Management of alveolar osteitis: new regenerative techniques in patients with type 2 diabetes

OBJECTIVES

Evaluation of the effectiveness Gengigel® Oral Gel (hyaluronic acid ) and photobiomodulation (magnetic laser) in the treatment of alveolar osteitis in patients with type 2 diabetes mellitus.

METHODS

This is a blind RCT study clinical prospective study in 69 patients with type 2 diabetes mellitus with alveolar osteitis. The subjects selected for study were examined under the inclusion and exclusion criteria and sign the written consent. The patients were blind randomly assigned into two groups: The Group I included 35 patients with alveolar osteitis, in which complex treatment including HA and magnetic laser therapy was carried out. The Group II is represented by 34 patients, with alveolar osteitis received treatment including antiseptic and inflammatory agents. Healing time and pain levels of the alveolar socket of the extracted tooth were appreciated. The pain levels in dynamics were assessed according to VAS.

RESULTS

After the 5th treatment session, 91% of patients in the 1st group had a VAS score of 0 (no pain), whereas in 9% of patients, the VAS score was 1-3. In group 2, a similar result of the VAS score was recorded but only on the 8th day of treatment.

CONCLUSION

The results show that the use of Gengigel® Oral Gel (hyaluronic acid ) and photobiomodulation(magnetic laser) recommended for the treatment of dry socket in patients with type 2 diabetes mellitus, can be considered as a promising method, as it has not only anti-inflammatory but also pronounced analgesic and tissue regenerating properties.

CLINICAL TRIAL NUMBER

Not applicable.

Comparison of the effect of the pulsed Er: YAG laser and topical corticosteroid on erosive oral lichen planus: a randomized clinical controlled trial

The formation mechanism of OLP is very complicated, and its treatment has always been a difficult problem. This study was to explore the feasibility of pulsed Er: YAG laser in the treatment of erosive OLP by comparing its effect with that of Triamcinolone Acetonide ointment(TA) of OLP, in order to provide new ideas for the clinical treatment of erosive OLP. Forty patients who were clinically and histopathologically diagnosed as OLP at the Department of Periodontics and Oral Mucosa Disease of Dalian Stomatological Hospital were selected, all lesions accompanied by erosion. The included patients were randomly divided into two groups: Er: YAG group and TA group, with 20 cases in each group. The visual analogue scale (VAS), mean lesion area, clinical sign score, and function score in both groups were evaluated at baseline, 1 week, 2 weeks, 1 month and 3 months after treatment, and the recurrence rate of cured patients in both groups was evaluated at 3 months after treatment. Er: YAG laser was superior to TA in relieving pain at 1 week(1.50 ± 0.946 vs. 2.10 ± 0.912, P < 0.05) and improving function at all stages(P < 0.05). But TA was superior to the pulsed Er: YAG laser in promoting the healing of erosive lesions at 2 weeks(0.07 ± 0.223 vs. 0.31 ± 0.549, P < 0.05). There was no significant difference in recurrence between the two groups(P > 0.05). There is no significant difference between pulsed Er: YAG laser and TA in the treatment of erosive OLP. The use of pulsed Er: YAG laser represents a viable and effective therapeutic option for erosive OLP.

Global burden of periodontal diseases among the working-age population from 1990-2021: results from the Global Burden of Disease Study 2021

BACKGROUND

Periodontal diseases among working-age individuals (15-69 years) represent a significant global health challenge, impacting oral health, quality of life, and economic productivity. Defined according to the 2021 Global Burden of Disease (GBD) framework, periodontal disease in this study encompasses symptoms such as halitosis, altered taste sensation, and occasional gingival bleeding that do not impair daily activities. Despite their prevalence, comprehensive analyses of the global burden of periodontal diseases specifically within this demographic remain limited.

METHODS

We analyzed data from the GBD 2021 study, examining periodontal disease burden among individuals aged 15-69 years across 204 countries and territories from 1990 to 2021. Age-standardized rates of prevalence, incidence, and disability-adjusted life years (DALYs) were calculated. We employed joinpoint regression analysis to assess temporal trends, decomposition analysis to examine contributing factors, and frontier analysis to evaluate the relationship between disease burden and sociodemographic development.

FINDINGS

In 2021, global periodontal disease cases reached 951.3 million (95% UI: 729.0-1,183.3 million), with an age-standardized prevalence rate (ASPR: 17,011.6 per 100,000 persons) and 80.3 million new cases (ASIR: 1,464.7 per 100,000). The burden accounted for 6.2 million DALYs globally (age-standardized DALY rate: 110.8 per 100,000). Asia demonstrated the highest age-standardized rates across all metrics, while Low-middle SDI regions showed the highest ASPR (20,920.5 per 100,000) and ASIR (1,627.9 per 100,000). At the national level, Sierra Leone, Gambia, and Cabo Verde had the highest disease burden. Males consistently showed higher prevalence rates than females, with peak rates observed in the 50-59 age group. Joinpoint regression analysis revealed an overall increasing trend from 1990 to 2021 (AAPC: 0.04, 95% UI: 0.01-0.06), with notable variations across different time periods. While some countries like Qatar, UAE, and Jordan experienced over 500% increase in prevalence since 1990, Pacific island nations like Tonga and Tokelau achieved reductions exceeding 70%. Decomposition analysis identified population growth (74.56%) and aging (23.00%) as primary drivers of increased disease burden.

INTERPRETATION

Our analysis reveals significant global disparities in periodontal disease burden among the working-age population, with concerning increases in many regions from 1990 to 2021. The disproportionate burden in Low-middle SDI regions and South Asia, coupled with the substantial impact of population growth and aging, highlights the urgent need for targeted interventions. While some countries have achieved remarkable reductions in disease burden, the dramatic increases in others underscore the importance of strengthening preventive oral healthcare systems and addressing socioeconomic determinants. These findings emphasize the need for country-specific strategies, particularly in regions with rising burden, and can inform evidence-based policy making to reduce the impact of periodontal diseases on the global workforce.

Exploring the impact of orthodontic appliances on the oral microbiome and inflammatory parameters

BACKGROUND

The symbiotic relationship between the oral microbiome and the host immune system is a prerequisite of oral health. Disruptions to this system can be associated with the development of diseases like dental caries. Introducing orthodontic treatments, such as aligners and fixed appliances, might impact this microbial ecosystem. This study evaluated potential changes in salivary microbiome and the level of inflammatory marker myeloid-related protein 8/14 in patients undergoing orthodontic treatment with aligners or fixed appliances.

METHODS

Forty-eight patients were divided into two groups for treatment with fixed appliances or clear aligners. Unstimulated saliva samples were collected at baseline, three, and six months for microbiome analysis via 16 S rRNA sequencing and MRP-8/14 level measurement using ELISA.

RESULTS

Among 503 identified microbial species, no significant changes were noted in overall microbiome. A considerable increase of caries-relevant species could not be observed either. MRP-8/14 levels remained unchanged across treatments, indicating no alterations in the inflammatory level.

CONCLUSION

Orthodontic treatment with fixed or removable appliances does not significantly alter the salivary microbiome or influence inflammation, suggesting that these interventions are unlikely to affect oral health negatively.

Loading Pressure Induced by 4 mm Implants on the Inferior Alveolar Nerve: A 3D Finite Element Analysis Model

Background/Objectives: One of the most serious complications following implant placement in the atrophic posterior mandible is injury to the inferior alveolar nerve (IAN), which can also happen during occlusal loading of the implants. This study investigates the effects of 4 mm implant stress transmission to the inferior alveolar nerve during occlusal loading in cases of severe posterior mandibular atrophy. Methods: The computer-aided design (CAD) model was created and modified through Direct Modeling techniques. The structure of cortical and trabecular bones was simplified, and it was modeled as a cylinder block. Finite element analysis (FEA) was carried out in 3D to investigate the pressure distribution over the IAN at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm), and stress and strain deformations were simulated in the mandibular model. Results: The results of the pressure analysis on the inferior alveolar nerve indicate that the pressure distribution at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm) is consistently below 0.026 MPa, which corresponds to the maximum pressure range that may block nerve impulses. This occurs even at the theoretical and simulated distance of 0.1 mm, suggesting that cortical bone stiffness plays a crucial role in mitigating stress at reduced implant-to-nerve proximities. Conclusions: Within the limits of this study, ultra-short implants can be placed even less than 0.5 mm (up to 0.1 mm under the 3D-FEA hypothesis) above the inferior alveolar nerve under the 3D-FEA hypothesis, while maintaining pressure below the threshold value. This is due to the rigidity of the cortical bone, which helps to reduce pressure transmission to the nerve. These findings may expand the indications for ultra-short implants, even in mandibles with a residual bone height of just 4 mm.

Minimally Invasive Access Cavities: A Benefit/Risk Analysis

Background/Objectives: Contemporary dentistry aims to preserve healthy tissues and perform minimally invasive procedures. The availability of ever-improving equipment allows practitioners to follow this conceptual innovation. This approach is also used in endodontics, as new types of access cavities seem to be gaining popularity, allegedly reducing tissue destruction and loss of mechanical resistance of the treated teeth. Methods: We performed a comprehensive review of the available literature on the subject, focusing on in vitro studies accessible through major search engines and limiting the search to English-language articles published between 2010 and 2024. Results: Our analysis showed that the realization of reduced access cavities seems to preserve the mechanical resistance of the treated teeth, may compromise disinfection, and respects the original root canal path and the quality of obturation. In addition, these procedures appear to increase instrument deformation, fracture susceptibility, and treatment time: Mini-invasive cavities have many limitations and should only be used in situations where there is a high likelihood of success, where there are few difficulties and where sufficient material is available. However, with appropriate case selection, these new approaches can be used and should improve the prognosis of endodontically treated teeth.

Developing and validating key performance indicators for breast, cervical, and colorectal cancer screening programs: a literature review and Delphi survey

Introduction

Early detection of cancer significantly impacts disease management and contributes to a reduction in cancer mortality rates. This study aims to identify, extract, systematize, and validate a set of indicators for breast, cervical, and colorectal cancer screening programs that are applicable and easily understood within any healthcare system.

Methods

This study is conducted in two phases: a literature review and an expert panel evaluation. In the first phase, electronic databases-PubMed, Web of Science, and Scopus-were searched for articles published from January 2000 to November 2023. Two reviewers critically appraised the articles based on predefined inclusion and exclusion criteria. Indicators were extracted from the selected articles through content analysis. In the second phase, the extracted indicators were reviewed by ten experts. Consensus on the indicators was achieved through two consecutive rounds of review.

Results

The final list comprises 30 indicators categorized into three dimensions: two for input, sixteen for process, and twelve for outcome. The overall content validity index (CVI) and content validity ratio (CVR) determined using the expert panel agreement approach, were high (≥ 0.9). The input dimension includes two indicators: Adequacy and Availability of Human Resources, and Percentage of Health Centers Providing Cancer Screening Services. The process dimension comprises 16 indicators, including Timely Diagnostic Evaluation of Abnormal Screenings, Rescreening, Recall Rate, Percentage of Smears per 1,000 Women Aged 20-29 per Year, Public Education, Data Availability, Referral Rates (to GP and Surgeon), Drop Rate During Referral, Biopsy Rate, Diagnostic and Therapeutic Endoscopy Rate, Proportion of Colonoscopies, Total and Partial Mastectomy Rates, Tumor Diameter, and Tumor Grading. Finally, the outcome dimension features 12 indicators: Screening Coverage, All-Cause Mortality Rate, Cause-Specific Mortality Rate, Invasive Cancer Detection Rate, Interval Cancer Rate, Ductal Carcinoma in Situ (DCIS) Rate, Cancer Detection Rate, Polyp Detection Rate, Fecal Occult Blood Test (FOBt) Positivity Rate, Adenoma Detection Rate, Positive Predictive Value for Cancer Detection (PPV), and Episode Sensitivity.

Conclusion

This study identified a robust set of 30 key performance indicators (KPIs) for breast, cervical, and colorectal cancer screening programs, with a high overall content validity index demonstrating strong expert consensus on their relevance and importance.

A Systematic Review on Immediate Implant Placement in Intact Versus Non-Intact Alveolar Sockets

Objectives: The primary objective of this systematic review was to compare IIP in intact versus non-intact sockets in terms of buccal bone thickness. Methods: Two independent reviewers carried out an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2024. Randomized controlled trials (RCTs), cohort studies, and case series on intact and/or non-intact sockets were included for analysis. The primary outcome was buccal bone thickness (BBT). Secondary outcomes were vertical midfacial soft tissue level change, pink esthetic score (PES), implant survival and complications. This systematic review was conducted in accordance with the PRISMA guidelines. Results: After screening 1001 unique titles and conducting manual searches, 20 articles reporting on 525 implants (intact: 265; non-intact: 260) in the anterior maxilla with a follow-up of up to 120 months were selected. The overall study quality was low, especially for non-intact sockets since only two RCTs could be found, and none demonstrated a low risk of bias. Meta-analyses were not feasible due to a lack of direct comparisons, and heterogeneity in terms of surgical approach, soft tissue handling, and restorative approach. BBT ranged between 1.10 and 3.18 mm (intact) and 1.18 and 3 mm (non-intact). Vertical midfacial soft tissue level change ranged between -0.13 and -0.58 mm (intact) and -0.03 and -0.59 mm (non-intact). Pink esthetic scores ranged between 10.48 and 12.80 (intact) and 9.25 and 12.43 (non-intact). Implant survival exceeded 90% in all studies and was 100% in the vast majority of the studies. Conclusions: This systematic review suggests a similar outcome of IIP in intact and non-intact sockets. However, the overall low study quality, a lack of direct comparisons, and heterogeneity rendered the comparison highly biased. Future studies should be conducted to establish an evidence-based treatment approach for IIP in non-intact sockets.

Dysregulation of the Immune System in Advanced Periimplantitis: Systemic Implications and Inflammatory Mechanisms-A Hematological and Immunological Study

Objectives: This study aimed to assess the systemic and local inflammatory responses in patients with periimplantitis, focusing on key immune markers and clinical parameters. The study further explores the relationship between inflammatory markers, clinical indices, and immune dysregulation, particularly regarding T-cell exhaustion and systemic inflammation. Methods: A cohort of patients with periimplantitis, classified into moderate and advanced stages, was compared to a control group of healthy individuals with dental implants. Clinical parameters, including plaque index (API), bleeding on probing (BoP), probing pocket depth (PPD), and peri-implant sulcus depth (PSI), were recorded. Hematological, immunological, and biochemical analyses were performed, with a focus on immune cell populations (NK cells, T-cells, and their exhaustion markers PD-1 and PD-L1). Results: Patients with periimplantitis exhibited significantly higher clinical indices (API, BoP, PSI, and PPD) than the control group, with the most pronounced differences in the advanced periimplantitis group. Hematological analysis revealed increased leukocyte and neutrophil counts, whereas NK cell levels were significantly reduced. Immunological profiling indicated elevated PD-1 and PD-L1 expression on T-cells, suggesting T-cell exhaustion and immune dysregulation. Furthermore, strong correlations were found between increased PPD values and elevated inflammatory marker levels, highlighting the relationship between peri-implant pocket depth and systemic inflammation. Conclusions: The findings confirm that immune dysregulation plays a central role in periimplantitis progression. The association between increased inflammatory markers, immune alterations, and clinical indices emphasizes the need for a multifactorial diagnostic and treatment approach. Integrating immune modulation strategies, clinical assessments, and lifestyle modifications, such as improved oral hygiene and smoking cessation, could improve disease management and reduce recurrence.

Mechanism of Tumor Budding in Patient-Derived Metachronous Oral Primary Squamous Cell Carcinoma Cell Lines

Tumor budding (TB) occurs at the deepest site of tumor invasion and is a significant prognostic indicator of cervical metastasis in oral squamous cell carcinoma (OSCC). The mechanism of TB, however, remains unclear. This study investigated the roles of the tumor microenvironment and partial epithelial-mesenchymal transition (p-EMT) in TB expression using molecular and cellular physiological analyses. We established oral metachronous carcinoma cell lines (gingival carcinoma: 020, tongue carcinoma with high TB expression: 020G) from two cancers with pathologically different TB in the same patient and subjected them to exome analysis to detect gene mutations related to carcinogenesis and malignancy. Differences in EMT expression induced by transforming growth factor-β (TGF-β) between 020 and 020G were analyzed by Western blotting and reverse transcription polymerase chain reaction, and TGF-β-induced changes in cell morphology, proliferation, migration, and invasive ability were also examined. TGF-β expression was observed in the deepest tumor invasion microenvironment. TGF-β also induced the expression of several p-EMT markers and increased the migration and invasive abilities of 020G compared with 020 cells. In conclusion, TGF-β in the deep-tumor microenvironment can induce p-EMT in tumor cells, expressed as TB.

Italian Consensus on the treatment of oral lichen planus

Oral lichen planus (OLP) is a chronic inflammatory condition of uncertain etiology affecting oral mucosae by T-cell mediated chronic inflammation. It affects between 1% and 3% of the global population, predominantly middle-aged adults (50-60 years), with a higher incidence in women. The immune response is thought to target keratinocytes, leading to cell death, particularly through CD8+ T lymphocytes. OLP manifests in various clinical forms, such as reticular, papular, erosive, and atrophic, with the reticular subtype being the most common. Erosive OLP is the most severe, characterized by widespread oral erosions, while atrophic OLP often follows erosive stages, affecting the tongue with a depapillated surface. Currently, no curative treatment exists for OLP, and the management focuses on symptom relief, including reducing pain and discomfort. Thus, a multidisciplinary approach involving dermatologists, oral surgeons, and dentists is often required. For this reason, the scientific community represented in Italy by the Mucosal Diseases Study Group of SIDeMaST (Italian Society of Dermatology and Venereology) reports its experience in the management of OLP, providing clinical recommendations for dermatologists based on the latest scientific evidence to optimize the treatment and management of OLP.

Dentists' Mental Health: Challenges, Supports, and Promising Practices

OBJECTIVES

The mental health of dentists, like all health professionals, is a growing concern. The objectives of this study were to identify the mental health challenges experienced by Canadian dentists and to describe the support needs and promising practices to better support them.

METHODS

This study used a mixed-methods case study design to gather data from semistructured qualitative interviews and a survey for triangulation.

RESULTS

Thirty-six dentists and 17 stakeholders participated in the interviews, and 397 dentists participated in the survey. The interview and survey data revealed that dentists have experienced several challenges personally, professionally, and socially. Around 44% of participating dentists experienced a wide range of mental health issues, including depression, anxiety, and posttraumatic stress disorder. Sex/gender shaped the mental health experiences of female dentists, who reported more stress related to caring responsibilities. They had a higher percentage of mental health issues (50%) than men (37%). Caretaking emerged as the main challenge in the social and personal domain, particularly for female dentists in both survey and interview findings. The dentists' role in practice was one of the most frequently reported professional challenges. While practice owners reported challenges with staff and practice management, associate dentists experienced difficulties with the lack of autonomy and conflicts with office managers and owners. Other challenges reported by participating dentists included patient care responsibilities, loneliness, and isolation. To address these challenges and their impact, dentists and stakeholders identified several support needs and promising practices, including increasing awareness about mental health issues, expanding existing mental health resources, incorporating mental health content in dental education, and encouraging engagement in organized dentistry, particularly for women.

CONCLUSIONS

The impact of mental health challenges on dentists' career trajectory and productivity is an ongoing concern in Canada. Gender-specific strategies to support the mental health of dentists should be developed.Knowledge Translation Statement:This study identified the mental health challenges of dentists in Canada to inform the development of interventions and strategies to promote the health and well-being of dentists and dental students. It also highlighted the need for clinicians, students, and individuals in leadership positions in institutions and professional organizations to recognize and consider the working conditions of dentists in various positions to avoid negative consequences on their mental health, reduce the attrition from the professional, and improve patient care outcomes.

Colour Changes and Surface Roughness After Air-Polishing for Tobacco Stain Removal

INTRODUCTION AND AIMS

We aimed to investigate the efficacy of air-polishing in restoring the original tooth colour of standardised tobacco-stained tooth specimens.

METHODS

Seventy-two specimens consisting of half dentine and half enamel were daily exposed to the smoke of five cigarettes in an automated smoking chamber. Four repetitions of a 14-day smoking cycle were performed. Specimens were cleaned after each cycle, either by air-polishing with erythritol or sodium bicarbonate powder, or with a rubber cup and pumice stone as control. Spectral photometric colour changes (ΔE) and profilometric surface roughness were measured before and after each cycle. All samples were stored for the entirety of the study period in artificial saliva to mimic oral conditions and to establish a pellicle layer on the samples.

RESULTS

The tested cleaning procedures effectively removed tobacco staining from dentine and enamel samples, however, none of the treatments could restore the original colour. Mean [SD] tooth colour of enamel specimens after four cycles was not statistically significantly different between erythritol (E = 77.6 [6.6]) and sodium bicarbonate air-polishing (E = 79.8 [7.0]) (P > .05). ΔE showed no significant differences between the air-polishing groups after four cycles (P > .05) but with the control group (P < .001). On dentine there was no statistically significant difference of ΔE between all three groups (P > .05). No significant differences in enamel and dentine roughness compared to baseline were observed after repeated air-polishing with erythritol (P > .05).

CONCLUSIONS

Erythritol air-polishing removed smoker's discolourations just as effectively as air-polishing with sodium bicarbonate and polishing with pumice, without altering the roughness of the tooth structures. Tobacco stains do not reoccur faster or stronger after the use of air-polishing devices than after polishing with rubber cup and paste.

CLINICAL RELEVANCE

Air-polishing with erythritol emerged as a safe and efficient option for removing extrinsic tooth discolourations with the least abrasive character. These findings support the clinical relevance of incorporating air-polishing devices, particularly with erythritol powder, in dental practice for managing tobacco-induced tooth discolourations.

Interceptive Treatment of Class II Malocclusion in Pediatric Patients Using Clear Aligner Mandibular Advancement: A Systematic Review Following PRISMA Guidelines

While conventional functional appliances have been widely used to manage Class II malocclusion in growing pediatric patients, advancements in interceptive treatments have introduced aligner mandibular advancement as a modern and aesthetic alternative. Despite its increasing popularity, the effectiveness of aligner mandibular advancement has not been systematically evaluated. This systematic review aimed to evaluate the effectiveness of interceptive aligner mandibular advancement in the treatment of Class II malocclusion in pediatric patients, focusing on skeletal, dental, and soft tissue outcomes. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses or PRISMA guidelines. Studies evaluating pediatric patients with Class II malocclusion treated with aligner mandibular advancement were included. The databases searched included PubMed, Cochrane Library, Web of Science, Embase, and Scopus, with searches conducted up to November 30, 2024, to identify relevant articles addressing the PICOS framework (Population, Intervention, Comparison, Outcome, and Study design). The focus questions were: How effective is clear aligner mandibular advancement in the treatment of pediatric patients with Class II malocclusion? What are its associated treatment outcomes? The ROBINS-I tool was used to assess the risk of bias. Data were synthesized narratively due to heterogeneity in study designs and outcomes. Nine studies with 426 participants were included, conducted between 2021 and 2024. Seven studies adopted retrospective designs, one study used a prospective design, and one relied on a survey-based design. Aligner mandibular advancement demonstrated effectiveness in reducing overjet and ANB while maintaining lower incisor inclination compared to conventional functional appliances. Soft tissue improvements were also reported. Patients favored aligner mandibular advancement over conventional functional appliances for its superior comfort, better aesthetics, and less breakage. However, most studies were retrospective, and the lack of randomized controlled trials limited the strength of the evidence. Clear aligner mandibular advancement appears to be an effective approach for managing Class II malocclusions in growing pediatric patients, offering the distinct advantage of maintaining lower incisor inclination compared to other conventional functional appliances. However, the evidence remains limited due to methodological constraints, including the lack of randomized controlled trials, small sample sizes, and inconsistencies in study designs.

Effects of Er,Cr:YSGG Laser Disinfection on the Bond Strength of Bioactive-Restorative Materials to Caries-Affected Dentin

Objective: This study aimed to evaluate the effects of different Er,Cr:YSGG laser disinfection protocols on the bonding performance of bioactive restorative materials to caries-affected dentin (CAD). Background: With the adoption of minimally invasive caries removal techniques, bonding to CAD has become increasingly important. Adhesion challenges caused by CAD can be overcome through the application of effective disinfection methods and the selection of compatible bioactive restorative materials. Methods: A total of 120 human third molars (240 specimens) were prepared, with dentin surfaces exposed under water cooling. After pH-cycling to simulate CAD, specimens were assigned to four disinfection groups: no disinfection (C), 2% chlorhexidine gluconate (CHX), Er,Cr:YSGG laser at 0.5 W (L1), and 1 W (L2). Four restorative materials (n = 12 per group)-G-ænial Achord (a resin composite used as the control group), Equia Forte HT, Beautifil-II Restorative, and Cention Forte-were applied according to manufacturers' instructions. Shear bond strength (SBS) testing was conducted on 192 specimens, while energy-dispersive spectroscopy (EDS) analyzed F, P, and Ca on 48 specimens, and scanning electron microscopy images were obtained from representative specimens. Results: CHX disinfection significantly improved SBS compared to the control group. Among restorative materials, G-ænial Achord showed the highest SBS, while Equia Forte HT demonstrated the lowest (p < 0.05). L1 disinfection combined with G-ænial Achord achieved the highest bond strength, whereas its combination with Equia Forte HT resulted in the lowest (p < 0.05). EDS revealed increased fluoride content on CAD surfaces treated with CHX. Conclusion: Er,Cr:YSGG laser disinfection at 0.5W improved bonding performance for resin composites. Selecting a disinfection protocol based on the restorative material is crucial for optimizing adhesion to CAD.

Evaluation of the cytotoxicity of new formulations of cariostatic agents containing nano silver fluoride: an in vitro study

The objective of the study was to assess the indirect cytotoxicity of 600 ppm and 1500 ppm nano silver fluoride (NSF) compared to other commercial cariostatic agents. 56 dentin discs with 0.4 mm in thickness were obtained from intact human molars and adapted to artificial pulp chambers (APCs). The discs were divided into seven groups according to treatment (n = 8): no treatment (positive control-PC), 29% hydrogen peroxide (negative control-NC), 30% Cariestop (CS30), 38% Riva Star (RS38), 38% Advantage Arrest (AA38), 600 ppm NSF (NSF600), and 1500 ppm NSF (NSF1500). The cariostatic agents were applied on the occlusal surface of the dentin discs (facing upward), and the pulp surface (facing downward) remained in contact with the culture medium. Immediately after the treatments, the extracts (DMEM + cariostatic agent components diffused through the discs) were collected and applied to MDPC-23 cells, which were assessed for viability (CV-alamarBlue, live/dead), adhesion/spreading (F-actin), alkaline phosphatase (ALP) activity, and mineralization nodule (MN) formation. The data were statistically analyzed by ANOVA/Games-Howell (p = 0.05). CV and ALP activity in CS30, RS38, AA38, and NSF600 were similar to PC (p > 0.05). MN formation significantly decreased only in NC, CS30, RS38, and AA38 compared to PC (p < 0.001). Only NSF600 and NSF1500 did not differ from PC (p > 0.05) with mineralization nodules, and this specific cell activity significantly decreased in all other groups (p < 0.05). NSF solutions (600 ppm and 1500 ppm) did not cause transdentinal toxicity on MDPC-23 cells.

Recurrent Aphthous Stomatitis and Sleep Quality Factors: A Comprehensive Analysis

BACKGROUND

Due to the unclear etiology of recurrent aphthous stomatitis (RAS), a painful and distressing condition with a high prevalence, the researchers have hypothesized a connection between sleep quality and RAS.

METHODS

The cross-sectional study enrolled 10,138 Fasa Cohort Study participants aged 35-70 years. Various sleep quality factors were calculated and categorized based on the Pittsburgh Sleep Questionnaire.

RESULTS

Among 9030 subjects finally included with RAS prevalence of 20.2%, adjusted logistic regression showed significant odds ratios (ORs) in subjects who sleep < 5 h (OR = 1.44, 95%CI 1.25, 1.66), have sleep latencies of more than 60 min (OR = 1.37, 95%CI 1.11, 1.69), have sleep efficiencies of 65%-75% (OR = 1.55, 95%CI 1.21, 1.98), or regularly go to bed after 11 p.m. (OR = 1.23, 95%CI 1.11, 1.37). Subgroup analyses indicated no significant associations between RAS and various sleep factors in individuals who worked night shifts, and stronger associations were observed in men than women.

CONCLUSION

The study found a significant positive association between RAS and sleep quality factors such as shorter duration, lower efficiency, longer latency, later bedtime, and regular sleeping pill use. Establishing early and sufficient sleep and addressing sleep onset disturbances by adhering to sleep hygiene principles should be prioritized in individuals with RAS.

Clinical Outcomes of Bulk-Fill Resin Composite Restorations: A 10-Year Mapping Review and Evidence Gap Map

OBJECTIVE

To map the evidence regarding the clinical performance of posterior restorations with bulk-fill resin composites and identify research gaps.

MATERIALS AND METHODS

This mapping review was conducted following PRISMA-ScR guidelines for scoping reviews, and its protocol was registered on the Open Science Framework platform. Systematic searches were conducted, considering studies published between 2013 and February 2024 in the PubMed, Embase, and Cochrane databases. Clinical studies investigating the performance of bulk-fill resin composite restorations in class I and/or class II preparations with increments of 4 to 5 mm were included.

RESULTS

A total of 147 articles were identified, and based on the eligibility criteria, 26 studies were selected for descriptive analysis. Of the reviewed studies, 73% (n = 19) investigated high-viscosity bulk-fill composites, while 30% (n = 8) focused on low-viscosity bulk-fill composites. Evaluation periods ranged from 1 week to 10 years. Reported annual failure rates varied from 0% to 3%, with survival rates between 78.9% and 100%.

CONCLUSIONS

Bulk-fill resin composites of high viscosity were the most analyzed in the published studies, with evaluation periods of up to 10 years. The review of available scientific evidence showed clinically acceptable performance for composite bulk-fill restorations, with high survival rates and minimal annual failure rates. There is a need for long-term clinical studies on bulk-fill resin composites.

CLINICAL SIGNIFICANCE

This review demonstrates that both high and low-viscosity bulk-fill resin composites exhibit satisfactory clinical performance, which can help clinicians optimize chairside time. However, it is important to highlight the need for further studies with longer follow-up periods.

Umbrella review of economic evaluations of interventions for the prevention and management of healthcare-associated infections in adult hospital patients

BACKGROUND

Healthcare-associated infections (HCAIs) result in worse outcomes for patients and greater financial burden. An estimated 4.8 million HCAIs occurred in hospitals across Europe in 2022-23. Sixty-four percent of antibiotic-resistant infections in Europe are associated with healthcare. It is therefore vital to identify cost-effective interventions.

AIM

To summarize the cost-effectiveness evidence of interventions addressing HCAIs in hospitals.

METHODS

An umbrella review was conducted to identify evidence on the cost-effectiveness of antimicrobial stewardship, infection prevention and control, and microbiology and diagnostic stewardship interventions for the prevention and clinical management of HCAIs in adult hospital patients. Medline, Embase, and EconLit databases were searched. A qualitative synthesis was undertaken.

FINDINGS

Twenty-four systematic reviews met the inclusion criteria, with 101 separate analyses extracted and grouped into 10 intervention and 14 infection/organism categories, across various countries and settings. Most evidence focused on screening followed by contact precautions, isolation and/or decolonization, with selective screening most cost-effective. Most infection prevention and control bundles were cost-effective, although interventions were heterogeneous. The evidence base was sparse for the remaining intervention categories, with more research required. The limited evidence suggests that standalone environmental cleaning, hand hygiene, diagnostics, surveillance, antimicrobial stewardship, and decolonization interventions were mostly cost-effective. The cost-effectiveness of standalone personal protective equipment, and education and training interventions was mixed. Most interventions focused on meticillin-resistant Staphylococcus aureus and other Gram-positive infections, with more research needed on Gram-negative infections. The comparator was unclear in many extracted analyses.

CONCLUSIONS

Cost-effective interventions to address HCAIs in hospitals exist, although more evidence is needed for most interventions.

Oral health and smoking in Bandare-Kong cohort study: a cross-sectional population-based study (findings from PERSIAN cohort study)

Considering the harmful effects of smoking on oral and dental health, our aim was to investigate the oral and dental health status of people in the city of Bandare-Kong, Iran, and its relationship to smoking. This cross-sectional population-based study used baseline data from the Bandare-Kong Cohort Study. A total of 4063 participants aged 35-70 years were included in this study. Using Stata17 software, negative binomial regression was employed to identify factors related to the decayed, missing, and filled teeth (DMFT) index. The association between smoking status and DMFT was assessed by the adjusted incidence rate ratio (IRR). Of the 4063 participants, 987 (24.29%) used cigarettes, hookahs, or both. The mean ± standard error (SE) DMFT index in all subjects was 11.08 ± 0.15; it was 14.17 ± 0.53 for cigarette smokers and 12.39 ± 0.37 for hookah users (p < 0.001). After adjusting for other variables, the rate of DMFT for cigarette smokers was 0.33 (IRR: 1.33; 95% confidence interval [CI]: 1.22, 1.44), which was higher than for those who did not use cigarettes. The rate of DMFT for those who used cigarettes, hookahs, or both was 0.11 (IRR: 1.11; 95% CI: 1.05, 1.18), which was also higher than for those who did not smoke. Cigarette smoking is a risk factor for oral health complaints. Although the rate of DMFT was increased in hookah smokers, it was not a predictor of dental problems. However, we suggest that hookah use be included in educational policies to control oral and dental diseases.

Efficacy of Clear Aligner Therapy for the Treatment of Anterior Open Bite in Adults: A Systematic Review and Meta-Analysis

The objective of the present systematic review and meta-analysis was to assess the effectiveness of clear aligner therapy (CAT) for the treatment of anterior open bite (AOB) in adults. The focused question was "Is CAT effective for the management of AOB in adults?". Databases were searched without time and language barriers up to and including August 2024 based on pre-specified eligibility criteria. Risk of Bias (RoB) assessment was performed using the Risk-of-Bias-In-Non-randomised-Studies-of-Intervention (ROBINS-I) tool. Meta-analyses were conducted using a random effects model (REM) for change in AOB and cephalometric measurements with an evaluation of the mean difference (MD) and/or standardised mean difference (SMD). The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool was used to assess the quality of evidence. Publication bias was assessed using Funnel plots and Egger's regression test. There were 14 studies included in the qualitative assessment and 12 in the meta-analysis. The RoB was moderate in 13 studies and low in one. The meta-analysis showed significant AOB correction with CAT [(MD) = 2.76 mm, 95% confidence interval (CI): 2.23-3.28] due to maxillary and mandibular incisor extrusion (MD = 0.85 mm, CI: 0.43-1.26 and MD = 0.86 mm, CI: 0.29-1.44, respectively). There were no significant changes identified for maxillary and mandibular molar intrusion or changes in the mandibular plane angle (MPA). The level of confidence was high for AOB correction, incisor extrusion, and molar intrusion and low for MPA. CAT leads to a significant correction of AOB of approximately 2.76 mm, which can be mainly attributed to incisor extrusion.

Mental health curricula in predoctoral dental school programs: A content analysis

BACKGROUND

Given the prevalence of mental health concerns, dentists have an opportunity to provide mental health screenings to enhance overall patient care. The purpose of this study is to summarize and discuss the characteristics of mental health curricula related to patient care in accredited dental schools.

METHODS

We identified accredited predoctoral dental programs incorporating mental health training related to patient care into their curriculum. We summarized course characteristics and thematically analyzed course descriptions using headings from the National Library of Medicine.

RESULTS

From our review of curricula from 80 dental programs, 27 included a mental health component, and these were found in both didactic and clinical courses. Behavioral science and building clinical competence were the most common themes.

DISCUSSION

While mental health is an important component in overall patient care, a minority of accredited dental programs' curricula address it. Further, the manner and extent of inclusion varies. Including mental health training into dental curricula will better prepare dentists for their patients' comprehensive health needs.

Evaluation of dental students' learning curve in intraligamentary anesthesia using different syringe systems: A prospective crossover study

PURPOSE/OBJECTIVES

This prospective crossover preclinical trial aimed to evaluate the learning curve of dental students in successfully administering intraligamentary anesthesia (ILA) using three different syringe systems.

METHODS

Dental students performed ILA using three devices in two separate sessions, each targeting mandibular and/or maxillary premolars. The devices included two manual systems (pistol-type and lever-based) and one computer-controlled local anesthetic delivery system (CCLAD). The primary research parameter was the success rate of anesthesia, defined as the percentage of successful ILA administrations confirmed by a negative response to a cold test. Secondary parameters included pain experienced during needle penetration and injection, students' self-reported levels of mental tension and handling of the syringes, and any potential side effects.

RESULTS

A total of 110 students performed ILA on 599 teeth during the study period. When comparing the CCLAD system to the manual syringes, the CCLAD system exhibited a significantly higher overall success rate in the first session (92.5% vs. 77.4%; p < 0.001), potentially due to its precise control of anesthetic flow and pressure, which likely facilitated more effective anesthetic delivery. However, when examining the individual manual techniques, no significant difference was found between the pistol-type manual and the CCLAD system (p = 0.66). All techniques' success rate increased from the first to the second session (80.4% vs. 86.9%; p = 0.0357). Additionally, penetration pain demonstrated a significant decrease across all techniques (p < 0.01). Notably, students' anxiety levels decreased, and self-assurance increased significantly over the sessions. Undesired reversible side effects were documented in 10.9% of cases.

CONCLUSION

These findings suggest that repeated practice of ILA, particularly with different syringe systems, enhances anesthetic success and psychological readiness for patient interaction. Additional training sessions may further improve proficiency.

Disparities in periodontitis risk and healthcare use among individuals with disabilities in Korea: a retrospective cohort study

BACKGROUND

We analyzed the relationship between disability status and periodontal disease, focusing on disparities in healthcare utilisation, including outpatient visits and hospitalisation rates, among disability types and severities.

METHODS

This study used data from the National Health Insurance Service(NHIS) of Korea, which includes comprehensive records of the insured population. We examined 966,200 individuals with disabilities, grouped into five categories, and applied propensity score matching to compare with a matched control population. Periodontal disease was defined by the Korean Classification of Diseases criteria, and we used chi-square tests, t-tests, multivariate logistic regression, and negative binomial regression.

RESULTS

Individuals with disabilities had higher odds of hospitalisation for periodontitis (OR: 3.83, 95% CI = 3.59-4.08) but lower odds for outpatient visits (OR: 0.68, 95% CI = 0.68-0.69) and dental treatments (OR: 0.73, 95% CI = 0.72-0.73) compared to those without disabilities. The highest hospitalisation rates were among those with mental health disabilities (OR: 13.70, 95% CI = 12.26-15.30). Severe disabilities were associated with increased hospitalisation rates (OR: 7.14, 95% CI = 6.66-7.66) and fewer outpatient visits and treatments.

CONCLUSION

Individuals with mental health disabilities or severe disabilities experience greater risks of hospitalisation for periodontitis and attend fewer outpatient visits and treatments. Targeted interventions are needed to improve dental care access and reduce disparities.

Field Cancerisation in Oral Squamous Cell Carcinoma Patients: A Systematic Review

Introduction

Field cancerisation refers to molecular level cancerous changes that occurs in clinically normal looking tissue. In oral cavity, widespread exposure to carcinogens like tobacco/alcohol makes the entire mucosa susceptible to malignant changes. This manifests as local recurrence and/second primary after initial treatment of primary tumours. The purpose of this review is to identify the most commonly used marker in oral cavity field cancerisation and also to find out its prognostic significance.

Materials and method

Systematic review was conducted following PRISMA guidelines. Literature search was conducted using PubMed, Web of Science and Google scholar. Study selection was done independently by two reviewers and any discrepancy was resolved by third reviewer. A total of 23 articles were included after full-text reading. JBI checklist was used to assess the risk of bias for each study and RevMan 5.4 software was used to develop graphs.

Discussion and conclusion

Ki-67, p53, cyclin-D1, E-Cadherin, vascular markers like α -SMA, mi-RNAs, chromosomal polysomy, and epigenetic modifications like gene methylations were the various biomarkers used in the included studies. Both Ki-67 and p53 were found to be the most commonly employed markers in field cancerisation. However Ki-67 has more confirmed role in identifying field changes and is an established independent prognostic indicator of loco-regional control and disease free- survival rate. Further prospective studies are needed to fully evaluate the role of these markers in predicting second events like loco-regional recurrences and second primaries.

Students' perceptions of knowledge reinforcement on indirect prosthetic dental material choices by a translational approach

PURPOSE/OBJECTIVES

The aim of this study is to evaluate students' perceptions of the reinforcement of knowledge via innovative, case-based, hands-on learning regarding indirect prosthetic material choice.

METHODS

Six different clinical cases that represented common prosthetics were used in this simulation training. In each case, clinical pictures were associated with three-dimensional (3D)-printed replicates of final restorations and PolyJet polychromatic models with the goal of enabling students to deliberate and exchange ideas in small groups. After a debriefing session regarding the therapeutic potentialities of the first three cases alongside teachers, a lecture concerning prosthetic material choices was provided, and a zirconia crown was stained by each student to enable them to obtain a better understanding of the dental technician profession. Finally, the latter three cases were studied and analyzed in the same manner. The students' perceived reinforcement of knowledge was recorded before and 1 month after the hands-on simulation training experience, and their satisfaction was evaluated immediately thereafter on Likert scales. Students' perceived reinforcement of knowledge was subjected to statistical evaluation.

RESULTS

A high level of overall satisfaction was observed (4.60). All of the items pertaining to students' satisfaction received scores >3. One month after this hands-on approach, students' confidence in their ability to choose a material on the basis of its mechanical, optical, and luting properties increased significantly (from 2.58 to 3.64; from 2.83 to 3.64; and from 2.72 to 3.58, respectively) (p < 0.05).

CONCLUSIONS

This innovative, hands-on approach had a significant positive effect on students' perceived reinforcement of knowledge.

Research Trends in Class II Malocclusion Treatment in Growing Individuals: A Bibliometric Study

INTRODUCTION AND AIMS

This study aims to perform a bibliometric analysis of the literature on correction of Class II malocclusion in growing individuals by evaluating the evolution and current state of treatment and to predict future research hot spots and trends.

METHODS

Keyword queries were used to search for articles in the Web of Science Core Collection at the electronic library of University of Catania. The resulting literature data were imported into CiteSpace 6.3.R1 and VOSviewer software to analyse authorship, countries, institutions, and keywords and to perform cluster analysis.

RESULTS

A total of 843 articles were analysed. Research in this field has shown a consistent and ongoing publication trend on the addressed topic, with a significant increase in the last decade, attributed to growing interest in skeletal anchorage. The institutions in the United States, Italy, and Brazil contributed predominantly to the investigated subject area.

CONCLUSIONS

Class II correction in growing individuals using functional appliances or headgears has gained widespread attention and popularity due to the potential to counteract unfavourable maxillary and/or mandibular growth patterns, improving skeletal disharmony and facial attractiveness. A specific geographic publication trend was found for functional appliances and headgears that may represent an ethical and racial bias . Both of the latter approaches are effective in reducing the overjet. However, the primary rationale for early intervention is reducing the risk of incisal trauma and bullying episodes at childhood.

Analysis of genetic polymorphism and expression of SOX2 in oral leukoplakia: a case-control study

PURPOSE

To investigate the association of SOX2 polymorphisms with oral leukoplakia with dysplasia (OLD) and compare it with the immunohistochemical expression of SOX-2.

METHODS

The samples comprised 64 patients with oral leukoplakia and 20 with normal oral mucosa who were subjected to SOX2 polymorphism rs77677339 genotyping by real-time polymerase chain reaction and immunohistochemistry for SOX-2 (basal epithelium expression, suprabasal and total; nuclear area and intensity). Statistical tests included the Chi-square and Fisher's exact tests.

RESULTS

No significant difference was observed in genotype distribution between the OLD and control groups. The GG genotype (96.9%) was observed in the OLD group and 100% in the control group. The GA genotype was not observed in the control group. Statistical comparisons between the immunohistochemistry and genetic results were not statistically significant. No association was identified between rs77677339 and immunohistochemistry in OLD; however, the presence of allele A in heterozygotes with OLD suggests that this allele may serve as a risk marker.

CONCLUSION

The variant rs77677339 is localized in a region that contains different micro-RNA-binding sites, which can lead to changes in gene expression, contributing to OLD development through unclear molecular mechanisms. This study presents the preliminary results for this single nucleotide polymorphism in the literature.

Testing the Causal Association Between Metabolic Syndrome and Periodontitis: A Two-sample Mendelian Randomisation Study

INTRODUCTION AND AIMS

Observational studies suggest an association between metabolic syndrome (MetS) and periodontitis. However, observational studies are susceptible to reverse causation and confounding factors, so the causality of this association is uncertain. Causal association between compounds of MetS and periodontitis has been well studied. Using Mendelian randomisation (MR), we aimed to comprehensively evaluate the bidirectional relationship between MetS as a whole and periodontitis and provide clinical insight.

METHODS

We used genetic instruments from the most comprehensive genome-wide association studies of European descent for MetS (n = 291,107) as well as periodontitis from both the FinnGen consortium (n = 195,395) and GeneLifestyle Interactions in Dental Endpoints (GLIDE, n = 45,563) consortium to investigate the causal relationship between MetS and periodontitis and vice versa. We used the inverse-variance weighted (IVW) method to derive the primary causal estimates and evaluated the robustness of our results with a series of sensitivity analyses.

RESULTS

MR analysis based on FinnGen consortium indicated a negative causal association of MetS on periodontitis (OR = 0.882, 95% CI = 0.791-0.983, P = .023), while MR analysis based on GLIDE consortium did not support a causal relation of MetS on periodontitis (OR = 0.986, 95% CI = 0.920-1.057, P = .697). These results were consistent after adjusting for potential confounding factors by multivariable MR analyses. Results from meta analysis did not support a causal association of MetS on periodontitis. Sensitivity analysis showed that there was no existence of pleiotropy. In the reverse direction, periodontitis showed no association with MetS.

CONCLUSIONS

Within the scope of this MR study, MetS and periodontitis are not causally related.

CLINICAL RELEVANCE

Further studies are needed to clarify the underlying mechanism between metabolic syndrome and periodontitis.

Comparison of Increase in Masticatory Efficiency Between Removable Partial Dentures Retained With Clasps and Retained With Attachments

OBJECTIVES

This study aimed to evaluate and compare the masticatory efficiency of removable partial dentures (RPDs) retained with clasps versus those retained with attachments.

MATERIAL AND METHODS

A total of 107 patients fitted with 138 RPDs participated in the study; 87 RPDs (63.0%) were clasp-retained, and 51 RPDs (37.0%) were attachment-retained. Subjects chewed 5.0 g of peanuts for 30 s, and masticatory efficiency was measured using a spectrophotometer at an absorption rate of 590 µm. Measurements were taken before insertion, immediately after, and 1 and 3 months post-insertion of RPDs.

RESULTS

The analysis revealed progressive masticatory efficiency improvements for both clasp-retained and attachment-retained RPDs over time, with significant enhancements observed at the 3-month post-insertion mark. Initially, clasp-retained RPDs showed slightly higher efficiency than attachment-retained RPDs; however, attachment-retained RPDs demonstrated superior efficiency after 3 months (p = 0.001). Consistent improvements were noted across different denture support types, with Triangular and Quadrangular supports showing the most notable gains by 3 months (p ≤ 0.006). GLMM analysis underscored the significant impact of time on masticatory efficiency (F(3, 511) = 4.926, p = 0.002), with no significant effects attributed to RPD type or support type alone, nor any significant interaction effects, indicating a universal improvement in masticatory function over time regardless of RPD design.

CONCLUSIONS

RPD insertion significantly improves masticatory efficiency, particularly evident 3 months post-insertion, with attachment-retained RPDs outperforming clasp-retained types. Improvements in masticatory function over time are consistent across all RPD designs, unaffected by denture type or support structure. This emphasizes the role of denture design in both immediate adaptation and long-term treatment success, suggesting that time significantly contributes to enhanced masticatory efficiency regardless of RPD design, highlighting the importance of tailored prosthetic rehabilitation.

Comparison of fixed dental prostheses digitally fabricated using various scan bodies: a clinical study

PURPOSE

Digitalization in dentistry has increased interest in the use of intraoral scanners (IOs) in clinical practice. However, knowledge of implant digitalization is primarily limited to in vitro studies. This study aimed to compare implant-supported fixed dental prostheses (FDP) fabricated following complete digital workflow using various implant scan bodies (SB) in treatment of short-span partial edentulism.

MATERIALS AND METHODS

Patients with 25 short-span posterior edentulous sites, each receiving two implants to support a fixed restoration, were included. Digital implant records were made consecutively with original, non-original, and generic SBs using IOs. A practitioner implemented a two-stage full-arch scanning protocol, beginning with continuous arch scanning, followed by individual scanning of SBs. For clinical evaluation, each site received screw-retained full-contour restorations to qualify the connection fit to the implants and contacts to the adjacent and antagonist teeth. For analytical comparison, implant axes calculated from SB scans were quantified using reverse engineering software to compare the differences three-dimensionally. Restorative outcomes and implant axes records were statistically analyzed using the chi-square test and generalized estimating equations, respectively.

RESULTS

Clinical delivery conditions did not differ significantly among the three intraoral SBs (P > .05). The analytical implant-position calculations for non-original and generic SBs did not present significant differences compared to original SBs (P > .05).

CONCLUSION

SBs with different hardware and software characteristics for an implant system are clinically acceptable for fabricating screw-retained short-span implant-supported FDPs using a complete digital workflow.

[Deaths from head and neck cancer according to schooling in Rio de Janeiro, Brazil, 2010-2018]

This study aimed to evaluate the differences in mortality rates from head and neck cancer according to schooling in the state of Rio de Janeiro, Brazil, from 2010 to 2018. This ecological study used head and neck cancer data from the Brazilian Mortality Information System. Mortality rates from head and neck cancer in individuals over 40 years of age were compared after inputting the schooling variable. A total of 20 databases were generated for each of which a negative binomial regression model was adjusted for age, sex, education, tumor topography, immediate geographic regions, and year of death. Combining the coefficients of the 20 adjusted models estimated the rates and mortality rate ratios for head and neck cancer. Death rates from head and neck cancer were highest in men aged over 50 years with less than eight years of schooling, exceeding 40 deaths per 100,000. Significant differences occurred in oropharyngeal and oral cavity cancer, with a mortality four times in those with less schooling and five times in men than in women. Northern Rio de Janeiro showed a mortality from head and neck cancer at least eight times higher in those with less schooling. A higher risk of mortality from head and neck cancer occurred in individuals with low schooling, especially in men over 50 years of age and those living in the inner state. These results underscore the importance of considering health inequalities and implementing prevention strategies to reduce the impact of head and neck cancer on more socially vulnerable groups.

Entire Papilla Preservation Technique with Enamel Matrix Proteins and Allogenic Bone Substitutes for the Treatment of Isolated Intrabony Defects: A 3-Year Follow-Up of a Prospective Case Series

Background: This study aimed to assess the effectiveness of a modified entire papilla preservation technique (MEPPT) for treating isolated intrabony defects in patients with stage III periodontitis. Material and Methods: Fifteen patients with 15 interdental intrabony defects were treated with a MEPPT using enamel matrix derivative and allogenic bone. Their probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), keratinized tissue width (KTW), defect depth (DD), full-mouth plaque score (FMPS), full mouth bleeding score (FMBS), radiographic images (radiographic angles, BF and LDF) and intrasurgical parameters were assessed at baseline and 3 years postsurgery. Standardized measurements were taken to evaluate the defect characteristics and treatment outcomes. Results: At 3 years, significant improvements from baseline were maintained. Probing pocket depth (PPD) decreased from 7.03 ± 1.61 mm to 3.33 ± 0.89 mm (p < 0.0001), clinical attachment level (CAL) improved to 3.08 ± 1.16 mm (p < 0.001) and defect depth (DD) decreased from 4.59 ± 1.24 mm to 0.38 ± 0.31 mm (p < 0.001). The changes in gingival recession and keratinized tissue were not statistically significant. The results demonstrate sustained clinical stability over a 3-year period. Conclusions: Within the limitations of this study, the findings suggest that the modified entire papilla preservation technique (MEPPT) in conjunction with enamel matrix proteins and allogenic bone grafting is an effective approach for the treatment of intrabony defects, leading to statistically significant and sustained clinical improvements over a 3-year period. The study protocol was registered in ClinicalTrials.gov ID NCT05029089.

Accuracy of Three-Dimensional Computer-Aided Implant Surgical Guides: A Prospective In Vivo Study of the Impact of Template Design

Background: Digital planning and the use of a static surgical guide for implant placement provide predictability and safety for patients and practitioners. The aim of this study was to investigate differences in the accuracy and fit of long and short guides. Methods: In patients with at least one missing tooth, long (supported by the entire dental arch) and short templates (supported by two teeth, mesial and distal) were compared via intraoral scans and the superimposition of the STL files of the initial planning and the actual position in the patient's mouth along the X-, Y- and Z-axes. Furthermore, this study evaluated the conditions (e.g., mouth opening, the implant position) under which fully guided implantation can be realized. Results: The largest deviation was observed in the Z-axis, although this deviation was not as high for the short templates (0.2275 mm) as it was for the long templates (0.4007 mm). With respect to the 3D deviation (dXYZ), the average deviation from the mean value was 0.2953 mm for the short guides and 0.4360 mm for the long guides (p = 0.002). The effect size (Cohen's d) was 0.709, which was between the medium (0.50) and large effect sizes (0.80). The shorter templates showed a smaller deviation from the actual plan by 80%. With a mouth opening ≥50 mm, fully guided surgery can be performed in the molar region. In the premolar region, the lower limit was 32 mm. Conclusions: The 3D accuracy was significantly higher for the shorter template, which could therefore be favored.

Analysis of the Relationship Between Unilateral Posterior Crossbite and Alterations in the Eruptive Trajectory of Maxillary Canines, the Occlusal Plane, and the Inclination of the Labial Commissure

OBJECTIVES

The aim was to establish whether there is a relationship between the presence of unilateral posterior crossbite (u-PCB) and the mesio-distal inclination of permanent upper canines, the angulation of the occlusal plane, or the labial commissure inclination in children.

METHODS

A cross-sectional association study was conducted. Panoramic radiography was used to measure the inclination of the canines and the occlusal plane, and frontal rest photography was used to measure the inclination of the labial commissure. The measurements were performed with tpsDig264 software version 2.25, 2016, Ecology & Evolution, SUNY), and the data obtained were analyzed with SPSS 22.0 software, using ANOVA and Kruskal-Wallis tests for the statistical analysis.

RESULTS

A total of 106 patients with u-PCB and 41 patients in the control group were studied. No statistically significant differences were observed in the inclination of the right and left canines in patients with u-PCB compared to patients in the control group. There is a relationship between the presence of u-PCB and the inclination of the occlusal plane. No statistically significant differences were observed in the inclination of the labial commissure in patients with u-PCB compared to patients in the control group.

CONCLUSIONS

There is no relationship between the presence of u-PCB and the alteration in the eruptive trajectory of the permanent upper canines or in the inclination of the labial commissure. However, a relationship between the presence of u-PCB and altered occlusal plane inclination was found.

An Assessment of Oral-Health-Related Quality of Life and Anxiety in Early Adolescents (11-14 Years) at Their First Dental Visit: A Cross-Sectional Study

Background: Knowing the oral-health-related quality of life (OHRQoL) status of pediatric patients would be helpful in analyzing their level of dental anxiety before their first visit to a pediatric dentist. However, few studies have analyzed OHRQoL and anxiety in early adolescent patients. The aim of this study was to describe the OHRQoL and anxiety levels of early adolescents, according to age and sex, at their first dental examination. Methods: A cross-sectional study was conducted on early adolescents (11-14 years old) attending their first dental examination in 2023-2024. OHRQoL was assessed using the Spanish version of the Child Perceptions Questionnaire 11-14 (CPQ-Esp11-14) and anxiety using the State-Trait Anxiety Inventory in Children (STAIC). Results: A total of 130 early adolescents were assessed, with an average age of 12.6 years (±1.06) and an equal sex distribution (65 boys and 65 girls). Among the analyzed sample, the OHRQoL dimension with the highest score was social well-being (15.01 ± 10.7), whereas the oral symptoms dimension (8.6 ± 4.25) had the lowest impact. There were no statistically significant differences between female and male early adolescents in the anxiety state or anxiety-trait dimensions or in the dimension of OHRQoL, except for oral symptoms, which were higher in boys (9.48 ± 4.51 versus 7.72 ± 3.81). Similarly, no significant differences were found based on age regarding anxiety or OHRQoL. Conclusions: Considering the limitations of this study, it can be concluded that higher levels of anxiety negatively impacted the OHRQoL of the early adolescent population studied.

Clinical and Microbiological Evaluation of 0.2% Tea Tree Oil Mouthwash in Prevention of Dental Biofilm-Induced Gingivitis

Background: Dental biofilm-induced gingivitis is a prevalent condition caused by dental plaque accumulation. Chlorhexidine mouthwash is a gold standard for plaque control but is associated with adverse effects such as tooth staining and altered taste. This study aimed to evaluate the clinical and antimicrobial effectiveness of 0.2% tea tree oil mouthwash as a natural alternative to 0.2% chlorhexidine mouthwash. Methods: A comparative study was conducted on 60 participants aged 18-60 years, divided into two groups: Group T (tea tree oil) and Group C (chlorhexidine), each comprising 30 participants. Clinical outcomes assessed included Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), and microbiological Colony Forming Units (CFUs). Parameters were recorded at baseline, 7 days, and 28 days. Results: Group T exhibited significantly lower PI and BOP scores at 7 and 28 days compared to Group C (p < 0.05). Both groups showed comparable reductions in CFU counts, indicating similar antimicrobial efficacy. Importantly, tea tree oil had fewer adverse effects, with no reports of tooth staining or altered taste, unlike chlorhexidine. Conclusion: Tea tree oil mouthwash demonstrated equivalent or superior clinical outcomes compared to chlorhexidine, with fewer side effects. It is a viable and well-tolerated alternative for managing plaque-induced gingivitis, supporting further research into its long-term use and efficacy.

Pediatric Preformed Zirconium Oxide Crowns vs. Preformed Metal Crowns After Pulpotomy in Primary Molars: A Practice-Based Retrospective 2.5 Year Cohort Study

Background: Primary molars with deep carious lesions often require a treatment with pulpotomy and restoration with a crown. Aim: This study aims to compare the survival rates of stainless steel (SSC) and zirconium oxide (ZOC) crowns carried out on pulpotomized primary molars using the International Caries Detection and Assessment System (ICDAS) 4 to 6 lesions. Materials and Methods: The data of 100 patients (mean age 5.3 ± 2.1 years, mean decayed, missing or filled primary teeth (dmft) 7.1 ± 3.2) with 272 primary molars (40, 225, 7 with ICDAS 4, 5, 6, respectively) were collected retrospectively from a specialized private pediatric dental office after ethical approval was obtained and each participant agreed to participation in the study. Primary molars were treated between 2019 and 2021 with pulpotomy (15.5% ferrous sulfate solution for hemostasis and zinc oxide eugenol as a wound dressing) followed by a crown (203 SSC and 69 ZOC) with a minimum follow-up period of 6 months and a mean follow-up time of 28.2 (±11.0) months. Results: Failure occurred significantly less often in SSC (n = 13 out of 203) than in ZOC (n = 20 out of 69; p < 0.001). Major failure was attributed to swelling and abscess (n = 13, 39.4%) followed by the occurrence of fistula (n = 15, 45.4%) and fracture of the crown and abutment (n = 5, 15.2%). Minor failure due to cement dissolution occurred significantly less often in SSC than in ZOC (n = 10 out of 203 vs. n = 9 out of 69; p < 0.005. A Kaplan-Meier survival analysis showed an overall estimated survival time of 38.25 (Confidence interval (CI): 37.0-39.4) months for both types of crowns. A Log-Rank (Mantel-Cox) analysis showed a statistically significant difference (p < 0.05) in the estimated mean survival time of SSC (39.75; CI: 38.5-40.9 months) and ZOC (33.4; CI: 30.5-36.3 months). Survival probability drops just below 80% for ZOC and stays a little over 90% for SCC around the 20th month. Conclusions: SSC showed an advantage over its ZOC counterpart when placed after pulpotomy for the management of primary molars with deep carious lesions. A higher necessity for re-intervention in the more aesthetic ZOC should be considered in clinical decision taking.

Eating behaviors, oral health care knowledge, and oral hygiene practices among residents in Fujian province, China: a cross-sectional study

BACKGROUND

There is little literature that focuses on eating behaviors, oral health care knowledge and oral hygiene habits at the same time. People's oral health is affected by a variety of factors. This study investigated the eating behaviors, oral health care knowledge, and oral hygiene practices among residents of Fujian province, China, with different gender, age, and educational attainment.

METHODS

A self-administered questionnaire was designed and distributed through the online questionnaire platform, Questionnaire Star. After excluding unqualified responses (due to excessively short completion time, conflicting answers, etc.), an Excel database was constructed. Frequency counts (composition ratio) were used to characterize data distribution, and the chi-square test was used to compare self-reported oral health, eating behaviors, oral health care knowledge, and oral hygiene practices across different age, gender, and educational attainment of respondents. Data were analyzed using IBM SPSS (version 26.0), and differences were considered statistically significant at P < 0.05.

RESULTS

A total of 10,480 individuals completed the online questionnaire, with 8,254 questionnaires deemed valid, yielding a validity rate of 78.76%. Significant differences were observed in various aspects of eating behaviors among respondents of different age, gender, and educational attainment (P < 0.001), except for the consumption of fruit juice and hard foods. There was a significant difference in self-reported oral health status among respondents by age and education (P ≤ 0.001), while the difference by gender was not significant (P = 0.303). The respondents displayed inadequate oral health care knowledge, with significant disparities among respondents of different age, gender, and educational attainment (P < 0.05). There were also significant differences in oral hygiene practices among respondents of different age, gender, and educational attainment (P < 0.05).

CONCLUSIONS

Eating behaviors, oral health care knowledge and oral hygiene practices of Fujian residents were related to age, gender and education attainment. Educational attainment was an important factor influencing the eating behaviors, oral health knowledge and oral hygiene practices of the population. Local residents' knowledge of oral health care was generally insufficient.

Assessment of Oral Health Knowledge and Practices and Its Association With Sociodemographic Factors Among Government Employes and Their Clients in Kuwait: A Cross-Sectional Study

Background and Aim: Oral health knowledge is a vital requirement for health-related practice. Adequate knowledge of oral health is important due to its influence to better oral health and in developing healthy oral health practices. This study aims to assess the knowledge, practices towards oral health, and its association with sociodemographic factors amongst government employes and their clients in Kuwait, as well as to provide information that could form the basis for targeted oral health promotion programs. This research also aimed at determining the pattern of oral hygiene practices of the adult employes. Materials and Methods: In this cross-sectional study, data were collected at the Ministries Complex and Housing Authority by a team of trained dentists using a customized questionnaire that was translated into Arabic language. The questionnaire included questions on demographic characteristics; questions about oral health practices; nutrition; knowledge of dental and oral health; and risk factors such as smoking and water pipe use. Results: Respondents in Kuwait demonstrate good oral health knowledge; however, daily dental flossing is inadequately practiced. Nutritional practices such as fast-food consumption and sugary sweet consumption are common amongst the employed adults. Males and smokers have poorer knowledge and inadequate oral hygiene practices. In multivariate analysis, employes having a post school education were significantly associated with an above median knowledge (AOR: 2.34). Male participants (AOR: 0.41) and smokers (AOR: 0.59) were significantly less likely to brush their teeth. Participants who used a water pipe (AOR: 0.57) were significantly less likely to floss their teeth. Conclusions: Majority of participants had a good knowledge level towards oral health. This study highlights the need for educational interventions focusing on comprehensive oral hygiene practices among adults. Further efforts are essential to increase awareness in workplaces to help encourage adult employes in Kuwait in developing healthy oral health practices.

Hypoxia signaling in cancer: HIF-1α stimulated by COVID-19 can lead to cancer progression and chemo-resistance in oral squamous cell carcinoma (OSCC)

The potential implications of Coronavirus disease-2019 (COVID-19) on oral squamous cell carcinoma (OSCC) development, chemo-resistance, tumor recurrence, and patient outcomes are explored, emphasizing the urgent need for tailored therapeutic strategies to mitigate these risks. The role of hypoxia-inducible factor 1-alpha (HIF-1α) in OSCC studies has highlighted HIF-1α as a crucial prognostic marker in OSCC, with implications for disease prognosis and patient survival. Its overexpression has been linked to aggressive subtypes in early OSCC stages, indicating its significance as an early biomarker for disease progression. Moreover, dysplastic lesions with heightened HIF-1α expression exhibit a greater propensity for malignant transformation, underscoring its role in early oral carcinogenesis. Cancer patients, including those with OSCC, face an elevated risk of severe COVID-19 complications, which may further impact cancer progression and treatment outcomes. Understanding the interplay between COVID-19 infection, HIF-1α activation, and OSCC pathogenesis is crucial for enhancing clinical management strategies. So, insights from this review shed light on the significance of HIF-1α in OSCC tumorigenesis, metastasis formation, and patient prognosis. The review underscores the need for further research to elucidate the precise mechanisms through which HIF-1α modulates cancer progression and chemo-resistance in the context of COVID-19 infection. Such knowledge is essential for developing targeted therapeutic interventions to improve outcomes for OSCC patients.

Predictability of maxillary dentoalveolar expansion with clear aligners in patients with mixed dentition

Objective

This prospective study evaluated the effectiveness of clear aligner treatment (CAT) in achieving dentoalveolar upper arch expansion in patients with mixed dentition and transverse maxillary deficiency.

Methods

Forty patients with mixed dentition and a transverse discrepancy of ≤ 5 mm were treated using clear aligners. Pre- and post-treatment digital dental models were measured using specific landmarks and compared with the programmed expansion in the virtual treatment plan. Statistical analyses included the inter-class correlation coefficient to evaluate inter-rater reliability. A paired t test was employed to compare pre- and post-treatment values and to examine the significance of the changes. Multiple regression analysis was conducted to estimate the relationship between the prescribed and observed measurements, stratified by inter-dental measurements (deciduous canines, first deciduous molars, and permanent molars, at cusp and gingival levels).

Results

Excellent measurement reproducibility was observed. The accuracy of dentoalveolar maxillary arch expansion varied among different tooth regions. The inter-canine accuracy was 87.7% at the cusp level and 82.7% at the gingival level. The inter-first deciduous molars exhibited accuracies of 84.9% (cusp level) and 80.5% (gingival level). The inter-first molars showed accuracies of 77.8% (cusp level) and 67.9% (gingival level). Significant differences were observed between the planned and obtained measurements for specific tooth regions.

Conclusions

CAT demonstrated reliable predictability in achieving dentoalveolar expansion of the maxillary arch in patients with mixed dentition. A higher accuracy was observed in the anterior region than in the posterior region. These findings suggest that CAT could be an effective option for treating transverse maxillary deficiencies in patients with mixed dentition with moderate inter-arch transverse discrepancies, considering tooth-specific predictability differences.

Ginsenoside Rb3 Inhibits Oxidative Stress and Alleviates Experimental Periodontitis in Rats

OBJECTIVE

This study investigated the anti-inflammatory and antioxidative effects of ginsenoside Rb3 on experimental periodontitis.

METHODS

Experimental periodontitis was established by ligating the maxillary first molars. After 21 days of Rb3 treatment, rats were sacrificed for micro-CT and H&E staining analysis and serum assay. qPCR detected the expression of inflammatory genes. IF detected MAPKs pathway activation in periodontal tissues. The effects were determined using LPS-induced RAW264.7 cells. Gene expression levels were determined by qPCR. Intracellular ROS generation was detected by DCFH-DA staining and flow cytometry. WB detected the activation of signaling pathways.

RESULTS

Rb3 inhibited oxidative stress in experimental periodontitis, showing reduced gingivitis and alveolar bone resorption on H&E staining and micro-CT, and reduced iNOS mRNA in rats. Colorimetric results showed that Rb3 increased serum SOD and GSH-Px activities and decreased MDA levels in rats. IF analysis showed that Rb3 inhibited P38, ERK, and JNK activation. Rb3 pretreatment significantly decreased iNOS and IL-6 mRNA expression and ROS in Raw264.7 cells. WB analysis demonstrated that Rb3 blocked the activation of P38 and ERK.

CONCLUSION

Rb3 inhibits the level of oxidative stress and attenuates gingivitis and alveolar bone resorption in rats via the MAPKs signaling pathway.

Factors affecting postoperative nasal morphology after Le Fort I osteotomy on multiple regression analysis

Changes in external nasal morphology after Le Fort I osteotomy can lead to reduced patient satisfaction and diminished quality of life postoperatively. Despite various modifications such as alar cinch suture and subspinal osteotomy to overcome such changes, the external nasal morphology may vary unexpectedly on an individual basis. This report investigated the factors influencing the changes in external nasal morphology, by considering the patient's preoperative external nasal morphology as well as the surgical technique, and the direction of repositioning of maxilla. Multiple regression analysis identified the patient's preoperative nasal width as a factor that increased the alar base width of the nose, in addition to incision (oral vestibular incision) and the amount of anterior and superior movements at point A of the maxilla. The factors that caused the nasal tip to turn upward were the amount of anterior and superior movements at point A and the absence of subspinal osteotomy. The direction of surgical maxillary movement was influenced not only by anterior movement, but also by superior movement and surgical technique. The patient's preoperative nasal morphology should also be considered during the preoperative planning for orthognathic surgery to ensure optimal esthetic and functional outcomes.

Retrospective analysis of removable partial denture treatment in a state-sponsored dental school

STATEMENT OF PROBLEM

Removable partial dentures (RPDs) provide an important treatment option for replacing missing teeth, particularly for vulnerable populations. However, RPDs have been associated with damage to the remaining dentition, which can lead to treatment failure.

PURPOSE

The purpose of this retrospective clinical study was to investigate the failure rates of RPD treatments among patients at a state-sponsored dental school and identify factors contributing to these failures.

MATERIAL AND METHODS

A retrospective analysis was conducted using electronic health records (EHRs) from 4941 individuals for a total of 7529 patient-arches. The outcome of RPD treatment was defined as failure when any major procedure was performed on any tooth adjacent to a treated edentulous span. The time to event was measured from the date of RPD placement to the first recorded failure or the last follow-up visit (censored). A multivariable Cox proportional hazards model was employed to assess the hazard ratios for the variables of interest (α=.05).

RESULTS

The average age of the cohort was 59 years, 52% female, and the mean follow-up period was 35 months. Among the arches that experienced failure (24.2%), the average time to failure was 33 months. In the multivariable model, statistically significant associations with RPD failure were found for several variables: Kennedy classification without distal extension (HR=1.23, P<.001), older age (HR=1.01, P<.001), male sex (HR=1.17, P=.008), maxillary arch (HR=1.60, P<.001), lack of insurance (HR=0.78, P<.001), cast metal framework (HR=0.55, P<.001), tobacco use (HR=1.21, P=.002), and dental fear (HR=1.26, P=.003).

CONCLUSIONS

While the associations were not particularly strong, dental school patients who smoked, experienced dental anxiety, or received maxillary RPDs or RPDs without a cast metal framework demonstrated an elevated risk of requiring major treatment to the abutment teeth, leading to the failure of the RPD treatment.

Nutrient Intakes in Vegans, Lacto-Ovo-Vegetarians, Orthodox Fasters, and Omnivores in Russia: A Cross-Sectional Study

In Eastern Europe, the number of vegetarians is growing, and the number of people adhering to Christian Lents is traditionally high. However, data on the nutritional value of plant-based diets in this part of the world are limited. The aim of this study was to compare the nutritional intakes of three groups with different plant-based patterns with that of omnivores in Russia, Moscow region. The nutrient intakes of 46 vegans, 49 lacto-ovo-vegetarians, 42 people who adhered to Orthodox Great Lent, and 48 omnivores were assessed. The food frequency questionnaire method was used for data collection and analysis. The differences in absolute and calorie adjusted nutrient intakes between the groups were analysed. Additionally, a pairwise comparison of the general plant-based group (combined of the vegan, lacto-ovo-vegetarian, and Great Lent samples) and the omnivorous groups was conducted. Vegan diet was the most favourable in micronutrient composition. The intake of many micronutrients increased when switching to a more plant-based diet from a more animal-based one. The opposite association was observed only for selenium and vitamins D and B12. Fasting people consumed more iodine and n-3 polyunsaturated fatty acids; however, after the calorie content was standardized, the omnivores caught up with them. The omnivores had the largest list of dietary inadequacies: they significantly more often than all other groups had inadequate intake of cholesterol (excessive), fibre, potassium, magnesium, iron, and vitamins B1, B6, B9, and E (insufficient). Inadequate intake of polyunsaturated fatty acids, calcium, iodine, chromium, molybdenum, and zinc; or vitamins B2, PP, H, B12, and D was observed rather often in all the studied groups. Although, the vegan diet was richer in most micronutrients, plant products often contain substances that reduce the bioavailability of various nutrients, which can partially affect their status in the body, and, thus, may increase the need in them in vegetarians and fasters.

Comparative Mucosal Wetting Capacity of Novel and Commercial Saliva Substitute Formulations: An in vitro Study

Purpose

This study evaluated the effectiveness of novel, inexpensive saliva substitute formulas (Rangsit University (RSU) preparation) in maintaining mucosal wetness compared with commercial products.

Materials and Methods

In vitro experiments were conducted using swine tongues to assess the wetness of various RSU saliva substitute solutions and gels, with four flavors each (sweet mint, sweet vanilla, sweet-sour mint, and sweet-sour lemon), compared with water, hospital-based mouth rinse from a government dental school, and commercial products (Biotene® mouthwash and GC Dry Mouth Gel®). The wetness was measured at baseline and at 0, 10, 20, 30, 60, and 120 minutes using a digital moisture analyzer.

Results

All saliva substitutes consistently maintained a higher relative wetness than water, particularly beyond 60 minutes (p < 0.001). RSU solutions with a sour flavor (sweet-sour mint and sweet-sour lemon) had a similar wetness to commercial saliva substitute mouthwash at all times. These solutions were more effective in maintaining higher relative wetness over time than those without a sour flavor (sweet mint and sweet vanilla) (p < 0.05) and provided more wetness than the hospital-based mouth rinse at 120 minutes. The RSU solution formula also provided comparable wetness to RSU gel preparation at every time point. While RSU gel formulas initially provided comparable wetness to water, they maintained significantly higher wetness at 60 minutes (p = 0.029) and 120 minutes (p = 0.002). These results were similar to those of commercial saliva substitute gel, which maintained stable wetness since application up to 120 minutes (p = 0.052).

Conclusion

Our novel saliva substitute formulas show similar effectiveness to commercial products in maintaining mucosal wetness. These inexpensive products could be a viable alternative for patients with dry mouth who cannot afford commercial formulations.

The Influence of the Periodontal Breakdown over the Amount of Orthodontic Force Reaching the Dental Pulp and NVB During Orthodontic Movements-A Biomechanical Finite Element Analysis

Background/Objectives: Most orthodontic forces are absorbed-dissipated before reaching the dental pulp and its neuro-vascular bundle (NVB); nonetheless, no data are available about this issue during the periodontal breakdown. The current study's objective was to investigate how much orthodontic force reaches the dental pulp and NVB during the orthodontic movements in periodontal breakdown. Methods: Herein, an assessment was performed on the second lower premolar of nine patients (72 3D models) and included 1440 numerical simulations. A gradual horizontal periodontal breakdown (1-8 mm loss) was simulated. Five orthodontic movements (intrusion, extrusion, rotation, translation, and tipping) under 0.5 N/5 KPa and 4 N/40 KPa were assessed. The numerical methods used were Von Mises/VM (overall homogenous) and Tresca (shear non-homogenous), suitable for the ductile resemblance of dental tissues. Results: Both methods showed similar color-coded projections for the two forces. Quantitatively, Tresca was 1.14 times higher than VM and lower than the maximum physiological hydrostatic circulatory pressure. During the bone loss simulation, the NVB stress was 5.7-10.7 times higher than the pulpal stress. A gradual tissue stress increase was seen, strictly correlated with the bone loss level. For 1 mm bone loss, only 2-3% of the applied force manifested at the NVB level (0.27-0.5% for pulp), while for 8 mm loss, the received stress was 4-10% for the NVB (0.6-0.9% for pulp) when compared to the applied force. Only translation displayed pulpal stress. Conclusions: When assessing NVB stress, the tooth absorption-dissipation ability of dental tissues varied between 90 and 93% (8 mm loss) and 97% (1 mm bone loss) and 99% when assessing pulpal stress.