2nd premolar and mandibular 2nd molar teeth. After adhesion to the implant abutments with resin cement (Pentron breeze, Kerr), the samples were applied with dynamic loading and thermomechanical ageing (120,000 cycles,120 N,5-55 °C). Fracture resistance values were obtained with a universal test device and SEM images were analysed. The analyses were performed with Two-Way ANOVA and the Tukey test (SPSS 23.00).

RESULTS

Both the material and the connector type were found to affect the fracture resistance (F = 8.354, p < 0.05). The highest fracture resistance value was obtained from the triangular shape in GroupZir(3200 ± 91.05) and the lowest from the oval connector design of GroupPEEK material (2410 ± 157.23). Statistically significant differences were determined in the different connector designs of GroupZir(p < 0.05). In the comparisons made according to connector design, a significant difference was obtained between GroupZir and GroupPEEK and between GroupZir and GroupFRC. Deformations were observed in the fracture pattern of the Group Zir samples and deformations in the form of rupture were seen in the GroupPEEK and GroupFRC material samples.

CONCLUSIONS

The study results demonstrated that the fracture resistance of zirconia, PEEK, and FRC restorations over 3-unit implants with different connectors is affected by connector design. All the materials were seen to be comparable in respect of the forces formed in chewing dynamics.

Incidence and risk factors of alveolar bone dehiscences and fenestrations after clear aligner therapy with Class II elastics: a retrospective study

BACKGROUND

In clear aligner therapy (CAT), Class II elastics are widely used to reinforce the anchorage during the distalization of upper molars, however, their association with alveolar bone dehiscences (ABDs) and fenestrations (ABFs) in the anterior region remains unclear. The aim of this research is to assess the incidence of ABDs/ABFs in adult patients undergoing non-extraction CAT with Class II elastics, and to explore risk factors associated with the occurrence of ABDs/ABFs.

METHODS

Thirty adult patients with Class II malocclusion who underwent non-extraction CAT with Class II intermaxillary elastics were enrolled in this study. Cone-beam computed tomography (CBCT) images were obtained before (T0) and immediately after (T1) CAT to assess the occurrence of ABDs/ABFs on the labial and lingual sides of anterior teeth. Chi-square tests were used to compare the incidence of ABDs/ABFs at T0 and T1, meanwhile, binary logistic regression was utilized to analyze the risk factors associated with ABDs/ABFs at T1.

RESULTS

On the labial side, the incidence of ABDs increased significantly in the mandibular central incisors (from 36.7 to 62.8%, P < 0.05), mandibular lateral incisors (from 36.7 to 70.0%, P < 0.05), mandibular canines (from 31.7 to 53.3%, P < 0.05) and maxillary canines (from 30.0 to 55.0%, P < 0.05). While on the lingual side, it increased significantly in the maxillary central incisors (from 1.7 to 23.3%, P < 0.05), lateral incisors (from 6.7 to 38.3%, P < 0.05), and canines (from 21.7 to 46.7%, P < 0.05). The incidence of ABFs only increased on the labial side of the maxillary canines and mandibular central incisors. The occurrence of maxillary ABDs was strongly associated with the crowding (OR = 1.318, P = 0.007), while the occurrence of the mandibular ABDs was significantly associated with root surface (labial vs. lingual, OR = 1.836, P = 0.008).

CONCLUSIONS

The incidence of ABDs/ABFs significantly increased after non-extraction CAT with Class II elastics in adults, especially on the labial root surface of the mandibular anterior teeth. Orthodontists should be well aware of the periodontal risks of CAT with Class II elastics.

Probiotic Bactolac alleviates depression-like behaviors by modulating BDNF, NLRP3 and MC4R levels, reducing neuroinflammation and promoting neural repair in rat model

Depression, a prevalent psychiatric disorder, exerts severe and debilitating impacts on an individual's mental and physical well-being, and it is considered a chronic mental illness. Chronic stress plays an important role in the pathophysiology of depression. Lactobacillus plantarum and Streptococcus thermophilus are psychobiotic bacteria and synthesize some neurotransmitters that play a role in the pathogenesis of depression. In this study, we aimed to investigate the therapeutic effects of Bactolac (Lactobacillus plantarum NBIMCC 8767  + Streptococcus thermophilus NBIMCC 8258) on chronic stress-induced depression in rats. Behavioral tests, including the sucrose preference test, elevated plus maze test, forced swim test, and three-chamber sociability test, were employed to assess depressive and anxiety-like behaviors. The expression level of the 5-HT1A, DRD1, ADRA-2A, GABA-A α1, CNR1, NR3C2, NOD1, NLRP3 and MC4R; BDNF levels, glial activity and intestinal permeability were determined in chronic stress-induced depression in rats. In conclusions, chronic stress decreased the expression levels of 5-HT1A, DRD1, ADRA-2A, GABA-A α1, CNR1, NR3C2, NOD1 and BDNF level; increased the expression levels of NLRP3 and MC4R, caused neurodegeneration and glial activity, ultimately led to depressive effects. Bactolac was effective in reducing depressive-like behaviors according to the results of behavioral tests. Bactolac treatment provided high neuronal survival rate increasing BDNF level, prevented the excessive release of pro-inflammatory cytokines by reducing the expression levels of NLRP3 and MC4R, therefore, prevented the excessive activation of the hypothalamus-pituitary-adrenal (HPA) axis and accordingly, reduced neurodegeneration and glial cell activation in depressed rats. We can suggest that Bactolac supplementation may be beneficial in coping with stress, alleviate the effects of chronic stress and help to protect mental health.

Prevention of Dental Demineralization by Fluoride Toothpastes Followed by Fluoride-Free Mouthwashes: A TMR-D Conventional and Single-Section Technique Study

BACKGROUND

The use of fluoride-free mouthwashes (FFM) can adversely affect the anticaries benefits of fluoride toothpaste.

AIM

This study investigated (i) the impact of FFM on the anticaries benefits of fluoride toothpaste and (ii) differences in enamel-lesion assessment between two TMR techniques.

DESIGN

The study followed a 2 (technique) × 2 (toothpaste) × 4 (mouthwash) factorial design. Toothpaste (1100 ppm F) contained either NaF or SnF2. Mouthwashes contained CPC or EOs. Control mouthwashes were DIW and not washed after toothpaste. Two TMR techniques, conventional specimens and single sections of enamel (n = 8), were utilized. During the 5-day/pH cycling, the specimens with artificial caries-like lesions were treated two times/day with toothpaste/1 min, followed by mouthwash/30s. There was a 4 h demineralization/day. Integrated mineral loss (ΔΔZ) and lesion depth (ΔL) were determined. Data were analyzed using three-way ANOVA.

RESULTS

There was no statistically significant interaction between the three factors for ΔΔZ (p = 0.894) or ΔL (p = 0.410) and no difference between toothpaste for ΔΔZ (p = 0.977) or ΔL (p = 0.507). However, mouthwashes affected ΔΔZ and ΔL (both p < 0.001). The non-wash group resulted in the most remineralization. The technique did not affect ΔΔZ (p = 0.973).

CONCLUSION

Fluoride-free mouthwashes may decrease the remineralization potential of fluoride toothpaste, and the single-section technique is a suitable alternative in caries research. Pediatric dentists can emphasize proper hygiene and parental guidance in supervising children's brushing/rinsing.

The effect of storage conditions and duration on dimensional stability of 3D-printed endoguides

BACKGROUND

This study evaluated the dimensional stability and angular deviations of 3D-printed endodontic guides under varying storage conditions (wet vs. dry, dark vs. daylight) and durations (7 vs. 14 days).

METHODS

Endodontic guides for the localization of obliterated canals were designed using BlueSkyPlan software (BlueSky Bio, IL, USA) and printed with Biomed Clear Resin V2 (Formlabs Inc., Somerville, USA) via SLA technology. A total of 40 endodontic guides were fabricated and divided into four groups (n = 10), each subjected to either light or dark storage conditions for durations of 7 or 14 days. Dimensional stability was assessed using root mean square (RMS) and angular deviations in Geomagic Design X (Oqton, USA). Statistical analyses were performed using IBM SPSS v29 with independent samples and paired t-tests (p = 0.05).

RESULTS

Guides stored in dry conditions had lower RMS (0.052 ± 0.013) and angular deviations (0.29 ± 0.11) than wet conditions (RMS: 0.069 ± 0.028, p = 0.001; angle: 0.36 ± 0.11, p = 0.008). Angular deviations increased at 14 days (p = 0.003). Daylight exposure increased RMS deviations at 14 days in dry conditions (p = 0.001). Wet storage in dark conditions led to greater deviations at both time intervals(p < 0.05).

CONCLUSIONS

Storage conditions and duration significantly affect the dimensional stability of 3D-printed endodontic guides. Wet storage and prolonged duration reduce accuracy. To maintain precision, guides should be used within 7 days and stored in dry, dark environments.

CLINICAL TRIAL NUMBER

Not applicable.

Flow Cytometry Illuminates Dental Stem Cells: a Systematic Review of Immunomodulatory and Regenerative Breakthroughs

BACKGROUND

Dental stem cells hold significant potential in regenerative medicine due to their multipotency, accessibility, and immunomodulatory effects. Flow cytometry is a critical tool for analyzing these cells, particularly in identifying and characterizing immunomodulatory markers that enhance their clinical applications. This systematic review aims to answer the question: "How does flow cytometry facilitate the identification and characterization of immunomodulatory markers in dental stem cells to enhance their application in regenerative medicine?".

METHODS

An exhaustive literature search was conducted in PubMed, retrieving 430 studies, of which 284 met inclusion criteria. Studies were selected based on the use of flow cytometry to analyze immunomodulatory markers in dental stem cells, focusing on methodologies, key findings, and challenges.

RESULTS

Of the 284 articles, 229 employed flow cytometry, with 115 reporting relevant results. Flow cytometry revealed important insights into the immunological interactions of various dental stem cells, including dental pulp stem cells, stem cells from human exfoliated deciduous teeth, periodontal ligament stem cells, and stem cells from the apical papilla, by identifying and characterizing immunomodulatory markers such as PD-L1, IDO, and TGF-β1.

CONCLUSIONS

Flow cytometry is essential for advancing the understanding of dental stem cells' immunomodulatory properties. Standardization of methodologies is required to overcome technical challenges and enhance the clinical applications of dental stem cells in regenerative medicine and immunotherapy.

Association Between Porphyromonas gingivalis and Alzheimer's Disease: A Comprehensive Review

Background

Periodontitis has long been linked to various inflammatory, chronic, and immunological diseases, such as heart disease or diabetes. Recently, there has been increasing scientific interest in the bidirectional relationship that may exist between periodontitis and the presence and progression of Alzheimer's disease (AD), where it is hypothesized that the infiltration of oral microorganisms (mainly Porphyromonas gingivalis) into the bloodstream, which subsequently reaches the brain, causes inflammatory and neurodegenerative processes related to AD.

Purpose

The purpose of this review is to determine the association between Porphyromonas gingivalis and Alzheimer's disease in older adults.

Patients and Methods

It was carried out using different databases such as PubMed, Web of Science, among others, of no more than 10 years old focused on older adult patients who have presented periodontitis and Alzheimer's disease. MESH-indexed terms were used, getting 307 articles. After removing 206 duplicates and applying inclusion criteria (language, relevance, and contribution to the study's objectives), 24 articles were selected for analysis.

Conclusion

Evidence has been found that gingipains produced by P. gingivalis may contribute to the formation of amyloid plaques in the brain and nerve cell damage characteristic of Alzheimer's disease. It has also been observed that P. gingivalis can enter the brain and stimulate a local immune response. Although the association is promising, more research is needed to confirm it and to develop effective treatments. These findings may have significant implications for clinical practice, potentially leading to preventive or therapeutic strategies targeting oral health as a modifiable risk factor for AD. Further research could focus on exploring these pathways and developing targeted interventions.

[Research progress on enhancing osseointegration properties of polyetheretherketone implants through various modification methods]

This review article summarizes the current modification methods employed to enhance the osseointegration properties of polyetheretherketone (PEEK), a novel biomaterial. Our analysis highlights that strategies such as surface treatment, surface modification, and the incorporation of bioactive composites can markedly improve the bioactivity of PEEK surfaces, thus facilitating their effective integration with bone tissue. However, to ensure widespread application of PEEK in the medical field, particularly in oral implantology, additional experiments and long-term clinical evaluations are required. Looking ahead, future research should concentrate on developing innovative modification techniques and assessment methodologies to further optimize the performance of PEEK implant materials. The ultimate goal is to provide the clinical setting with even more reliable solutions.

Impact of different chemical debridement agents on early cellular responses to titanium dental implants: A transcriptome-based in vitro study on peri-implant tissue regeneration

BACKGROUND

Poor peri-implant health leads to biofilm accumulation, peri-implantitis, and bone loss. Chemical debridement may help maintain peri-implant health, but its effects on peri-implant cells remain unclear.

METHODS

Five cleaning agents-hydrogen peroxide (H2O2), Poloxamer, H2O2 +Poloxamer, Perisolv, and Paroex-were applied on titanium (Ti) surfaces. Mouse pre-osteoblasts (MC3T3-E1), human gingival fibroblasts (HGF), and human bone marrow stromal cells (hBMSC) were cultured on agent-treated Ti surfaces for up to 120 minutes to assess morphology, cytotoxicity, adhesion, and proliferation. RNA sequencing was performed on hBMSC.

RESULTS

Except for Poloxamer, all treatments inhibited cellular spreading. Paroex increased cytotoxicity and inhibited proliferation. Perisolv impaired hBMSC adhesion and variably affected proliferation. H2O2, alone or with Poloxamer, elevated cytotoxicity and inhibited adhesion in hBMSCs but not MC3T3-E1 or HGF. In contrast, Poloxamer-treated Ti surfaces enhanced adhesion and proliferation across all cell types. RNA sequencing revealed that oxidant-based treatments (H2O2, H2O2 +Poloxamer, Perisolv) suppressed key genes for proliferation (HMGA2, JAG1, NOTCH1, YAP1, TBX3), anti-apoptosis (MCL1, BCL2L2), and adhesion (ITGA2, ITGB3, SPP1), while inhibiting MAPK, PI3K-Akt, and pluripotency pathways.

CONCLUSION

Commercial agents like Perisolv and Paroex impair hBMSC function, with Paroex demonstrating significant cytotoxicity. H2O2 exhibits toxicity, particularly to hBMSCs. Poloxamer improves cell attachment and growth. Given these findings, careful selection of debridement agents is critical to balance cleaning efficacy and cytocompatibility. The adverse effects on hBMSCs necessitate prompt removal postapplication. Further research on biomaterials supporting tissue regeneration postdebridement is needed to restore peri-implant health.

Comparing Burnout Between Traditional and Advanced Standing Student Program Dental Students

INTRODUCTION

The literature has established burnout syndrome as a modern epidemic with adverse consequences. Burnout data for dental students training in the United States is lacking. This study aimed to examine differences in the dimensions of burnout between traditional standing (TS) and advanced standing (AS) dental students.

MATERIALS AND METHODS

TS and AS predoctoral dental students transitioning from didactic course work to preclinical and clinical education completed an informed consent, a demographic survey, and the Maslach Burnout Inventory-General Survey for Students. Statistical analyses included descriptive statistics, assumptions testing, independent samples t-test analysis, and Cronbach's alpha analysis.

RESULTS

Significant differences in the burnout dimension of exhaustion, M = 0.82, 95% CI (0.41, 1.22), t (108) = 3.97, p < 0.001, and the burnout dimension of cynicism, M = 0.96, 95% CI (0.50, 1.42), t (182) = 4.11, p < 0.001, existed between TS and AS dental students. TS dental students demonstrated significantly higher exhaustion (M = 4.61) and cynicism (M = 3.43) compared to AS dental students (M = 3.79 exhaustion and M = 2.47 cynicism). No significant difference in professional efficacy, M = -0.096, 95% CI [-0.38, 0.18], t (182) = 0.68, p = 0.50, was observed between the TS dental students (M = 4.38) and AS dental students (M = 4.47).

CONCLUSION

While both groups of dental students experienced burnout, TS dental students experienced significantly more burnout along the dimensions of exhaustion and cynicism. The presence of burnout in both groups of students suggests the need to develop programme-based strategies that aim to alleviate academic burnout and promote the wellbeing of the future dental workforce.

A case of orthodontic splint ingestion misclassified as a sharp/pointed foreign body in a child: A case report

RATIONALE

Foreign body (FB) ingestion is common, particularly among children. While most FBs pass through the gastrointestinal tract without complications, some cases can lead to morbidity or even mortality. Management strategies depend on the size, sharpness, toxicity, and location of the FB. Plain radiographs are essential for diagnosis, treatment planning, and follow-up, especially for radiopaque FBs. Ingestion of dental-related FBs is rare, with reported cases involving orthodontic wires, braces, retainers, and other dental materials. Composite resin-wire splints are commonly used in orthodontics to manage dental traumatic injuries. We present a case of a patient who ingested a composite resin-wire splint, initially misclassified as a sharp FB, leading to unnecessary aggressive treatment.

PATIENT CONCERNS

A 2-year-old girl presented to the emergency department after accidentally ingesting a FB of dental origin. She had a recent traumatic dental injury and displayed no symptoms of ingestion. Initial radiographs revealed a dental wire in the stomach.

DIAGNOSES

Ingestion of orthodontic splint (composite resin-wire splint).

INTERVENTIONS

Considering the pointed tip of the wire, the emergency department physician transferred her to the endoscopy specialist for endoscopic removal. However, given the expected passage into the small bowel after a proper fasting period for endoscopy, close observation with follow-up radiographs was chosen amid parental anxiety.

OUTCOMES

Follow-up imaging showed FB migration to the ascending colon without perforation. Stool inspection revealed the dental wire and 4 composite resins, with the sharp tips covered by the resin, classifying it as a blunt FB. A retrospective review of radiographs revealed faint oval-shaped, mid-level radiopacities at each end of the wire covering the sharp/pointed tips.

LESSONS

In evaluating orthodontic splints as FBs, identifying faint composite resin on radiographs is crucial for planning milder treatment and alleviating parental anxiety.

Effects of interferential current transcutaneous electrical sensory stimulation in patients with severe dementia and dysphagia in long-term care facilities

BACKGROUND

The aim of the study was to ascertain the efficacy of interferential current-transcutaneous electrical sensory stimulation (IFC-TESS) in treating patients with severe dementia accompanied by dysphagia who reside in long-term care facilities.

METHODS

We conducted a comparative intervention study. Forty-four patients with severe dementia and dysphagia in a long-term care facility were administered IFC-TESS for 15 min twice daily, 5 days a week. The clinical findings before and after 3 weeks of intervention were compared.

RESULTS

The study participants showed significant improvement in oral calorie intake after the intervention (p<0.05). The oral calorie intake indicated an improved nutritional state.

CONCLUSIONS

IFC-TESS may be effective in improving oral intake by patients with dementia.

TRIAL REGISTRATION

The trial was registered at UMIN-CTR under the identifier UMIN000032262 (Registration date: 16/04/2018).

Evaluating the effectiveness of clear aligner therapy in leveling the curve of spee: a comparative study of extraction vs. non-extraction patients

BACKGROUND

The proper leveling of curve of Spee (CoS) is critical in orthodontic treatment. However, achieving a leveled CoS using clear aligner therapy (CAT), particularly in cases involving premolar extractions, poses significant challenges. This retrospective study aims to evaluate the effectiveness of clear aligners in leveling the CoS in premolar extraction and non-extraction patients, and to identify key factors influencing post-treatment CoS.

METHODS

Thirty non-extraction patients and thirty patients with bilateral mandibular first premolar extractions, all of whom received CAT, were included in the study. The CoS of the pre-treatment, predicted post-treatment, and actual post-treatment dentition models were measured using Geomagic Studio software.

RESULTS

The pre-treatment CoS showed significant correlations with overbite, overjet, and Angle classification. Both the non-extraction and extraction groups failed to achieve the predicted improvement in CoS. However, the extraction group exhibited a greater discrepancy between the predicted and actual changes (1.38 ± 0.74 mm for the extraction group vs. 0.84 ± 0.58 mm for the non-extraction group). The regression model indicated that the post-treatment CoS was positively correlated with pre-treatment CoS, predicted CoS, and the use of Class II intermaxillary elastics, while it was negatively correlated with initial crowding.

CONCLUSIONS

The extraction group showed less effectiveness in leveling the curve of Spee compared to the non-extraction group. The results of the regression analysis can aid clinicians in identifying factors that impact the post-treatment curve of Spee, thereby contributing to improved treatment outcomes.

Surgical extraction with photobiomodulation as an adjunctive modality in patients at-risk for medication-related osteonecrosis of the jaw: retrospective study

AIM

The study aims to retrospectively assess and share the experience of the use of photobiomodulation (PBM) as an adjunctive to surgical extraction in patients at-risk for medication-related osteonecrosis of the jaw (MRONJ) due to a treatment history with bone-modifying agents.

METHODS

The department database and medical records were examined in the period between 2016 and 2023. The inclusion criteria were; at-risk patients for MRONJ with current or previous treatment with bone-modifying agents, with or without a history of antiangiogenic agents administration, who underwent single or multiple dental extractions, subjected to PBM preventive protocol, and without a diagnosis or history of MRONJ development. The PBM protocol consisted of four sessions, two sessions before the intervention and two sessions after the intervention. The PBM parameters (per session) were; total power of 0.6 W, time of 15 min, frequency of 30 kHz, and total energy of 577.4 J.

RESULTS

A total of 62 patients (58 females and 4 males) fulfilled the inclusion criteria with a mean age of 67.5 years. Complete healing without the development of MRONJ was shown in 50 (80.65%) patients, and the development of MRONJ was shown in 12 (19.35%) patients. The statistical analysis revealed a higher risk of MRONJ in patients with a history of administration of zoledronic acid (p = 0.029) and in patients undergoing corticosteroid therapy (p = 0.039). While a lower risk was observed in patients in treatment for thyroid pathology (p = 0.055).

CONCLUSIONS

The majority of the included at-risk MRONJ patients showed complete healing after surgical extraction with the use of PBM as an adjunctive modality. Corticosteroid treatment as a systemic risk factor and zoledronic acid as a drug-related risk factor show significant associations with the development of MRONJ.

Evaluation methods of artificial demineralization protocols for coronal dentin: a systematic review of laboratory studies

BACKGROUND

Despite the widespread use of various laboratory models such as chemical, bacterial, or combination as demineralization protocols to induce artificial caries in dentin, there is lack in the literature regarding a comparison of their effectiveness and assessment of dentin mineral density through using several analytical techniques, including microscopic and spectroscopic ones. The purpose of this review was to determine the appropriate demineralization protocols for inducing artificial caries utilizing coronal dentin. Furthermore, this evidence-based study was conducted to identify the most reliable evaluation methods in assessing the efficiency of the reviewed protocols.

MATERIALS AND METHODS

An electronic search was conducted on three databases: MEDLINE/PubMed, Scopus, and ScienceDirect, following PRISMA guidelines. Only the studies published between 2019 and 2024 were considered. All studies were assessed based on predefined eligibility criteria. English laboratory studies that employed chemical models for induction of artificial caries on human mid-coronal dentin were included. The selected studies were individually reviewed for potential bias according to predetermined criteria.

RESULTS

A total of 23 studies met the inclusion and exclusion criteria of this systematic review. From the included studies, 11 studies utilized pH-cycling model, 10 studies reported using simple demineralization model, while only one study reported an undetailed protocol. Moreover, combined 'chemical and biological' protocol for dentin demineralization was reported in two studies. According to the outcome of included studies, dentin mineral density, depth of lesions, crystalline structure, surface morphology, and surface microhardness were evaluated using a variety of laboratory methods offering, either qualitative, quantitative, or semi-quantitative analysis. The conclusions of the studies revealed confirmatory results regarding the use of multiple devices.

CONCLUSIONS

The pH-cycling model was found to be the most common type of chemical model used to induce dentin demineralization for 14 days immersion time, followed by a simple demineralization model through using an acetic acid solution. There was no single evaluation approach found to provide comprehensive information about the mineral content independently. Therefore, a combination of multiple techniques is recommended to yield sufficient and more accurate data.

Development of an artificial intelligence model for optimizing periodontal therapy decision-making: a retrospective longitudinal cohort study

OBJECTIVES

This study aims to develop and validate an artificial intelligence (AI) - driven model to assist periodontal therapy decision-making and minimize tooth loss.

METHODS

A retrospective longitudinal cohort study was conducted using clinical and radiographic data from 3,347 teeth treated and followed up for at least 10 years. The parameters included in the machine learning training and testing processes included: probing pocket depth (PPD), bone loss (BL), systemic diseases, therapy type, and others. Various machine learning models were developed and evaluated for accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC-ROC).

RESULTS

The Random Forest model demonstrated superior performance and was selected as the final predictive model achieving an AUC score of 0.91 and an accuracy of 0.93. Significant associations were found between tooth loss and variables such as age, PPD, bone loss, and furcation involvement.

CONCLUSION

This AI-driven platform may provide a reliable tool for stratifying periodontal therapy decisions and predicting tooth loss risk, offering clinicians a supportive approach to personalize treatment plans. However, the study's retrospective design and reliance on traditional clinical metrics highlight the need for future prospective studies.

CLINICAL SIGNIFICANCE

This study introduces and validates a novel AI-driven predictive model for periodontal therapy, utilizing data from treatment cases. Unlike previous models, this approach integrates multiple clinical and radiographic parameters, demonstrating high predictive accuracy (AUC=0.91, accuracy=0.93). The use of the Random Forest algorithm allows for robust predictions, offering an innovative, data-driven approach to periodontal treatment planning. Implementing AI in periodontal therapy decision-making may have the potential to improve patient outcomes by guiding clinicians toward optimal treatment strategies, enhancing therapeutic precision, and reducing the likelihood of unnecessary interventions.

Post-operative supplementation with vitamin D after mucogingival surgery significantly enhances autophagy and improves life quality following feline chronic gingivostomatitis

Oral mucositis is a complex inflammatory and ulcerative condition frequently associated with a heightened risk of infections, malnutrition and diminished quality of life in both humans and animals. Despite the availability of various preventive and therapeutic interventions, their overall efficacy remains unclear. Considering that vitamin D exhibits pronounced anti-inflammatory properties by modulating autophagic pathways via activation of the vitamin D receptor (VDR), the present study aims to determine whether supplementation with vitamin D after the mucogingival replacement surgery (MGRS) would effectively enhance autophagy, and therefore, protect the integrity of mucosal lining in cases of severe oral mucositis. Adult domestic cats suffered from feline chronic gingivostomatitis and undergoing MGRS were used in this study. After MGRS, experimental cats were orally administered either fat-soluble or water-soluble vitamin D at a dose of 200 ng/kg twice daily for 6 weeks. Quantitative analysis revealed that in cats with oral mucositis and received MGRS, post-operative supplementation of both types of vitamin D greatly improved the quality of life and increased the anti-inflammatory reactivity. Moreover, both types of vitamin D considerably enhanced the expression of VDR and light chain 3B (LC3B, a biochemical marker for autophagy) within the affected tissues, with the most notable change observed in cats that received fat-soluble vitamin D. Based on these findings, incorporating vitamin D into the post-operative care regimens may enhance the therapeutic efficacy of surgical interventions targeting severe mucosal injury. This strategy may also hold a novel promise for improving the overall management of oral mucositis and associated complications.

Mitochondrial dysfunction as a key player in aggravating periodontitis among diabetic patients: review of the current scope of knowledge

Periodontitis is a prevalent inflammatory disease that leads to significant periodontal tissue destruction and compromised dental health, with its severity exacerbated in individuals with Diabetes Mellitus (DM). This review explores the complex relationship between mitochondrial dysfunction and periodontitis in diabetic patients. Recent studies indicate that the excessive production of reactive oxygen species (ROS), primarily generated by dysfunctional mitochondrial electron transport chain (ETC) complexes, contributes to oxidative stress (OS) and subsequent periodontal tissue damage. The interplay between impaired mitochondrial biogenesis, apoptosis of periodontal cells, and ROS accumulation highlights a critical area of concern in understanding the pathophysiology of diabetic periodontitis. Furthermore, altered glycemic control due to inflammatory processes associated with periodontitis may perpetuate a cyclical detriment to oral and systemic health. This review aims to highlight the mechanistic roles of mitochondrial dysfunction in the aggravation of periodontitis among diabetic patients, emphasizing further research to identify potential therapeutic targets and improve treatment efficacy for this dual pathology.

An Open-Source, AI-Supported Teaching Tool in Orthodontic Education-Assessment of Acceptance and Effectiveness

This study aimed to evaluate the effectiveness and acceptance of an AI-supported teaching tool for cephalometric tracing in orthodontic education. Munich Cephalometric Application for Training (MCAT) was introduced to students from two consecutive semesters. Participants were given access to independently train on their own computers. Finally, they submitted the results of three manually traced radiographs. To evaluate the effectiveness, their measurements were compared with those of students from another semester who did not have access to the application. The acceptance was assessed using a questionnaire. Students who used MCAT demonstrated reduced variability in their tracings, with a lower interquartile range compared to the control group. Significant improvements were noted for specific cephalometric variables. The tool was positively received, with 86.5% of the participants perceiving greater learning outcomes for themselves when working with MCAT. MCAT effectively enhances cephalometric tracing skills and is well-accepted by students, supporting its integration into orthodontic curricula.

Advances in laser-assisted regenerative endodontic procedures: a scoping review

OBJECTIVES

This scoping review explores advancements in integrating laser technologies into regenerative endodontic procedures (REPs) and evaluates their potential benefits compared to conventional approaches.

DATA AND SOURCES

The review encompassed searches in electronic databases - Embase, Cochrane Library, PubMed, Scopus, and Web of Science (September 27th, 2024) - and grey literature from Google Scholar and ProQuest.

STUDY SELECTION

Out of 480 identified references, 14 studies met the inclusion criteria. Laser applications were categorized into photobiomodulation (PBM), photodynamic therapy (PDT), and other laser-assisted techniques, such as Er:YAG laser-assisted irrigation and diode laser dentin etching. PBM showed enhanced tissue regeneration through improved angiogenesis, cell proliferation, and the release of growth factors such as TGF-β1. PDT provided antimicrobial effects without compromising cell viability. Er:YAG laser-assisted irrigation demonstrated increased growth factor release but posed risks of irrigant extrusion. Additionally, diode laser dentin etching enhanced stem cell attachment, offering improvements to REPs.

CONCLUSIONS

With an expanding evidence base, laser technologies hold promise for becoming integral to REPs, enabling minimally invasive and effective treatments for necrotic and traumatized immature teeth. Nonetheless, the limited number of studies highlights the need for further research. Standardized clinical trials are crucial to establish long-term outcomes and address safety concerns.

CLINICAL SIGNIFICANCE

REPs offer a promising approach for treating immature necrotic teeth, and the use of lasers in endodontics has demonstrated advantages over traditional methods. This scoping review aimed to explore significant findings regarding the use of laser-assisted therapies in REPs.

The effect of different whitening mouthwashes and simulated tooth brushing on surface roughness and microhardness of nanohybrid resin composite: an in vitro study

BACKGROUND

This study investigated the effects of whitening mouthwashes containing active ingredients on a nanohybrid resin composite's surface roughness (Ra) and Vickers microhardness (VHN) under distinct brushing conditions.

METHODS

Fifty-four disc-shaped specimens (10 mm diameter × 2 mm thickness) were fabricated and randomly assigned to three experimental conditions (n = 18): distilled water (Control), Patent Blue V-containing mouthwash (Colgate Optic White, COW), and activated charcoal-containing mouthwash (Colgate Plax White + Charcoal, CPWC). Each group was subdivided into brushed and non-brushed subgroups (n = 9). Non-brushed specimens were immersed in 20 mL of the assigned solution at 37 °C for 6 h (T1) and 12 h (T2). Brushed specimens underwent 5 000 and 10 000 brushing cycles before immersion at T1 and T2, respectively. Surface roughness was measured using a contact profilometer, and microhardness was assessed with a Vickers hardness tester. Data were analyzed using three-way mixed ANOVA, one-way ANOVA, repeated measures ANOVA, and Bonferroni correction (α = 0.05).

RESULTS

Significant differences were observed in Ra values based on mouthwash type and brushing (p < 0.05), while VHN remained unaffected (p > 0.05). In non-brushed specimens, CPWC exhibited the highest Ra increase (31.2%, + 0.296 μm), significantly higher than Control (1.6%, + 0.015 μm, p = 0.001) and COW (5.9%, + 0.055 μm, p = 0.001). Under brushed conditions, CPWC again showed the most significant increase (33.3%,+ 0.311 μm,p = 0.012). Microhardness showed no statistically significant changes across time points or groups (p > 0.05). However, at T2, CPWC (non-brushed) presented the most significant reduction (- 3.38%, - 1.4 VHN), which was significantly lower than Control (+ 1.98%, + 0.8 VHN) and COW (+ 3.3%, + 1.3 VHN) (p = 0.001). A 5.33% increase (+ 2.1 VHN, p = 0.756) was observed in the brushed CPWC group.

CONCLUSIONS

Activated charcoal-containing whitening mouthwashes significantly increased surface roughness, particularly under brushing conditions, indicating a synergistic effect of chemical and mechanical wear. Microhardness values remained stable, suggesting the preservation of the internal structure. These findings highlight the need for cautious recommendation of charcoal-based mouthwashes for patients with resin restorations due to potential surface degradation risks.

Different treatment strategies for monozygotic twins with Class II division 1 malocclusion: 10-year follow-up study

BACKGROUND

Early-stage growth modification has been demonstrated effective in treating prepubertal patients with Class II division 1 malocclusion. Since monozygotic twins are genetically identical, environmental factors, including oral habits and treatment strategies, may contribute to different treatment outcomes. To date, few reported comparisons of different treatment strategies in monozygotic twins with Class II division 1 malocclusion exist.

CASE DESCRIPTION

In this case report, we compare the effects of different functional appliances and extraction strategies in a pair of prepubertal monozygotic twins. Different compliance and treatment protocols may have different effects on their early changes in facial profile. Customized treatment plans are necessary for optimal treatment outcomes. Both twins achieved favourable improvements in facial profile, and their long-term stability of functional occlusion was also maintained after a ten-year follow-up.

PRACTICAL IMPLICATIONS

With the outcome of the case, we acknowledged that functional appliance therapy can affect the potentiality of mandibular growth. Individualized protocols should be approached aside from different functional appliances.

Evaluating visual thresholds and color metrics in dental research: An exploratory study

OBJECTIVES

This study aimed to evaluate perceptibility (PT) and acceptability thresholds (AT) for multiple color measurement devices and assess the performance of three color difference equations (∆E*ab, ∆E00, and ∆E94) using a visual dataset from expert observers.

METHODS

A visual dataset previously published was extended by adding the x-rite MetaVue spectrophotometer and ∆E94 to the analysis. Visual scaling was performed on 26 sample pairs of teeth using magnitude estimation. Observers answered PT and AT questions to determine thresholds. Threshold estimation was conducted using a model-free method, and device performance was analyzed using the standardized residual sum of squares (STRESS) index and visual instrument agreement scale (VIAS).

RESULTS

The PT and AT thresholds varied across devices and color difference equations. For ∆E00, STRESS values ranged from 23 to 32 (mean 29, sd 2.9), with VIAS scores between 68 % and 77 % (mean 71 %, sd 2.9). ∆E94 showed higher STRESS values (24-42, mean 34, sd 5.5) and lower VIAS scores (58-76 %, mean 66 %, sd 5.5). ∆E*ab demonstrated excellent visual-instrumental agreement with STRESS values from 18 to 36 (mean 24, sd 5.9) and lower VIAS scores (82-64 %, mean 76 %, sd 5.9) outperforming ∆E94 and ∆E00. The x-rite MetaVue achieved excellent results under controlled conditions but it is unsuitable for clinical research due to its design.

SIGNIFICANCE

This study highlights the variability in PT and AT across devices, suggesting the need for device-specific thresholds. It also demonstrates the effectiveness of ∆E*ab in dental colorimetry compared to more complex color difference metrics.

Influence of Various Irrigation Protocols on the Push-Out Bond Strength of TotalFill and AH Plus Bioceramic Sealers to Root Dentin: A Comparative In Vitro Study

This study aimed to compare the push-out bond strength (POBS) of TotalFill (TFB) and AH Plus bioceramic (APB) sealers with different irrigation protocols.Sixty maxillary central incisors were prepared and randomly divided into three groups (n = 10) based on the final irrigation protocol. Group NC: 5.25% sodium hypochlorite (NaOCl); Group NE: 5.25% NaOCl and 17% EDTA; Group NH: 5.25% NaOCl and dual rinse HEDP (1-hydroxyethylidene-1,1-diphosphonic acid). Samples were obturated using either TFB or APB sealer only. In groups NC and NE, NaOCl was used during canal preparation, while in Group NH, NaOCl/HEDP was utilized. The teeth were then horizontally sectioned into three 3-mm thick sections at the apical, middle, and coronal levels. The POBS was performed on the root sections at a 1 mm/min speed. The failure mode was assessed using an optical microscope and a scanning electron microscope.Two-way ANOVA (analysis of variance) was used for statistical analysis to test the interaction between sealer type and irrigation solution, while an independent t-test was conducted to compare the means of the two sealer types at a significance level of 0.05.Specimens obturated with TFB showed significantly higher POBS than APB (p < 0.001). The highest bond strength was observed in the HEDP/TFB group and the lowest in the HEDP/APB group. Irrigation did not significantly influence the POBS (p > 0.05). Mixed failure was most commonly observed in all groups (>65%).TFB sealer had improved bond strength over APB sealer, regardless of the final irrigation protocol used, which did not significantly affect the bond strength.

Evaluation of the anti-inflammatory, antioxidant and regenerative effects of microbiota-derived postbiotics in human periodontal ligament mesenchymal stromal cells

OBJECTIVE

This study investigates the regenerative and protective effects of postbiotics (cell-free supernatant) derived from the Lactiplantibacillus plantarum EIR/IF-1 strain on human periodontal ligament mesenchymal stromal cells (hPDL-MSCs).

MATERIALS AND METHODS

hPDL-MSCs were isolated from periodontal ligament tissues (PDL) of wisdom teeth using enzymatic digestion and subsequently characterized through immunophenotyping. The effect of postbiotics on the viability of hPDL-MSCs was assessed using the MTT assay and flow cytometry, while their impact on cell migration was evaluated via the scratch assay. Anti-inflammatory effects of postbiotics were investigated on lipopolysaccharide (LPS, derived from Porphyromonas gingivalis)-stimulated hPDL-MSCs through Enzyme-Linked Immunosorbent Assay (ELISA). Additionally, the antioxidant effects of postbiotics were analyzed in hydrogen peroxide (H₂O₂)-induced hPDL-MSCs by measuring reactive oxygen species (ROS) levels using flow cytometry. The expression of collagen type I (COL1A1) gene was further assessed by quantitative reverse transcription PCR and immunofluorescence staining.

RESULTS

Treatment with postbiotics (250 µg/mL) significantly increased the viability and migration capability of hPDL-MSCs, while enhancing collagen production for PDL repair. Treatment with postbiotics for 24 h resulted in a 54.53 ± 2.01% reduction in intracellular ROS levels compared to untreated H2O2-induced hPDL-MSCs. Furthermore, postbiotics significantly decreased the production of pro-inflammatory cytokines (IL-8, IL-6, and IL-1β), and increased the anti-inflammatory cytokine IL-10 (2.67-fold) compared to untreated LPS-stimulated hPDL-MSCs.

CONCLUSION

Our findings indicate that postbiotics exhibit biological activity throughout all stages of the healing process, beginning with the modulation of the inflammatory response to LPS stimulation, followed by the promotion of cell migration, proliferation, and collagen synthesis. Given the unmet need for safe and adjuvant therapeutic approaches that promote comprehensive periodontal regeneration in periodontal diseases, this study presents postbiotics as a promising candidate.

CLINICAL RELEVANCE

Postbiotics could be integrated into regenerative therapies as a novel bioactive material to improve the healing and regenerative outcomes in periodontal defects by both controlling inflammation and stimulating tissue repair processes.

Low intensity pulsed ultrasound versus low-level laser therapy on peri-implant marginal bone preservation and soft tissue healing following dental implant surgery: a randomized controlled trial

BACKGROUND

Low-intensity pulsed ultrasound (LIPUS) and low-level laser therapy (LLLT) are proposed adjunctive therapies to enhance healing after dental implant surgery. However, direct comparisons of their effects on peri-implant marginal bone preservation and soft tissue healing remain limited. This randomized controlled trial aimed to compare the effectiveness of LIPUS and LLLT on peri-implant marginal bone preservation, soft tissue healing, pain levels, and oral health-related quality of life following dental implant placement.

METHODS

This single-blind, randomized controlled trial included 63 patients undergoing maxillary or mandibular implant placement, randomly allocated to LIPUS (n = 21), LLLT (n = 21), or control (n = 21) groups. LIPUS was applied twice weekly for 4 weeks, while LLLT was administered in 4 sessions over 2 weeks post-implant. Marginal bone loss (MBL) and OHRQoL (OHIP-14) were assessed at baseline, 6, and 12 weeks. Soft tissue healing (Landry Healing Index) and pain (VAS) were evaluated at baseline, 7-, 14-, 21-, and 30-days post-implant.

RESULTS

LIPUS significantly reduced marginal bone loss at 6 weeks and 3 months post-implant compared to LLLT and control groups (p < 0.05). LLLT demonstrated superior soft tissue healing at 7-, 14-, 21-, and 30-days post-implant (p < 0.05). Both interventions significantly decreased pain intensity and improved OHRQoL at various time points compared to the control group (p < 0.05).

CONCLUSIONS

LIPUS and LLLT significantly enhance peri-implant marginal bone preservation, soft tissue healing, pain management, and OHRQoL in dental implant patients compared to standard care. LIPUS was more effective for peri-implant marginal bone preservation, while LLLT excelled in soft tissue healing.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT05938868) on July 11, 2023.

Methods of evaluating mechanical properties of 3D printed occlusal device materials: Flexural strength, fracture toughness, and impact strength

STATEMENT OF PROBLEM

The best method of characterizing the strength of 3-dimensionally (3D) printed occlusal devices is unknown.

PURPOSE

The purpose of this in vitro study was to compare the flexural strength, flexural modulus, fracture toughness, and impact strength of flexible and stiff 3D printed occlusal device materials with those of milled and conventionally processed materials under wet and dry conditions.

MATERIAL AND METHODS

Specimens were fabricated from flexible (KeySplint Soft, NightGuard Flex 2) and stiff (KeySplint Hard, NightGuard Firm) 3D printed resins using a Digital Light Processing (DLP) printer and milled (ProArt CAD) and heat-polymerized (Excel Formula) materials. Specimen dimensions varied based on testing: flexural strength and flexural modulus (65×10×3.3 mm), toughness (4×8×39 mm, 3-mm cut with a 100- to 400-µm notch), and impact strength (63.5×12.7×4 mm, 1.2 mm, 45-degree notch). Specimens were stored wet (37 °C, 48 h) or dry (37 °C in water and then air dried for 24 h). Flexural strength and flexural modulus and fracture toughness were tested on a universal testing machine until fracture or 15-mm deflection, while impact strength was assessed with an Izod impact machine (7.5 J, 150 degrees). Data were analyzed using 2-way ANOVA and Tukey tests (α=.05).

RESULTS

Milled and heat-polymerized materials demonstrated higher flexural strength and flexural modulus than stiff 3D printed materials, which outperformed flexible 3D printed materials. Fracture toughness was better in milled and heat-polymerized materials under dry conditions, but one flexible 3D printed material outperformed all others under wet conditions. Flexible 3D printed materials exhibited significantly higher impact strength under both conditions.

CONCLUSIONS

Flexible 3D printed occlusal device materials excel in impact strength and show variable performance in other mechanical properties depending on material type and testing conditions.

Comparing the Accuracy of Conventional Gypsum and 3D-Printed Dental Casts Using Three-Dimensional Analysis

INTRODUCTION

Dental impressions and casts play a critical role in dental care, facilitating diagnoses and the fabrication of prostheses. Traditional methods of fabrication involve elastomeric materials that are more prone to errors and patient discomfort. Digital advancements offer promising alternatives, yet their accuracy and applicability to military dentistry remain under-explored. This study evaluates the accuracy of digital casts produced with material available in the Military Health System compared to conventional methods.

MATERIALS AND METHODS

Using a digital (n = 10) and analog (n = 10) methodology casts were fabricated from a reference cast (n = 1). The reference and cast samples were scanned with a reference scanner to generate stereolithography files. These files were used to generate full arch, single crown, fixed dental prosthesis, and inlay digital casts which were then compared using a three-dimensional (3D) comparison software to evaluate accuracy. Root mean square values were obtained, giving a quantitative evaluation of the deviation of each sample from the reference cast. Statistical analysis consisted of a Shapiro-Wilk and Levene test to account for homogeneity of variances in each group. An ANOVA and Tukey post-hoc test were used to determine differences in accuracy among the full arch and a two-way ANOVA and Tukey post-hoc test evaluated differences in trueness among the casts of the individual preparations.

RESULTS

Analog full arch casts had an average root mean square of 106 ±19.18 µm when examining trueness and 12 ±2.58 µm for precision. Digital full arch casts had an average root mean square of 51.9 ±5.39 µm when examining trueness and 4.2 ±1.57 µm for precision. Overall digital casts surpassed analog counterparts in accuracy. Fixed dental prostheses were found to be the only group, which showed no statistically significant difference between digital and analog.

CONCLUSION

These findings validate the potential of digital workflows in enhancing the speed and accuracy of dental care in the Military Health System, while underscoring the need for further exploration and refinement in specific clinical contexts.

The effect of contouring instruments on immediate quality and porosity of direct restorations

OBJECTIVE

The study aims to evaluate the effect of contouring instruments on the porosity and immediate quality of direct dental restorations.

MATERIALS AND METHODS

Fifteen human molars with 30 Class II and 10 Class V cavities were restored by five voluntary dentists using three contouring instruments (conventional steel, silicone-tipped and diamond-like carbon coated-instruments) and three filling materials (Admira Fusion, Filtek Supreme XTE and Fuji II LC). The restorations were evaluated for immediate quality, porosity and number of pores using stereomicroscope and micro-computed tomography. Statistical analysis included the Shapiro‒Wilk test for normality, one-way ANOVA with Holm‒Sidak post hoc test for normal data, Kruskal‒Wallis ANOVA and Dunn's test for non-normal data, and Fisher's exact test for restoration quality comparisons. Statistical significance level was set at p < 0.05.

RESULTS

The proportion of restorations with acceptable immediate quality was higher for the restorations that had been contoured using a diamond-coated non-stick contouring instrument compared to the restorations that had been contoured using a conventional steel instrument (p = 0.033). The number of pores and porosity were similar for restorations that had been contoured with different contouring instruments. However, the number of pores and porosity were lowest in the restorations made of Filtek Supreme XTE followed by Admira Fusion and Fuji II LC.

CONCLUSION

The use of diamond-like carbon-coated contouring instruments increased the proportion of acceptable composite restorations compared to conventional steel instruments.

CLINICAL RELEVANCE

Non-stick contouring instruments should be considered for wider use.

Digital Occlusion Tracking by T-Scan Novus System in Bruxism Patients Treated With 3D Printed Occlusal Splints

Background: Bruxism is a chronic pathological condition with significant clinical implications, necessitating meticulous monitoring for comprehensive treatment. The primary aim of this study was to conduct a digital measurement-based comparative analysis of occlusal alterations in occlusal splints over a 3-month period. Methods: This investigation involved 32 patients with natural dentition, fixed dental restorations, implant treatments, and a minimum of second molars. Intraoral scanning was executed using the 3DISK OVO imaging system. Digital models generated from these scans were employed to design occlusal splints using the 3Shape design software in conjunction with its splint studio module. The splints were subsequently fabricated using 3D printing technology and a biocompatible resin, Ortho Rigid (Nextdent). The assessment of occlusion was carried out using the T-Scan Novus system (Tekscan, 2018) and subjected to analysis with licensed software version 10.0.40 (T-Scan 10). Student's t-test for independent samples and a paired-sample t-test were used to detect the statistically significant difference in the distribution of occlusal force. Results: Initial digital occlusal measurements revealed statistically significant disparities in two specific regions between male and female subjects-the right first molar (t(31) = 2.04, p < 0.05) and left second molar (t(31) = 1.95, p < 0.05). Following a 3-month follow-up, significant differences in occlusal splint wear were discerned among male subjects (p < 0.01), whereas such differences were not observed among female subjects (p > 0.01). Conclusion: The digital design of occlusal splints facilitates the development of uniform contact areas across the entire occlusal surface. Nonetheless, the examination with T-Scan Novus unveiled that uniformity in contact area does not necessarily correspond to uniformity in force distribution.

Comparative analysis of antimicrobial activity and oxidative damage induced by laser ablation with indocyanine green versus aPDT with methylene blue and curcumin on E. coli biofilm in root canals

BACKGROUND

Laser ablation and Antimicrobial Photodynamic Therapy (aPDT) serve as adjunctive treatments to enhance microbial reduction in endodontic root canals. This in vitro study assessed laser ablation with Indocyanine Green (ICG) compared to aPDT using Methylene Blue (MB) and Curcumin (CUR) photosensitizers for reducing E. coli biofilms and inducing oxidative damage in root canals. Methods Standardized bovine upper incisor roots (n = 100) were contaminated with E. coli for 10 days to form biofilms. Groups included ICG 0.05% activated by infrared diode laser, CUR 0.05% activated by blue LED, MB 0.01% activated by red laser, sterile saline (NC), and 2.5% sodium hypochlorite (PC). Root canal samples were collected pre- and post-treatment, plated on BHI agar for CFU/mL counting. Oxidative damage was assessed using TBARS and carbonylated protein methods. Percentage reduction data underwent two-way ANOVA and Student-Newman-Keuls test, Kruskal-Wallis, and Dunn's tests for CFU reduction, and one-way ANOVA (p < 0.05) for oxidative damage. Results No statistical differences were found among groups for E. coli reduction. All groups had higher reduction than NC and lower reduction than PC (p < 0.05). ICG and CUR showed higher oxidative damage than MB and controls in protein carbonyl analyses. In TBARS analysis, ICG exhibited the greatest oxidative damage, statistically higher than other photosensitizers, negative, and positive controls. Conclusion There was no difference between laser ablation with ICG and aPDT with CUR and MB, which were less effective in bacterial reduction than NaOCl. However, ICG-induced higher oxidative damage in Gram-negative bacteria, suggesting its potential as an adjunctive therapy in root canal procedures.

Polydopamine-assisted dual metal ion modification of titanium: Enhancing osseointegration and antibacterial performance

Titanium (Ti) implants are widely used for tooth replacement due to their exceptional mechanical properties and high biocompatibility. However, their inherently inert surface limits osteogenic potential and makes them prone to bacterial colonization, increasing the risk of biofilm formation and implant-related infections. To address these limitations, surface modification of Ti is essential. This study aimed to enhance the surface properties of Ti by coating it with polydopamine (PDA) and further doping it with copper and calcium ions. TPDA was prepared and subsequently used to fabricate TPDA@Cu and TPDA@CuCa samples. Material characterization confirmed that TPDA@CuCa exhibited excellent surface wettability and biocompatibility, with Cu2 + and Ca2+ being continuously and stably released in liquid environments. Additionally, TPDA@CuCa significantly improved protein adsorption, facilitating favorable cellular interactions. In vitro experiments demonstrated that TPDA@CuCa exhibited strong antimicrobial activity against Escherichia coli and Staphylococcus aureus, enhanced osteoblast adhesion, mineralization, and upregulated osteogenic gene expression. This bifunctional surface modification strategy offers a promising approach to enhancing both the osteogenic and antibacterial properties of Ti implants.

Knowledge and Attitudes of Dental Students Towards Treatment of Pregnant Women: A Cross-Sectional Study

INTRODUCTION

The aim of this study is to address the barriers that pregnant women face when accessing oral health care, particularly due to the lack of confidence and knowledge among dental professionals. We focus on final-year Portuguese dental students, aiming to characterise their self-assessed knowledge and attitudes in providing care to pregnant women.

METHODS AND MATERIALS

Between March and April 2024, final-year dental students from all Portuguese dental faculties completed a 16-question web-based survey assessing their attitudes and knowledge regarding dental care for pregnant women.

RESULTS

Among 119 respondents, 98.3% emphasised the importance of dental check-ups during pregnancy, 79.8% were aware of periodontitis' adverse effects, and 75.6% identified the second trimester as optimal for dental visits. However, only 36.1% knew the correct position to prevent hypotension syndrome in the third trimester, and 37.8% were unsure about safe medications. Additionally, 92% supported integrating oral health education for pregnant women into the curriculum, with 95% believing it would increase their comfort in treating pregnant women.

CONCLUSION

The study reveals significant deficiencies in the knowledge and attitudes of Portuguese dental students regarding evidence-based dental care for pregnant women. This underscores the urgent need for improved dental education and training to ensure that these students are adequately prepared to provide care to pregnant women.

Determinants of post-stroke cognitive impairment in patients with periodontal disease

INTRODUCTION

Periodontal disease (PD) is a risk factor for stroke and cardiovascular disease. The effect of PD on post-stroke cognitive impairment (PSCI) remains underexplored.

METHODS

A cross-sectional analysis of the Periodontal tReatment to Eliminate Minority InEquality and Rural disparities in Stroke (PREMIERS) study participants was conducted. Baseline cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) within 90 days of the index event. MoCA score ≤21 indicated severe PSCI. White matter hyperintensity, indicating cerebral small vessel disease (cSVD), was evaluated using the Fazekas scale on MRI. Due to non-normal MoCA distribution, two analytical approaches were employed: 1) logistic regression using dichotomized MoCA scores based on clinically relevant cutoffs and 2) generalized linear mixed modeling after bootstrap normalization that examined MoCA scores continuously.

RESULTS

Among 280 participants with PD, 48% exhibited severe PSCI. Both analytical approaches demonstrated that severe PD, African American (AA) race, and greater stroke severity significantly and independently predicted severe PSCI, while advanced education was protective. Fazekas' scale showed no significant associations with PSCI.

CONCLUSIONS

This study identifies PD severity as a novel and independent contributor to early PSCI. Traditional predictors like AA race, educational attainment, and stroke severity remained significant.

CLINICAL TRIAL REGISTRATION INFORMATION

https://www.

CLINICALTRIALS

gov; Unique identifier: NCT02541032.

Impact of modifications on the characteristics of salivary pellicle on dental hard tissue: a scoping review

OBJECTIVES

The salivary pellicle regulates interfacial events on dental surfaces and is a promising target for modification to improve dental health. This scoping review systematically examines substances that modify the pellicle, evaluating their potential and identifying knowledge gaps.

DATA

This review followed the PRISMA-ScR guidelines. Studies investigating how substances applied during pellicle formation on enamel or dentin affect its structure, composition, or protective function were included.

SOURCES

A systematic search of Medline was conducted up to March 2024 using predefined terms. Only English-language research articles were included. No hand-searching was performed.

STUDY SELECTION

A total of 864 records were identified. After title and abstract screening, 110 articles were assessed in full, resulting in 85 eligible studies for data charting. These studies investigated human saliva-derived pellicles on enamel or dentin, comparing their composition, structure, or protective properties with and without modification. Most studies, conducted equally in vitro and in situ, focused on fluorides and metals (n = 28), peptides and proteins (n = 21), and polyphenols (n = 18), while other substances were less frequently examined (n = 17). Modifications affected the pellicle's ultrastructure, altered its proteome, or enhanced its protective role against erosion, abrasion, and bacterial adherence.

CONCLUSIONS

Despite numerous studies and distinct substance classes, findings remain inconclusive and must be interpreted within the context of individual study designs.

CLINICAL SIGNIFICANCE

Modifying the pellicle can improve its protective function, presenting a promising approach for preventive dentistry. However, the long-term effects of these substances within the dynamic oral environment remain unclear. This review underscores the need for further research to close existing knowledge gaps and confirm clinical relevance.

Assessment of the incisor angles as a function of golden proportion and lower facial height

Mathematical models to determine diverse parameters in biological systems have been a challenging and interesting topic for the scientific community. This work aimed to determine the angles of the lower and upper incisor teeth as a function of the angle of the lower facial height and the golden proportion. The cephalometric parameters reported by Ricketts like the lower facial height angle, the axis of the mandibular body (Xi-Pm), the line that forms the mandibular geometric center with the anterior nasal spine (Xi-ENA), the occlusal plane, the dental line, and the upper and lower incisors lines and some cephalometric constraints were used to determine the proposed models.The analysis of several values for the lower facial height in the Ricketts range showed that both the model for the upper incisor (A) and lower incisor (B) provide functional values for these angles, which are within the statistical range reported by Ricketts with a maximum mean deviation of 1.58° and a maximum percentage difference of up to 10.40%. Outside of the Ricketts range, a maximum mean deviation of 5.15° and a maximum difference of up to 49.72% was found regarding the mean values. As a first approximation, the proposed models let us determine and personalize the target angle for orthodontic treatment of the upper and lower incisors based on the lower facial height of each patient and the golden proportion. These models can be a starting point for further research in this area, considering other parameters to be added to the proposed models.

Effect of Whitening dentifrice on discoloration of tooth surface: an updated systematic review and meta-analysis

Tooth discoloration is a common cosmetic concern, often addressed using whitening dentifrices (WDFs). This updated systematic review and meta-analysis aimed to assess the effectiveness of WDFs in decreasing tooth surface discoloration compared to regular dentifrices (RDFs). A comprehensive search of multiple electronic databases identified 14 randomized controlled trials (RCTs) meeting the inclusion criteria. The meta-analysis showed that WDFs significantly reduced both the area and intensity of stains, with 94.45% and 77.78% efficacy, respectively. Studies incorporating adjunctive chemical agents in WDFs showed enhanced stain reduction. Despite significant heterogeneity (I2 = 91%) among the studies, the results consistently favored WDFs over RDFs. Low publication bias was detected, and sensitivity analyses confirmed the robustness of the findings. These results endorse the utilization of WDFs for managing extrinsic tooth stains, though further research is needed to standardize methodologies and assess long-term effects.

Ex-Gaussian vector metric and similarity index applied to reaction time analysis

In psychology and cognitive neuroscience, reaction time (RT) series and their ex-Gaussian distributions are commonly used as scalar quantities to explore the time course of attentional processes. However, we propose that such attentional processes can also be analyzed using an "ex-Gaussian vector", defined by successive triads of ex-Gaussian sigma, tau, and mu parameters from RT series. This geometrical object may help characterize interindividual differences between congruent and incongruent stimuli in the attentional Stroop task within a group of participants. To test these hypotheses, we calculated the similarity index of these geometrical objects in young adults without detectable neurological disorders. Our findings show that during two weeks of continuous Stroop task application, each participant displayed distinct ex-Gaussian RT vectors in a Cartesian 3D plot. Furthermore, our study found that the similarity index between ex-Gaussian RT vectors was significantly higher for incongruent stimuli than for congruent stimuli.

Supportive periodontal care during active orthodontic therapy in patients with history of stage IV periodontitis: A narrative review

The present narrative review aims to summarize the existing literature on recommendations for supportive periodontal care (SPC) in patients undergoing combined periodontal-orthodontic treatment. It outlines a comprehensive step-4 treatment sequence in patients diagnosed with stage IV periodontitis and concurrent orthodontic problems. The delivery of SPC characterizes step 4 of the comprehensive treatment sequence, focusing on the prevention of bacterial re-infection and the recurrence of the disease. Step 4 includes repeated assessments of residual probing pocket depths (PPD) greater than 5 mm, bleeding on probing (BoP) and/or suppuration around teeth and implants, as well as evaluation of furcation involvement. Extensive evidence indicates the efficacy of rigorous self-performed plaque control and adherence to regular SPC following active periodontal therapy as vital for managing caries and periodontitis, thereby reducing possible tooth loss. Current evidence indicates that patients with stage IV periodontal disease can safely proceed with orthodontic treatment following active periodontal therapy. Nonetheless, it is the authors' recommendation for patients undergoing periodontal-orthodontic treatment to participate in an SPC program scheduled every 3-4 months.

Breaking the silence: confidence and barriers in raising concerns among undergraduate dental students- "a national study"

BACKGROUND

Raising concerns in clinical settings, also known as whistleblowing, is vital for safeguarding patient safety and improving the quality of care. Despite research on whistleblowing in medical and nursing fields, there is limited evidence on this topic within dental education. This study aims to assess the self-reported confidence of undergraduate dental students in raising concerns and identify any barriers.

METHODS

This cross-sectional study utilized an online close-ended questionnaire distributed via Google Forms to senior undergraduate dental students from Jordan University of Science and Technology and the University of Jordan, Jordan. Data collection was voluntary, with subsequent analysis performed using RStudio (version 2023.06.2) incorporating R version 4.0.5. T-tests and Analysis of Variance (ANOVA) were used to assess significant variations between results by gender and stage of study.

RESULTS

A total of 382 participants were included in the study yielding a response rate of 30.80%. Of these, 257 were female (67.28%) and 125 were male (32.72%). Overall, 169 (44.24%) participants reported that their institutions had a policy document on raising concerns, while only 71 (18.58%) participants reported receiving formal training in raising concerns at their institution. Approximately 45% of participants reported experiencing situations which warranted raising concerns in clinical settings. The overall mean score for all items was 0.13 (95% CI -0.18 to 0.43). The findings revealed that students were marginally confident in raising concerns related to patient safety. However, their confidence was lower when addressing issues related to the conduct of clinical staff or peers. Common barriers reported included fear of causing trouble, lack of support, and fear of being ignored. ANOVA revealed significant variation by gender and year of study, with female students and final-year students reporting greater self-confidence in raising concerns (p < 0.001).

CONCLUSIONS

Notwithstanding the limitations of the current study, the results show that participants were marginally confident in raising concerns related to patient safety and several barriers to raising concerns were also identified. These findings underscore the need for dental schools to focus on enhancing students' confidence and empowering them to report concerns when warranted. A transparent and supportive culture can contribute to improvements in patient safety and enhancing professionalism of dental students.

Use of a Modified Gradual Release of Responsibility Pedagogy in Student Preparation for an Objective Structured Clinical Examination

PURPOSE

Dental education, especially in pediatric dentistry, faces varied challenges in the pursuit of preparing competent and confident oral health professionals. The authors introduced a modified gradual release of responsibility (GRR) pedagogy designed to balance traditional instruction and active learning strategies. This study assessed the effect of the pedagogy on first-time pass rates of a pediatric dentistry specific Objective Structured Clinical Examination (OSCE) and student's self-efficacy with the course content.

METHODS

Three online modules were created using a modified GRR framework. These modules addressed three critical topics that historically had higher failure rates on the OSCE, namely: local anesthesia maximum dosage calculation, pulpal diagnosis and treatment planning in primary teeth, and management of time-sensitive dental trauma. First-time pass rates and overall exam performance were compared to five-year historical data as the control with the chi-square test of independence. Participants also completed a ten-item, pre- and post-module completion five-point Likert scale questionnaire assessing student self-efficacy, and the results were compared using a Wilcoxon matched-pairs signed-rank test.

RESULTS

First-time pass rates for the test group (n = 228) were significantly improved compared to historical controls (n = 546) for pulpal diagnosis (p = 0.002), dental trauma management (p = 0.002), and overall OSCE performance (p = 0.003). First-time pass rates for local anesthesia calculation were not significantly different (p = 0.09). Student self-efficacy significantly improved for all ten items (p < 0.001).

CONCLUSIONS

Using the GRR pedagogy improved student pass-rates on an OSCE; as well as increased student self-efficacy with the course material. This pedagogy holds promise in developing engaged learners across dental education settings.

Effectiveness and Adherence of Pharmacological vs. Non-Pharmacological Technology-Supported Smoking Cessation Interventions: An Umbrella Review

Background: Smoking cessation has a crucial public health role. To overcome non-technological and technology-based smoking cessation intervention limitations, technology-supported programs were developed. Objectives: The present umbrella review aimed to evaluate the long-term effectiveness (≥6 months) of pharmacological vs. non-pharmacological technology-supported smoking cessation interventions on adult daily smokers and the related human health benefits. Methods: Following PRISMA guidelines, the protocol was registered on PROSPERO (CRD42024601824). Fifty systematic reviews were included, evaluated through AMSTAR-2, and qualitatively synthesized. Results: A total of 69,269 smokers underwent pharmacological (39,367) and non-pharmacological (29,902) technology-supported interventions. The biochemically-verified effectiveness assessed as continuous abstinence rates (CARs) and seven-day point prevalence abstinence (PPA) of pharmacological vs. non-pharmacological at 6 and 12 months were, respectively, CARs 9.06% vs. 14.85%, 7-day PPA 17.37% vs. 17.15%; CARs 8.51% vs. 9.08%, 7-day PPA 14.00% vs. 5.63%. The 6-month adherence rates were higher in the non-pharmacological group (41.37% vs. 83.43%). Conclusions: Non-pharmacological technology-supported interventions showed similar effectiveness and higher adherence at 6 months. At 12 months, the CARs were similar despite lower adherence. Adherence quality and consistency may be important for sustained success, probably due to the "reverse causality". Non-pharmacological interventions showed similar effectiveness, lower costs, and shorter durations than pharmacological interventions.

Impact of the in-office bleaching gels pH on tooth sensitivity in combined bleaching techniques: a randomized clinical trial

OBJECTIVES

This randomized, parallel, single-blind clinical trial evaluated tooth sensitivity (TS), efficacy, gingival irritation (GI), aesthetic self-perception, and psychosocial impact of combined bleaching using in-office bleaching agents with different pHs.

MATERIALS AND METHODS

160 participants were randomized into two groups (n = 80) with 35% hydrogen peroxide in-office bleaching gels: Whiteness HP Maxx (acidic, unstable pH) and Whiteness HP Automixx Plus (neutral, stable pH). In-office bleaching was performed in one session: HP Maxx (3 applications of 15 min) and HP Automixx Plus (1 application of 50 min). Both groups then received at-home bleaching with 10% carbamide peroxide for 4 h daily for two weeks. TS and GI were assessed using Visual Analogue Scales. Color change was measured with a spectrophotometer and color guides. Aesthetic self-perception and psychosocial impact were evaluated using three scales: Orofacial Aesthetics Scale, Oral Health Impact Profile, and Psychosocial Impact Questionnaire of Dental Aesthetics.

RESULTS

The risk and intensity of TS significantly favored the neutral and stable pH gel for both in-office (p < 0.001) and combined treatments (p < 0.004). Both groups achieved significant whitening (p > 0.37). No difference in GI risk or intensity was found (p > 0.11). All aesthetic and psychosocial scales showed significant improvement post-treatment (p < 0.05).

CONCLUSION

Using a gel with neutral and stable pH during in-office bleaching reduces the risk and intensity of TS without compromising whitening efficacy.

CLINICAL RELEVANCE

Combining at-home and in-office bleaching with a neutral, stable gel reduces TS risk and intensity while ensuring optimal whitening results and patient comfort.

The Use of Hyaluronic Acid in the Non-Surgical Treatment of Periodontitis-An Umbrella Review

Background: Periodontitis is a prevalent inflammatory condition that destroys periodontal tissues. Scaling and root planing (SRP) is the gold standard for non-surgical treatment; however, its efficacy may be limited in cases with complex dental issues. This umbrella review aims to evaluate the effectiveness of hyaluronic acid (HA) as an adjunct to scaling and root planing (SRP) in enhancing clinical outcomes for periodontitis management. Methods: A comprehensive review of five systematic reviews, including meta-analyses where available, was conducted to synthesize evidence on the adjunctive use of HA with SRP. The studies were evaluated using the AMSTAR-2 quality assessment tool to determine methodological rigor. Data on clinical parameters such as probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were extracted and analyzed. Results: The findings indicate that HA supplementation leads to moderate improvements in PD, CAL, BOP, GI, and PI compared to SRP alone. Notable reductions in PD and gains in CAL were observed, with some meta-analyses showing statistically significant benefits. However, the heterogeneity in HA concentrations (0.2-1.4%), application methods, treatment frequencies, and follow-up durations (1 week to 12 months) limits definitive conclusions. Additionally, HA did not significantly affect the reduction in P. gingivalis prevalence. Conclusions: The use of HA in conjunction with SRP shows promise in enhancing the efficacy of non-surgical periodontal therapy. However, the heterogeneity in the quality and methodologies of the studies indicates the necessity for high-quality, standardized randomized controlled trials to establish clear clinical guidelines for the application of HA in the treatment of periodontitis.