Nitroreductase-activatable photosensitizers for selective antimicrobial photodynamic therapy

Antimicrobial photodynamic therapy (aPDT) utilizes light, oxygen and a photosensitizer (PS) to enact cell death via the production of reactive oxygen species (ROS). This mechanism of cell death, via oxidative stress, has allowed aPDT to be effective against antibiotic-resistant bacterial strains, with the development of resistance being minimal as no specific pathway is targeted. While promising, as ambient light can activate PSs, damage to mammalian tissues can occur, leading to drug-induced photosensitivity. To mitigate this, we developed a nitroreductase-activatable PS containing a quenching group that inhibits fluorescence and ROS. Upon reaction with nitroreductase, the quenching group can be liberated, restoring fluorescence and ROS production. As nitroreductase is not present in healthy mammalian tissues but expressed in many bacteria, photosensitivity of mammalian cells can be reduced. Herein, the synthesis and photophysical characterization of the nitroreductase-activatable PS, DB2, is described. DB2 was quenched compared to the free PS, DB1, and activation both in vitro by purified nitroreductase and in the gram-positive bacterial strain, Bacillus subtilis, was confirmed by fluorescence recovery. Cell viability studies in B. subtilis showed low dark toxicity and an IC50 of 0.16 μM under 10-minute irradiation (530 nm, 42 mW cm-2). Minimal toxicity was observed under the same conditions in mammalian cell cultures demonstrating the potential of DB2 to mitigate photosensitivity and provide a promising approach for aPDT.

Effectiveness and Methodologies of Virtual Reality Dental Simulators for Veneer Tooth Preparation Training: Randomized Controlled Trial

Background

Virtual reality (VR) simulators are increasingly used in dental education, offering advantages such as repeatable practice and immediate feedback. However, evidence comparing their efficacy to traditional phantom heads for veneer preparation training remains limited.

Objective

This study aimed to compare the effectiveness of 2 widely used VR simulators (Unidental and Simodont) against traditional phantom heads for veneer tooth preparation training and evaluate the impact of training sequence (simulator-first vs phantom-head-first) on skill acquisition.

Methods

A randomized controlled trial was conducted with 80 fourth-year dental students from Peking University School of Stomatology. Participants were stratified by gender and academic performance, then equally allocated to 8 groups. Groups 1-3 trained exclusively using Unidental, Simodont, or phantom heads, respectively, while groups 4-8 followed hybrid sequences combining simulator and phantom-head training. Each participant performed veneer preparations on a maxillary central incisor. Preparations were evaluated by a blinded instructor using a validated 100-point rubric assessing marginal integrity (30%), preparation depth (25%), proximal contour (25%), and surface smoothness (20%). Posttraining questionnaires (100-point scale) compared user perceptions of simulator realism, haptic feedback, and educational value.

Results

There were no statistically significant differences in the preparation quality among groups using different training methods (Unidental: 88.9, SD 3.6; Simodont: 88.6, SD 1.6; phantom heads: 89.4, SD 2.8; P=.81) or different training methodologies (simulator-first vs phantom-head-first) (simulator first: P=.18; phantom head first: P=.09, different sequences of Unidental: P=.16; different sequences of Simodont: P=.11). However, significant differences were observed between the evaluations of the 2 simulators in terms of realism of the odontoscope's reflection (Simodont: 55.6, SD 33.7; Unidental: 87.5, SD 13.9; P<.001), force feedback (Simodont: 66.2, SD 22.4; Unidental: 50.8, SD 18.9; P=.007), and simulation of the tooth preparation process (Simodont: 64.4, SD 16.0; Unidental: 50.6, SD 16.6; P=.003). Evaluation results showed no statistical differences between the 2 simulators in display effect (Simodont: 77.43, SD 21.58; Unidental: 71.68, SD 20.70; P=.24), synchronism of virtual and actual dental instruments (Simodont: 67.86, SD 19.31; Unidental: 59.29, SD 20.10; P=.11), and dental bur operation simulation (Simodont: 63.32, SD 19.99; Unidental: 55.79, SD 19.62; P=.16). The Unidental simulator was rated better than the Simodont simulator in terms of the realism of odontoscope's reflection. In all other aspects, Simodont was superior to Unidental. There was no significant difference in the students' attitudes towards the 2 simulators (improve skills: P=.19; inspire to learn: P=.29; will to use: P=.40; suitable for training: P=.39).

Conclusions

The study found no significant differences in training outcomes between VR simulators and traditional phantom heads for veneer preparation, suggesting that VR technology may serve as a viable alternative or supplementary tool in dental education. However, the absence of significant differences does not imply equivalence, as formal equivalence testing was not performed. Future studies should incorporate equivalence testing and explore cost-effectiveness, long-term skill retention, and adaptability to complex clinical scenarios.

Biochemical and histopathological evaluation of rapid maxillary expansion in experimentally induced sinusitis: A controlled animal study

BACKGROUND

Rapid maxillary expansion (RME) is a commonly used orthopedic method in orthodontics that may influence upper airway physiology. However, its effects on inflammation in sinusitis have not been clearly identified. This study aimed to evaluate the impact of RME on experimentally induced sinusitis in rats using biochemical and histopathological markers.

OBJECTIVES

To investigate the effects of RME on inflammatory cytokine levels (neopterin, IFN-γ, IL-6, TNF-α) and histopathological changes in rats with sinusitis. The secondary objective was to analyze histological changes in the sinus epithelium.

METHODS

Thirty-two male rats were divided into four groups (Control, Sinusitis, RME, RME+Sinusitis). Sinusitis was induced using Staphylococcus aureus. RME was performed using a helical spring appliance applying 120 g force for 5 days, followed by a 10-day retention period. Serum cytokines were analyzed by ELISA. Histopathological evaluation was conducted on hematoxylin-eosin stained sections. One-way ANOVA and Tukey post hoc tests were used (P < 0.05).

RESULTS

RME significantly reduced neopterin, IL-6, and TNF-α levels in rats with sinusitis. Histopathological analysis showed decreased PMNL infiltration, fibroblast activity, and epithelial damage in the RME+Sinusitis group compared to the Sinusitis group.

CONCLUSIONS

RME application reduced inflammation and tissue damage in rats with induced sinusitis, suggesting a potential therapeutic role in upper airway inflammatory conditions.

Fluoride Release from Pediatric Dental Restorative Materials: A Laboratory Investigation

Objectives: Dental caries remains a prevalent issue in pediatric dentistry, necessitating restorative materials that not only repair decay but also provide protective benefits. Fluoride-releasing restorative materials have a key function in preventing recurrent caries by inhibiting bacterial activity and promoting remineralization. The objective of this study was to examine fluoride release from three pediatric dental restorative materials-Riva Light Cure HV, Fuji IX GP Fast, and the Cention Forte Filling Material-under different pH and temperature conditions. Methods: Specimens (10 mm diameter and 2 mm thickness; n = 3 for each material) were prepared according to the manufacturers' instructions; immersed in buffer solutions at pH 4.8, 6.8, and 8.8; and stored at 37 °C and 44 °C. Fluoride release was quantified using ion chromatography at three time points (1 day, 7 days, and 28 days). Results: The data revealed that fluoride release was significantly influenced by pH, temperature, and time (p < 0.05). Riva Light Cure HV exhibited the highest release, particularly in acidic conditions (pH 4.8), reaching 40.14 mg/L at 44 °C after 28 days. The Cention Forte Filling Material and Fuji IX GP Fast also showed increased release over time, but with lower cumulative concentrations. Higher temperatures generally enhanced fluoride diffusion across all materials. Conclusions: These findings emphasize the pivotal impact of environmental factors in fluoride release dynamics. Riva Light Cure HV demonstrated superior fluoride release, particularly in acidic environments, suggesting its potential for high-caries-risk pediatric patients. These insights can inform the selection of restorative materials in pediatric dentistry, optimizing caries prevention strategies.

Open Mouth Posture Syndrome (OMPS): Classification

Objectives: This narrative review aims to redefine Open Mouth Posture Syndrome (OMPS) as a multifactorial condition with overlapping symptoms and a cyclical pathophysiology. A novel classification system for OMPS subtypes is proposed to standardize research approaches and enhance clinical understanding. Methods: An interdisciplinary literature review was conducted, focusing on structural, functional, and adaptive mechanisms underlying OMPS. Subtype definitions were refined based on recent findings. Results: OMPS is categorized into five subtypes: Obstructive, Habitual, Anatomical, Sleep-Disordered Breathing, and Tongue-Related Pathologies. These subtypes share interconnected etiologies and manifestations, contributing to a feedback loop that complicates diagnosis and management. Conclusions: This classification system lays the foundation for future research and clinical protocols, emphasizing the need for a systematic approach to understanding OMPS.

Management of trismus after radiation therapy

PURPOSE OF REVIEW

The purpose of this review is to summarize the current management of radiation-induced trismus. It will provide an overview of radiation-induced trismus' pathophysiology, assessment, diagnosis, and treatment, along with directions for future research.

RECENT FINDINGS

Despite advances in radiation technology, the proximity of head and neck tumours to the masticatory muscles prevents shielding of these critical structures, increasing the risk of trismus. Trismus has been treated using various techniques including stretching and strengthening exercises in the rehabilitation setting that have resulted in improvements in mouth opening, however, the exercise approach in both research and clinical practice rarely accommodates an individual's goals and priorities. The effect of prophylactic trismus exercises during radiation can be challenging to measure, likely due to exercise adherence with the onset of treatment related toxicities. There is limited support from the literature as to its preventive efficacy. Recent papers provide direction for trismus exercises and devices which may offer greater capacity to individualize treatment and optimize both functional and quality of life outcomes.

SUMMARY

The incidence of radiation induced trismus is anticipated to rise along with that of head and neck cancers globally. Trismus carries significant functional and quality of life implications with known limitations and opportunities for optimizing its management.

Validity and Reliability of the Dental Neglect Scale in German

Background/Objectives: The Dental Neglect Scale (DNS) is known and used to evaluate and assess adult behaviors and attitudes related to oral self-care and oral-health. In English-speaking countries, the DNS has been used in many studies. At the moment, there is no validated version of the DNS that is available in the German language. The aim of this study is to validate a German version of the DNS to evaluate and assess the oral health and behavior among the German population. Methods: The study population consisted of N = 311 German adults (180 female, 130 male, 1 diverse) aged from 18 to 90 years from a dental clinic in Germany. The participants answered a questionnaire. In addition to questions on their socio-demographic background and the DNS, the survey included more standardized instruments relating to preventive behavior, dental anxiety, and oral health. Results: The DNS was translated into German. An explanatory factor analysis was conducted, which supported the unifactorial structure of the scale. The following results were obtained for the reliability of the resulting DNS: Cronbach's Alpha = 0.710, McDonald's Omega = 0.711, and Mean = 25.63 (SD = 4.02, Range 12-30). Convergent and divergent validity were demonstrated through associations between the DNS and various oral health scales, and by differences between genders and age groups. Conclusions: This study confirms the quality of the criteria of the DNS for German adults. The DNS is a convincing instrument that is used for epidemiological studies in the field of dentistry and psychology. Further validation with other samples should be conducted.

Diagnostic accuracy of non-invasive SARS-CoV-2 screening tests: a national prospective analysis

BACKGROUND

Providing non-invasive, accurate and affordable SARS-CoV-2 tests represents a public health priority, to better control the spread of the virus while protecting healthcare workers. Saliva is a robust alternative to nasopharyngeal (NP) swabs, but there is heterogeneity in collection and pre-analytical methods.

METHODS

Relying on a national COVID-19 Public Health Programme, we prospectively recruited 3,488 symptomatic and asymptomatic adults attending the Monaco community centre for NP RT-PCR testing from February 2021-2023. Saliva was concomitantly obtained with either a buccal swab or an oral sponge (OS) and analysed by an RT-PCR assay and a fully automated electrochemiluminescence enzyme immunoassay (ECLIA) rapid antigen test (RAT).

RESULTS

The sensitivity of the buccal RT-PCR varied according to previous SARS-CoV-2 infection, vaccination, and the presence of symptoms, while it remained around 95% for the OS RT-PCR. The specificity of the buccal RT-PCR approached 100% and was around 95% for the OS-RT PCR. The RAT sensitivity was 66.9% and 69.1% compared to NP and OS RT-PCR assays and increased to 71% and 97% in case of a high viral load (Ct < 25), respectively.

CONCLUSIONS

RT-PCR assay using OS saliva showed high accuracy in symptomatic and non-symptomatic adults, including the identification of negative nasopharyngeal swabs. This method allows self-collection without any prior conditions for the patient nor laboratory pre-analytical steps. The ECLIA RAT offers high throughput but is only useful in individuals with high viral loads. Our findings encompassed the latest SARS-CoV-2 omicron subvariants, such as BA.4&5 and the XBB series.

TRIAL REGISTRATION

Registry: ClinicalTrials.gov.

REGISTRATION NUMBER

NCT05074745. Registration date: 12-10-2021.

Enhancing Ergonomics in Paediatric Dentistry: A Longitudinal Study on the Role of Photography in Undergraduate Student Training

PURPOSE

Dental surgeons are particularly exposed to musculoskeletal disorders. Ergonomics can help prevent them. Third-party ergonomic assessment is beneficial in the short term. However, self-assessment of one's working posture is even more valuable, as it fosters lifelong awareness.

METHODS

Fifth year odontology students were randomly assigned to one of two groups (control and training) to evaluate whether a protocol for ergonomic self-assessment by paediatric odontology students, using photography, led to an improvement in their working position. The Modified-Dental Operator Posture Assessment Instrument was used.

RESULTS

The study included 82 fifth-year odontology students who performed paediatric care between September 2022 and June 2023. A statistically significant difference was found between the control and training groups for both self-assessments (p < 0.001) and evaluator analyses (p < 0.001).

CONCLUSIONS

The longitudinal follow-up approach appears to be unique in the field of ergonomics education in dentistry. The results demonstrated a significant reduction in ergonomics scores for the group that received ergonomic advice and visual feedback compared to the control group. This improvement was confirmed both by evaluator-assigned scores and by students' self-assessments.

Complications of cartilage and bone grafting to the head and neck

PURPOSE OF REVIEW

With the exception of blood, bone and cartilage grafts are the most common form of transplanted tissue in the world. Many graft materials are available to utilise in head and neck reconstruction with an array of oncologic, traumatic, congenital and cosmetic applications. Accordingly, it is imperative to understand the complications associated with these grafts, especially in relation to specific materials available.

RECENT FINDINGS

Infection, warping, resorption and donor site morbidity are the most commonly reported complications in the literature. In relation to cartilage grafts, autologous costal cartilage is the preferred material owing to low immunogenicity and ease of harvest. However, with the disadvantage of donor site morbidity, more recent literature has shown comparable complication rates with allogenic fresh frozen and irradiated costal cartilage. Alloplastic grafts have been associated with concern for a higher risk of complications, although there is a lack of high-quality studies to demonstrate this risk. Bone is subject to similar complications with the exception of graft warping. However, bone grafts are typically used to treat more significant and sizeable defects, which can engender more severe complications.

SUMMARY

Complications regarding grafting of cartilaginous and bony material to the head and neck continue to evolve in the literature. Advances in graft material, including the advent of bio-engineered tissue, remain a developing area with auspicious prospects.

Evaluating the penetration, interfacial adaptation, and push-out bond strength of four bioceramic-based root canal sealers

BACKGROUND

This study evaluated the penetration, interfacial adaptation, and push-out bond strength of four bioceramic-based root canal sealers (iRoot SP, Well-Root ST, C-Root SP, and KP-Root SP).

METHODS

A total of ninety mandibular first premolar teeth were used in this study, with eighty teeth randomly divided into eight groups (n = 10). Four groups were designated for sealer penetration analysis, using each of the four sealers mentioned above mixed with 0.1% rhodamine B and applied using the single-cone technique. Horizontal root sections were prepared at 2 mm (apical), 5 mm (middle), and 8 mm (coronal) from the root apex, resulting in a total of 120 slices. Penetration was evaluated using confocal laser scanning microscopy. The other four groups were used for marginal adaptation analysis, with the same sealers applied without rhodamine B, and adaptation was assessed using scanning electron microscopy on sections prepared at the same depths. The remaining ten teeth were used to evaluate push-out bond strength, with 30 dental slices prepared from the middle third, each drilled with four 1 mm diameter holes and randomly filled with one of the four sealers; bond strength was measured using a universal testing machine.

RESULTS

There was no statistically significant difference in the depth and circumference of dentin tubule penetration between different materials (P > 0.05). However, the coronal third was significantly higher than the apical third (P < 0.001). For iRoot SP, the percentage of dentin tubule penetration circumference at the middle third was significantly higher than that at the apical third (P < 0.05). Additionally, Well-Root ST demonstrated superior adaptability for interfacial adaptation than C-Root SP at all the sites (P < 0.05). However, the adaptability of iRoot SP was superior to C-Root SP at the coronal and middle thirds (P < 0.05). Moreover, the push-out bond strength conformed to the following order: Well-Root ST > iRoot SP > KP-Root SP > C-Root SP, with notable variations (P < 0.05).

CONCLUSION

The Well-Root ST sealer demonstrated the best interface adaptation and push-out bonding strength, as well as iRoot SP showed better permeability.

Enhancing Intraoral Scanning Accuracy: From the Influencing Factors to a Procedural Guideline

Background/Objectives: Intraoral scanning, a fast-evolving technology, is increasingly integrated into actual dental workflows due to its numerous advantages. Despite its growing adoption, challenges related to the accuracy of digital impressions remain. The existing literature identifies most of the factors influencing intraoral scanning accuracy (defined by precision and trueness), but it is fragmented and lacks a unified synthesis. In response to this gap, the present study aims to consolidate and structure the current evidence on the determinant factors and, based on these findings, to develop a clinically applicable procedural guideline for dental practitioners. Methods: A comprehensive literature review identified 43 distinct factors influencing intraoral scanning. Results: These factors encompass variables such as software versions and updates, implant characteristics (e.g., position, angulation, scan body design), materials, environmental conditions (e.g., lighting), and procedural elements including scanning strategy, pattern, aids, and operator experience. Subsequently, these identified factors were systematically classified into five distinct groups based on inherent similarities and relevance within the scanning workflow: IOS-characteristics and maintenance, intraoral morphology, materials, ambient conditions, and scanning strategy. To translate these findings into a practical framework, a four-step protocol was developed, designed for straightforward application by researchers and clinicians. Conclusions: This protocol-comprising: (1) Maintenance, (2) Evaluation, (3) Establishment and Execution of Scanning Strategy, and (4) Verification-aims to guide users effectively through the intraoral scanning process, mitigate common clinical challenges, and ensure broad applicability across diverse scanner systems, irrespective of the manufacturer or model.

Advances in biomaterials and regenerative medicine for diabetic foot ulcer therapy

Diabetic foot ulcer (DFU), a severe complication of diabetes mellitus, presents significant clinical challenges due to its rapid deterioration and high morbidity rates. While conventional therapies exist kinds of limitations, their clinical utility is frequently constrained. Recent advancements in biomedical engineering have introduced innovative therapeutic modalities, particularly nanomaterials and hydrogels. However, emerging technologies face translational barriers including immature manufacturing processes leading to elevated costs, and insufficient long-term safety data due to limited clinical validation periods. Current clinical studies remain constrained by small cohort sizes and preliminary-stage investigations. The purpose of this study was to review traditional primary treatment and simultaneously combine clinical data to increase the speed of innovative safety, cost, and effectiveness indicator testing.

The relationship between vertical malocclusions and ossification changes in the cranial base and upper cervical spine

The growth and development of the maxillofacial complex share a common embryological origin with the cranial base and upper cervical spine; therefore, anomalies in these regions may be linked to variations in the skeletal pattern. This study aimed to evaluate the relationships between the morphological features of the sella turcica bridging, ponticulus posticus, posterior arch deficiency of the first cervical vertebra, known as the atlas, and the cervical vertebral maturation stages and vertical malocclusions. Randomly selected 300 pre-orthodontic treatment patients (aged 7 to 40 years) were divided into groups according to cervical stage (CS1-CS6) and type of vertical malocclusion. According to the study protocol, cephalometric analysis and evaluation of the sella turcica and atlas were performed twice by two researchers under the supervision of a radiologist. Statistical analysis was performed using SPSS 29.0. Sella turcica bridging was significantly more common in postpubertal patients (58.2%; p < 0.05). Ponticulus posticus and sella turcica bridging occurred more frequently in patients with low mandibular plane angle (43.3% and 51.1%, respectively), whereas atlas posterior arch deficiency occurred more frequently in patients with high mandibular plane angle (24.2%). However, only atlas posterior arch deficiency showed significant difference (p < 0.05). According to logistic regression, patients in the CS6 stage were less likely to have type 1 ponticulus posticus and more likely to have type 2 sella turcica bridging (p < 0.05). Patients with low angle were less likely to have atlas posterior arch deficiency (p < 0.05). Sella turcica bridging and atlas posterior arch deficiency are associated with the skeletal pattern and cervical stage. Sella turcica bridging was more prevalent during the postpubertal period, whereas atlas posterior arch deficiency was more prevalent in those with a high mandibular plane angle.

Dysregulated autophagy in periodontal ligament stem cells of individuals with type 2 diabetes mellitus and periodontitis

This study aimed to investigate autophagy and its associated mechanisms in periodontal ligament stem cells (PDLSCs) within the inflammatory microenvironment of type 2 diabetes mellitus (T2DM) and periodontitis. Periodontal ligament tissues were obtained from healthy individuals, individuals with T2DM, individuals with chronic periodontitis, and individuals with both T2DM and periodontitis. PDLSCs were isolated, cultured, and treated with the autophagy inhibitor 3-methyladenine (3-MA) and the autophagy activator rapamycin (Rapa). Cell proliferative capacity was evaluated, autophagic activity and organelle damage were assessed using transmission electron microscopy, and the relative expression levels of autophagy-related genes (Beclin-1, LC3 II, P62) were measured using real-time quantitative PCR. Compared to PDLSCs derived from healthy individuals, those from individuals with chronic periodontitis or T2DM exhibited no significant morphological differences but demonstrated reduced proliferative capacity. Treatment with 3-MA and Rapa did not significantly alter proliferative capacity across groups. PDLSCs from individuals with chronic periodontitis and T2DM displayed increased autophagosome formation, more severe organelle damage, and upregulated expression of autophagy-related genes Beclin-1 and LC3 II, while P62 expression was downregulated, compared to PDLSCs from healthy individuals. PDLSCs from individuals with T2DM and periodontitis exhibit excessive autophagy and organelle damage. Autophagy dysregulation in PDLSCs within a diabetic and inflammatory microenvironment may contribute to the severity of periodontal destruction observed in individuals with T2DM.

Effectiveness of calcium hydroxide compared to hydraulic calcium silicate cements for direct pulp capping in managing deep caries in vital permanent teeth: A systematic review and meta-analysis

BACKGROUND

Direct pulp capping (DPC) is the least minimal approach for maintaining pulp vitality after pulp exposure. Besides calcium hydroxide (CaOH), hydraulic calcium silicate cements (HCSC) have increasingly been used for DPC.

OBJECTIVES

During the S3 level guideline development for material choice in DPC, we conducted a systematic review and meta-analysis of existing literature comparing CaOH and HCSC for DPC on permanent teeth. We aimed (1) to assess clinical and radiographic outcomes and (2) patient-reported outcomes of DPC.

METHOD

Three databases from 1 January 1990 to 19 February 2025 (MEDLINE via PubMed, EMBASE and Cochrane Database of Systematic Reviews). Prospective comparative clinical studies comparing CaOH to HCSC for DPC in permanent teeth with healthy or reversibly inflamed pulps were included. Studies on primary teeth or teeth indicative of irreversible pulpitis, teeth with unclear diagnoses or pulp exposure of non-cariogenic origin were excluded. The risk of bias and certainty of evidence were evaluated using the GRADE approach. Using the effect sizes and standard errors for every study, pairwise meta-analysis was performed comparing CaOH and different subgroups of HCSC. Success was defined as the absence of any clinical symptoms (e.g. pain, swelling) and any radiographical signs of an apical lesion. Patient-reported outcomes were additionally sought after.

RESULTS

Five randomized-controlled trials including 552 teeth with an overall moderate certainty of evidence were included. HCSC showed a significantly higher probability of success compared to CaOH (Odds Ratio (OR): 2.68, 95% confidence interval [1.7, 4.22], I2 = 0%). The differences between various HCSC materials were minimal. Meta-regression indicated that neither follow-up nor risk of bias significantly influenced treatment outcomes, and the funnel plot did not reveal evidence of publication bias.

CONCLUSION

HCSC showed significantly higher probability for clinical and radiographic success than CaOH. This finding comes with moderate certainty. The impact of material choice on postoperative pain remains unclear. Future clinical studies should include patient-reported outcomes.

Tegafur-Uracil Maintenance Therapy in Non-Metastatic Head and Neck Cancer: An Exploratory Systematic Review

BACKGROUND

Tegafur-uracil (UFT), an oral fluoropyrimidine developed in Asia, has been investigated as a maintenance or adjuvant therapy in various malignancies. Its use in head and neck cancers, however, remains limited to small retrospective studies, primarily from East Asia. Given the need for cost-effective maintenance strategies in resource-limited settings, we conducted an exploratory systematic review to evaluate the clinical utility of UFT in non-metastatic head and neck squamous cell carcinoma (HNSCC) and nasopharyngeal carcinoma (NPC).

METHODS

We systematically searched PubMed, EMBASE, and Cochrane Library from inception through 1 May 2025 for retrospective cohort studies evaluating UFT after definitive therapy in non-metastatic HNSCC or NPC. Study selection followed PRISMA guidelines. Given the heterogeneity of included studies, we performed a structured narrative synthesis using the SWiM (Synthesis Without Meta-analysis) framework to summarize survival outcomes, treatment settings, and clinical contexts.

RESULTS

Seven retrospective studies (four HNSCC, three NPC) involving 508 patients were included. UFT was generally administered at 300-400 mg/day for 6-12 months. Across studies, UFT use was associated with favorable disease-free and overall survival trends in high-risk subgroups, including patients with extranodal extension and persistent EBV DNA. Treatment adherence and toxicity profiles were acceptable.

CONCLUSIONS

While the evidence remains limited and heterogeneous, this review highlights recurring signals of benefit associated with UFT maintenance therapy in selected high-risk patients. Prospective trials are warranted to confirm these findings and better define a possible role of UFT in maintenance therapy in some advanced non-metastatic HNSCC and NPC.

Comparison of the effectiveness of different ırrigation activation methods on biofilm removal in lateral canals - an ın vitro study

OBJECTIVES

Activation of sodium hypochlorite (NaOCl) to remove biofilm from lateral canal is important for the success of endodontic treatment. This study aimed to compare the biofilm dissolving capacity of different irrigation techniques in resin blocks with two lateral canals manufactured with 3D printers.  Materials and methods: Biofilm-mimicking hydrogel was placed in the upper and lower lateral canals of 75 resin blocks. Main canals of the blocks were irrigated with 5% NaOCl. Then, the blocks were randomly divided into five groups: sonic activation (SA), passive ultrasonic irrigation (PUI), intracanal heating (ICH), self-adjusting file (SAF) and control. The amount of hydrogel removed was measured by weighing the blocks before and after the treatment and further visually scored. Data were analyzed using Kruskall Wallis H, Wilcoxon, Tukey Post-hoc HSD (Honestly Significant Difference) and one-way ANOVA tests.

RESULTS

The SAF group showed the highest hydrogel scores compared to other groups (p < 0.05). The hydrogel dissolution capacity of the SA group was lower compared to SAF, PUI and ICH techniques (p < 0.05). Based on visual scoring, SAF group was superior to other activation methods (p < 0.05) which are similar to each other (p > 0.05) in both upper and lower lateral canals.  Conclusion: All activation methods were superior than the control group. The SAF system demonstrated superior hydrogel dissolving ability, while SA, PUI, and ICH groups showed similar effectiveness.

High-performance ratiometric fluorescent probe for rapid, visual and ultrasensitive monitoring/bioimaging of hypochlorite in real-life samples and living systems

Hypochlorite (ClO-) is a highly reactive chemical extensively used in households, public areas, and various industries due to its multiple functions of disinfection, bleaching, and sterilization. However, overuse of ClO- may contaminate the water, soil, air and food, leading to negative impacts on the environments, ecosystems and food safety. Meanwhile, excessive ClO- in human body can also cause severe damage to the immune system. Thus, the development of effective and precise detection tools for ClO- is of great significance to better understand its complicated roles in environments and biosystems. Herein, a new high-performance ratiometric fluorescent probe 2-amino-3-((10-propyl-10H-phenothiazin-3-yl)methylene)-amino)maleonitrile (PD) was developed for effective detection of ClO- in various bio/environmental and food samples. Probe PD exhibits highly-specific "ratiometric" fluorescent response to ClO- with rapid response (< 1 min), excellent sensitivity (detection limit, 47.4 nM), wide applicable pH range (4 -12), and excellent versatility in practical applications. In practical applications, PD enables the sensitive and quantitative detection of ClO- levels in various water samples, bio-fluids, dairy products, fruits and vegetables with high-precision (recoveries, 97.00 -104.40 %), as well as the successful application for visual tracking ClO- in fresh fruits and vegetables. Furthermore, test strips containing PD offer a visual and convenient tool for quick identification of ClO- in aqueous media by the naked eye. Importantly, the good biocompatibility of PD enables its practical applications in real-time bioimaging of endogenous/exogenous ClO- levels in living cells, bacteria, onion cells, Arabidopsis, as well as zebrafish. This study provided an effective method for visual monitoring and bioimaging of ClO- levels in various environments, foods and living biosystems.

Concentrated growth factor with guided tissue regeneration for shallow infrabony defects: A one-year prospective study

BACKGROUND

This study evaluated the efficacy of concentrated growth factor (CGF) sticky bone combined with guided tissue regeneration (GTR) in treating shallow infrabony defects and explored factors influencing clinical outcomes.

METHODS

Thirteen patients with 31 shallow defects (≤3 mm) were treated using CGF sticky bone (CGF + deproteinized bovine bone mineral), covered with a collagen membrane and CGF membrane. Probing depth (PD), clinical attachment level (CAL), and gingival recession (REC) were examined at baseline and 1 year post surgery. The distance between the base of the defect and the cementoenamel junction (BD-CEJ) were measured on periapical radiographs. Gingival volume and thickness were assessed with digital intraoral scans. Linear regression identified factors influencing CAL gain, PD reduction, and bone gain (ΔBD-CEJ).

RESULTS

One year post surgery, CAL increased by 2.48 ± 1.72 mm (p < 0.001), PD reduced by 2.90 ± 1.40 mm (p < 0.001), and bone gain was 2.46 ± 1.71 mm (p < 0.001). REC remained stable (p = 0.254), and the volume and thickness of gingival contour showed no significant changes (p = 0.751 and p = 0.915, respectively). Greater baseline attachment loss was associated with higher CAL gain (coefficient 0.436, p = 0.001). Deeper preoperative PD predicted greater PD reduction (coefficient 0.573, p = 0.029). Greater bone gain was correlated with lower baseline bone height (coefficient 0.305, p = 0.018).

CONCLUSIONS

CGF sticky bone combined with GTR demonstrates benefits in CAL gain, PD reduction, and bone gain while preventing REC and gingival contour collapse in the treatment of shallow infrabony defects with residual pockets after initial therapy.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300069617).

PLAIN LANGUAGE SUMMARY

This study explored a novel approach to treating shallow bone defects around teeth using a combination of concentrated growth factor (CGF) sticky bone and guided tissue regeneration (GTR). The treatment involved using a specially prepared bone graft material (CGF sticky bone) along with a collagen membrane and a CGF membrane. The researchers tracked the changes in gum and bone health in 13 patients with 31 shallow defects over 1 year. The results showed significant improvements: Gum attachment levels increased by an average of 2.48 mm, gum pockets reduced by 2.90 mm, and bone growth averaged 2.46 mm. Notably, gum recession and gingival contour remained stable, meaning the treatment did not compromise the appearance of the gums. The study also found that patients with worse gum or bone loss at the start of the treatment tended to experience the greatest improvements. These findings suggest that CGF sticky bone combined with GTR is a promising option for restoring shallow bone defects, particularly in cases where traditional therapy has left residual gum pockets.

A Randomized Controlled Study on the Treatment of Isolated Interdental Intrabony Defects Using the Modified Minimally Invasive Surgical Technique With or Without a Collagen-Enriched Bovine-Derived Xenograft: A 2-Year Analysis

AIM

This study aimed to evaluate the efficacy of the modified minimally invasive surgical technique (M-MIST) combined with a collagen-enriched bovine-derived xenograft (CEBDX) for the treatment of isolated interdental intrabony defects.

MATERIALS AND METHODS

This is a randomized controlled trial including 40 isolated interdental intrabony defects in 40 patients. The test group received M-MIST and CEBDX, and the control group received M-MIST alone. Re-evaluations were performed 1 and 2 years after surgery, with probing depth (PD) and clinical attachment level (CAL) measured at the buccal/labial and lingual/palatal sides of the defects as at baseline. Periapical radiographs and CBCT were also performed to evaluate the radiographic bone changes of the defects.

RESULTS

Thirty-eight defects were evaluated at the 1- and 2-year follow-ups, and both groups showed statistically significant improvements in PD, CAL and radiographic bone volume. The test group exhibited increased PD reduction (3.95 ± 1.39 mm vs. 2.95 ± 1.51 mm, p = 0.041) and CAL gain (3.58 vs. 2.53 mm on average, p = 0.043) at the buccal side of the defects. No difference was found at the lingual side. A significantly greater radiographic bone volume gain (17.77 ± 11.44 mm3 vs. 8.63 ± 7.10 mm3, p = 0.011) was found in the test group at the 2-year follow-up.

CONCLUSIONS

M-MIST was effective both alone and with CEBDX. The addition of CEBDX significantly improved radiographic bone volume gain and PD reduction, and CAL gain at the buccal side of the defects.

Exploring dental students' attitudes and perceptions toward artificial intelligence in dentistry in Iran

INTRODUCTION

AI has the potential to enhance diagnostics, optimize treatment planning, and improve patient care. However, concerns remain regarding professional autonomy, ethical considerations, and the need for adequate training. This research aims to address the gap in understanding how Iranian dental students perceive AI in their future practice.

METHODOLOGY

A cross-sectional study was conducted among 235 dental students from different academic years who were selected through stratified sampling. A validated questionnaire with a high Cronbach's alpha coefficient (0.90) was used to assess students' attitudes toward AI. Data were analyzed via descriptive statistics, with a chi-square test examining associations between demographic factors and AI perceptions.

RESULTS

Overall, 80.4% agreed that AI would significantly advance dentistry, particularly in diagnostic applications such as radiographic analysis (75.7%) and periodontal disease detection (78.7%). However, skepticism persisted regarding AI replacing human professionals, with nearly 50% disagreeing that AI could replace dentists and with only 31.1% viewing AI as a definitive diagnostic tool. The attitudes varied by demographic factors, with female students favoring AI inclusion in education and male students exhibiting greater confidence in the diagnostic capabilities of AI. Compared with general dentistry students, specialized students were more confident in AI-assisted implant planning.

CONCLUSION

Dental students hold a generally positive view of AI's role in dentistry while maintaining caution about its limitations. Integrating AI into dental curricula is essential for addressing knowledge gaps and preparing students for AI-enhanced practice. Future research should balance technological advancements with ethical considerations to ensure that AI effectively contributes to improved dental education and patient care.

CLINICAL TRIAL NUMBER

Not applicable.

Enhancing the Physical Properties of Calcium Silicate Cement Modified with Elastin-like Polypeptides and Bioactive Glass

Conventional calcium silicate cement (CSC) formulations often exhibit insufficient mechanical strength and low initial stability. This study aimed to develop an organic-inorganic hybrid biomaterial by incorporating an elastin-like polypeptide (ELP) (V125E8) and bioactive glass (BG) (63S) into CSC to improve its mechanical properties and wash-out resistance during the initial setting. Experimental groups included ProRoot MTA (Dentsply Sirona, USA) as a control (0BG), inorganic hybrids containing BG (2% or 5%; 2BG, 5BG), and organic-inorganic hybrids combining BG (2% or 5%; 2BG-L, 5BG-L) with a 10 wt% ELP solution. The compressive strength, microhardness, and wash-out resistance of the specimens were evaluated. The organic-inorganic hybrid groups (2BG-L and 5BG-L) exhibited significantly higher compressive strength and microhardness than the control (0BG) and inorganic-only groups (2BG and 5BG). Additionally, the incorporation of ELP markedly improved wash-out resistance, minimizing material disintegration during the initial setting in aqueous environments. The organic-inorganic hybrid groups (2BG-L and 5BG-L) exhibited significantly higher compressive strength and microhardness than the control (0BG) and inorganic-only groups (2BG and 5BG). Additionally, the incorporation of ELP markedly improved wash-out resistance, minimizing material disintegration during the initial setting in aqueous environments.

Vacuum Ultraviolet (VUV)-Induced Physicochemical Engineering of Titanium: Enhanced Fibroblast Activity, Redox System, and Glycosaminoglycan Binding for Soft Tissue Integration

Bacterial invasion at the titanium-tissue interface causes peri-implant inflammation, posing challenges for implants in orthopedics, maxillofacial prosthetics, and dentistry. This study hypothesized that titanium surface decarbonization improves soft tissue cell adhesion and growth. One-minute vacuum ultraviolet (VUV) light treatment at 172 nm reduced surface carbon from 60% to 29% without altering surface topography, making surfaces hydrophilic and hydro-attractive. Human fibroblasts attached to VUV-treated surfaces 2-4 times more frequently than untreated surfaces, with an even greater increase on tilted and curved surfaces. Fibroblast proliferation rose 2-6 times, with an expedited G1-to-S phase transition. Cell retention under dislodging forces increased 2-5 times on VUV-treated surfaces. RNA sequencing showed upregulation of extracellular matrix production, growth factors, cell cycle progression, antioxidant defenses, and proteoglycan/glycosaminoglycan (GAG)-binding, alongside downregulation of the inflammatory response on VUV-treated titanium surfaces. An oxidative stress test showed minimal adverse effects from hydrogen peroxide on cells on VUV-treated surfaces, attributed to increased intracellular glutathione reserves. Enhanced adhesion on VUV-treated titanium was negated by treating the cells with GAG-cleaving enzymes. These findings demonstrate that VUV-mediated decarbonization enhances fibroblast attachment, proliferation, and adhesion by fostering homeostatic cellular phenotypes involving proteoglycan/GAG interactions and antioxidant defense, offering a strategy to improve the soft tissue sealing around titanium implants.

Risk of dental caries and periodontal disease among older adults and elderly persons with diabetes in India: a population-based cross-sectional study

BACKGROUND

Oral health is a key indicator of overall well-being, and diabetes, a complex metabolic disorder, often leads to related oral health problems. Given the high prevalence of diabetes among Indian older adults and elderly persons, this study examines the diabetes associated risk of dental caries and periodontal disease among them.

METHODS

This cross-sectional study analysed data from 65,562 adults aged 45 and above, based on the 2017-18 Longitudinal Ageing Study in India (LASI) Wave-1 survey. We used bivariate cross-tabulation to estimate the prevalence, chi-square analysis to examine the prevalence differentials and multivariate logistic regression to estimate the adjusted odds ratio (AOR).

RESULTS

Bivariate analysis shows that diabetic older adults demonstrate a slightly higher prevalence of dental caries (20.43%) compared to those without diabetes (18.62%), but there is no significant difference in periodontal disease between the two groups. The regression analysis confirms that diabetes significantly increases the risk of both dental caries (AOR: 1.18, p < 0.001) and periodontal disease (AOR: 1.10, p = 0.008). Additionally, females and urban residents are at a higher risk of dental caries, while rural residents face a greater risk of periodontal disease. Socioeconomic factors, such as lower education and higher wealth, play a key role in caries and periodontal problems.

CONCLUSION

Effective management of diabetes-associated oral health problems in India requires a comprehensive, population-specific approach due to the country's diverse demographic and socioeconomic landscape. Tailored interventions focusing on diabetes care, education, and access to oral health services are essential, particularly for high-risk groups like older adults, women, rural residents, and those with lower education or socioeconomic status.

Advances in the Fabrication of Polycaprolactone-Based Composite Scaffolds for Bone Tissue Engineering: From Chemical Composition to Scaffold Architecture

Thermoplastic polymer-based materials, which feature essential biological properties and opportunities to implement the cutting-edge additive manufacturing technologies aimed at obtaining high-precision 3D models, have attracted intense interest for porous and bioresorbable bone tissue implants development. Among the wide range of materials, polycaprolactone was found to provide a balance between the biodegradation rate and biocompatibility with various tissues. Recent advances in the fabrication of polymer-polymer and polymer-inorganic composites have opened new ways to improve biological and mechanical outcomes and expanded the range of applications for bone and cartilage restoration, including the development of conductive composites for electrostimulation. While the chemical composition of the manufactured scaffolds played a vital role in their general biological performance and biocompatibility with bone tissue, the micropattern and roughness of the surface were shown to be additional stimuli for stem cell differentiation. More challenges came from the fabrication technique suitable for the proposed scaffold design. Here we summarize the key challenges and advances in fabrication and approaches to the optimization of certain chemical, morphological, or geometrical parameters of polycaprolactone-based scaffolds for bone tissue engineering applications.

Microstructural and Elemental Characterization of Calcium Silicate-Based Sealers

Calcium silicate-based sealers (CSBS) vary in chemical composition, which can influence treatment outcomes. Therefore, the study aimed at comparing several commercially available CSBS regarding microstructure and elemental characterization. Four CSBS (AH Plus Bioceramic Sealer, BioRoot RCS, BioRoot Flow, TotalFill BC Sealer) and a control resin-based sealer (AH Plus) were evaluated using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and X-ray powder diffraction analysis (XRD). The specimens were analyzed after setting (SEM, EDX, XRD), as well as after 7 (SEM) and 28 days (SEM, EDX) of incubation in Hank's balanced salt solution. AH Plus exhibited a uniform matrix and small amounts of calcium (Ca), significantly decreasing after incubation. In contrast, CSBSs exhibited crystalline forms on the surface and increased Ca content, significantly increasing after 28 days of incubation. The main crystalline phase for all tested CSBS was zirconium oxide, while for ERBS it was calcium tungstate. In conclusion, the amount of calcium increased on the surface of CSBSs after incubation, which alkalinized the pH, promoting mineralization, apatite formation, and antibacterial potential. Despite this, the formation of a hydroxyapatite layer was not demonstrated, possibly due to the high dissolution potential of CSBSs.

Scar-associated macrophages and biliary epithelial cells interaction exacerbates hepatic fibrosis in biliary atresia

BACKGROUND

Biliary atresia (BA) is a severe pediatric biliary disorder characterized by the progressive obstruction of liver bile ducts. In the absence of treatment, fibrosis advances rapidly in most affected children. Despite the identification of various factors contributing to fibrosis progression, comprehensive investigations into the microenvironmental alterations within the liver are still scarce.

METHODS

Single-cell RNA sequencing (scRNA-seq) was conducted on two normal tissues adjacent to liver tumors, two choledochal cyst liver tissues, and four BA liver tissues. This analysis, combined with spatial localization data, elucidated the heterogeneity of the livers affected by BA. Ultimately, a diagnostic model for BA was developed, leveraging high-resolution fibrosis-related gene signatures.

RESULTS

We identified scar-associated macrophages (SAMs) originating from monocytes, which played a pivotal role in fibrosis progression and may be implicated in the epithelial-mesenchymal transition (EMT) of biliary epithelial cells (BECs). Furthermore, the hub genes CD96, EVL, S100A6, and S100A11 were found to be upregulated in SAMs and regulatory T cells (Tregs), aiding in the diagnosis of BA.

CONCLUSION

SAMs and BECs not only exhibited a pro-fibrotic phenotype but also co-localized within fibrotic regions. Their interaction may facilitate the activation of EMT, highlighting a potential therapeutic target for BA treatment.

IMPACT

Analysis of the immune landscape: Through single-cell and spatial transcriptomic techniques, the paper reveals the complex immune landscape associated with BA fibrosis. Exploration of new therapeutic targets: This paper reveals that SAMs can promote the progression of liver fibrosis by regulating the EMT conversion of BECs, opening up a new therapeutic approach. Application of diagnostic markers: The paper identifies biomarkers that may improve early diagnostic accuracy and postoperative prognosis and recommends their incorporation into clinical practice.

A practice and exploration of blended learning in medical morphology during the post-COVID-19 pandemic era

BACKGROUND

Since 2021, the prevention and control of the coronavirus disease 2019 epidemic has been normalized. However, considering the high density of students and the potential for epidemic relapse, our medical morphological teaching team established a novel blended learning mode with mainly offline teaching in the general sections and blend learning in systematic sections. Specifically, this study sought to improve the teaching quality of the two courses of "Histology and Embryology" and "Pathology", and lay a solid foundation for clinical medical undergraduates to learn medical courses well in the future.

METHODS

In the Spring 2021 semester, two classes from the Class of 2019 and two classes from the Class of 2020 were randomly selected as the intervention groups, to carry out blended learning of "Histology and Embryology", and "Pathology", respectively. Meanwhile, four parallel classes were randomly selected as control groups to carry out completely traditional offline teaching. The blended learning was based on outcome-based education concepts and used small private online courses from the "Xuexi Tong" (Century Superstar Information Technology Development Co., Ltd., Beijing) platform. In the theory class, case-based learning following a self-designed P-C-P-E-S-E (Pre-class-Case-Problem-Expansion-Summary-Expansion) teaching sequence was implemented. In the experimental class, a virtual digital platform with flipped classroom learning was integrated.

RESULTS

Both teaching satisfaction and students' scores were found to be significantly greater in the intervention group than in the control group. Furthermore, the intervention group also effectively surpassed the control group in terms of students' comprehensive abilities such as drawing, scientific research, participating in competitions, forensic case analysis, and so on.

CONCLUSION

Our novel blended learning approach strengthened the communication between teachers and students, obviously improved students' self-directed learning abilities, and finally achieved the purpose of improving the comprehensive abilities of students. This mode is suited for the post-epidemic era and future variable environments. It also has substantial promotional instructive modeling value.

CLINICAL TRIAL REGISTRATION

Not applicable.

The Role of Digital Technologies in Personalized Craniomaxillofacial Surgical Procedures

Craniomaxillofacial (CMF) surgery addresses complex challenges, balancing aesthetic and functional restoration. Digital technologies, including advanced imaging, virtual surgical planning, computer-aided design, and 3D printing, have revolutionized this field. These tools improve accuracy and optimize processes across all surgical phases, from diagnosis to postoperative evaluation. CMF's unique demands are met through patient-specific solutions that optimize outcomes. Emerging technologies like artificial intelligence, extended reality, robotics, and bioprinting promise to overcome limitations, driving the future of personalized, technology-driven CMF care.

Tartaric acid-branched polyethyleneimine carbon dots promote repair of bone defect via osteogenic differentiation

Treating bone defects is a critical challenge in regenerative medicine. Carbon nanomaterials, with their unique physicochemical properties, offer significant potential for enhancing bone regeneration. In this study, we developed tartaric acid (TA)-based carbon dots (CDs) by synthesizing TA with branched polyethyleneimine (bPEI). These TA-bPEI CDs were systematically evaluated to determine their effects on osteogenic differentiation in human bone marrow-derived mesenchymal stem cells (BMSCs) and their capacity to repair calvarial defects in an in vivo model. Characterization of TA-bPEI CDs revealed a size of approximately 10 nm and a positive surface charge. The CDs exhibited fluorescence emission peaks between 464 and 506 nm under excitation wavelengths of 340-440 nm. Cytotoxicity assays demonstrated that TA-bPEI CDs maintained BMSC viability at concentrations up to 250 μg/ml. However, at concentrations of 500 μg/ml and above, apoptosis was induced. Treatment with TA-bPEI significantly enhanced osteogenic differentiation in vitro, as evidenced by increased expression of osteogenic-specific proteins such as Runx2, ALP, OCN and OPN. In vivo, the application of TA-bPEI CDs in a mouse calvarial defect model promoted robust new bone formation, reduced defect gaps, and improved bone morphometric parameters, including bone volume fraction and trabecular thickness. These results suggest that TA-bPEI CDs enhance osteogenesis by directly stimulating osteogenic differentiation and upregulating osteogenesis-specific genes. This study demonstrates the high potential of TA-bPEI CDs as a novel nanomaterial for bone regeneration applications.

Botulinum Toxin for Bruxism: An Overview

This overview aimed at assessing botulinum toxin type A (BoNT-A)'s effectiveness in managing bruxism compared to a placebo, the absence of treatment, or other interventions in adults. Only systematic reviews (SRs), with or without a meta-analysis, were included. A comprehensive literature search was conducted on 16 June 2024, encompassing seven databases and grey literature sources. Experts and reference lists of the included SRs were also consulted. Study selection was conducted in two phases by two independent authors. Methodological quality was evaluated using AMSTAR-2. Overlap was assessed using the corrected covered area. The 14 included SRs addressed several outcomes. In most studies, BoNT-A showed effectiveness in reducing pain (n = 10), the frequency of bruxism events (n = 7), and the maximum bite force (n = 5). None of the SRs effectively evaluated BoNT-A's impact on functional movements. All of the included SRs scored "critically low" and "low" confidence rates in AMSTAR-2. Only one SR attempted to assess the certainty of the evidence, although unsuccessfully. The overlap across included SRs was rated as "high", with a corrected covered area of 10.11%. The current systematic reviews on BoNT-A for bruxism lack methodological quality, limiting the reliability of their findings. Despite evidence indicating a potential reduction in pain, bruxism events, and the maximum bite force, methodological limitations prevent definitive conclusions from being drawn. High-quality research with standardized methodologies is essential to establish BoNT-A's efficacy and support evidence-based clinical practice.

Systematic review and meta analysis of first and second generation bioceramic materials in primary dentition pulpotomies

Calcium silicate-based materials are considered the gold standard in vital pulp therapy due to their ability to induce favorable repair responses. Mineral trioxide aggregate (MTA), a first-generation bioceramic cement, has demonstrated high clinical and radiographic success rates but is associated with disadvantages such as coronal discoloration, difficult handling, and long setting time. To address these issues, second-generation bioceramic cements were developed with improved chemical composition, radiopacifiers, and handling properties. This systematic review followed the PRISMA guidelines and included a comprehensive search of PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS, and TRIP databases from 2011 up to August 2023. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. Meta-analysis was performed using a random-effects model to compare the clinical and radiographic success rates of first- and second-generation bioceramics in pulpotomies of primary teeth, with heterogeneity assessed using the I2 statistic. A total of 14 studies were included, involving 1128 primary molars from 637 children. The meta-analysis revealed no statistically significant differences in clinical or radiographic success rates between first- and second-generation bioceramics across follow-up periods of up to 24 months. Both first- and second-generation bioceramics demonstrate comparable clinical and radiographic success in pulpotomies of primary teeth. The choice of material should be guided by clinical considerations and practitioner preference, as no significant differences in outcomes were observed.

Assessment of Novel Boron-doped Mesoporous Bioactive Glass Nanoparticles Loaded Alginate Hydrogel in Dogs

INTRODUCTION

Dentin regeneration is pivotal to preserve tooth vitality. This study aims to evaluate, histologically, the dentine regenerative potential of a novel injectable boron-doped, mesoporous, bioactive glass nanoparticle (BMBGNPs) loaded alginate hydrogel in dogs METHODS: The formulation and optimisation of the novel alginate/BMBG NPs (20 wt. %) loaded composite hydrogel were performed. Next, 66 teeth of 3 dogs were allocated into 3 groups (each including 22 teeth) according to post-operative follow-up period: group I: 2 weeks, group II: 4 weeks, and group III: 8 weeks. Each group was further subdivided according to pulpotomy filling material into two subgroups, with subgroup 1 (alginate/BMBGNPs (20 wt. %) loaded hydrogel) and subgroup 2 mineral trioxide aggregate (MTA). Pulp chambers were mechanically exposed through class V cavities. A complete pulpotomy was executed. The tested materials were positioned on the radicular pulp and finally covered with resin composite restorations. One dog was sacrificed after 2, 4, and 8 weeks. Teeth were prepared for histological evaluation assessing inflammatory cell response, pulp tissue organisation, and dentin bridge formation. The Mann-Whitney U test was employed to evaluate the scores of histological parameters between tested materials (P ≤ .05).

RESULTS

Alginate/BMBG NPs (20 wt. %) loaded hydrogel showed normal pulp configuration at 2 and 4 weeks, which was enhanced after 8 weeks (P ≤ .05). Moderate inflammatory reaction was noted at 2 weeks, which was improved after 4 and 8 weeks (P ≤ .05). MTA group demonstrated less favourable pulpal response and inflammatory reaction with a statistically significant difference across all observational periods (P ≤ .05). After 8 weeks all teeth in group 1 exhibited the thickest dentin bridge (P ≤ .05).

CONCLUSIONS

Alginate/BMBG NPs (20 wt. %) loaded hydrogel offers the promise of regenerating dentin and maintaining pulp vitality reaching the desired level as an alternative to MTA.

CLINICAL RELEVANCE

Alginate/BMBG NP loaded hydrogel is an alternative, reliable option for vital pulp therapy.

Estimation of patient safety culture in private and public hospitals using machine learning methods

BackgroundPatient safety is a critical component of health care systems. Large groups of patients, as a result of medical errors, are at risk of harm. OBJECTIVE: This study evaluated the patient safety culture (PSC) between different work groups in both public and private hospitals, using machine learning approaches.MethodsThe HSOPSC questionnaire was used for evaluating safety culture, and the artificial neural network (ANN), random forest (RF) and linear regression (LR) algorithms were used for data modeling. Orange Data Mining version 3 and SPSS software were used for analysis.ResultsThe overall PSC score in public and private hospitals was 41.99 and 40.96, respectively. According to the results, the examined hospitals have a weak PSC. The safety culture level was correlated with education level, work experience, gender, income, and organizational position of the workers. The ANN showed that the issues mostly effecting PSC, in order of priority, include the feedback and communication about errors, organizational learning and continuous improvement, and management support for patient safety. Also, based on the findings LR model showed better performance for PSC prediction than RF model.ConclusionsThe healthcare experts and policymakers can improve PSC in hospitals through training and allocation of resources. Considering the importance of PSC in preventing accidents and reducing injuries, the results of the present study and the presented models can be used to predict PSC in hospitals.

Effect of screw access hole or vent hole opening strategies on the adhesive filling rate of oral implant cement-retained posterior crowns

PURPOSE

This study investigated the adhesive filling rate (AFR) of implant prostheses on the abutment shoulder and axial surfaces under various hole opening strategies,and examined the correlation between hole openings and permanent adhesive retention strength.

METHODS

Implant crowns were divided into five groups: No hole (NH); Occlusal regular hole (ORH: 2.5 mm); Occlusal mini-hole (OMH: 1 mm); Lateral upper mini-hole (LUMH: 1 mm); and Lateral down mini-hole (LDMH: 1 mm). In the AFR experiment, abutments and prostheses were connected with two-color silicone rubber; the coverage of rubber at the inner surface of the prostheses was photographed. Images were analyzed by ImageJ software. In the adhesive retention strength experiment, prostheses and abutments were bonded using permanent resin cement; retention strength was measured using a universal testing machine. Data were analyzed using one-way analysis of variance (ANOVA) or Welch's ANOVA, followed by Tukey's honestly significant difference test.

RESULTS

Abutment shoulder AFRs were OMH (98.70 ± 0.42%), LDMH (98.40 ± 1.30%), LUMH (97.92 ± 1.33%), NH (93.99 ± 5.45%), and ORH (86.11 ± 4.90%). One-way ANOVA revealed significant difference among groups (p < 0.001). Axial AFRs were LUMH (99.2 ± 0.47%), ORH (98.3 ± 0.8%), OMH (98.1 ± 0.5%), LDMH (97.9 ± 1.06%), and NH (96.4 ± 4.5%),Welch's ANOVA indicated no significant difference between groups (p = 0.054). In the retention strength experiment, OMH had the highest retention force (369.58 ± 27.27 N), whereas ORH had the lowest (272.81 ± 41.43 N), showing significant differences (p = 0.002).

CONCLUSIONS

Implant screw access hole or vent hole opening strategies affected AFR of implant cement-retained posterior crowns. Larger holes or no openings decreased AFR at the abutment shoulder, whereas axial AFR was less affected. Hole openings variations on implant cement-retained posterior crowns might also influence their retention strength.

Functionalized 3D-printed scaffolds for enhanced osteogenesis and guided bone regeneration

In this study, we introduced an innovative approach to guided bone regeneration (GBR) that effectively addresses the challenges of treating large bone defects. Our pioneering 3D-printed multifunctional scaffolds uniquely integrate polycaprolactone (PCL), chitosan (Cs), L-arginine (L-Arg), and β-tricalcium phosphate (β-TCP), leveraging the synergistic effects of these materials to enhance immunomodulation, bioactivity, and mechanical integrity. These PCL/Cs-L-Arg/βTCP scaffolds exhibit remarkable mechanical properties (Young's modulus ∼32.84 ± 4.11 MPa) and maintain structural integrity for 60 days under physiological conditions when fabricated through extrusion-based 3D printing. A key feature of this composite is the dual role of L-Arg, which not only supports osteogenesis but also acts as a potent immunomodulator. The scaffolds facilitate the sustained release of L-arginine over 21 days, fostering a pro-regenerative environment that promotes significant immunomodulatory effects, including a decrease in pro-inflammatory cytokines (IL-6, TNF-α) and an enhancement of anti-inflammatory and osteogenic growth factors (BMP-2, TGF-β) in macrophages. This cytokine profile shift suggests a transition from a pro-inflammatory M1 phenotype to an anti-inflammatory M2 phenotype. A progressive increase in alkaline phosphatase activity, nearly double that of PCL/Cs scaffolds by day 21, reflects enhanced osteogenic differentiation. Additionally, the scaffolds demonstrate exceptional bioactivity, with over 83% and 93% reductions in calcium and phosphorus ions, respectively, in simulated body fluid over 28 days, as evidenced by Alizarin red staining. This integrated approach signifies a major breakthrough in biomaterial design for GBR, presenting transformative potential for treating bone defects in dental and orthopedic applications, and marking a significant leap forward in the field of bone regeneration.

Immediate Loading of Implants-Supported Fixed Partial Prostheses in Posterior Regions: A Systematic Review

Background: Modern dentistry strives to achieve increasingly less invasive procedures as the ultimate therapeutic goal. The careful selection of suitable candidates for immediate dental implants can offer an opportunity to reduce treatment time, lower the relative costs and improve overall patient satisfaction. Methods: A systematic search was conducted in March 2025, without any time restrictions, in Medline, Pubmed and Web of Science databases. To identify other related references, further research was performed. Articles related to current knowledge about the immediate loading of dental implants supporting fixed partial prosthesis in the posterior region were included. Articles not available in abstract form and articles not published in the English language were excluded. Results: A total of ten studies were eligible for inclusion in the current study. The search strategy resulted in a survival rate ranging from 86% to 100%, and a failure rate of less than 21.6%, with a mean follow-up of 55.6 months. Statistical analysis revealed no significant differences in survival rates between implants placed in the maxilla and mandible (χ2 = 0.42, p = 0.81, df = 2). Follow-up varied from one to ten years, reflecting variability both in study design and duration. Conclusions: The selected studies highlight the heterogeneity in immediate loading protocols for implant-supported fixed partial prosthesis in the posterior regions, emphasizing the variability in prosthetic materials and implant types, suggesting that immediate loading is a reliable, patient-centered therapeutic option with favorable long-term outcomes.

Jaw Bone Density in Chronic Areca Nut Chewers and Nonchewers Using Digital Panoramic Radiography Indices as a Screening Tool for Osteoporosis: Protocol for a Comparative Evaluation

BACKGROUND

Jaw bone density can be altered due to various factors including aging, bone pathologies, hormonal levels, medications affecting bone density, and undue stress posed by parafunctional and adverse habits. Of these factors, chronic areca nut chewing, which creates a heavy load on jaw bones, is a commonly encountered adverse habit in patients. Digital panoramic radiography (OPG) indices are an easy and cost-effective method to evaluate jaw bone density. Index values can also be used as a screening tool for osteoporosis.

OBJECTIVE

This study aims to compare and evaluate jaw bone density in chronic areca nut chewers and nonchewers using OPG indices as a screening tool for osteoporosis.

METHODS

Patients aged 20 years to 40 years reporting to the Department of Oral Medicine and Radiology with and without a history of chronic areca nut chewing will be recruited. OPG will be collected for all recruited patients. The mandibular cortical index, panoramic mandibular index, gonial index, antegonial index, antegoinal notch depth, and mental index will be calculated.

RESULTS

The values of these indices will be used to assess and compare osteoporosis in chronic areca nut chewers and nonchewers. Data will be entered and displayed in a tabular format, and correlations between osteoporosis and OPG index values will be determined. The study did not receive any external funding. Recruitment is expected to begin in summer 2025, and publication of the results is expected to occur in late 2026.

CONCLUSIONS

Evaluation of jaw bone density in chronic areca nut chewers using OPG indices might prove to be a feasible and cost-effective technique for assessing osteoporotic bone changes. Although the gold standard modality is dual x-ray absorptiometry, its cost and availability create challenges for use in the general population. As osteoporosis of jaw bones does not usually present with symptoms, patients can be made aware of it using the findings from this evaluation. Hence, it will ultimately aid in early detection and prompt interventions, thereby halting disease progress.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/72041.

Bond preservation in caries-affected dentin restored with acrylamide-based adhesives

OBJECTIVES

Multi-acrylamides have been shown to enhance the bond stability of the adhesive interface in sound dentin (SD). This study aimed to evaluate the performance of triacrylamides as primers for improving bonding efficacy in caries-affected dentin (CAD).

MATERIALS AND METHODS

Caries was induced in dentin using a 5-day microcosm biofilm model, and demineralization was characterized by ATR/FTIR spectroscopy. Primers were formulated with glycerol dimethacrylate (50 %) combined with secondary (TAAEA) or tertiary (TMAAEA) triacrylamides, HEMA (control), or dopamine methacrylamide (Dopa) with HEMA or TMAAEA, in a solvent mixture (ethanol/water, 70/30, 40 vol%). CAD and SD were treated with a three-step etch-and-rinse adhesive, restored with resin composite, and sectioned (1 mm²) for microtensile bond strength (μTBS, n = 6) testing after 24 h and six months of water storage at 37 °C. Collagen degradation (hydroxyproline assay, n = 5), in situ zymography (n = 2), and monomer viscosity (n = 3) were also evaluated. Data were analyzed using ANOVA and Tukey's post hoc test (α=0.05).

RESULTS

In SD, all acrylamides and the control exhibited stable or increased μTBS after six months (>50 MPa). For CAD, bond strengths were comparable to SD, except for HEMA, which consistently showed lower μTBS (<40 MPa). CAD demonstrated reduced mineral content, elevated hydroxyproline release, and greater collagen degradation (p < 0.001). Acrylamides indirectly protected collagen by mitigating enzymatic activity and exhibited higher viscosity than HEMA.

SIGNIFICANCE

Multi-acrylamides effectively preserve the structural integrity of collagen and sustain bond strength in both sound and caries-affected dentin, contributing to the longevity and performance of adhesive restorations.

Comparison of different auxiliary techniques used during root canal filling removal in terms of the amount of apically extruded debris: In vitro study

BACKGROUND

One of the main challenges in endodontic retreatment is managing apical debris extrusion, which can influence both healing and patient comfort. Different retreatment methods result in varying levels of extrusion. This study aims to quantitatively compare the extent of apical debris extrusion caused by different auxiliary techniques during the extraction of root canal fillings in mandibular molars, to help guide the selection of an optimal endodontic approach.

MATERIALS AND METHODS

Sixty mandibular molar teeth scheduled for extraction due to periodontal reasons, such as advanced bone loss and periodontal disease, which rendered them non-restorable, were collected. All extractions were performed with prior informed consent from the patients, ensuring adherence to ethical standards. Preparation was performed with the Protaper Next file system, focusing on X3 files according to the manufacturer's guidelines. Teeth were filled using the lateral compaction technique with AH Plus sealer and stored at 100% humidity at 37°C for two weeks for the sealant to set. The samples were divided into four groups (n = 15 each): Protaper Universal Retreatment (PTUR), Ultrasonic + PTUR, Orange Oil + PTUR, and System B + PTUR, with PTUR procedural steps followed to attain working length. During preparation, 15 ml of distilled water was used, followed by 1 ml of distilled water for debris collection post-procedure. The debris was incubated at 68°C for five days to evaporate the water, and tube weights were recorded and compared statistically across groups.

RESULTS

The study assessed debris extrusion during endodontic retreatment. The PTUR group showed the least extrusion (average 1.1 mg, SD ± 1.05 mg), indicating a more controlled approach. The Ultrasonic + PTUR group exhibited higher extrusion (average 4.2 mg, SD ± 2.12 mg), reflecting a more invasive technique with a greater potential for debris extrusion. The Orange Oil + PTUR group displayed moderate extrusion levels (average 2.5 mg SD ± 1.46 mg), reflecting the solvent's effect. The System B + PTUR group had the highest extrusion (average 4.3 mg, SD ± 1.87 mg), indicating it as the method associated with the greatest debris displacement. Statistically significant differences were found between the PTUR group and the other groups (P < 0.05). Additionally, a significant difference was observed between the Orange Oil + PTUR group and both the Ultrasonic + PTUR and System B + PTUR groups (P < 0.05). No significant difference was noted between the System B + PTUR and Ultrasonic + PTUR groups (P > 0.05).

CONCLUSION

The study concludes that auxiliary methods used during root canal filling removal significantly impact the degree of apical debris extrusion, with some methods leading to greater extrusion than others.

Sinus Wall Changes in a Patient With Chronic Rhinosinusitis

A 64-year-old woman with an extensive medical history was referred for continued management of long-standing chronic rhinosinusitis without nasal polyps. What is your diagnosis?

Haematologic Data Improves Long-Term Prediction Accuracy of Artificial Intelligence Models for Temporomandibular Disorders

OBJECTIVES

This study aimed to develop and evaluate an artificial intelligence (AI) model to predict long-term treatment outcomes in temporomandibular disorder (TMD) patients using clinical data and verify the value of adding haematologic data in enhancing predictive accuracy.

METHODS

The medical records of 132 TMD patients who visited the clinic and underwent 6 months of non-invasive conservative treatment between 2013 and 2019 were included in this study. The clinical data and haematologic features were collected from medical records. A decision tree algorithm was employed for feature selection, followed by a deep neural network (DNN) to build the prediction model. The performance of the models based on the decision tree algorithm and DNN was evaluated.

RESULTS

The decision tree model achieved an accuracy of 90.6% and an F1-score of 0.800. The subjective pain-related features, along with haematologic markers associated with systemic inflammation, were proven to be important features in the decision tree model. The predictive performance of the DNN model improved as haematologic features were added, with the final model achieving an accuracy of 90.6% and an F1-score of 0.769.

CONCLUSIONS

This study showed the potential of machine learning models in predicting long-term TMD prognosis using clinical and haematological features. In addition, these findings highlight the importance of including both subjective pain assessments and systemic haematologic markers for the development of aetiology-based diagnostic systems for TMD to enhance clinical decision-making and prognosis prediction accuracy.

Impacts of an Oral Appliance on Snoring in Adults with Varying Degrees of Snoring Severity: A Preliminary Study

Background and Objectives: Oral appliances (OAs) are commonly used to manage sleep-disordered breathing conditions, including primary snoring, and offer an alternative treatment for individuals with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP) therapy. Our study analyzed the possible factors associated with higher snoring rates compared with those associated with lower snoring rates. Materials and Methods: A customized dental brace with a tongue compressor was the essential part of the Lin OA (LOA). The compressor is available in various lengths, ranging from 0.5 to 3.0 cm across different versions. The participants wore the LOA throughout the night while sleeping. Their snoring rates were recorded using the SnoreClock app on their cell phones. Results: The analysis included 36 participants, comprising 30 males and 6 females. The participants had a mean age of 44.91 ± 9.96 years, a mean BMI of 26.18 ± 3.50 kg/m2, and an average recording duration of 398.27 ± 77.56 min per session. In total, 4052 sleep recordings were analyzed. The number of files for females was less than that for males (563 vs. 3489). In this study, individuals belonging to the highest one-third based on the baseline snoring rate (H group) experienced a significant reduction in snoring, approximately 84.8%, when using the LOA-3 cm device equipped with a 3 cm tongue compressor. The individuals who belonged to the lower two-thirds based on the baseline snoring rate were classified as the L group. Among male participants, snoring decreased by approximately 66.4%. Similarly, among female participants in the L group, snoring decreased by approximately 69.3% when using the LOA-3 cm. Conclusions: In this study, we observed a significant reduction in snoring for the two groups of participants wearing the LOA-3 cm, with the rate decrements ranging from 66.4% to 84.8%. This reduction was more pronounced in the H group than in the male participants in the L group. Further studies are needed to explore the reasons for these findings.

Access to dental services for children: a scoping review on the impact of COVID-19 and implications for future models of care

BACKGROUND

The COVID-19 pandemic had detrimental effects on routine health and social care as countries instituted widespread public health measures to control transmission of SARS-CoV-2. This affected care delivery for many chronic and non-communicable diseases, including oral health and dental diseases with implications in the postpandemic period.

OBJECTIVES

This scoping review, conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review guidelines, aims to synthesise evidence regarding the impact of COVID-19 on access to dental services among children and their implications for future models of care, especially for children from low-income families, to inform policy decision making around subsidised dental services in Australia.

DATA SOURCES

PubMed, Web of Science, Embase, Cochrane Library of Systematic Reviews and Cochrane Central Register of Controlled Trials.

ELIGIBILITY CRITERIA

Primary studies of any design published between 1 January 2020 and 31 July 2024. Included studies described provision of paediatric dental services, considered components of access or utilisation and were published in English. Excluded studies were those that only evaluated maxillofacial services.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a standardised template in MS Excel then analysed to thematically classify findings based on key areas of impact. Quality assessment of studies was not conducted.

RESULTS

54 articles from 17 countries were included. Studies identified reductions in service availability and utilisation, including patient and parent-driven demand. Changes to the configuration of services included greater rates of emergency treatment, reductions in use of aerosol-generating procedures and more use of teledentistry, as well as self-management and prevention approaches. Substantial delays to routine dental care, leading to more dental problems and ongoing need, especially untreated dental caries, were observed with a disproportionate impact on socioeconomically disadvantaged and vulnerable children and families.

CONCLUSION

The COVID-19 pandemic has had pronounced negative effects on the provision of primary and secondary dental care for children around the world. Access to care was affected by disruptions to service availability and by changes in demand for services related to parental anxiety around the risk of COVID-19 transmission. Delays in receipt of routine dental care and changes to oral health behaviours are likely to lead to an increased need for oral health services, with service adaptations needed to ensure this increased demand can be met.

Evaluating the feasibility of conventional and digital impressions of full-arch by the absolute linear deviation method: an in vitro study

BACKGROUND

Intraoral scanners (IOS) facilitate dental treatment, but the efficacy in full-arch scanning remains controversial. The aim of this study was to compare arch deformations between conventional impressions (CIs) and digital impressions (DIs) across six distinct spans in the maxillary and mandibular models, using the absolute linear deviation method.

METHODS

Standard maxillary and mandibular models, each with seven cylindrical landmarks added, were used as the reference. CIs and DIs as test scans (n = 15 each) were performed on the models using silicone impression material and three IOSs: CS3600, Trios3, and Trios5. The trueness of the distances and angles between the remaining cylinders and initial scanning cylinder were evaluated. Data were analyzed using the Kruskal-Wallis and One-way ANOVA tests, with the Bonferroni test for post hoc analysis (α = 0.05).

RESULTS

Deviations of DIs increased gradually from smaller spans to full-arch spans, while deviations of CIs remained stable. Within a 5-tooth-units, DIs provided superior trueness compared to CIs (P < 0.05), except for ΔL8, where the results from four impression methods were comparable (P = 0.28). For other measurements, CIs exhibited significantly better trueness than three IOSs (P < 0.05).

CONCLUSIONS

The current accuracy of IOSs was insufficient for full-arch applications, but suitable for short scan ranges (fixed prostheses within a 5-unit span).

Clinical and radiographic outcome of a bioceramic sealer compared to a resin-based sealer: a retrospective study

Effective sealing of root canal systems is paramount in achieving favorable and enduring prognosis of root canal treatments (RCTs). Root canal sealers play a pivotal role in sealing the canal system. To date, there is a scarcity of clinical research investigating the implications and long-term performance of bioceramic (BC) sealers. This study aims to compare the treatment outcome of resin-based (RB) and BC root canal sealers. Retrospective data comparing clinical outcomes of 248 endodontically treated teeth was performed utilizing dental records and radiographic assessments. Clinical outcome of the RCTs using both types of sealers were measured by percentages of success rates. Chi square statistical test was used to analyze data at 0.01 and level of significance via SPSS software. Success rate of RCTs was not influenced by patient's age, gender, tooth type and number of visits. There were no significant differences in the success rate amongst treatment types, obturation techniques, quality of restoration and the sealer type. BC and RB sealers revealed comparable clinical and radiographic outcomes with high success rates. The choice between BC and RB sealers should be guided by case-specific factors, including tooth's anatomical considerations, patient's dental health status, obturation techniques and clinician's skills.

Is the presence of accessory mandibular canals associated with the dimensions of the mandibular canal?

AIM

The aim of this study is to classify accessory mandibular canals (AMC) and investigate their association with the dimensions of the mandibular canal (MC) to enhance surgical planning and prevent complications in dental treatments.

METHODS

Cone-beam computed tomography (CBCT) images were evaluated. AMC's frequency, length, and diameter, including dental, superior, inferior, forward-open, forward-closed, and retromolar types, were determined. Additionally, the dimensions of the MC, including its length and diameter, were measured, and the relationship between the AMC and MC was statistically analyzed. Descriptive statistics, chi-square test, independent samples t-test (for normally distributed data), Kruskal-Wallis test (for non-normally distributed data), and Tamhane post hoc test were used for statistical analysis of the data.

RESULTS

AMC was identified in 82 of the 222 hemimandibles examined (36.9%). It was found that the length and diameter of AMCs varied significantly depending on the AMC type (p = 0.000). The diameter of the dental type AMCs (mean 0.40 ± 0.22 mm) was considerably smaller than that of other AMC types (mean 0.86 ± 0.37 mm). The length and diameter of the MC were measured as 69.20 ± 5.10 mm and 2.96 ± 0.57 mm, respectively. While MC length was not found to influence the presence of AMC (p = 0.785), MC diameter was significantly associated with the occurrence of AMC (p = 0.000).

CONCLUSIONS

AMC, which is critical for improving surgical planning and reducing the risk of complications in dental procedures, is not uncommon. Their presence should be carefully evaluated, particularly in cases where the MC has a larger diameter.