Dentistry Journal doi: 10.3390/dj14090590

Authors: Kawther Ali Sasiya Bhumpattarachai Roberto Savignano Mason Possinger Joseph Kan

Background: This pilot clinical study aimed to evaluate the mandibular position at the maximum intercuspal position (MIP) obtained with a virtual interocclusal record using an intraoral scanner across different dental chair backrest inclinations, in order to establish a protocol for future larger studies. Methods: In this single-center pilot study, 10 fully dentate participants underwent maxillary and mandibular full-arch intraoral scans. Virtual interocclusal records at MIP were obtained with an intraoral scanner at three dental chair backrest inclinations (90, 120, and 180 degrees). Conventional vinyl polysiloxane interocclusal records were made at the same inclinations. All scans were printed into physical models and mounted using the conventional records. Digitized casts and intraoral scans were superimposed onto a single common reference, the virtually mounted 90-degree scan, using metrology software. Because all deviations were expressed relative to that reference, the virtual 90-degree condition is zero by construction and was excluded as a data level from inferential models. Separate linear mixed-effects models were fitted for each translation and rotation axis, with participant as a random intercept and recording method, inclination, and their interaction as fixed effects; p values were Holm-adjusted across the six axes. Equivalence was explored with two one-sided tests against margins of ±0.5 mm and ±1.0 degrees; because these margins were specified post hoc, the equivalence analysis is exploratory. Results: Chair inclination did not detectably affect either recording method: no inclination main effect or method × inclination interaction survived multiplicity correction, and virtual records at 120 and 180 degrees differed by no more than 0.05 mm and 0.08 degrees. Recording method did differ. Conventional records were displaced relative to virtual records by 0.27 mm along the Y axis (95% CI 0.19 to 0.34; Holm-adjusted p < 0.001), in the same direction in 9 of 10 participants. The corresponding X-axis offset was 0.23 mm (95% CI 0.06 to 0.40) and did not survive multiplicity correction in the primary analysis (Holm-adjusted p = 0.060). The exploratory equivalence criterion was met, that is, the 90% confidence interval fell entirely within the post hoc equivalence margin, for 11 of 18 method × inclination comparisons, rising to 16 of 18 in the sensitivity analysis. Conclusions: In this pilot sample, no statistically detectable effect of dental chair backrest inclination between 90 and 180 degrees on the recorded mandibular position at MIP was observed for either recording method in healthy, fully dentate individuals; virtual and conventional records met the exploratory post hoc equivalence criterion in most rotational axes but showed a small, systematic translational offset of approximately 0.23 to 0.31 mm, most clearly along the Y axis. These preliminary findings require confirmation in a larger, prospectively powered and randomized equivalence trial with a prospectively defined equivalence margin.

Dentistry Journal doi: 10.3390/dj14090589

Authors: Maria Pia Di Palo Federica Di Spirito Francesco Giordano Giuseppina De Benedetto Elena Gaia Colacurcio Vittoria Ferraro Olimpia Prevete Antonio Di Giulio Marina Garofano Alessia Nunziante Alessia Bramanti

Background/Objectives: Deaf or Hard-of-Hearing (DHH) individuals face significant barriers in accessing healthcare, which may negatively impact oral health outcomes. Despite increasing recognition of these disparities, oral health remains underexplored, and the integration of emerging digital technologies to support accessible dental care is still limited. Therefore, the present comprehensive review aims to provide an overview of the oral health status of DHH individuals and the potential role of emerging digital technologies specifically tailored for the DHH population, considering, when relevant, the heterogeneity of this population based on the subgroup impairments classification. Methods: An electronic search was conducted across PubMed/MEDLINE, Scopus, and Web of Science databases till October 2025. An additional manual search was performed through reference screening of included studies. Results: DHH individuals exhibited poor periodontal health, high caries experience with predominant untreated decayed components, and unmet orthodontic needs. Emerging technologies, including m-health applications, 3D sign language avatars, speech-to-text systems, and virtual reality, may improve oral health literacy, reduce dental anxiety, and enhance patient-provider communication. Conclusions: Disparities in oral health among DHH individuals stem primarily from communicative impairments. Integrating tailored digital solutions into clinical pathways and professional education may offer a viable solution for fostering equitable, patient-centered dental care.

Dentistry Journal doi: 10.3390/dj14090588

Authors: Leopoldo Mauriello Vitolante Pezzella Andrea Blasi Giuseppe Trapanese Elio Ramaglia Vincenzo Iorio-Siciliano Luca Ramaglia

Background/Objectives: Postoperative pain following impacted mandibular third molar extraction is a common complication that negatively affects patients’ quality of life. Photobiomodulation (PBM) therapy has been proposed as a non-pharmacological adjunctive approach to reduce postoperative pain. This study aimed to evaluate the effectiveness of intraoral PBM in reducing postoperative pain after impacted mandibular third molar extraction compared with placebo, sham treatment, or standard postoperative care. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed and Embase were searched through January 2025 for randomized controlled trials (RCTs) investigating intraoral PBM after impacted mandibular third molar extraction. Only studies reporting postoperative pain using the Visual Analog Scale (VAS) were included. Risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Random-effects meta-analyses were performed at 24, 48, and 72 h postoperatively using standardized mean differences (SMDs). Results: Eight RCTs met the inclusion criteria for qualitative synthesis, whereas only two provided extractable data for quantitative analysis. Meta-analysis demonstrated a significant reduction in postoperative pain in the PBM group at 24 h (SMD = −0.64; 95% CI: −0.90 to −0.38; p < 0.001), 48 h (SMD = −0.82; 95% CI: −1.64 to −0.01; p = 0.047), and 72 h (SMD = −1.11; 95% CI: −1.38 to −0.84; p < 0.001). Conclusions: Intraoral PBM appears to reduce postoperative pain during the first 72 h. However, the available evidence is limited by the small number of studies included in the meta-analysis, heterogeneity in PBM protocols, and inconsistent outcome reporting. Additional well-designed RCTs are needed to strengthen the current evidence.

Dentistry Journal doi: 10.3390/dj14090587

Authors: Leyre Millas Javi Vilarrasa Neus Carrió Jose Nart Javier Gil

Objective: Implantoplasty smoothens exposed implant surfaces but disrupts the titanium oxide layer, reducing corrosion resistance, increasing ion release, and facilitating bacterial colonization. Restoring a stable and biologically favorable surface is therefore critical. Chemical agents capable of repassivating titanium may enhance surface integrity and antibacterial performance, yet the optimal agent remains unclear. This study evaluated the repassivation effects of common disinfectants on corrosion resistance, ion release, cytotoxicity, and antibacterial activity. Methods: One hundred twenty-eight discs underwent manual implantoplasty and were treated with citric acid (CA), ethylenediaminetetraace acid (EDTA), hydrogen peroxide (H2O2) or saline (S). Surface topography and wettability were analyzed using white-light interferometry and contact angle measurements. Corrosion behavior was assessed via open-circuit potential monitoring and potentiodynamic polarization in Hank’s solution. Titanium ion release was quantified over 21 days using inductively coupled plasma mass spectrometry. Cytotoxicity was evaluated in human fibroblast and osteoblast cultures exposed to sample extracts. Bacterial adhesion and viability of Streptococcus sanguinis and Pseudomonas aeruginosa were analyzed by scanning electron microscopy and confocal laser scanning microscopy after 24 h and 48 h. Results: H2O2 increased surface roughness, while CA and EDTA showed no effect. All agents enhanced hydrophilicity, with CA and H2O2 producing the greatest increase in surface energy. CA showed the highest corrosion resistance and lowest ion release. No treatment exhibited cytotoxicity, and all reduced bacterial adhesion, with CA and H2O2 showing superior bactericidal activity. Conclusions: CA and H2O2 improved surface properties after implantoplasty, with CA providing the most favorable combination of corrosion resistance, minimal ion release and antibacterial effect.

Dentistry Journal doi: 10.3390/dj14090586

Authors: Kamolporn Wattanasirmkit Karnkanith Hansomwong Trakol Mekayarajjananonth Sunphat Namano Jaijam Suwanwela Taksid Charasseangpaisarn

Background: Proximal contact loss is a major problem in zirconia restorations on implant abutments. This study investigated the effect of surface treatments on the shear bond strength (SBS) between veneering porcelain and translucent zirconia (4Y-PSZ and 5Y-PSZ) compared with conventional zirconia (3Y-TZP). Methods: Forty-four specimens of each zirconia type (10.0 × 7.0 × 1.0 mm) were prepared and randomly assigned to four surface treatment groups: control (C), grinding with 150-grit silicon carbide paper (GR), airborne-particle abrasion with alumina particles (AB), and glazing (GL). Surface roughness (Ra) was measured for one specimen from each treatment group. Veneering porcelain cylinders (2.38 mm in diameter, 0.5 mm in thickness) were fabricated and bonded to the zirconia surfaces. SBS was evaluated using a universal testing machine (n = 10). Data were analyzed using two-way ANOVA and Tukey’s HSD test (α = 0.05). Results: The GL group exhibited the lowest Ra, whereas the AB group showed the highest Ra. Regarding zirconia type, 3Y-TZP demonstrated significantly higher SBS than 5Y-PSZ, while no significant differences were found between 3Y-TZP and 4Y-PSZ or between 4Y-PSZ and 5Y-PSZ. The AB and GL groups showed significantly higher SBS than the C group, whereas the GR group did not differ significantly from the C group. Conclusions: Airborne-particle abrasion and glazing effectively enhanced SBS across the zirconia types evaluated prior to veneering.

Dentistry Journal doi: 10.3390/dj14090585

Authors: Teodora Filipova Stefan Peev Stanislav Mitkov

Purpose: This study investigated the surface morphology and roughness of the dental implant platform and abutment at their junction interface, comparing parameters before and after mechanical assembly (screwing). Methods: The experimental specimens comprised 40 implants from the TBR, Bone Level M System (TBR, France) with a diameter of 4.7 mm and a length of 10 mm, and 40 matching abutments from the same system (Titanium Standard Abutment, TBR, France) with a diameter of 4 mm and a gingival height of 3 mm. All components were fabricated from Grade 4 titanium. The implants and abutments were divided into two equal groups. In the first group (control), 20 implants and 20 abutments remained unassembled. In the second group, 20 implants were coupled with 20 abutments and tightened to the manufacturer-recommended torque. To achieve this, the implants were stabilized with pliers to prevent rotation, and the abutments were screwed using a screwdriver and a torque wrench at 30 N.cm. Subsequently, the abutments were unscrewed counterclockwise. Surface evaluations were conducted using scanning electron microscopy (SEM) and 3D surface modeling. Results: The obtained results demonstrate a statistically significant reduction in the parameters reflecting the roughness of the implant platform. Based on the analysis, a pronounced decrease in the average roughness (Ra, Rq) of the abutment was observed (p < 0.001). Furthermore, it was established that the implant platform exhibits nearly twice the surface roughness of the abutment even in its baseline state. Conclusions: Within the limitations of this in vitro study, a single tightening and removal procedure was associated with measurable changes in the roughness parameters and surface morphology of the implant platform and abutment. These findings indicate microtopographic adaptation at the conical interface under the tested conditions; however, biomechanical reliability and resistance to bacterial micro-leakage were not evaluated.

Dentistry Journal doi: 10.3390/dj14090584

Authors: Shuma Hamaguchi Tatsuya Akitomo Masashi Ogawa Satoru Kusaka Ryota Nomura

Background/Objectives: Toothpastes have recently been developed with purposes ranging from strengthening teeth and restoring periodontal tissue to removing stains and alleviating tooth sensitivity. Although the individual effects of each component are well understood, their interactions with each other remain unclear. Methods: The oral fluoride concentration following the use of dentifrices with different abrasive contents was evaluated in seven healthy adults. In addition, in in vitro apatite pellet experiments, fluoride concentration from the pellets was compared after the use of dentifrices with different abrasive contents. Results: A comparison of fluoride ion concentrations in the oral cavity after using five different types of toothpaste showed that toothpaste without abrasive ingredients retained the highest concentration at all time points from 5 min onward. When the concentration of abrasive ingredients was adjusted in the same toothpaste and compared, the toothpaste with no abrasive (0%) resulted in the highest fluoride concentration compared to all the other toothpastes (10%, 20%, 30%) at 10, 20 and 30 min. The concentration of fluoride released from apatite pellets was also highest in the toothpaste without abrasive ingredients. Conclusions: These results suggest that abrasive ingredients affect the concentration of fluoride in the oral cavity, and the effect may be particularly pronounced in hard tissues such as teeth.

Dentistry Journal doi: 10.3390/dj14090583

Authors: Francesco Saverio Ludovichetti Simone Smania Ernesto Comitale Marco Rossi Gabriel Leonardo Magrin Edoardo Stellini Sergio Mazzoleni

Background: The longevity of composite restorations in primary teeth depends on the preservation of both mechanical performance and surface integrity under daily oral hygiene procedures. While powered toothbrushes have been widely investigated for plaque control, their potential effects on restorative materials in the primary dentition remain insufficiently characterized. This preliminary in vitro study evaluated the influence of manual, oscillating-rotating electric, and sonic toothbrushing on the surface microhardness, surface roughness, and shear resistance of resin composite restorations in primary teeth. Methods: Thirty extracted non-carious primary teeth were standardized, cavity-prepared, and restored using a self-etch adhesive system and a resin composite material. Specimens were randomly assigned to three groups (n = 10) according to brushing modality: manual, electric, or sonic. After a standardized 60 min brushing simulation under controlled conditions, surface microhardness was measured using a Vickers microhardness tester, surface roughness was assessed with contact profilometry, and restoration retention was evaluated as maximum load at failure under shear-type mechanical loading. Surface morphology was further analyzed by scanning electron microscopy. Results: No statistically significant differences were observed among groups in surface microhardness (p = 0.606) or maximum dislodgement load (p = 0.806). In contrast, surface roughness differed significantly according to toothbrush type (p < 0.001), with the highest Ra values recorded in the sonic group. Scanning electron microscopy corroborated these findings, showing progressively greater surface irregularities, porosities, and microdefects from manual to sonic brushing. Under the present in vitro conditions, the sonic toothbrush group showed the highest final surface roughness values, whereas no significant differences were observed in microhardness or restoration retention. Conclusions: Under the present short-term in vitro conditions, the sonic toothbrush group showed higher final surface roughness values than the manual and electric groups, while no significant differences were observed in microhardness or restoration retention. These results are limited to the specific toothbrush systems tested and these findings should be interpreted as preliminary in vitro results from an exploratory sample with limited statistical power.

Dentistry Journal doi: 10.3390/dj14090582

Authors: Franco Mauricio Cesar Mauricio-Vilchez Luzmila Vilchez Mesias Rojas Diego Galarza-Valencia Fran Espinoza-Carhuancho Frank Mayta-Tovalino

Objective: To evaluate surface temperature changes during the setting reaction of six dental gypsums using infrared thermography. Methods: This experimental in vitro study evaluated six dental gypsum materials randomly allocated into six groups: three Type IV materials (Elite Rock, Dürum, and Velmix) and three Type III materials (Elite Model, Pentadur, and Duromix). Specimens were manually mixed for a few minutes using a gypsum spatula and a rubber mixing bowl and subsequently formed in triangular stainless-steel molds with a 2 cm base and 2 cm equal sides. Thermographic evaluation was performed using a Fluke TiS55+ infrared camera. Surface temperature measurements were recorded for each specimen at baseline and at 10 and 25 min. Results: Distinct thermal profiles were observed among the dental gypsum materials. Compared with the baseline, Type IV dental gypsum showed an increase in temperature of 1.05 °C at 10 min (95% confidence interval [CI]: 0.23–1.87; p = 0.012) and 2.46 °C at 25 min (95% CI: 1.64–3.28; p < 0.001). Compared with Elite Rock, the reference material, Dürum and Velmix showed significantly lower temperatures, with differences between −2.94 °C and −2.47 °C, respectively (both p < 0.001). Type III dental gypsum showed an increase in temperature of 6.16 °C at 10 min (95% CI: 5.50–6.82; p < 0.001), followed by an increase of 1.76 °C at 25 min (95% CI: 1.10–2.42; p < 0.001). Conclusions: Type III dental gypsums exhibited marked early increases in temperature, whereas Type IV dental gypsums showed more gradual and material-specific thermal patterns. These findings demonstrate differences in the thermal behavior of the evaluated dental gypsum materials during the setting reaction and support further investigation into the relationship between thermal behavior and other physicochemical properties, including dimensional stability and material performance.

Dentistry Journal doi: 10.3390/dj14090581

Authors: Abdeen Shaker Selim Arici

Background/Objectives: Direct bonding of orthodontic brackets is standard in fixed-appliance therapy, but clinical success depends on achieving reliable bond strength without compromising enamel integrity during debonding. This in vitro study evaluated whether applying a metal primer to stainless-steel bracket bases affects shear bond strength (SBS) to enamel, and whether primer coverage and bracket-base design influence adhesive-remnant distribution and enamel integrity. Methods: A total of 132 extracted human maxillary premolars were randomly allocated to six groups (n = 22 each) defined by bracket base design (mesh or integral) and primer coverage (none, full, or partial central coverage). Brackets were bonded with Transbond XT, and Reliance Metal Primer was applied according to group allocation. After 2000 thermal cycles (5–55 °C), specimens were debonded in shear at 1 mm/min. SBS was calculated, adhesive remnants were quantified with ImageJ and scored using the adhesive remnant index (ARI), and enamel damage was assessed using an enamel damage index (EDI). Results: Mean SBS values were 15.68 MPa (MC), 18.38 MPa (MF), 20.89 MPa (MP), 13.04 MPa (IC), 17.11 MPa (IF), and 12.66 MPa (IP). Two-way ANOVA showed significant main effects of bracket base design (F(1, 126) = 16.06, p < 0.001, partial η2 = 0.113) and primer coverage (F(2, 126) = 3.98, p = 0.021, partial η2 = 0.059), together with a significant bracket-base-design × primer-coverage interaction (F(2, 126) = 4.46, p = 0.014, partial η2 = 0.066). ARI distributions differed significantly across the six experimental groups (χ2(15) = 75.24, p < 0.001, Cramér’s V = 0.436), whereas EDI scores did not differ significantly among groups (p = 0.756). Conclusions: The effect of the metal primer on SBS depended on bracket base design and primer coverage. Partial coverage produced the highest SBS among mesh-base brackets and was significantly higher than the mesh control. Among integral-base brackets, full coverage yielded the highest numerical SBS, but within-design pairwise differences were not significant. ARI failure patterns also varied significantly across the six experimental groups, whereas no significant difference in stereomicroscopically detectable enamel damage was observed.

Dentistry Journal doi: 10.3390/dj14090580

Authors: Hind W. Albilali Abdulaziz S. Alamri Suliman Y. Shahin Naif N. Almasoud Osama A. Alsulaiman Dalal M. Almazrou Ahmed A. Alsulaiman

Background/Objectives: A recent feature in the Invisalign® system allowed integration of cone-beam computed tomography (CBCT) with intraoral scans, thereby enabling visualization of the tooth roots and surrounding alveolar bone. Here, we aimed to compare differences between anatomical measurements obtained from integrated CBCT using Invisalign® software and conventional CBCT images. Methods: In this cross-sectional study, we included 45 adult patients (mean age 29.53 ± 7.66 years). Alveolar bone width was measured at the crestal, mid-root, and apical levels and the root length, maxillary and mandibular outer and inner transverse widths, and symphyseal width were assessed. Intra-examiner reliability was assessed using intraclass correlation coefficients. Paired t-tests were used to compare the two methods, and Bland–Altman analysis was used to evaluate agreement. Results: Intra-examiner reliability demonstrated excellent agreement for all measurements (intraclass correlation coefficients > 0.90). Integrated CBCT models showed greater alveolar bone width, symphyseal width, and interbuccal transverse measurements than conventional CBCT, whereas the root length and interlingual transverse widths were underestimated. Most of the differences between the two methods were statistically significant (p < 0.05), although 5 of the 12 crestal measurements did not reach statistical significance (p > 0.05). For most measurements, the mean absolute differences were below 0.7 mm, except for root length, which showed larger discrepancies. Bland–Altman analysis revealed good agreement between the methods, with most observations lying within the 95% limits of agreement and no evident proportional bias. Conclusions: Most measured variables showed significant differences between integrated and conventional CBCT (p < 0.05), ranging from 0.7 mm to 1.3 mm; however, at the crestal level, 5/12 measurements showed no statistically significant difference between methods (p > 0.05).

Dentistry Journal doi: 10.3390/dj14090579

Authors: Larisa Pătru Ciprian Laurențiu Pătru Elena Cristina Andrei Oana Andreea Diaconu Maria Cristina Comănescu Daniela-Maria Micu Virginia Maria Rădulescu

Background/Objectives: Medico-legal preparedness is relevant throughout dental education because awareness develops before independent clinical responsibility is assumed. This study examined malpractice awareness, self-perceived preparedness, legal awareness and defensive-practice tendencies among Romanian dental students, residents and dentists. Methods: A cross-sectional survey was conducted between May and June 2026 among 176 participants from the Faculty of Dentistry and its associated professional community in Craiova, Romania. The author-developed questionnaire was completed online (n = 134) or on paper at a professional conference (n = 42). Associations were assessed using non-parametric tests, ordinal logistic regression and robust linear regression. A sensitivity analysis excluded early-year students. Results: Respondents demonstrated moderate legal awareness (mean 3.29 of 5), whilst only 8.0% felt well or very well prepared to manage a malpractice-related situation. In the main model, previous legal training was associated with greater preparedness (adjusted odds ratio 2.52, 95% CI 1.03–6.15), as were resident status and professional clinical experience. In the clinically exposed subgroup (n = 68), practising dentists reported greater preparedness than clinical-year students, whereas familiarity with malpractice and paper-based participation were associated with stronger defensive-practice tendencies. Conclusions: Awareness of medico-legal issues is present across dental education, but perceived preparedness remains limited. The findings support longitudinal, applied medico-legal education and require cautious interpretation because early-year and clinically experienced respondents evaluated partly different aspects of the same phenomenon.

Dentistry Journal doi: 10.3390/dj14090578

Authors: Darja Gostilo Xenia Teplitzky Blend Hamza Georgios Tsilingaridis Sivaprakash Rajasekharan Līna Petrova Megija Florentine Shaju Jacob Pulikkotil

Background/Objectives: Dental caries remains one of the most prevalent chronic diseases affecting children worldwide and continues to pose a substantial challenge to healthcare systems. Although the clinical consequences of paediatric dental caries are well documented, the associated economic burden has not been comprehensively synthesised. This systematic review aimed to evaluate and summarise the available evidence regarding the costs associated with dental caries in children and adolescents under 18 years of age. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251138979). MEDLINE via PubMed, Scopus, and Dentistry & Oral Sciences Source (EBSCOhost) were searched for studies published between January 2012 and July 2025. The MEDLINE and Scopus searches were conducted on 22 July 2025, and an additional search of Dentistry & Oral Sciences Source (EBSCOhost) was conducted on 19 August 2026. Eligible studies included peer-reviewed cost-of-illness studies, economic evaluations, cost analyses, cross-sectional studies, retrospective studies, and randomised controlled trials reporting economic outcomes related to the prevention or management of dental caries in individuals under 18 years of age. Methodological quality was assessed using the Drummond 10-item checklist. Data were extracted on study characteristics, population demographics, cost components, study perspective, and key findings. Reported costs were categorised as direct, indirect, and intangible costs where applicable. Due to substantial methodological heterogeneity among studies, a narrative synthesis was performed. Results: Seventeen studies met the inclusion criteria. Most studies focused on direct medical costs associated with restorative treatment, hospital-based dental care, and emergency services. Direct costs were consistently substantial across different healthcare settings, particularly for cases requiring advanced treatment or general anaesthesia. Preventive interventions were generally reported to be more cost-effective than curative approaches. Indirect costs, including caregiver productivity losses, were infrequently assessed, while no study comprehensively evaluated intangible costs. Considerable variation in study design, costing perspective, and reporting methodology limited direct comparison across studies. Conclusions: Dental caries in individuals under 18 years of age imposes a considerable economic burden, driven primarily by direct treatment costs. Preventive oral health strategies appear to provide greater economic value than treatment-focused approaches. The limited assessment of indirect and intangible costs suggests that the overall societal burden of paediatric dental caries is likely underestimated. Future research should adopt standardised and comprehensive costing methodologies to better support policy development and resource allocation in paediatric oral healthcare.

Dentistry Journal doi: 10.3390/dj14090576

Authors: Nicholas David Sung Tiffany See Nok Chen Melissa Rachel Fok Mihai Tarce Jasmine Loke Luigi Nibali Ana Castro Georgios Pelekos

Objectives: The objectives of this study were to investigate whether cone-beam computed tomography (CBCT) provides additional benefit in assessing periodontal infrabony defect topography, and whether assessment accuracy differed between clinicians in periodontology with different levels of experience. Background: A comprehensive assessment of the periodontal condition usually comprises clinical periodontal examination and two-dimensional radiographic evaluation. Whilst periapical radiographs are the most frequently employed for radiographic assessment of periodontal bone loss, they have some limitations in assessing infrabony defects. As a result, CBCT has been gaining attention recently as an adjunctive periodontal diagnostic modality that can overcome these limitations. It is well established that the use of CBCT for periodontal diagnosis is not routine and should only be reserved for judicious case selection in accordance with the as low as reasonably achievable (ALARA) principle. Given these considerations, studies evaluating whether CBCT provides any additional benefit in the assessment of periodontal infrabony defects remain limited, and no formal guidelines currently exist regarding its role or implementation in postgraduate periodontal education. Methods: Forty-six participants (26 residents and 20 specialists in periodontology) from three European Federation of Periodontology (EFP)-accredited centres were invited: King’s College London (KCL), United Kingdom; KU Leuven, Belgium; and The University of Hong Kong (HKU), Hong Kong SAR, China. The participants were required to complete two case-based questionnaires on infrabony defect assessment, with a two-week washout period in between. Eight complex cases were presented, once with periodontal charting and periapical radiography (Questionnaire S1), and once with CBCT images in addition to the conventional data (Questionnaire S2). For all eight cases, an HKU panel performed reference-standard intra-surgical or CBCT measurements against which the participants’ answers were scored. Results: Forty participants returned the questionnaires (25 residents and 15 specialists). The response rate was, therefore, 87.0%. Participants assessed the infrabony defects more accurately in Questionnaire S2 compared with Questionnaire S1 (the mean scores [%] were 69.8 ± 11.9 and 63.5 ± 11.8 respectively); the mean difference was statistically significant (p < 0.001). When comparing residents and specialists, the mean difference in scores (%) was 0.5 (95% CI: −7.4–8.5) for Questionnaire S1 and −2.5 (95% CI: −10.4–5.5) for Questionnaire S2, with neither difference reaching statistical significance (p > 0.05). However, a larger study is required to draw more definitive conclusions about differences between clinician groups. Conclusions: CBCT, adjunctive to conventional periodontal diagnostics, provided statistically significant additional benefit in assessing infrabony defect topography by increasing assessment accuracy. However, whether the magnitude of this improvement is clinically meaningful requires further research. This study shows that between residents and specialists in periodontology, there was no statistically significant difference in the accuracy of infrabony defect topography assessment; nonetheless, given the limited sample size, further work is needed to clarify potential between-group differences. Whilst keeping the ALARA principle in mind, this study highlights the need for further investigation into the value of CBCT in complex periodontal cases, emphasises the importance of defining its role in postgraduate periodontal education, and underscores the need for a larger-scale study involving additional EFP-accredited centres to enable more robust conclusions.

Dentistry Journal doi: 10.3390/dj14090577

Authors: Pritam Mohanty Saundarya Priyadarshini Debapreeti Mohanty Margherita Tumedei Massimo Del Fabbro Parameswaran Tirunelveli Mani Partha Pratim Chaudhary Balaji Krishnan Monalisa Das Bhagabati Prasad Dash Bhabani Shankar Biswal Funda Goker Saurav Panda

Objectives: This systematic review aims to compare the forces and moments generated by thermoforming aligners and direct-printed aligners in guiding tooth movement in orthodontic patients, evaluating their impact on orthodontic outcomes. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus databases, covering studies on thermoforming and direct-printed aligners from inception to October 2024. Eligible studies included randomized controlled trials, quasi-experimental studies, and observational studies assessing forces and moments generated by these aligners on teeth. In vitro studies pertinent to the topic were also considered. Data extraction focused on study characteristics, aligner details, force and moment measurements, and clinical outcomes. Quality assessment utilized the ROBINS- I for Risk of Bias. The review has been registered on PROSPERO CRD42024620341. Results: A total of nine studies met the inclusion criteria. Findings indicate that thermoforming aligners, while effective in initial force application, exhibit significant force decay over time due to material stress relaxation. In contrast, direct-printed aligners maintain more consistent force levels, potentially resulting in more predictable and sustained tooth movement. Both aligner types vary in their ability to control force direction and magnitude, with direct-printed aligners showing advantages in customization and force retention. Conclusions: The biomechanical properties of thermoforming and direct-printed aligners offer distinct advantages and limitations. Direct-printed aligners may enhance clinical predictability and reduce treatment time through consistent force application, though further research is necessary to validate these benefits in clinical settings. This review underscores the importance of material selection and fabrication method in optimizing orthodontic outcomes.

Dentistry Journal doi: 10.3390/dj14090575

Authors: Yoshifumi Kobayashi Shuying Jiang Jia Huang Tami Kim Kathryn Roeder Liyaa Chen Nika S. Kobayashi Daniel H. Fine Emi Shimizu

Objectives: The objectives of this study were as follows: (1) statistical investigation of the association between systemic diseases and dental pulp condition; and (2) utilization of locally running large language models (LLMs) to handle a large number of dental charts written in natural languages, while protecting patients’ information. Methods: A total of 5820 endodontic charts, including healthy controls and patients with a history of cancer, HIV, type 1 diabetes mellitus (DM), and type 2 DM, were selected from 15,147 samples. Using a local LLM environment, the dental charts from each group were classified into six categories: normal pulp (NP); reversible pulpitis (RP); asymptomatic irreversible pulpitis (AIP); symptomatic irreversible pulpitis (SIP); pulp necrosis (PN); and “others”, including unclear diagnoses. The distributions of these diagnoses across groups were statistically analyzed. Results: The prompt for the local LLM was repeatedly refined by classifying 400 test cases, resulting in 97.0% agreement with the judgments of three human dentists. The refined prompt was then applied to classify 5820 charts, followed by statistical analyses. Using a generalized linear mixed-effects model (GLMM), the cancer-history group showed a significantly higher NP and a lower AIP proportion, whereas the type 2 DM group showed a significantly lower AIP and a higher SIP proportion. Conclusions: The findings in the cancer-history group could be attributable to a worsened oral environment in the patients and difficulties in diagnosing AIP. Meanwhile, the lower proportion of AIP and higher proportion of SIP in type 2 DM group may reflect pulpal inflammation associated with the disease. Additional attention may be warranted for caries’ prevention and treatment in patients with type 2 DM.

Dentistry Journal doi: 10.3390/dj14090574

Authors: Desislava Tomlekova Aleksandra Pecheva Silviya Dimitrova

Root perforations represent a pathological communication between the root canal system and the external root surface and are among the most serious complications in endodontics. Their occurrence leads to bacterial contamination and inflammatory tissue destruction, resulting in resorption of dentin, cementum, and alveolar bone, thereby compromising the tooth’s long-term prognosis. Objective: The aim of this review is to summarize current data regarding the etiology, diagnosis, treatment strategies, and contemporary materials used in the management of root perforations, with particular emphasis on recent advances in non-surgical treatment. Methods: A narrative literature review was conducted using sources from PubMed, Scopus, Web of Science, Embase, CINAHL, and the Cochrane Library. After applying a predefined search strategy of inclusion and exclusion criteria, 60 scientific sources published between 2003 and 2026 were included. Results: Current evidence indicates that the treatment outcome depends primarily on the location and size, prompt perforation sealing, bacterial contamination, and selection of restorative material. Cone-beam computed tomography has improved diagnostic accuracy, while a non-surgical approach remains the preferred approach in most clinical situations. Mineral trioxide aggregate (MTA) continues to be the reference standard material due to its biocompatibility, bioactivity and sealing ability. New-generation calcium-silicate bioceramics offer improved physicochemical properties, while maintaining favorable biological properties. Regenerative materials have shown promising potential to enhance healing processes, but available evidence remains limited. Conclusions: Successful treatment of root perforations requires early diagnosis, timely repair of the defect, effective bacterial control, and use of bioactive materials with reliable sealing and regenerative properties. Modern calcium-silicate bioceramics have improved non-surgical treatment predictability, whereas regenerative approaches appear to be a promising alternative that requires further clinical studies to develop standardized therapeutic protocols.

Dentistry Journal doi: 10.3390/dj14090573

Authors: May Aljanahi Gerry Mckenna Keyvan Moharamzadeh Haitham Elbishari

Background/Objectives: Occlusal analysis plays a key role in restorative and prosthodontic treatment, influencing diagnosis, treatment planning, and long-term outcomes. This narrative review provides an overview of conventional and digital methods for occlusal analysis and their clinical applications. Methods: A literature search was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify relevant publications on conventional and digital occlusal analysis. The retrieved literature was reviewed and synthesized narratively. Results: Conventional methods, including articulating paper, shimstock foil, films, sprays, and waxes, remain widely used because of their simplicity and accessibility but are limited by subjective interpretation and the inability to quantify occlusal forces. Digital technologies, including T-Scan, OccluSense, Accura, intraoral scanners, virtual articulators, and jaw-tracking systems, provide objective information on occlusal contacts, force distribution, timing, and mandibular movements. However, their use may be limited by cost, technical requirements, and operator training. Conclusions: Conventional methods remain valuable in daily clinical practice, while digital technologies provide objective data that can enhance occlusal assessment and treatment planning. As digital workflows continue to evolve, structured training and standardized clinical protocols will be important for their successful integration into clinical practice.

Dentistry Journal doi: 10.3390/dj14090571

Authors: Zachary Zhaoqian Pan Thomas Pan

Background/Objectives: Symptomatic irreversible pulpitis (SIP) is conventionally treated with pulp tissue removal via root canal treatment, pulpectomy, or pulpotomy. This case series introduces the Pulpitis Restorative Protocol (PRP), a novel method used to treat SIP without pulp removal, relieve pain, and maintain a positive pulp sensibility response. Methods: In this retrospective case series (March 2022–March 2025), 17 SIP patients (plus 10 reversible pulpitis [RP] control cases) were treated with the PRP utilizing a bioactive glutaraldehyde (GA)-resin-modified glass ionomer (RMGI) solid matrix. Follow-up to 36 months (average 17.37 ± 9.61 months) included clinical examination, cold sensibility testing, and radiographs. Results: Treatment was successful in 15/17 SIP cases, an 88.2% success rate, and 9/10 RP cases, a 90.0% success rate. Overall, a total of 24 of 27 cases were successful, a rate of 88.89%. Success criteria were the absence of pain, no soft-tissue abnormality, a positive cold test response, and no radiographic apical lesions. No failures occurred in the first year; two cases failed in the second year and one in the third year. The PRP provided favorable pain relief: 74.1% of patients reported minimal post-operative pain (0–1/10 VAS) the evening of treatment, and 96.3% of patients reported no pain at 24 h without analgesics. All 24 successful cases maintained a positive pulp sensibility response at their final visit. Radiographs were stable in 24 cases. In vitro experiments showed that the GA-RMGI solid matrix exhibits contact-independent bactericidal activity. Conclusions: The PRP provides a promising approach to SIP management, offering a conservative, cost-effective, and efficient alternative to conventional endodontic treatments alongside favorable pain relief. Its clinical significance warrants further verification in various clinical settings and randomized clinical trials.

Dentistry Journal doi: 10.3390/dj14090572

Authors: Alin Flavius Cozmescu Ana Cernega Andreea Cristiana Didilescu Marina Meleșcanu Imre Cristian Funieru Silviu-Mirel Pițuru

Background/Objectives: The integration of artificial intelligence (AI) and digital technologies into dental practice is reshaping clinical workflows, administrative processes, and, increasingly, the patient experience and the doctor–patient relationship. While prior research has documented the attitudes of clinicians and practice managers, the perspective of the patient remains comparatively underexplored. This study examined how dental patients perceive AI integration and digital tools across the dental care pathway, together with the associated implications for data security, cost, and the human dimension of care. Methods: A cross-sectional, questionnaire-based study was conducted among 200 dental patients in Bucharest, Romania, and the surrounding region. The instrument assessed perceived difficulty and availability regarding digital technology, current use of digital tools, demographic and educational characteristics (age, gender, practice environment, educational level), and two attitudinal dimensions, namely digital prudence and concern for technological sustainability, across five subdomains of the dental care pathway: scheduling, diagnosis, treatment planning, feedback, and follow-up (dispensarization). Responses were analyzed using non-parametric tests and exploratory principal component analysis with internal-consistency validation. Results: Patients expressed moderate-to-high interest in AI support during the diagnostic (median = 3.3, IQR = 2.7–3.9) and feedback (median = 3.11, IQR = 2.78–3.67) stages and the lowest interest in scheduling (median = 2.7, IQR = 2.0–3.3). A marked level of digital prudence was observed (median = 3.24, IQR = 2.82–3.61), reflecting concerns about data security, automation, and a possible weakening of the clinician–patient bond. Younger and academically educated patients reported lower perceived difficulty, higher availability, and greater current use of digital tools (all p ≤ 0.001); counterintuitively, the same patients scored significantly higher on digital prudence (Spearman’s ρ = −0.260, p < 0.001). Greater familiarity with digital tools was therefore accompanied by a more critical awareness of their informational risks rather than by uncritical acceptance. Conclusions: Dental patients approach AI through a dual lens of openness and informed caution, welcoming efficiency gains in the clinical and continuity-of-care stages while voicing measured concerns about data security, affordability, and the preservation of human contact. To interpret this profile, we propose two conceptual contributions: a mapping of patient needs onto Maslow’s hierarchy in the context of AI-mediated care and the Informational VUCA framework, which characterizes the volatility, uncertainty, complexity, and ambiguity that patients face when navigating AI-generated information. The findings point to a clear practical agenda of transparent communication, robust data governance, and education strategies adapted to patients’ educational and demographic profiles, so that AI-enhanced workflows strengthen rather than erode the doctor–patient relationship.

Dentistry Journal doi: 10.3390/dj14090570

Authors: Daiana Andrea Boca Codruta-Eliza Ille Anca Jivanescu

Background/Objectives: Artificial intelligence (AI) is transforming prosthodontic procedures into data-driven support systems. This scoping review systematically maps the literature using an evidence maturity framework, distinguishing it from recent applications-focused compilations by Aljulayfi, Schwendicke, and others. Methods: A comprehensive search of PubMed, Scopus, and Web of Science (January 2023–March 2026) was conducted in accordance with PRISMA-ScR guidelines, supplemented by targeted manual citation tracking. Fifty studies were included in the review. Results: The evidence base comprises approximately half primary research (computational, in vitro, clinical) and half review articles. Foundational diagnostic CNNs report high technical performance metrics (i.e., sensitivity 98.67%, precision 78.12%), while generative CAD/CAM approaches reduce design time by up to 52% in vitro. However, the evidence synthesis reveals a significant gap between algorithmic efficacy and clinical utility. Most applications currently reside at the “technical validation” stage, while emerging domains such as large language models remain largely experimental. Conclusions: Impressive computational metrics do not automatically equate to patient-centered clinical benefits. Current AI systems must be regarded as adjunctive decision-support instruments rather than autonomous tools. Future research must prioritize prospective multicenter validation, implementation science, explainability, and robust regulatory oversight.

Dentistry Journal doi: 10.3390/dj14090569

Authors: Sara M. ElKhateeb Eman Allam Heba H. Bakhsh Dur Alomair Nada Ahmed AlShehri Nozha Sawan

Objectives: To evaluate and compare the tooth detection and numbering performance of two commercially available artificial intelligence (AI) software systems, ThakaaMed and EM2AI, in the automated detection and numbering of permanent teeth on panoramic radiographs. Methods: A retrospective study was conducted using a randomized sample of 595 panoramic radiographs obtained from multiple dental outpatient facilities. The sample included patients aged 6–18 years with mixed or permanent dentition. Ground truth (GT) annotations were established independently by three experienced dental clinicians using the FDI tooth numbering system. Each radiograph was analyzed using ThakaaMed Dental IQ (Version 1.9) and EM2AI (Version 3.2.0), and AI-generated outputs were compared with GT annotations. Tooth detection and numbering performance was assessed using sensitivity, specificity, and accuracy, and sensitivities and specificities were compared between the two AI systems across anatomical regions. Third molars were analyzed separately because of their variable developmental stages in mixed dentition radiographs. Results: EM2AI demonstrated superior performance in third molar detection compared with ThakaaMed. Excluding third molars, overall diagnostic accuracy was 96.81% for ThakaaMed and 99.48% for EM2AI. Regional analyses demonstrated significantly higher sensitivity for EM2AI in the upper anterior, lower anterior, and lower posterior regions, whereas no significant differences in specificity were observed between the two AI systems. EM2AI maintained consistently high tooth detection and numbering performance across anatomical regions. Conclusions: Both ThakaaMed and EM2AI demonstrated favorable tooth detection and numbering performance and potential utility as supportive tools in routine dental diagnostic and documentation workflows. EM2AI demonstrated greater consistency across anatomical regions and superior performance in third molar detection. These findings highlight the importance of evaluating AI systems across diverse anatomical regions and developmental stages when assessing their clinical applicability.

Dentistry Journal doi: 10.3390/dj14090568

Authors: Yasser Alsayed Tolibah Wahid Juha Mhd Kheir Awad Mohammad Tamer Abbara Marwan Alhaji Jihad Abou Nassar Osama Aljabban Nada Bshara Ziad D. Baghdadi

Objectives: To evaluate the three-dimensional adaptation of prefabricated Bio-Root inlays fabricated from impressions of simulated immature permanent root canals using four techniques: direct intraoral scanning (A), a light-body rubber impression digitized with an intraoral scanner (B), cone-beam computed tomography (CBCT)-based design (C), and a conventional indirect technique (D). Methods: Ten standardized simulated immature roots (extracted mandibular premolars prepared to a 1.5 mm apical diameter and 10 mm length) were used in a within-specimen comparative design, with each root receiving inlays fabricated by all four techniques. After fabrication and seating of the bioceramic inlays, the void percentage around each inlay was quantified by CBCT at the coronal, middle, and apical thirds relative to the baseline empty-canal volume. Data were analyzed using the Friedman, Wilcoxon signed-rank (Bonferroni-corrected), and linear mixed-model tests (α = 0.05). Results: Technique significantly affected void percentage (F(3,98) = 12.87, p < 0.001). Pooled across all canal thirds, Technique B had the lowest median void percentage (6.00 [7.00]), followed by A (8.00 [8.75]), C (12.00 [12.50]), and D (12.00 [19.00]). Independently of technique, the median void percentage increased from the coronal (6.00) to the middle (11.00) and apical (19.00) thirds. Differences among techniques were non-significant coronally (p = 0.437) but significant in the middle (p = 0.014) and apical (p < 0.001) thirds, with Technique B providing the best apical adaptation. Conclusions: The impression method significantly affected inlay adaptation. A light-body rubber impression digitized with an intraoral scanner yielded the best overall and apical fit, supporting digital workflows, particularly those using digitized physical impressions, for apexification. Adaptation deteriorated toward the apex regardless of technique.

Dentistry Journal doi: 10.3390/dj14090567

Authors: Angelina Stoyanova-Ivanova Velizar Georgiev Petar Lilov Todor Vlakhov Laura Andreeva Valeri Petrov Mirela Georgieva Jorge N. R. Martins

Objectives: To evaluate the corrosion behavior and surface characteristics of four nickel-containing orthodontic archwires (stainless steel (SS), superelastic nickel–titanium (NiTi), copper–nickel–titanium (CuNiTi), and multiforce NiTi) under unused, in vitro artificial saliva-immersed, and clinically used (in vivo) conditions. Methods: Rectangular SS, NiTi, CuNiTi, and multiforce NiTi archwires were analyzed in the following three conditions: as received, after one week of immersion in artificial saliva (pH 6.4), and after clinical use for 6–8 weeks. Corrosion behavior was assessed using cyclic voltammetry (CV), open-circuit voltammetry (OCV), and electrochemical impedance spectroscopy (EIS). Surface morphology was examined by scanning electron microscopy (SEM). Results: Corrosion behavior was dependent on archwire type and exposure condition. SS archwires exhibited reduced impedance response after clinical use, indicating passive-film degradation. In the clinically used NiTi specimen, pronounced electrochemical instability was observed, characterized by a deep OCV transient, slow repassivation, and SEM evidence compatible with localized pitting corrosion. In the CuNiTi specimens, minimal differences were observed between the unused and clinically used conditions, which may be consistent with stable passive-film integrity in these specimens. In the multiforce specimen, clinical use was associated with a higher impedance response than the unused and saliva-immersed conditions of that same specimen. In the saliva-immersed specimens, possible passive-film formation and a higher impedance response were observed relative to the other conditions of the same specimens, but these did not reproduce the electrochemical and morphological changes observed after clinical use. Conclusions: In vitro artificial saliva immersion does not reliably replicate in vivo aging of nickel-containing orthodontic archwires. Corrosion behavior evolves during clinical service in an archwire-specific manner, with NiTi archwires showing susceptibility to clinically induced surface degradation.

Dentistry Journal doi: 10.3390/dj14090566

Authors: Mayar Alharbi Eman Bakhurji Ashwin C. Shetty Mohammed Alsaati Yousef Alyousef

Background/Objectives: Accurate selection of stainless steel crown (SSC) size is essential for successful restoration of primary molars. Conventional crown selection relies on a trial-and-error approach, which may increase chair time and reduce clinical efficiency. Preoperative digital radiographic measurements may provide an objective adjunct for predicting SSC size; however, evidence supporting their agreement with clinically selected crown sizes remains limited. This study aimed to evaluate the agreement between preoperative digital radiographic measurements and clinically fitted SSC size in primary molars, and to assess whether this agreement is influenced by dental arch or tooth type. Methods: This retrospective cross-sectional study analyzed archived patient records and preoperative digital radiographs of pediatric patients who received SSCs on primary molars. Mesiodistal tooth dimensions were measured and converted to SSC sizes according to manufacturer guidelines. The clinically fitted and cemented crown size, as recorded in the patient chart, served as the reference standard against which radiographically predicted size was compared. Intra-examiner reliability was assessed using the intraclass correlation coefficient. Associations were analyzed using chi-square tests and binomial logistic regression (p ≤ 0.05). Given repeated teeth within patients, the primary logistic regression model was additionally re-fit using generalized estimating equations (GEEs) with an exchangeable working correlation structure and robust standard errors, and prediction error was further characterized using near-miss accuracy, direction of bias, weighted kappa, and Bland–Altman analysis. Results: A total of 152 primary molars from 71 patients were included. Intra-examiner reliability was excellent (ICC = 0.99). Radiographic prediction agreed with the clinically fitted crown size in 33.6% of cases, and 69.7% of predictions fell within one crown size of the cemented crown. Agreement was significantly higher for mandibular molars than maxillary molars (p = 0.010) and varied by tooth type (p < 0.001). Mandibular molars were more likely to show accurate prediction (OR = 2.52; 95% CI: 1.23–5.17); this association remained statistically significant after accounting for within-patient clustering using GEEs with an exchangeable correlation structure (OR = 2.46; 95% CI: 1.10–5.49; p = 0.029). Maxillary first molars showed a systematic under-prediction of exactly two crown sizes in 97% of cases (mean bias −2.00), identifying a specific, correctable calibration problem. Conclusions: Preoperative digital radiographic measurements show moderate agreement with clinically fitted crown size and may serve as a useful adjunct to clinical judgment for SSC size selection, particularly for mandibular molars. Because the reference standard reflects clinical judgment itself rather than an independent anatomical gold standard, these findings should be interpreted as a concordance analysis, and further prospective work is needed before efficiency benefits can be confirmed.

Dentistry Journal doi: 10.3390/dj14090565

Authors: Marco Serafin Marina Borgese Elisa Boccalari Gilberto Binda Mario Raspanti Piero Antonio Zecca

Background/Objectives: Directly printed orthodontic appliances rely mostly on vat-photopolymerisation resins; pre-polymerised thermoplastics processed by fused deposition modelling (FDM) and selective laser sintering (SLS) are a less-explored, single-component route, but are poorly characterised. This study compared six thermoplastic material–process systems, supplied for biomedical or dental use, using a single intraoral-simulating protocol. Methods: Thin specimens (25 × 5 × 0.6 mm) of polyethylene terephthalate glycol (PETG), polycarbonate (PC), polyamide (PA), polyether-ether-ketone (PEEK) and a thermoplastic copolyester elastomer (TPC) printed by FDM, and of polyamide 12 (PA12) by SLS, underwent three-point bending and 10 min stress relaxation at 37 °C in artificial saliva (n = 5). Differences were assessed using the Kruskal–Wallis test with Dunn post hoc comparisons (Holm correction), and Fourier-transform infrared (FTIR) spectroscopy was used to compare virgin and printed materials for the five FDM polymers. Results: Apparent flexural moduli were 989 (PA12), 750 (PC), 687 (PEEK), 509 (PETG), 85 (PA) and 32 MPa (TPC), a very large material effect (ε2 = 0.95), with post hoc comparisons separating only the extremes of that range. Relaxation over 10 min ranged from 2.6% (PC) to 22.1% (PA12) among the five materials in which it could be quantified, with TPC falling below the load-cell resolution; expressed as force, PA12 lost the most (0.86 N) and yet still delivered 3.01 N, which was above the initial force of PEEK, PETG, PA and TPC, though not separable from that of PC, which retained 97.4% of its own. Virgin and printed spectra were concordant (Pearson r ≥ 0.986, against ≤ 0.80 between different materials). Conclusions: The PA12/SLS system was the stiffest, followed by PC and PEEK, but, as the only laser-sintered material, its polymer and process effects cannot be separated. PETG and PC combine useful stiffness with accessible FDM; PA and TPC are far more compliant. These specimen-level findings provide a screening basis for selecting material–process systems for printed orthodontic appliances, preceding device-level validation.

Dentistry Journal doi: 10.3390/dj14090564

Authors: Katja Hashemi Elses Tommi Pätilä Ann-Marie Roos Jansåker

Background/Objectives: Patients with fixed orthodontic appliances are at increased risk of plaque accumulation, gingivitis, and caries because brackets and bands hinder mechanical hygiene. This study evaluated whether regular home use of dual-light antibacterial photodynamic therapy (aPDT) supports oral hygiene during fixed orthodontic treatment in adolescents. Methods: In a single-center, randomized, assessor-blinded trial, forty-one adolescents starting fixed orthodontic treatment were randomised to a Control group (standard hygiene) or a Test group (standard hygiene plus home-use dual-light aPDT). Visible Plaque Index (VPI%), Bleeding on Probing (BOP%), and Orthodontic Plaque Index (OPI) were assessed at baseline and 12 weeks by an assessor blinded to allocation. After two protocol-driven exclusions, 39 participants (20 Test group, 19 Control group) were analysed. Site-level proportions were compared using the chi-square test. Results: VPI decreased in both groups, with a larger mean within-group reduction in the Test group (−7.0%) than in the Control group (−3.7%); exploratory site-level analysis showed a greater reduction in plaque-positive sites in the Test group at 12 weeks (p < 0.001). BOP increased in both groups but to a smaller extent in the Test group (mean +2.4% versus +5.7%), and a higher proportion of Test-group participants maintained BOP ≤ 10% (85% versus 58%); bleeding-positive sites were lower in the Test group at 12 weeks (p < 0.001). The Test group also showed a flatter distribution of OPI scores around orthodontic brackets. No device- or protocol-related adverse events were reported. Conclusions: In adolescents undergoing fixed orthodontic treatment, regular home use of dual-light aPDT was safe and associated with better site-level plaque and bleeding control, with directional but non-significant trends at the participant level. The findings support further evaluation of dual-light aPDT as an adjunct to mechanical hygiene during this vulnerable treatment period.

Dentistry Journal doi: 10.3390/dj14090563

Authors: Maria Cecilia Galvez Aaron Mharl Barlisan Emmanuelle Hermosilla Mark Nickole Tabafa Ernest Macalalad Jose Esmeria Jr. Edgar Vallar Seiroh Okaneya Jumar Cadondon Tatsuo Shiina

Background/Objectives: Dental biofilm formation on prosthetic materials contributes to oral diseases and material degradation. This pilot study evaluated the feasibility of combining time-domain optical coherence tomography (TD-OCT) and non-contact atomic force microscopy (NC-AFM) to characterize biofilm-associated optical and surface changes in dental prosthesis materials following antiseptic treatment. Methods: Acrylic resin, composite resin, and stainless-steel specimens were inoculated with Streptococcus mutans biofilms and exposed to water, Orahex, and Watsons mouthwash. TD-OCT was used to obtain extinction coefficient (EC) and optical thickness measurements, while NC-AFM was performed on Orahex-treated specimens to assess nanoscale surface morphology. EC distributions were analyzed descriptively from valid TD-OCT A-scans. Results: Within the examined specimens, EC distributions varied following biofilm formation and antiseptic treatment, with material-dependent responses. Composite resin exhibited the clearest reduction in EC following Watsons treatment, whereas acrylic resin and stainless-steel specimens showed more variable responses. Physical thickness remained relatively stable, while NC-AFM observations of the Orahex-treated specimens supported the TD-OCT findings by demonstrating corresponding surface morphological changes. Conclusions: This pilot study demonstrates the preliminary feasibility of integrating TD-OCT with NC-AFM for non-destructive evaluation of biofilm-associated optical and surface changes in dental prosthesis materials. The findings are descriptive and exploratory, highlighting the potential of TD-OCT for monitoring prosthetic materials while emphasizing the need for future studies incorporating independent biological replicates and complementary biological validation techniques.

Dentistry Journal doi: 10.3390/dj14090562

Authors: Maria Pia Di Palo Federica Di Spirito Francesco Giordano Giuseppina De Benedetto Roberto Lo Giudice Federica Piedepalumbo Gabriele Balsamo Colomba Pessolano Marina Garofano Andrea Marino Alessia Bramanti

Background/Objectives: Periodontal and peri-implant diseases are influenced by several risk factors, including smoking. While cigarette smoking (CS) is a well-established risk factor, the impact of heated tobacco products (HTPs), electronic cigarettes (E-Cigs), and waterpipe (WS) remains less clear. This systematic review aimed to update the current evidence evaluating the clinical, radiographical, and inflammatory biomarkers of periodontal and peri-implant status among different untreated adult users of inhaled tobacco and nicotine products. Methods: A systematic search of PubMed/MEDLINE, Scopus, and Cochrane Library was performed for studies published between April 2022 and December 2025. Data were extracted and synthesized qualitatively according to the study protocol (PROSPERO: CRD420261284851). Studies were qualitatively assessed using the Risk-of-Bias in Nonrandomized-I. Results: Thirty-one studies including 3106 subjects were analyzed. CS consistently showed the worst periodontal and peri-implant status, with higher plaque indices, probing depth (PD), clinical attachment level (CAL), marginal bone loss (MBL) and more missing teeth. WS showed parameters comparable to CS and worse than non-smokers, with particularly high plaque accumulation and probing depth, as well as a pro-inflammatory biomarker profile. E-Cigs and HTPs generally exhibited intermediate status; E-Cigs showed increased PD and CAL compared with non-smokers, with elevated bleeding on probing despite a lower gingival index, whereas MBL was notably higher, showing the highest overall values among all smoking categories, exceeding CS. HTPs presented slightly less harmful outcomes than other smokers, but the evidence was limited. Biomarker analysis indicated elevated pro-inflammatory and tissue-destructive markers, particularly in CS and WS. Conclusions: Smoking negatively affects periodontal and peri-implant status, with CS exhibiting the worst impact. E-Cigs and HTPs appear less harmful but are not risk-free. Longitudinal studies are warranted to define long-term effects, particularly on peri-implant status, for which robust evidence was restricted to CS.

Dentistry Journal doi: 10.3390/dj14090561

Authors: Fares Kablan Asaf Zigron Idan Redenski Shadi Daoud Amjad Shhadeh Adeeb Zoabi Samer Srouji

Background: Rehabilitation of the severely atrophic posterior mandible remains challenging when the residual bone height above the inferior alveolar nerve (IAN) is insufficient for conventional implant placement. In such cases, IAN lateralization or transposition may facilitate placement of longer implants and support fixed prosthetic rehabilitation. However, these procedures require careful case selection because of their technical complexity and the risk of neurosensory complications. Objective: This narrative review presents a literature-informed, expert-derived, parameter-based clinical decision framework for preoperative planning of IAN lateralization and transposition in the severely atrophic posterior mandible. Methods: A focused appraisal of the literature was performed to identify anatomical, prosthodontic, and surgical parameters relevant to IAN repositioning. Parameters were selected according to their recurrent relevance to surgical feasibility, implant positioning, procedural safety, and restorative planning, and were integrated with the authors’ clinical experience to develop a structured decision-making framework. No formal risk-of-bias or certainty-of-evidence assessment was performed. Each parameter was assigned an evidence-source category and a threshold status to make its evidentiary basis explicit. Results: The proposed framework organizes treatment planning into three domains: bone-related, prosthodontic, and surgical considerations. Key parameters include residual bone height above the IAN canal, global mandibular height, ridge width, bone density, crown-to-implant ratio, intermaxillary space, ridge angulation, buccal cortical plate thickness, and the three-dimensional course of the IAN. Additional parameters include interforaminal dentition, implant trajectory, canal diameter, bifid canal anatomy, and ridge contour. Collectively, these variables are integrated into a stepwise decision pathway to help determine whether IAN repositioning is appropriate, whether lateralization or transposition is preferable, and when alternative approaches, such as short implants, ridge splitting, or vertical augmentation, may be more suitable. The framework links restorative feasibility and surgical risk to the choice of technique within a single sequential pathway, and reports the evidence basis of each decision point. Conclusions: The proposed framework should not be regarded as a validated clinical decision tool; prospective clinical validation and consensus-based refinement are required before routine clinical implementation. The framework is intended to structure and guide multidisciplinary assessment and discussion of cases; it should not independently determine treatment selection or replace individualized clinical judgment.

Dentistry Journal doi: 10.3390/dj14090560

Authors: Miika Penttala

Background/Objectives: A parsimonious multivariable model was engineered and externally validated using dental electronic health records to screen for a clinician-evaluated “gum disease or related problem” status. Designed for seamless electronic integration, a positive screening result triggers a targeted referral—and the model is well-suited for dental hygienist use— while providing clinical decision support for dentists during definitive diagnoses. This automated support standardises workflows, maximises team efficiency, and supports data-driven clinical decision-making. Methods: This cross-sectional study developed the model using the US National Health and Nutrition Examination Survey (NHANES) 2011–2012 cohort (n = 1732) and independently validated it on the 2013–2014 replication cycle (n = 1855) for the high-risk 30–50-year-old demographic. Survey-weighted logistic regression incorporated age, gender, and eight targeted molar probing depth (PD) measurements paired with binary indicators for tooth presence to predict whether an individual has a gum disease or related problem. Results: External validation demonstrated high parameter generalisability, yielding a pooled population-level AUC of 0.859 (95% CI: 0.828–0.885). At the prevalence-matched threshold of Pt = 0.367, the framework yielded a sensitivity of 78.39% (95% CI: 69.48–85.29%) and a specificity of 79.10% (95% CI: 74.55–83.04%). Demonstrating public health utility via Decision Curve Analysis, the model avoided approximately 39 unnecessary clinical examinations by a dentist per 100 individuals at a practical clinical decision threshold of 0.33, achieving a substantial pooled net benefit compared with a treat-all strategy without compromising case-detection metrics. Conclusions: This scalable screening model offers a highly practical pathway for gum disease and related problem interception. Optimised for seamless software integration, the framework facilitates rapid, hygienist-led risk stratification without increasing chairside burden, and delivers objective data streams to reinforce the dentist’s definitive diagnostic workflow.

Dentistry Journal doi: 10.3390/dj14090559

Authors: Suwat Tanya Chattarika Domdok Patcharawan Srisilapanan

Background/Objectives: Orofacial laserology is being increasingly incorporated into contemporary dental practice, yet its integration into dental education remains inconsistent. National evidence regarding institutional readiness for integrating orofacial laserology into dental curricula remains limited. This study examined the current status of orofacial laserology education in Thailand. Methods: A national cross-sectional survey was conducted between May and July 2026 among all accredited Thai dental schools. Academic leaders and full-time lecturers completed a structured online questionnaire addressing curriculum implementation, educational delivery, competency assessment, institutional readiness, perceived barriers, and future priorities. Descriptive and non-parametric statistical analyses were performed. Results: Fifteen of 18 dental schools (83.3%) participated, yielding 38 respondents. Undergraduate orofacial laserology education showed limited curricular integration, whereas postgraduate programs demonstrated broader implementation, particularly in hands-on, supervised clinical, and competency-based training. Institutional readiness did not differ between academic leaders and full-time lecturers (p > 0.05). Across historical phases of institutional establishment, perceived importance (p = 0.743) and interinstitutional collaboration (p = 0.800) were comparable, whereas institutional readiness differed significantly (p = 0.008), with regional pioneer dental schools reporting higher readiness than expansion-phase and contemporary dental schools. The principal barriers were insufficient qualified instructors, limited curriculum integration, and high equipment costs. Faculty development, funding and equipment support, and national competency frameworks were identified as the highest priorities. Conclusions: Orofacial laserology education in Thailand remains heterogeneous, with broader implementation in postgraduate than undergraduate programs. Strengthening faculty capacity, competency-based curricula, institutional support, and national collaboration may facilitate more consistent integration of orofacial laserology into dental curricula.

Dentistry Journal doi: 10.3390/dj14090558

Authors: Amirhossein Bahador Seyed Ali Mostafavi Moghaddam Hamid Mojtahedi Lotfollah Kamali Hakim Hamid Tebyaniyan

Background: Reconstruction of craniofacial bone defects caused by tumor removal, infection, congenital anomalies, or trauma remains a major challenge. Recent advances in artificial intelligence (AI), digital imaging, and additive manufacturing have enabled personalized treatment strategies. This review discusses AI-driven workflows from cone-beam computed tomography (CBCT) image acquisition to implant fabrication using patient-specific bioceramics. Methods: Several electronic databases were searched, including Scopus, PubMed, ScienceDirect, and Web of Science. A peer-reviewed article published between 2015 and 2026 was considered for inclusion. This review provides an overview of AI applications in craniofacial tissue engineering, including CBCT image segmentation, three-dimensional reconstruction, virtual surgical planning, computer-aided design/computer-aided manufacturing (CAD/CAM), topology optimization, finite element analysis, and three-dimensional bioceramic scaffold printing. Results: AI improves accuracy, efficiency, and reproducibility of craniofacial reconstructions when used in conjunction with AI-assisted workflows. Through automated image segmentation and anatomical modeling, operator dependence can be reduced, and predictive algorithms can optimize biomechanical properties. CAD/CAM and 3D printing are used to manufacture bioceramic implants with controlled porosity, mechanical integrity, and enhanced osteoconductive properties. AI-driven predictive models have demonstrated potential for supporting material selection, manufacturing quality control, and treatment planning; however, their ability to reliably predict long-term postoperative outcomes requires further validation through prospective clinical studies. Data standardization, algorithm transparency, regulatory approval, clinical trial validation, and ethical considerations remain challenges. Conclusions: AI, CBCT imaging, computational modeling, and advanced bioceramic manufacturing are being combined to create an end-to-end digital workflow for personalized reconstruction. Clinical studies must be conducted prospectively to maximize the therapeutic potential of these technologies.

Dentistry Journal doi: 10.3390/dj14090557

Authors: Mădălina Monica Bicheru Andreea Zamfirescu Elena Preoteasa Adrian Iustin Georgevici Nicolae Vladimir Bicheru Cristina Teodora Preoteasa

Background/Objectives: In institutionalized older adults, we examined the concordance between self-reported xerostomia and chairside salivary dysfunction and explored whether a smaller subset of Xerostomia Inventory items could retain comparable screening performance. Methods: This cross-sectional study included institutionalized older adults. The 11-item Xerostomia Inventory was compared with a six-marker chairside whole-saliva panel, with all variables scaled 0 (normal) to 1 (pathological). We measured how closely symptoms tracked each objective marker, how well the questionnaire identified hyposalivation, and whether fewer questions could be comparable with the full 11-item inventory. Results: The study included 90 participants, with a mean age of 79.5 years; 55.6% were women. Symptoms tracked every marker in the expected direction (correlation τ-b 0.32 to 0.62). The questionnaire identified objective hyposalivation with an area under the ROC curve of 0.87 (95% CI 0.78–0.96) and substantial chance-corrected agreement (Cohen’s κ 0.69, 95% CI 0.51–0.87). A five-item short form reproduced the objective findings as well as the full questionnaire did (cross-validated R2 0.56 ± 0.03 versus 0.56). Conclusions: In this high-prevalence institutional cohort, self-reported symptoms agreed with graded salivary function more closely than the older discordance literature would suggest, though still within the range of recent studies rather than beyond it. A five-item subset, chosen for its alignment with the objective salivary axis rather than for internal consistency, recovered as much as the full inventory, which points to a short, function-oriented score as a plausible first-stage screen. We would treat this short form as a candidate first-stage screening approach that requires external validation, rather than as a replacement for objective salivary assessment or as a validated replacement for the Xerostomia Inventory.

Dentistry Journal doi: 10.3390/dj14090556

Authors: Kenko Okamoto Michiko Nishimura Yuji Miyazaki Miyako Hoshino Shinnichi Sakamoto Miki Haruyama Fumio Ide Nobuharu Yamamoto Kentaro Kikuchi

Background: Epstein–Barr virus (EBV) enters the human body via saliva. EBV-encoded latent membrane protein-1 (LMP-1) activates the mitogen-activated protein kinase (MAPK) pathway. MAPK signaling pathway activation due to the BRAF-V600E mutation is widely known as a major event in the pathogenesis of ameloblastoma. It is unclear whether EBV infects ameloblastoma and is involved in the pathogenesis of ameloblastoma. We investigated the relationship between LMP-1 and BRAF-V600E mutant protein expression in ameloblastoma by immunohistochemistry. Methods: We examined a total of 334 samples (ameloblastoma 117 samples, odontogenic keratocyst 127 samples, dentigerous cysts 45 samples, and dental follicle 45 samples). Ephrin type-A receptor 2 (EphA2), BRAF-V600E mutant protein, and γH2AX expression were confirmed by immunohistochemistry. We confirmed that the positive cases of BRAF-V600E mutant protein and γH2AX segregated based on LMP-1 expression: high grade (HG) and low grade (LG). Results: EphA2 expression was high in all lesions. The positive rate of BRAF-V600E mutant protein expression was significantly higher in ameloblastoma, and the positive rate of BRAF-V600E mutant protein in LMP-1 HG cases (71.9%) was significantly greater than in LG cases (39.6%) in ameloblastoma. The positive rate of γH2AX expression was significantly higher in ameloblastoma than in the other lesions. The positive rate of BRAF-V600E mutant protein in LMP-1 HG cases (71.9%) was significantly greater than in LG cases (39.6%) in ameloblastoma. Conclusions: BRAF-V600E mutant protein and γH2AX expression in ameloblastoma were significantly higher in LMP-1 HG cases than in LG cases.

Dentistry Journal doi: 10.3390/dj14090555

Authors: Yanfei Yin Wenxia Li Wei Zhang Ying Huang Lingying Fan Xiaolin Wei Dongyang Ma

Background: Dental caries remains a globally prevalent biofilm-mediated disease driven by microbial dysbiosis and progressive enamel demineralization. The traditional “drill and fill” paradigm has increasingly given way to biologically informed preventive frameworks emphasizing ecological management. Methods: This narrative review synthesizes 134 studies (2016–2026) retrieved from PubMed, Web of Science, Scopus, and Google Scholar to evaluate emerging caries prevention strategies across three domains. Results: Three interrelated domains of advancement were identified. First, microbial ecological modulation—including probiotics, prebiotics, and targeted antimicrobial peptides—aims to restore oral microbiome homeostasis by disrupting cariogenic virulence without eliminating commensal flora. Second, nanomaterial-based targeted interventions utilizing stimuli-responsive carriers and biofilm-penetrating nanoparticles enable site-specific drug delivery with enhanced therapeutic efficacy. Third, precision-guided strategies incorporating caries risk assessment models and salivary biomarker diagnostics facilitate individualized prevention protocols. Conclusions: These findings demonstrate a fundamental paradigm shift from indiscriminate microbial eradication to equilibrium-driven, ecology-centered disease management. Future directions include AI-assisted personalized prevention, chairside microbiome diagnostics, and smart responsive biomaterials for sustained caries control.

Dentistry Journal doi: 10.3390/dj14090554

Authors: Benjamin Allen Bingham Suchunya Rose Bumrung Hassan Ziada Neamat Hassan Abubakr

Background: Accurate reproduction of occlusal anatomy is a critical determinant of the clinical performance of posterior composite restorations. The present study compares marginal adaptation in Class I composite restorations completed using a Kool-Dam STAMP, a flowable-composite STAMP, or conventional hand-carving techniques. Methods: Sixty extracted caries-free molars were randomly allocated to three experimental groups (n = 20). Two fixed marginal sites per tooth (mesial and distal) were measured at four measurement time points: immediately after restoration, before thermocycling, and after 10,000, 30,000, and 50,000 cumulative thermal cycles (5 °C/55 °C; 20 s dwell time). The two site-level values were averaged within each tooth for the primary analysis. A linear mixed-effects model included technique, measurement time point, and the technique-by-time-point interaction, with a random intercept for tooth. Results: No significant interaction was observed between restorative technique and measurement time point, indicating that changes in marginal gap over time were not statistically significant among the three techniques (likelihood-ratio χ2(6) = 1.43, p = 0.964). The overall effect of the technique was also not significant (χ2(2) = 1.26, p = 0.532). In contrast, marginal-gap measurements increased considerably across the four measurement time points (χ2(3) = 218.52, p < 0.001), indicating progressive increases in marginal gaps with thermal ageing. Following the Holm adjustment, no pairwise comparisons between techniques at any individual time point achieved statistical significance. Conclusions: In the present in vitro study, no statistically significant differences in marginal-gap values were detected among the Kool-Dam STAMP, flowable-composite STAMP, and conventional hand-carving techniques. The study was not designed to demonstrate equivalence or noninferiority; therefore, the absence of a statistically significant difference should not be interpreted as evidence that the techniques are equivalent. These findings suggest that the STAMP approach may be a useful technique for reproducing occlusal morphology while maintaining marginal fit. However, further clinical studies are needed to confirm its long-term performance in vivo.

Dentistry Journal doi: 10.3390/dj14090553

Authors: Mounir Ajjan Alhadid Sabina Noreen Wuersching Falk Schwendicke Chantal Herbst Sascha R. Herbst

Objectives: To evaluate the inter- and intra-observer reliability of three methods for measuring root canal curvature and the reliability of canal visibility ratings on periapical radiographs over repeated calibration rounds. Materials and Methods: A total of 360 clinical periapical radiographs were divided into six batches and independently evaluated by three observers. Root canal curvature was measured using the Schneider, Weine, and a novel tangency-based method, while canal visibility was classified on a three-category scale. Inter- and intra-observer reliability were assessed using intraclass correlation coefficients (ICC). Agreement between observers was evaluated using Bland–Altman analysis, and differences between measurement methods were compared using repeated-measures analysis. The association between canal visibility and inter-observer measurement differences was assessed using Spearman rank correlation. Results: Inter-observer reliability for curvature measurements was predominantly good to excellent across all methods, with no consistent improvement over successive calibration rounds. Intra-observer reliability, assessed in one observer, was excellent (ICC 0.90–0.97). Measurement method significantly influenced angle values, with the Weine method producing larger angles than the Schneider and tangency-based methods, whereas the latter two showed comparable results. Agreement on canal visibility remained fair to moderate, and reduced canal visibility showed a weak but significant association with greater inter-observer differences in curvature measurements. Conclusions: All three methods demonstrated comparable inter-observer reliability, although the Weine method yielded systematically larger curvature angles. Agreement did not consistently improve over repeated calibration rounds. Reduced canal visibility may increase measurement variability and should be considered when interpreting root canal curvature on periapical radiographs.

Dentistry Journal doi: 10.3390/dj14090552

Authors: Cristina Gena Dascalu Magda-Ecaterina Antohe Diana Tatarciuc Roxana Ionela Vasluianu Cristina Iordache Anca Vitalariu Odette Elena Luca Georgeta Liliana Foia

The practice of contemporary dentistry requires not only technical skills but also the development of soft skills, such as communication, empathy, and ethical and professional values. Although the importance of these skills is increasingly recognized, the perceptions of dental students in Romania regarding their relevance to their future professional practice remain insufficiently explored. Objectives: The study aimed to assess the perceptions of final-year students at the Faculty of Dentistry in Iași regarding the importance of soft skills, in relation to their demographic characteristics, professional motivations, and preferences regarding their future practice settings, as well as to identify distinct profiles through cluster analysis. Material and Methods: The study included 205 students in their fourth through sixth years at the Faculty of Dentistry in Iași, who anonymously completed a 26-item questionnaire rated on a Likert scale from 1 to 5. The statistical analysis included the chi-square test, Ward’s method, and k-means clustering. Results: Ethical and professional values, artistic skills, and empathy were most frequently rated as “very important.” Female students assigned significantly higher scores than male students to empathy, ethical and professional values, personal characteristics, and communication (p < 0.05–0.001). Professional independence, financial stability, and professional prestige were the main motivations for career choice. Cluster analysis identified four distinct profiles, with significant differences based on gender, professional motivations, and preferences regarding future practice. Conclusions: Students place a high value on soft skills, with differences based on gender and professional profile. The results support the integration of these skills into university education, to complement specialized clinical training.

Dentistry Journal doi: 10.3390/dj14090551

Authors: Selma Dervisbegovic Reinhard Gruber Andrea Gamper Stefan Nemec Xiaohui Rausch-Fan Gabriella Dvorak

Background/Objectives: Accurate assessment of gingival thickness (GT) is important for periodontal and implant treatment planning. Methods: In this method-comparison study based on prospectively collected clinical data from 2012, GT was assessed at standardized buccal sites using cone beam computed tomography (CBCT), bone sounding (BS), an earlier-generation pulse–echo ultrasound (US) device, and direct digital caliper (CA) measurement. Of 53 acquired CBCT scans, 12 (23%) were non-evaluable because the buccal soft tissues could not be reliably delineated, leaving 41 sites from 41 patients for analysis. A ±0.30 mm clinical comparison margin, based on the difference used in the original sample-size calculation, was applied to interpret agreement. Results: Mean comparator-minus-CBCT biases were −0.19 mm for BS (95% limits of agreement [LoA], −0.98 to 0.61 mm), −0.16 mm for US (95% LoA, −0.83 to 0.51 mm), and −0.71 mm for CA (95% LoA, −1.99 to 0.56 mm). Although BS and the tested US device showed smaller average differences from CBCT than CA, the LoA for all comparisons exceeded this margin. Phenotype classification was exploratory because only four sites were classified as thin by CBCT. Conclusions: BS and the tested pulse–echo US device showed smaller average differences from CBCT than CA; however, the limits of agreement for all comparisons exceeded this margin, so none of the comparator methods can be considered interchangeable with CBCT. The 23% non-evaluable CBCT rate and the device- and protocol-specific nature of the findings limit their generalizability to current-generation systems.

Dentistry Journal doi: 10.3390/dj14090550

Authors: Esteban Colombo Enrica Giammarinaro Maria Menini Paolo Pesce Nicola De Angelis

Objectives: The primary objective of this retrospective pilot study was to evaluate the long-term radiographic stability of peri-implant marginal bone levels (MBLs) at a five-year follow-up, comparing two different socket preservation protocols against spontaneous healing. Materials and Methods: A total of 24 patients who underwent tooth extraction followed by delayed implant placement were divided into three groups of 8 subjects each. Test Group 1 was treated with a heterologous cortico-cancellous bone graft covered by a slow-resorbing bovine pericardium membrane. Test Group 2 received the same bone graft but covered by a rapidly resorbing native porcine collagen membrane. The Control Group was left to heal spontaneously. Marginal bone loss (MBL) was calculated radiographically by measuring the difference in bone levels between the time of osseointegration (T0) and the 5-year follow-up (T1). For each implant, mesial and distal MBL values were averaged to obtain a single mean per-implant MBL value for group-level analysis. Results: The 5-year implant survival rate was 100% across all analyzed groups. Test Group 1 demonstrated the highest peri-implant bone stability, recording a mean MBL of 0.17±0.20 mm. In contrast, Test Group 2 and the Control Group exhibited greater resorption, with mean MBL values of 0.46±0.12 mm and 0.45±0.27 mm, respectively. Descriptive analysis indicated a trend toward improved peri-implant bone preservation in the group treated with biomaterial and a slow-resorbing pericardium membrane compared to both the short-resorbing collagen membrane group and the spontaneous healing control group. Conclusions: Within the limitations of this pilot study, the results suggest that the choice of barrier membrane in socket preservation procedures could affect 5-year marginal bone stability. The application of a slow-resorbing membrane provided a prolonged barrier action and showed a descriptive trend of lower mean marginal bone loss. However, the extremely small sample size precludes establishing clinical superiority over standard collagen membranes or spontaneous healing. Further randomized clinical trials with larger cohorts are necessary to confirm these long-term findings.

Dentistry Journal doi: 10.3390/dj14090549

Authors: Stella O. Oyewole Emma Butler Sagun D. Goyal Adepitan A. Owosho

Background/Objectives: Chimeric antigen receptor T-cell (CAR-T) therapy has been approved for the management of relapsed and refractory hematologic malignancies, transforming the oncologic landscape and producing durable remissions in patient populations with limited alternatives. The systemic adverse events of CAR-T are well characterized; however, the orofacial adverse events have not been well described. The objective of this study is to leverage a large, de-identified, real-world dataset to (1) estimate the prevalence of orofacial adverse events following CAR-T, (2) compare event rates with the general population, and (3) directly contrast the orofacial toxicity burden of CAR-T with that observed after hemopoietic stem cell transplant (HSCT). Methods: We performed a retrospective cohort study using de-identified electronic health record data from TriNetX. CAR-T and HSCT cohorts were identified via RxNorm and procedure codes; a non-exposed control cohort was included. Patients with prior orofacial conditions or confounding therapies were excluded. New adverse orofacial events within one year were identified by International Classification of Diseases, 10th Revision (ICD-10) codes. Cohorts were 1:1 propensity-matched by age and sex; associations were estimated as odds ratios with two-sided 95% CIs. Results: In 1142 CAR-T recipients (mean age of 62), gastroesophageal reflux disease (GERD) was most frequent (5.18%). Oral mucosal events included stomatitis in 1.52%, mucositis in 1.31%, and lichenoid reactions in 1.03%. Dysphagia occurred in 1.8% and oral candidiasis in 1.6%. Several severe oral conditions were absent. Compared with the general population (CART vs. general population): mucositis—[12/995 vs. 0/1112] (OR 28.3)—and stomatitis—[16/987 vs. 0/1119] (OR 38)—risks were significantly increased, while CAR-T patients had significant lower risks of mucosal complications than HSCT recipients in this analysis (CART vs. HSCT): mucositis—[1.21% vs. 3.72%] (OR 0.316) and stomatitis—[1.42% vs. 3.91%] (OR 0.354). Conclusions: CAR-T therapy carries a distinct and generally lower orofacial toxicity burden than HSCT, but targeted dental assessment and prospective surveillance remain important to optimize supportive care for cellular therapy recipients.

Dentistry Journal doi: 10.3390/dj14090548

Authors: Alice Kit Ying Chan Lindsey Lingxi Hu Joanna Cheuk Yan Hui Chun Hung Chu

Background: Geriatric dentistry prepares dentists to care for an aging population. Yet, its integration into undergraduate curricula remains inconsistent. Objectives: To map evidence on the barriers to and facilitators of the implementation and development of undergraduate geriatric dental education. Methods: A scoping review was conducted using systematic searches of PubMed, Scopus, and Embase for English-language original research articles published from 1 January 2016 onward. Two reviewers screened titles, abstracts, and full texts independently against eligibility criteria. Studies were included if they examined barriers and/or facilitators related to undergraduate geriatric dental education. Data were extracted independently and synthesized descriptively to identify themes and evidence gaps. No critical appraisal was performed. Results: This review identified 1376 studies and included 11 studies, including seven cross-sectional and four cohort studies. Barriers clustered into three themes: structural and workforce-related barriers (resource constraints and a lack of equipped/trained staff), curricular and regulatory barriers (overcrowded curricula and a lack of curriculum guidelines), and interprofessional and attitudinal barriers (limited interprofessional collaboration and negative attitudes among students and teaching staff towards older adults). Facilitators were grouped into three themes: pedagogical and experiential learning strategies (didactic teaching, clinical training, extramural exposure, simulation-based training, and communication training), curricular and policy enablers (integrated curricula and national guidelines), and institutional and faculty support (staff support). Conclusions: This review identifies the multifaceted, modifiable educational, institutional, and policy factors that influence the implementation and development of geriatric dental education. By consolidating the existing evidence, this review provides a foundation for curriculum development and policy planning to prepare graduates to deliver age-responsive oral healthcare.

Dentistry Journal doi: 10.3390/dj14090547

Authors: Takahisa Iida Shunsuke Baba Giovanna Iezzi Ermenegildo Federico De Rossi Fernando Maria Muñoz Guzon Karol Alí Apaza Alccayhuaman Daniele Botticelli

Background: Buccal overbuilding may support the buccal contour before tooth extraction, but the effect of collagen membrane fixation on graft stability remains unclear. This study evaluated whether pin fixation influences buccal ridge dimensions and graft persistence in a pre-extraction dog model. Methods: In six Beagle dogs, bovine bone mineral was grafted bilaterally at the mandibular first molar region without tooth extraction and covered with a native collagen membrane, fixed with titanium pins at test sites and left unfixed at control sites. After three months, histological measurements were performed. The primary outcome was buccal bone width at 2 mm apical to the cemento-enamel junction. Results: Buccal bone width was 1.02 ± 0.30 mm in the Pin group and 0.89 ± 0.37 mm in the No-pin group. The mean paired difference was 0.13 mm (95% CI: −0.55 to 0.81 mm; p = 0.6875). The combined outer mineralized contour measured 1.06 ± 0.37 mm and 0.95 ± 0.42 mm, respectively. Residual graft occupied 19.4 ± 6.9% of the standardized buccal region in the Pin group and 8.7 ± 6.6% in the No-pin group. Conclusions: Membrane fixation did not significantly improve buccal bone width after three months. The greater residual-graft fraction in the Pin group was exploratory and requires confirmation in studies including tooth extraction and subsequent implant placement.

Dentistry Journal doi: 10.3390/dj14090545

Authors: Anastasia Timoschenko Lea Stoilov Michael Marder Helmut Stark Norbert Enkling Dominik Kraus Milan Stoilov

Objectives: To compare prosthesis survival, complication-free survival, and maintenance-free survival between telescopic-crown-retained dentures (TCDs) and root-cap-retained overdentures with ball attachments (RCDs), and to evaluate associated clinical factors. Methods: This retrospective single-center cohort study included 654 unique patients, each contributing one eligible prosthesis (406 TCDs and 248 RCDs). Mean follow-up was 4.15 years for TCD and 2.75 years for RCD. Time-to-event outcomes were analyzed using Kaplan–Meier methods and multivariable Cox regression. Adjusted analyses were restricted to prostheses supported by one to three abutments. Results: Unadjusted prosthesis survival was higher for TCD (p = 0.0001), whereas prosthesis type was not clearly associated with loss after adjustment (RCD vs. TCD: HR = 1.28; 95% CI: 0.75–2.19). Single-abutment support and, in sensitivity analysis, point-like support were associated with higher loss hazards. The higher adjusted complication hazard for RCD was attenuated in sensitivity analysis. RCDs were consistently associated with earlier maintenance (average HR = 1.75; 95% CI: 1.43–2.13), with exploratory analyses suggesting a greater difference during early follow-up and among single-abutment prostheses. Conclusions: The support situation appears more relevant to prosthesis loss than the retention concept alone. RCDs show earlier first documented maintenance requirements, whereas evidence for an independent difference in complication risk is model-dependent.

Dentistry Journal doi: 10.3390/dj14090546

Authors: Efstathios Grammatikis Corina Laura Ștefănescu Liliana Sachelarie Marius-Florentin Popa Marius-Daniel Radu Rodica-Maria Murineanu Elena Șapte

Background/Objectives: Periodontitis and peri-implantitis are inflammatory conditions associated with progressive loss of supporting bone, but they differ in tissue architecture, biological response, and disease progression. Conventional radiographic assessment often reports bone loss as a global value, which may overlook site-specific mesial–distal differences. This study aimed to compare mesial and distal radiographic bone loss around natural teeth affected by periodontitis and dental implants affected by peri-implantitis, with a focus on quadrant 1. Methods: This retrospective comparative CBCT-based radiographic study analyzed 128 within-patient paired tooth/implant observations in quadrant 1. Mesial and distal bone loss values were recorded separately for natural teeth and corresponding implant sites. Each pair included one natural-tooth site and one implant site from the same patient, matched by comparable anatomical position and surface. Paired-samples t-tests were used, and mean differences were calculated as implants minus natural teeth. Given the multiple site-specific comparisons, p-values were interpreted as unadjusted exploratory findings. Results: Statistically significant differences were observed only on the mesial surface of anterior implants. Mesial bone loss was significantly greater around implants than natural teeth for central incisors (8.30 ± 3.31 mm vs. 4.90 ± 1.78 mm; mean difference = 3.39 mm; p = 0.004), lateral incisors (8.12 ± 3.57 mm vs. 4.94 ± 2.82 mm; mean difference = 3.18 mm; p = 0.028), and canines (5.99 ± 3.12 mm vs. 4.42 ± 1.26 mm; mean difference = 1.57 mm; p = 0.018). No statistically significant differences were observed for distal surfaces or posterior tooth/implant positions. Conclusions: Within the limitations of this quadrant-specific retrospective radiographic analysis, peri-implant bone loss showed a surface- and position-dependent distribution, with greater mesial bone loss around anterior implants. Separate mesial and distal assessment may provide additional value for periodontal and peri-implant monitoring.

Dentistry Journal doi: 10.3390/dj14090544

Authors: Osama Zakaria

Background/Objectives: Dental needles are used routinely for local anaesthesia, but repeated insertion, needle selection, and operator handling may all compromise tip integrity. This study assessed bevel deformation, biological debris, and manual bending in used dental needles collected during undergraduate clinical practice. Their associations with needle dimensions, insertion frequency, injection technique, and operator seniority were also examined. Methods: 192 discarded needles were collected from fourth-, fifth-, and sixth-year students and dental interns after routine local anaesthesia procedures at an academic dental hospital. Each needle was examined under stereomicroscopy. Needle bevels were classified as intact, outward bending, or inward bending; biological debris and manual bending were also recorded. Predictors of bevel deformation were identified by multivariable logistic regression. Results: Bevel deformation was present in 93 of 192 needles. Thirty-gauge needles showed higher odds of deformation than 27-gauge needles (OR = 2.54, p = 0.004), and each additional insertion further increased the odds (OR = 1.98, p = 0.016); once gauge was accounted for, needle length was not an independent predictor. Intended bone contact showed no association with deformation. Outward bending predominated among deformed tips (63.4% vs. 36.6% inward), and biological debris was detected on 16.1% of needles. Manual bending was more frequent among interns than students (OR = 3.67, p = 0.007). Conclusions: Used dental needles frequently exhibited bevel deformation, particularly with 30-gauge needles and after repeated insertions. The occurrence of deformation even in the absence of intentional bone contact further supports strict single-use practices and careful needle handling during local anaesthesia. Although the higher frequency of manual needle bending observed among interns should be interpreted cautiously, this finding highlights a potential area for targeted operator training and further investigation.

Dentistry Journal doi: 10.3390/dj14090543

Authors: Panaite Tinela Carmen Diana Nicoleta Savin Ana Sîrghie Teona Ana-Maria Tudorici Irina Bamboi Anca Rapis Ana Nemțoi Ciprian-Iulian Axinte Carina Ana-Maria Balcos

Background/Objectives: Patient-reported outcome measures (PROMs) complement clinical indicators in orthodontics, yet validated instruments for children undergoing removable orthodontic treatment remain limited. This study aimed to develop and validate a questionnaire assessing compliance and physical discomfort, psychosocial impact, and perceived support. Methods: A cross-sectional validation study included 250 children and adolescents (<14 years) treated with removable orthodontic appliances, regardless of treatment duration. The 14-item questionnaire was evaluated for internal consistency (Cronbach’s alpha), reliability (intraclass correlation coefficient, ICC), item discrimination (ANOVA), and construct validity using exploratory factor analysis with Varimax rotation. Sampling adequacy was assessed using the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test of sphericity. Results: Internal consistency was satisfactory (Cronbach’s alpha: 0.747–0.823), with corrected item–total correlations above 0.30. ICC values indicated moderate reliability for single measures and good reliability for average measures. The KMO value was 0.713, and Bartlett’s test was significant (p < 0.001). Three factors explained 58.69% of the total variance, representing psychosocial impact, compliance/discomfort, and perceived support. Conclusions: The questionnaire demonstrated satisfactory reliability and construct validity for assessing patient-reported outcomes in children undergoing removable orthodontic treatment. It provides a practical instrument for evaluating compliance and physical discomfort, psychosocial impact, and perceived support in both clinical practice and research.

Dentistry Journal doi: 10.3390/dj14090542

Authors: Tomás Quintero De La Hoz Yaskara Sanjines Peña Fernando Quispe Ramírez Oriana Rivera-Lozada Joshuan J. Barboza

Background: Radiotherapy-induced xerostomia is a prevalent and disabling complication in patients with head and neck cancer, leading to persistent oral pain, impaired salivary function, and substantial deterioration in quality of life. Photobiomodulation (PBM) has emerged as a supportive therapeutic strategy with potential anti-inflammatory, analgesic, and tissue-preserving effects; however, its clinical effectiveness remains incompletely defined. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials evaluating PBM for the management of radiotherapy-induced xerostomia in adults with head and neck cancer. MEDLINE (PubMed), Embase, Scopus, and Web of Science were searched from inception to October 2025. Eligible studies assessed intraoral and/or extraoral PBM using predefined laser parameters and reported outcomes related to oral pain, salivary flow, or xerostomia-related quality of life. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Random-effects meta-analyses were performed using the Paule–Mandel estimator. Certainty of evidence was appraised using the GRADE framework. Results: Seven randomized trials were included. PBM significantly reduced oral pain compared with control interventions (mean difference [MD] −0.76; 95% CI −1.33 to −0.20), with moderate heterogeneity. For stimulated and unstimulated salivary flow, pooled estimates favored PBM but did not reach statistical significance, and heterogeneity was considerable (I2 > 90%). Substantial variability in laser wavelength, energy density, treatment frequency, anatomical targeting, and radiation exposure of salivary glands contributed to inconsistent effects across studies. The certainty of evidence was rated as moderate for pain reduction and low to very low for salivary flow outcomes. Conclusions: Photobiomodulation provides a clinically meaningful reduction in radiotherapy-related oral pain and may confer symptomatic benefit in xerostomia; however, its effect on salivary flow restoration remains uncertain. Standardized PBM protocols, improved methodological rigor, and adequately powered trials are required to clarify its role in supportive care for head and neck cancer patients.

Dentistry Journal doi: 10.3390/dj14090541

Authors: Benjamin Reto Huber Noah Walser Thiemo Gamma Philipp Metzler

Background: Severe tooth loss affects approximately 267 million people worldwide and has a significant impact on quality of life and general health. Various prosthetic treatment concepts exist for oral rehabilitation. The All-on-Four concept, first described by Maló in 2003, is considered a modern approach for timely and patient-friendly restoration of oral function and esthetics. Methods: A systematic literature search was conducted in the electronic databases MEDLINE/PubMed and EMBASE (Elsevier). Eligible studies were identified according to the framework, including investigations on the All-on-Four concept (PIO) and alternative implant-supported full-arch rehabilitation strategies (FDP4+, PCO). The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale. Results: Following the selection process, eleven PIO studies and nine PCO studies were included for qualitative analysis. Reported prosthesis survival rates were comparable between All-on-Four (85.0–100%) and concepts with more than four implants (88.2–100%) over up to 20 years. Implant survival ranged from 89.7–97.9% for All-on-Four and 98.9–99.0% for alternative concepts. Marginal bone loss after 5 years reached up to 1.9 mm for All-on-Four and 2.9 mm for alternative concepts. Metal–ceramic prostheses demonstrated lower fracture rates (7.27–18.2%) compared with metal–acrylic restorations (7.3–36.7%). Discussion: The available evidence suggests that the All-on-Four concept represents a predictable treatment option for edentulous patients, with implant and prosthetic survival rates comparable to FDP4+ concepts. Immediate loading protocols may improve patient satisfaction and reduce treatment time when adequate primary stability is achieved. However, biological and technical complications remain clinically relevant. Interpretation of the findings is limited by heterogeneous study designs and predominantly retrospective evidence. Conclusions: The All-on-Four concept provides a reliable rehabilitation option for patients with advanced ridge atrophy who decline regenerative procedures or removable prostheses. Current evidence indicates no significant differences in survival or complication rates compared to other implant-supported treatment concepts.

Dentistry Journal doi: 10.3390/dj14090540

Authors: Sophie-Myriam Dridi Carole Charavet

Background/Objectives: Wire syndrome (WS) is a recognized post-orthodontic complication associated with bonded fixed retainers. It is characterized by abnormal, unexpected or excessive tooth movement in teeth that are still being held in place by a wire retainer. WS is likely to be underdiagnosed due to its slow, often asymptomatic, progression in the early stages, as well as due to a lack of knowledge among practitioners. This article proposes an etiopathogenic concept for WS associated with twisted or braided multistrand wires, with the aim of improving our understanding of the mechanisms involved in its onset and iatrogenic progression for the purposes of prevention and clinical management. Materials and Methods: A narrative review of the available clinical and experimental data in the literature was conducted to identify factors that could be involved in the initiation and progression of WS. Results: The qualitative analysis suggested that WS is the result of a multifactorial phenomenon that combines intrinsic factors linked to the mechanical properties of the orthodontic appliance and extrinsic factors corresponding to functional, muscular, and parafunctional stresses exerted on the teeth. Several etiopathogenic scenarios can be proposed, including loss of wire–composite adhesion, maintenance of this adhesion in the context of excessive muscular forces, and a mixed mechanism. In all cases, secondary deformation of the wire could alter its mechanical properties progressively, leading to unintended orthodontic activation of the appliance. This review also emphasizes the importance of rigorous retainer placement protocols, prolonged post-orthodontic follow-up and preventing excessive mechanical stress. Artificial intelligence could be a promising way to detect WS early on through the automated analysis of successive optical impressions. Conclusions: This review puts forward a coherent etiopathogenic concept for WS associated with multistrand wires. This concept is based on the interaction between wire deformation, progressive alteration to the wire–composite interface and mechanical stresses in the oral environment. This concept could explain the wide clinical variability of the syndrome, as well as its often slow and insidious progression. A better understanding of these mechanisms is essential for improving the prevention, early diagnosis, and clinical management of WS.

Dentistry Journal doi: 10.3390/dj14090539

Authors: Albert Ramírez-Rámiz María Dolores Rocha-Eiroa Lluís Brunet-Llobet Mar Muñoz-De Gea Octavi Camps-Font Jaume Miranda-Rius

Background: Periodontal disease has been increasingly associated with several systemic conditions, including diabetes mellitus. During pregnancy, both periodontitis and diabetes mellitus—including gestational and pre-existing forms (type 1 and type 2)—share common inflammatory and metabolic pathways that may influence maternal and neonatal outcomes. However, the consistency and strength of this association remain under debate. Objective: Our objective was to synthesize the available evidence from systematic reviews and meta-analyses on the association between maternal periodontal disease and diabetes mellitus during pregnancy, as well as its relationship with adverse pregnancy outcomes. Methods: An overview of systematic reviews was conducted following PRISMA recommendations. A comprehensive search was performed in PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to the search date. A total of 161 records were identified, with 23 articles assessed in full text. Finally, nine systematic reviews were included, seven of which incorporated meta-analyses. Methodological quality was evaluated using AMSTAR 2, and risk of bias was assessed with ROBIS. Due to heterogeneity, a narrative synthesis was conducted. The degree of overlap among reviews was quantified using the corrected covered area (CCA). Results: The evidence consistently suggests a positive association between periodontal disease and diabetes mellitus during pregnancy, with increased risk reported in multiple meta-analyses, particularly for gestational diabetes mellitus. Periodontitis was also associated with adverse pregnancy outcomes, including preeclampsia, preterm birth, and low birth weight, although findings were not entirely homogeneous. The methodological quality of the included reviews was variable, predominantly low or critically low. A high level of overlap among reviews was observed (CCA = 15.2%). Conclusions: Current evidence supports an association between maternal periodontal disease, diabetes mellitus during pregnancy, and adverse maternal-fetal outcomes. However, these findings should be interpreted with caution due to methodological limitations and study overlap. Periodontal assessment in prenatal care and oral health education may be preventive strategies. Further studies are needed to clarify causality and evaluate these interventions.

Dentistry Journal doi: 10.3390/dj14090538

Authors: Yasser Sherif Soliman Nadine Gräfin von Krockow Fatma E. A. Hassanein Mihad Ibrahim Abdelsalam ElAskary Hossam Ismail

Background/Objectives: Vestibular socket therapy (VST) is a minimally invasive technique for immediate implant placement (IIP) in compromised extraction sockets that reconstructs the deficient buccal plate while preserving the crestal soft tissue. Despite growing clinical adoption, the randomized evidence on its predictability and biological performance remains limited. Methods: Following PRISMA 2020 and prospectively registered in PROSPERO (CRD420261288724), PubMed/MEDLINE and EMBASE were searched to January 2026 for randomized controlled trials (RCTs) evaluating VST with IIP. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed. Final follow-up buccal bone plate thickness was pooled using a random-effects model; trials comparing variations within VST were reported narratively but not pooled. Results: Seven RCTs (186 participants) were included; implant survival was 99.5%, with no shield exposure, peri-implantitis, or dehiscence. Meta-analysis of the three trials comparing VST against a distinct alternative technique showed no significant between-group difference in final buccal bone plate thickness at any level: crestal +0.24 mm (95% CI−0.13 to 0.61; I2 = 45%), mid-root +0.32 mm (−0.45 to 1.09; I2 = 82%), or apical +0.19 mm (−0.48 to 0.87; I2 = 67%). VST showed minimal mid-facial recession, stable papillae, and Pink Esthetic Scores of 10.29–13.17. Certainty was very low for all outcomes. Conclusions: VST achieved high implant survival and favorable soft tissue and esthetic outcomes but did not significantly outperform comparator techniques in buccal bone plate thickness, with very low certainty. Adequately powered, independent trials with longer follow-up are needed.

Dentistry Journal doi: 10.3390/dj14090537

Authors: George Dumitru Constantin Alexandru Cucui-Cozma Ioana Veja Crisanta-Alina Mazilescu Roxana Oancea

Background/Objectives: Dental graduates make clinical decisions shaped by ethical principles, legal obligations, patient expectations, and private-practice economics. This study synthesized empirical findings from Romanian healthcare education and practice and proposes an exploratory model for teaching ethical decision-making in entrepreneurial dentistry. Methods: Exploratory conceptual framework development informed by four previously published Romanian healthcare studies examining business-ethics attitudes using the Attitudes Toward Business Ethics Questionnaire (ATBEQ), moral reasoning using an adapted Defining Issues Test-2 (DIT-2; 242 valid cases), scenario-based ethical decision-making (n = 244), and ethical reasoning profiles derived from the joint administration of the ATBEQ and 35-item scenario questionnaire (n = 277). Results: “It depends” accounted for 47.8% of scenario responses. Students and practitioners differed regarding vaccination of healthcare workers, risk-based insurance contributions, and organ-market policy (chi-square, df = 2, uncorrected). Practitioners endorsed law-oriented arguments more strongly but weighted patient autonomy more heavily at end of life. Idealism/Legalism showed an isolated exploratory association with fewer conditional responses (B = −0.69, 95% CI −1.28 to −0.11, p = 0.021); however, the overall regression model was not statistically significant and had low explanatory power (R2 = 0.04, adjusted R2 = 0.02, p = 0.08). Four ethical reasoning profiles were identified. Conclusions: The G.D.C. framework is a theory-informed, hypothesis-generating educational framework derived from mixed Romanian healthcare samples. It has not been validated specifically in entrepreneurial dentistry and requires prospective, dental-specific validation.

Dentistry Journal doi: 10.3390/dj14090536

Authors: Víctor Juan Vera-Ponce Jhosmer Ballena-Caicedo Nelly Del Carmen Villegas Ampuero Julio David Sagastegui Jauregui Fiorella E. Zuzunaga-Montoya

Background/Objectives: Early glycemic abnormalities may identify adults at increased oral health risk, but longitudinal evidence from Latin American occupational populations is limited. We evaluated whether screening-based baseline prediabetes and hyperglycemia were associated with recorded incident dental outcomes among Peruvian formal-sector workers. Methods: We conducted a retrospective cohort study using occupational health records from 2013–2021. The primary outcome was a composite incident dental outcome, defined as incident caries or gingivitis; secondary outcomes were incident caries and incident gingivitis separately. Screening-based baseline prediabetes was compared with normoglycemia after excluding diabetes, whereas screening-based baseline hyperglycemia included prediabetes or diabetes and was compared with normoglycemia. Cox proportional hazards models were adjusted for age, sex, occupation type, smoking, and alcohol consumption, with inverse-probability weighted analyses for exposure and follow-up. Results: Among 79,660 workers, 12,049 (15.1%) had longitudinal dental follow-up. After outcome-specific exclusions and glycemic classification, the hyperglycemia analysis included 10,050 workers and 345 composite dental events, and the prediabetes analysis included 9804 workers and 335 events. Prediabetes was associated with higher hazards of the composite outcome (adjusted HR 1.61; 95% CI 1.20–2.17) and incident caries (adjusted HR 1.94; 95% CI 1.42–2.65). Hyperglycemia showed similar associations with the composite outcome (adjusted HR 1.55; 95% CI 1.17–2.05) and incident caries (adjusted HR 1.87; 95% CI 1.39–2.52). No increased hazard of incident gingivitis was observed. Estimates were directionally stable after obesity adjustment and inverse-probability weighting. Conclusions: Screening-based baseline prediabetes and hyperglycemia were associated with higher recorded incidence of dental outcomes, mainly incident caries, among workers with longitudinal dental follow-up. Limited dental follow-up reduces generalizability and may reflect heterogeneous implementation of dental surveillance. Because proportional hazards diagnostics suggested time-varying associations for the composite outcome and caries, Cox estimates should be interpreted as summary associations over follow-up.

Dentistry Journal doi: 10.3390/dj14090535

Authors: Thomas Corfield Denice Higgins

Background/Objectives: Human teeth naturally fluoresce due primarily to organic components within dentine, contributing to their vitality and appearance under ultraviolet (UV) light. Contemporary resin composites increasingly incorporate fluorescent agents to reproduce this property and improve aesthetic integration with natural dentition. This narrative review examines the fluorescence characteristics of natural teeth and direct resin composites, evaluates methods used to assess dental fluorescence, and identifies factors influencing fluorescence stability and biomimetic performance. Methods: Peer-reviewed studies published between 2004 and 2025 investigating fluorescence in human teeth and direct resin-based composites under UV, visible or infrared illumination were reviewed. Studies focused on indirect restorative materials, non-human specimens or caries detection alone were excluded. Results: Natural teeth generally exhibit fluorescence emission peaks between 410 and 500 nm, with dentine demonstrating greater fluorescence intensity than enamel. Composite resins commonly incorporate rare-earth oxide fluorophores and often display similar emission wavelengths (approximately 450–485 nm), although fluorescence intensity varies considerably among brands and shades. Material fluorescence is influenced by composition, aging and environmental exposure. Spectrofluorometry provides highly accurate quantitative assessment, whereas photographic and quantitative light-induced fluorescence (QLF) methods offer greater clinical applicability. Despite advances in fluorescence mimicry, variability among contemporary materials generally continues to permit differentiation from natural tooth. Conclusions: Although substantial progress has been made in reproducing natural tooth fluorescence, significant variability and temporal instability remain among contemporary composite materials. Fluorescence-based methods therefore remain useful for restoration identification. However, continued improvements in biomimetic performance may reduce their future effectiveness. Greater standardisation of fluorescence assessment and investigation of alternative detection approaches are needed to support clinical and forensic applications.

Dentistry Journal doi: 10.3390/dj14090534

Authors: Francesca Gazzani Chiara Pavoni Francesca Chiara De Razza Letizia Lugli Paola Cozza Roberta Lione

Objective: Class II malocclusion with mandibular retrusion in growing patients is traditionally managed with functional appliances. Recent advances in clear aligner therapy have introduced new biomechanical approaches combining aligners with intermaxillary elastics. This case report describes the correction of a skeletal Class II malocclusion using clear aligners combined with Class II elastics during the pubertal growth spurt. Methods: An 11-year-old female patient with skeletal Class II due to mandibular retrusion, increased overjet, deep bite, and dental Class II relationship was treated with clear aligners, transverse expansion, bite ramps, attachments, and full-time Class II elastics. Results: After 24 months of treatment, favorable dentoskeletal and occlusal outcomes were achieved, including improvement of the sagittal relationship (ANB reduction from 7° to 4°), mandibular advancement (SNB increase from 76° to 79°), and correction of overjet and overbite. Conclusions: The combination of clear aligners and Class II elastics may represent a valid treatment option for growing patients with mandibular Class II malocclusion, providing effective sagittal correction and good control of dental movements when applied during the appropriate growth phase.

Dentistry Journal doi: 10.3390/dj14090533

Authors: Samille Biasi Miranda Rosalia Maux de Carvalho Rodrigues Caroline de Farias Charamba Leal Fernanda Campos Hugo Rafael de Souza Cavalcante Priscylla Gonçalves Correia Leite de Marcelos Marcos Antonio Japiassú Resende Montes Rodrigo Barros Esteves Lins

Background: In-office dental bleaching is a common aesthetic procedure, and different application methods may influence laboratory and clinical outcomes. Objectives: This systematic review and meta-analysis evaluated the effects of applicator brush use compared with conventional application without a brush during in-office hydrogen peroxide bleaching. Methods: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42023491451). Electronic searches were conducted in PubMed, Cochrane Library, LILACS, and OpenGrey for studies published until April 2026. Clinical and in vitro studies comparing bleaching gel application with and without an applicator brush were included. Outcomes included hydrogen peroxide concentration in the pulp chamber, bleaching gel consumption, color change, and tooth sensitivity. Risk of bias was assessed using RoB 2 for the randomized clinical trial and the Sarkis-Onofre tool for in vitro studies. Meta-analyses were performed using RevMan, and certainty of evidence was assessed using the GRADE approach. Results: Of 10,260 records identified, four studies met the eligibility criteria, including one randomized clinical trial and three in vitro studies. Quantitative synthesis was based exclusively on the three in vitro studies. The randomized clinical trial showed low risk of bias, whereas the in vitro studies presented methodological limitations. Meta-analyses showed no statistically significant differences between applicator brush and conventional application methods for hydrogen peroxide concentration in the pulp chamber or bleaching gel consumption, although pooled estimates showed a tendency toward lower values with applicator brush use. No significant differences were observed in color change outcomes assessed by ΔEab, ΔE00, or ΔWID (p > 0.05). Heterogeneity ranged from 0% to 99%, and the certainty of evidence for all outcomes was rated as very low. Conclusions: Based on predominantly laboratory evidence of very low certainty, applicator brush use may be associated with lower hydrogen peroxide concentration in the pulp chamber and reduced bleaching gel consumption; however, these findings should be interpreted cautiously, and the clinical relevance of this application method remains uncertain.

Dentistry Journal doi: 10.3390/dj14080532

Authors: Benso Sulijaya Melinda Rabekka Purba Mardikacandra Manggala Putra Fatimah Maria Tadjoedin

Background: To date, several studies have confirmed the fact that over 700 species of microbiota interacts with host, modulating immunity, controlling the homeostasis environment, and thus maintaining systemic condition. Dysbiosis in the subgingival biofilm can initiate chronic inflammation of the gingiva, potentially progressing to periodontitis. Advances in DNA sequencing analysis of the subgingival microbial community have shown that periodontal treatment causes a microbial shift in subgingival plaque, affecting the taxonomic composition (disease- and health-associated taxa). Yet, none of these have been investigated in Indonesia. Objective: The objective was to profile the composition of oral microbiome in Indonesian population with healthy, gingivitis, and periodontitis status. Further, we analyzed the subgingival bacterial alteration following the therapy in periodontitis group. Methods: Twelve subjects consisting of healthy, gingivitis, and periodontitis patients were included. Additionally, the periodontitis group was observed at baseline, 1-month, and 3-month. Subgingival dental plaque were sampled and 16S rRNA NGS analysis was performed. Alpha (Chao1, Shannon, and Simpson indices) and beta diversity (PCoA plots based on Bray–Curtis dissimilarity) were observed. Microbiota composition at the genus and species levels was analyzed. Results: No statistically significant differences (p > 0.05) were found for Chao1, Shannon, and Simpson indices amongst groups and in periodontitis patients across the observation. At the genus level, PCoA plots based on Bray–Curtis dissimilarity revealed that the clinical status accounted for 21.9% of the total variation (R2 = 0.219, p = 0.197), while at the species level, it accounted for 19.8% (R2= 0.198, p = 0.281). Periodontitis samples across all timepoints showed no distinct clustering at either the genus 7.6% (R2 = 0.076 p = 0.097) or species levels 9.7% (R2 = 0.097 p = 0.995). Top five subgingival microbiota at the genus and species levels in all groups showed definite pattern of composition. Although no significant association was found (p > 0.05), it described that Veillonella parvula, Campylobacter gracilis, and Capnocytophaga granulosa were more abundant in healthy subjects than in gingivitis and periodontitis. Prevotella oris and Selenomonas noxia were less abundant in healthy subject than in gingivitis and periodontitis. In periodontitis subjects, Prevotella intermedia was increased by the therapy at 1 month and reduced again at 3 months. On the other hand, Capnocytophaga granulosa was increased by the therapy at 1 and 3 months. Hoylesella loescheii was reduced by the time. Porphyromonas gingivalis was reduced at 1 month and increased again at 3 months. Discussion: The result showed that the number of alpha diversity was notably higher in the gingivitis and periodontitis groups compared to health group, supporting a trend toward increased community richness and evenness in diseases states. The microbial richness and evenness remained relatively stable across the evaluated periods within periodontitis cohort. Oral microbial composition defines the periodontal status and disease. More abundance of Red Complex bacteria is associated with disease-associated condition. Pathogen re-colonization may occur 3 months after the therapy. Conclusions: These findings suggest that maintaining health-associated microbiome may be beneficial to the clinical status. Periodontal recall may be addressed from 1 to 3 months after the therapy to avoid bacterial re-colonization. Suppressing bacterial dysbiosis and regulating periodontal homeostasis are the main key in managing periodontal treatment.

Dentistry Journal doi: 10.3390/dj14080531

Authors: Marco M. Herz Valentin Bartha

Background/Objectives: We aimed to evaluate the methodological quality, translational limitations, and clinical applicability of current artificial intelligence (AI) applications in periodontology and to propose a framework for validated prediction and decision support. Methods: A structured narrative review based on a targeted, non-systematic literature search was conducted using PubMed and cross-disciplinary sources (January 2015–April 2026). Evidence from primary studies, systematic reviews, and methodological guidance for AI prediction models and clinical decision-support systems was synthesized with a focus on clinical applicability. Results: Current periodontal AI research is dominated by retrospective studies focusing on radiographic phenotyping, where deep learning models demonstrate promising diagnostic performance for detecting and quantifying periodontal bone loss. However, substantial limitations persist, including heterogeneous endpoints, inconsistent reporting, limited external validation, and insufficient calibration assessment. Importantly, there is little evidence that AI-based tools improve clinical decision-making or patient-relevant outcomes. Emerging work on prognostic modeling and multimodal data integration highlights the potential for individualized periodontal risk prediction but remains undervalidated, with limited evidence for clinical implementation. Conclusions: Although AI-based models show promising diagnostic performance, translational progress in periodontology is currently limited by insufficient validation and the lack of evidence for clinical utility. Future research should prioritize clinically actionable prediction models, robust external validation, and prospective evaluation of AI-supported decision-making within real-world periodontal care pathways.

Dentistry Journal doi: 10.3390/dj14080530

Authors: Mohammed Khalid S. Alsharif Ahmad Iqmer Nashriq Mohd Nazan Ahmad Zaid Fattah Azman

Background/Objectives: Dental caries remains one of the most prevalent and preventable childhood diseases worldwide. Despite universal access to free dental care in Saudi Arabia, preventable oral diseases remain common, highlighting persistent gaps in oral health literacy and preventive behaviours among children. Male students consistently demonstrate poorer oral health knowledge and practices than their female counterparts, yet they remain understudied. This study aimed to assess oral health knowledge, attitudes, and practices (KAP) among male primary school students in Al Lith city, Saudi Arabia, and to identify their associated sociodemographic determinants. Methods: A school-based analytical cross-sectional study was conducted during the 2023–2024 academic year in Al Lith city, Makkah Province, Saudi Arabia. A total of 430 male students aged 10–13 years from grades five and six were recruited via multistage cluster sampling from 8 randomly selected schools. A validated, interviewer-administered, Arabic-language questionnaire assessed knowledge (18 items), attitudes (12 Likert-scale items), and practices (12 items) related to oral health, alongside sociodemographic data. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data were analysed using IBM SPSS Statistics version 27. Descriptive statistics and multivariable logistic regression were performed. Results: Of the 430 participants, 83.3% were aged 11–12 years, 89.8% were Saudi nationals, and 89.1% resided in intact, two-parent households. Knowledge deficits were widespread: only 8.4% correctly identified the recommended timing of sweet consumption, 20.2% understood dental plaque, and 28.6% recognised the protective role of fluoride. Attitudes were generally positive, with 80.1% agreeing that teeth should be brushed twice daily and 71.6% endorsing regular dental visits; however, 60.3% held that dental attendance was necessary only when pain was present. Substantial practice gaps were also evident: only 33.3% brushed for the recommended two minutes, and 12.6% had never visited a dentist. In multivariable analysis, low household income was independently associated with better oral health knowledge (adjusted odds ratio [AOR] = 2.22; 95% confidence interval [CI]: 1.04–4.74; p = 0.039), divorced parental status was independently associated with positive oral health attitudes (AOR = 5.40; 95% CI: 1.28–22.79; p = 0.022), and older age was independently associated with poorer oral health practices (AOR = 0.72; 95% CI: 0.55–0.93; p = 0.014). Conclusions: Male primary school students in Al Lith demonstrated generally positive oral health attitudes but significant deficits in knowledge and preventive practices. Comprehensive, school-based oral health promotion programmes that address key misconceptions, actively engage parents, and integrate culturally accepted practices—such as miswak use—with evidence-based preventive guidance are needed.

Dentistry Journal doi: 10.3390/dj14080529

Authors: Ghazal Ek Vår Kristidatter Syversen Qalbi Khan Tor Paaske Utheim Amer Sehic

Background/Objectives: Basic sciences form the conceptual foundation of dentistry, yet their delivery in dental curricula varies worldwide. As demographic shifts, growing healthcare complexity and scientific advances continue to reshape the dental profession, renewed attention to how these subjects are taught has become essential. This comparative narrative review aims to examine different approaches to basic science education in dentistry, exploring variation in curricular structure, depth, timing and pedagogical strategies across diverse dental schools. Particular emphasis is placed on models of vertical, horizontal and spiral integration, the alignment of basic sciences with clinical training and the implications of instructional design for long-term knowledge retention and professional competence. Methods: PubMed and Google Scholar were searched from November 2025 to June 2026 using terms related to dental education, curriculum integration and geographic regions. Sources were selected based on predefined relevance criteria rather than through systematic screening. Published literature was supplemented by structured outreach to faculty representatives using a standardised set of questions. Of the 25 dental schools contacted, nine responded, and five were included. Results: Across the programs examined, a structure of approximately two preclinical years followed by clinical training remained the most common. Early clinical exposure appeared to strengthen student confidence and professional identity. Heavy workload and curricular overload were recurring challenges in the dental curricula examined. Conclusions: The findings suggest that although curriculum integration is widely recognised as essential, no single model appears to be universally superior. Its effectiveness likely depends on the quality of implementation and faculty coordination. However, the lack of independent evaluation studies limits the ability to draw conclusions about the long-term effectiveness of different educational approaches. The review highlights the need for independent and systematic evaluation of dental curricula.

Dentistry Journal doi: 10.3390/dj14080528

Authors: Baoluo Xing Gao Francisco G. F. Tresguerres Natalia Monasterio Sebastian Anna Millán Raventós Rui Xie Joaquín Delgado Gregori Joaquín López-Malla Matute

Objectives: To evaluate the clinical accuracy and patient-reported outcomes (PROMs) of robotic-assisted full-arch implant rehabilitation performed with an autonomous robotic implant system. Materials and Methods: Six consecutive edentulous patients requiring implant-supported full-arch rehabilitation were treated using the Yakebot task-autonomous robotic implant system following a fully digital workflow. A total of 36 Straumann Bone Level Tapered implants were placed using a flapless approach. Implant placement accuracy was assessed by comparing planned and postoperative CBCT datasets. Coronal, apical, depth, and angular deviations were automatically calculated using dedicated robotic planning software. Patient-reported outcomes were prospectively evaluated through a structured questionnaire assessing preoperative perceptions, postoperative morbidity, and overall treatment satisfaction. Results: All implants were successfully placed according to the robotic-assisted workflow without intraoperative complications or conversion to conventional surgery. Mean three-dimensional coronal and apical deviations were 0.45 ± 0.18 mm and 0.47 ± 0.19 mm, respectively, while mean total angular deviation was 1.30 ± 0.63°. Patients reported low preoperative anxiety (0.5 ± 0.8/10), limited postoperative pain (2.2 ± 3.5/10), swelling (1.3 ± 2.2/10), and interference with daily activities (1.3 ± 2.2/10). Overall surgical experience was highly rated (9.7 ± 0.8/10). Final satisfaction scores were exceptionally high, with all patients indicating they would undergo robotic-assisted surgery again and recommend the procedure to others. Conclusions: Robotic-assisted full-arch implant rehabilitation demonstrated a high level of clinical accuracy, with submillimetric coronal and apical deviations and low angular discrepancies. In addition, treatment was associated with low postoperative morbidity, excellent patient acceptance, and very high satisfaction. These findings support the potential of autonomous robotic implant surgery as a predictable and patient-centered approach for full-arch rehabilitation, although larger controlled studies are required to confirm these results.

Dentistry Journal doi: 10.3390/dj14080527

Authors: Benya Kangsanarak Wissanee Jia-Mahasap Pimduen Rungsiyakull

Background/Objectives: This study evaluated the influence of sintering conditions and acidic environments on the wear of 5 mol% yttria-stabilized zirconia (5Y-ZP). Methods: Sixty zirconia specimens were divided into two sintering groups (conventional and speed) and three immersion media (n = 10): distilled water, Coca-Cola, and vinegar. Wear testing was performed using a chewing simulator under a 49 N load for 120,000 cycles, simulating 6 months of clinical function. Volume loss, mean wear depth, and surface roughness were measured using a 3D profilometer. Surface and compositional analyses were performed using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray diffraction (XRD). Results: Significant differences in wear were observed (p < 0.05). The greatest wear occurred in distilled water (58.927 ± 13.199 µm; 0.3518 ± 0.1062 mm3 for speed-sintered and 53.408 ± 6.784 µm; 0.3211 ± 0.0546 mm3 for conventional). Vinegar produced moderate wear (15.478 ± 2.584 µm; 0.0482 ± 0.0142 mm3 and 11.575 ± 3.334 µm; 0.0360 ± 0.0116 mm3), whereas Coca-Cola produced the least (2.899 ± 1.377 µm; 0.0049 ± 0.0027 mm3 and 1.870 ± 0.688 µm; 0.0027 ± 0.0012 mm3). Sintering condition affected only wear depth. SEM showed localized surface alterations in acidic media, EDS revealed reduced yttria content, and XRD revealed no detectable monoclinic phase, with no interaction between variables. Conclusions: Acidic environments had a greater influence on the wear of 5Y-ZP zirconia than sintering conditions. Speed sintering influenced wear far less than the immersion medium, supporting its use in patients exposed to acidic conditions.

Dentistry Journal doi: 10.3390/dj14080526

Authors: Konstantinos Koutoulas Nikos Pantazis Vasileios Makris Dimitrios Tsatsas Alexandros Skountzouris Eleftherios Terry R. Farmakis

Background/Objectives: This study aims to evaluate the pulp space morphology (PSM) of both first and second mandibular premolars in a sample of a Greek population using cone beam computed tomography (CBCT). Methods: Two hundred and ninety nine CBCTs of a Greek population were assessed to evaluate the PSM using Vertucci’s classification. CBCTs were prescribed for non-endodontic reasons. Results: In the aforementioned data set, the most common PSM was Vertucci’s 1 (V1) in all subgroups of mandibular premolars. V3 was the second most frequent PMS in the #34 group (10.67%), and it was V5 in the #35 group (3.1%), V3 in the #44 group (14%), and V8 in the #45 group (2.7%), with the rest of the morphologies being sparse. Across the four teeth, there was a statistically significant difference in Vertucci class distribution (p = 0.001). No significant difference was found between genders (p = 0.120); bilateral symmetry analysis showed high concordance for both premolars. Conclusions: Within the limitations of this study, it is concluded that the reported pulp space morphology in the mandibular premolars of a Greek sub-population sample presented as less complicated compared to other similar reports of (sub)-populations of different descent.

Dentistry Journal doi: 10.3390/dj14080525

Authors: Sufyan Garoushi Enas Mangoush Aous A. Abdulmajeed Jasmina Bijelic-Donova Pekka K. Vallittu Lippo Lassila

Objectives: The aim was to evaluate the mechanical, physical, and surface properties, as well as the microstructure, of three direct resin composites with different formulations (CLEARFIL AP-X, MAJESTY ES Flow, and MAJESTY ES-2) from the same manufacturer. Methods: Mechanical properties, including flexural strength, flexural modulus, and fracture toughness, were determined for each material (n = 8/material) according to ISO standards. Fourier transform infrared (FTIR) spectroscopy was used to determine the degree of conversion (DC%). Two-body wear was evaluated using a ball-on-flat configuration in a chewing simulator for 15,000 cycles, and wear depth was measured using a non-contact 3D optical profilometer. Polymerization shrinkage stress was measured using a tensilometer. Surface roughness and gloss were evaluated on disk-shaped specimens (n = 5/material) after polishing with 2400- and 4000-grit abrasive papers. Microstructural characterization was performed using scanning electron microscopy. Data were analyzed using ANOVA followed by Tukey’s HSD test (α = 0.05). Results: CLEARFIL AP-X exhibited the highest flexural strength (186.95 MPa), flexural modulus (19.25 GPa), and fracture toughness (1.50 MPa m1/2) among the tested materials (p < 0.05). However, it also showed the highest surface roughness and the lowest gloss values. MAJESTY ES Flow demonstrated the lowest wear depth and the highest gloss and polymerization shrinkage stress, whereas MAJESTY ES-2 exhibited the greatest wear and the lowest DC%. Conclusions: The three resin composites exhibited distinct mechanical, physical, surface, and microstructural characteristics associated with differences in their formulations, including filler content, filler morphology, and resin matrix composition. No single material demonstrated superior performance across all evaluated properties, highlighting the importance of selecting resin composites according to the specific clinical requirements.

Dentistry Journal doi: 10.3390/dj14080524

Authors: Andrea Chango-Chávez Marco Vizuete-Bolaños Stephany Paladines-Calle Juan Marcos Parise-Vasco

Intraluminal unicystic ameloblastoma is characterized by tumor proliferation confined to the cystic lumen, without invasion of the supporting connective tissue, a feature that has led some authors to regard it as particularly suited to conservative surgical treatment. Objective: This study aims to describe the conservative two-stage management of a mandibular unicystic ameloblastoma with an intraluminal pattern, treated by decompression followed by enucleation with the aim of avoiding mandibular resection. Case Report: A 24-year-old female patient presented with a slight swelling in the right mandibular angle that had evolved over two years without prior treatment. Panoramic radiography revealed a well-defined radiolucent lesion extending from the mesial surface of the right mandibular second molar through the mandibular ramus to the ipsilateral coronoid process. Cone-beam computed tomography (CBCT) confirmed the lesion as a hypodense area measuring approximately 6 × 3.4 × 2.9 cm. A two-stage surgical approach was performed: the first stage consisted of an incisional biopsy and the placement of a decompression tube for six months; the second stage consisted of enucleation of the lesion. The definitive histopathological diagnosis was intraluminal unicystic ameloblastoma with a plexiform growth pattern. The surgical procedures were completed without preoperative, intraoperative, or postoperative complications. Follow-up evaluations were performed at 3 and 6 months and at 1 and 2 years after the initial surgical stage. Conclusions: At 24 months from the initiation of treatment, the outcome was favorable, with evidence of mandibular bone apposition and no signs of lesion recurrence.

Dentistry Journal doi: 10.3390/dj14080523

Authors: Paolo De Angelis Giuseppe De Rosa Iacopo Cioccoloni Alberto Staffieri Gioele Gioco Romeo Patini Luca Raffaelli Carlo Lajolo

Background: Vertical implant positioning may influence peri-implant health outcomes and long-term stability; however, the impact of baseline vertical implant positioning relative to adjacent teeth remains unclear. The aim of this systematic review and meta-analysis was to assess the association between baseline vertical implant positioning and peri-implant clinical and radiographic outcomes. Methods: The Cochrane Central Register, PubMed, SCOPUS, and Web of Science were searched. Vertical implant positioning relative to adjacent teeth was assessed using two radiographic reference distances: implant platform to cemento-enamel junction (IP–CEJ) and implant platform to adjacent interproximal alveolar bone level (IP–ABL). The primary outcome was peri-implant marginal bone loss (MBL). Secondary outcomes included implant survival and success rates, peri-implant mucositis and peri-implantitis prevalence. Risk of bias was assessed using the Moga checklist, and certainty of evidence was evaluated according to GRADE. Results: Four studies including 267 implants fulfilled the inclusion criteria. The pooled mean baseline IP–CEJ and IP–ABL distances were 4.69 mm (95% CI 2.05 to 7.32) and 2.13 mm (95% CI 1.29 to 2.98), respectively. The pooled mean marginal bone loss after at least 12 months, based on three studies, was 0.21 mm (95% CI −0.28 to 0.70). Conclusions: The available evidence is insufficient to determine whether baseline IP–CEJ or IP–ABL distances are associated with peri-implant outcomes or to identify an optimal range of vertical implant positioning. The findings should be interpreted cautiously because the certainty of evidence is very low, highlighting the need for prospective studies with long-term follow-up.

Dentistry Journal doi: 10.3390/dj14080522

Authors: Laura Costa Pinho Catarina Santos Maria Helena Fernandes Bruno Colaço

Guided bone regeneration (GBR) is a widely used clinical approach for managing bone defects associated with periodontal disease in dogs, employing barrier membranes to selectively direct tissue regeneration. The performance of these membranes is influenced by composition, structural design, and degradation behavior, which together determine biological responses and clinical outcomes. Biodegradable GBR membranes, fabricated from natural polymers, synthetic polymers, or composite materials, offer advantages over non-biodegradable membranes, including controlled resorption, elimination of secondary surgery, and the potential for delivery of bioactive agents. Preclinical studies in dogs have demonstrated that GBR membranes can promote periodontal regeneration, including bone and cementum formation and space maintenance; however, optimization of degradation behavior remains critical to align membrane resorption with tissue healing in some cases. Clinical studies in dogs with naturally occurring periodontal disease remain scarce, and only two biodegradable membranes (Ossiflex® and Doxirobe®) are commercially approved for veterinary use, while all others are applied off-label. These limitations highlight the need for more adaptable and cost-effective regenerative strategies, including membranes that can be customized to different defect sizes and multifunctional membranes incorporating bioactive agents that will offer an advanced regenerative potential and improved predictability in veterinary periodontal therapy.

Dentistry Journal doi: 10.3390/dj14080520

Authors: Gabriela Guadalupe Zambrano Manzaba Jossue Tarquino Narvaez Guerrero Luis Chauca-Bajaña Edwin Geovanny Socasi Dioses Héctor Alfredo Lema Gutiérrez Gema Nallely Mendoza Manzaba Rito Alfonso Salazar Román Andrea Ordoñez Balladares Byron Velásquez Ron

Background: Osteoradionecrosis (ORN) is a severe late complication of radiotherapy for head and neck cancer, associated with impaired bone healing, infection, pain, and exposed bone. Periodontal disease may contribute to ORN by maintaining inflammatory and infectious foci within irradiated tissues with reduced vascularity and repair capacity. Objective: To evaluate whether periodontal disease or poor periodontal status is associated with increased ORN risk in patients with head and neck cancer undergoing radiotherapy. Methods: This systematic review and meta-analysis followed PRISMA 2020 recommendations and was structured according to the PECO framework. Searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, WHO databases, and gray literature. Observational studies involving head and neck cancer patients treated with radiotherapy and reporting periodontal status in relation to ORN were included. Risk of bias was assessed using a domain-based approach. Random-effects models estimated pooled relative effect estimates and ORN prevalence. Results: Six studies were included in the primary association meta-analysis. Periodontal disease was significantly associated with increased ORN risk, with a pooled relative effect estimate of 4.83 (95% CI: 1.96–11.93; p = 0.0006; I2 = 50.4%). Seven studies including 1785 patients and 118 ORN events were included in the prevalence meta-analysis, showing a pooled ORN prevalence of 9% (95% CI: 6–13%; I2 = 78.0%). Conclusions: The findings suggest that periodontal disease or poor periodontal status may be associated with an increased likelihood of ORN in patients with head and neck cancer undergoing radiotherapy. Given the observational nature of the evidence and the moderate between-study heterogeneity, this association should be interpreted cautiously. Comprehensive periodontal assessment and long-term oral surveillance may be considered as components of multidisciplinary care before and after radiotherapy.

Dentistry Journal doi: 10.3390/dj14080521

Authors: Shiya Wang Qiong Zhang Ran Yang Jing Zou Yan Wang

Background: Biodentine has emerged as a promising calcium silicate-based material for vital pulp therapy in primary teeth. This case series describes short-term clinical and radiographic outcomes of Biodentine pulpotomy followed by immediate stainless steel crown restoration for deeply carious primary molars treated under general anesthesia. Methods: Data were collected prospectively within an ongoing clinical project. Five pediatric patients, aged 3 to 6 years, presented with multiple carious primary teeth. A total of 15 deeply carious primary molars without clinical or radiographic signs of irreversible pulpitis, pulp necrosis, or periradicular pathology were included. Under general anesthesia, pulpotomies were performed. Pulp status was assessed intraoperatively based on bright-red pulp bleeding and hemostasis achieved within 5 min. Biodentine was applied to cover the pulp stumps and fill the cavities, followed immediately by stainless steel crown restoration. Results: During the 1-year follow-up, all treated teeth maintained normal chewing function without unfavorable symptoms. Radiographic examination revealed normal periodontal ligament spaces and no furcation or periapical radiolucency, pathological internal or external root resorption, or abnormality of the developing permanent tooth germs. Conclusions: For deeply carious primary molars, Biodentine pulpotomy followed by immediate stainless steel crown restoration showed favorable short-term clinical and radiographic outcomes. This single-session approach may represent a feasible option for deeply carious primary molars.

Dentistry Journal doi: 10.3390/dj14080519

Authors: Koichiro Tabata Tetsuji Azuma Komei Iwai Takatoshi Yonenaga Gen Tanabe Takaaki Tomofuji

Background/Objectives: Mastication may influence oral mucosal immunity; however, its association with postprandial salivary secretory immunoglobulin A (s-IgA) dynamics remains unclear. This pilot study examined the association between mean chewing count per bite during rice ball consumption and the postprandial salivary s-IgA response in healthy men. Methods: Thirty-seven healthy adult men were enrolled. Mean chewing count per bite was analyzed continuously and secondarily in exploratory groups defined by the median (<30, n = 18; ≥30 chews/bite, n = 19). Unstimulated whole saliva was collected before, 0–5, 10–15, and 25–30 min after eating. Salivary s-IgA concentration, saliva weight, and s-IgA secretion rate were evaluated as absolute values and baseline ratios. Baseline-adjusted, repeated-measures, and sensitivity analyses were performed. Results: Mean chewing count per bite correlated positively with normalized salivary s-IgA concentration at 10–15 min (ρ = 0.347, p = 0.036) and 25–30 min (ρ = 0.352, p = 0.033), but these associations were attenuated after false discovery rate correction (q = 0.053 for both). Baseline salivary s-IgA was inversely associated with normalized responses. In exploratory group comparisons, normalized salivary s-IgA concentration was higher in the ≥30 chews/bite group at 10–15 and 25–30 min, whereas absolute s-IgA concentration, saliva weight, and s-IgA secretion rate did not differ between groups. Baseline-adjusted associations were not statistically significant. Conclusions: Higher mean chewing count per bite may be associated with greater relative postprandial salivary s-IgA responses in healthy adult men, but these findings are exploratory and should be interpreted cautiously.

Dentistry Journal doi: 10.3390/dj14080518

Authors: Angelo Auricchio Antonio Lanza Roberto Duraccio

Background: Accurate three-dimensional positioning of dental implants is fundamental for long-term prosthetic success. While static guided surgery and traditional dynamic navigation present intrinsic limitations related to physical bulk or hand–eye coordination (the “look-away” phenomenon), Augmented Reality (AR) via Head-Mounted Displays (HMDs) promises to overcome these barriers by superimposing virtual holograms directly onto the surgical field. Objectives: The aim of this scoping review is to map the existing literature to evaluate the positioning accuracy, workflow efficiency, and ergonomic/technical barriers of HMD-based AR navigation systems in implant dentistry. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases, following the PRISMA-ScR guidelines. In vitro, ex vivo, and clinical studies utilizing AR headsets (e.g., HoloLens) for implant guidance, reporting quantitative data on accuracy and/or qualitative data on usability issues, were included. Results: Eleven studies were included (7 in vitro, 1 ex vivo, 3 clinical). Accuracy showed a strong dependence on case complexity: for standard implants, the mean error at the entry point ranged between 0.33 and 1.51 mm, which is comparable to s-CAIS techniques. However, in complex scenarios (zygomatic implants), significant deviations were reported (up to 5.64 mm and 9.60°). The main barriers to routine adoption identified include tracking instability due to line-of-sight interruption, device weight, and the vergence–accommodation conflict. Conclusions: AR dynamic navigation demonstrates promising potential. Nevertheless, current evidence relies predominantly on in vitro studies that fail to fully replicate real-world surgical complexities. Persistent technical and ergonomic barriers, such as tracking instability and hardware limitations, indicate that the technology remains largely in a preclinical phase and is not yet suitable for routine clinical application. Further advancements toward markerless tracking systems, lighter headsets, and rigorous in vivo trials are required.

Dentistry Journal doi: 10.3390/dj14080517

Authors: Carmen Machuca-Portillo Maria Biedma-Perea Cira Suárez-Marchena Carolina Caleza-Jiménez Lucy Chandler-Gutiérrez Lydia López-del Valle Juan J. Segura-Egea

Objective: To systematically evaluate the effectiveness of virtual reality (VR) distraction systems in reducing pain perception and dental anxiety during pediatric pulp therapy procedures. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42026139774). PubMed/MEDLINE, Scopus, and Embase were searched for randomized clinical trials evaluating immersive VR distraction during pediatric pulp therapy. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated with GRADE. Random-effects meta-analysis was performed for pain outcomes. Results: Seven randomized clinical trials were included in the qualitative synthesis. Three parallel-group randomized controlled trials were included in the pain meta-analysis. VR distraction significantly reduced self-reported pain (SMD) = −1.28 (95% C.I. = −2.49 to −0.07; p = 0.038) compared with control interventions. Substantial heterogeneity was observed for both outcomes (I2 > 93%). Most studies also reported improvements in behavioral cooperation, whereas physiological measures showed inconsistent findings. The certainty of evidence was rated as low for pain and anxiety outcomes. Conclusions: VR distraction may represent a promising non-pharmacological behavioral management strategy for reducing pain perception and dental anxiety during pediatric pulp therapy. However, these findings should be interpreted with caution because they are based on a small number of studies with substantial methodological heterogeneity. Further well-designed randomized clinical trials using standardized intervention protocols and outcome measures are required before firm conclusions or recommendations for routine clinical implementation can be established.

Dentistry Journal doi: 10.3390/dj14080516

Authors: J. M. Aguado-Gil S. Arena-Echeverry A. Suárez-García M. Gómez-Sánchez G. González-Cuevas

Background: Objective assessment of preclinical dental practices remains challenging, as it requires consistency, transparency, and standardization in the evaluation of practical competencies. Rubrics have been proposed as useful tools for improving the quality of assessment; however, evidence regarding their psychometric properties in preclinical orthodontic education remains limited. Aim: This study aimed to analyze the reliability, internal structure, and academic usefulness of assessment rubrics applied to preclinical orthodontic practice in undergraduate dental education. Methods: A cross-sectional psychometric retrospective study was conducted with 175 third-year dentistry students enrolled in Orthodontics I at the European University of Madrid. Two analytical rubrics designed to assess wire-bending and cephalometry practices were evaluated. Reliability was assessed using Cronbach’s alpha, construct validity using exploratory factor analysis, and associations with academic performance by correlation analyses. Results: The wire-bending rubric showed moderate internal consistency (α = 0.61), whereas the cephalometry rubric demonstrated adequate reliability (α = 0.71). Exploratory factor analysis yielded evidence consistent with a one-dimensional structure for both instruments. Cephalometry performance was positively associated with theoretical examination scores and seminar performance, whereas no significant associations were observed for wire-bending performance. Students reported generally positive perceptions of rubric use, although lower post-assessment ratings were observed in the wire-bending activity. Conclusions: These findings provide preliminary evidence supporting the reliability and educational usefulness of rubric-based assessment in preclinical orthodontic education. These instruments may contribute to greater transparency and consistency in student assessment. Further studies involving multiple evaluators, multicenter samples, longitudinal designs, and psychometric approaches specifically developed for ordinal data are required.

Dentistry Journal doi: 10.3390/dj14080515

Authors: Alanoud Alotaibi Zaina Altahiri Fajer Aljaser Ghadeer Alenezi Dena Kayed Ali Mirza Rustum Baig

Objectives: This study aimed to investigate the sociodemographic factors influencing oral hygiene habits and oral health-related quality of life (OHRQoL) among complete denture wearers at Kuwait University Dental Clinic (KUDC). Methods: A cross-sectional observational study was conducted using a self-administered questionnaire and an Oral Health Impact Profile-19 (OHIP-19) instrument to assess oral hygiene habits and OHRQoL in 61 complete denture patients, treated by dental undergraduate students at KUDC, between January 2019 and December 2023. Additionally, a clinical assessment of denture hygiene was performed using the Budtz-Jörgensen denture plaque index for all patients (n = 61). Sociodemographic, general health status, oral hygiene habits, and OHRQoL-related data were collected. Results: A total of 37.7% of included participants were aged 51–60 years, with 75.4% being male. Most participants (81.96%) had a high school education or less. Caries was reported as the primary cause of tooth loss (83.6%), and 77.04% recorded irregular dental visits. Only 46.05% of participants demonstrated optimal and/or good denture hygiene. Toothpaste was the most common cleaning method (79.21%), and 70.62% removed their dentures at night. A significant association was found between education level and denture wearing (p = 0.035), as well as between gender and the frequency of dental visits (p = 0.024). However, no significant relationship was observed between gender and denture hygiene (p = 0.52). The OHIP-19 results revealed that poor denture hygiene impacted OHRQoL across multiple domains, including functional limitation, physical pain, psychological discomfort, and social disability. Conclusions: Unsatisfactory denture hygiene was prevalent among participants, possibly due to limited awareness or inadequate instructions provided by dental health practitioners. Education level and gender influenced certain aspects of denture care, highlighting the need for targeted oral health education programs and improved patient guidance from dental practitioners. Additionally, poor denture hygiene was associated with reduced OHRQoL, emphasizing the importance of addressing both oral hygiene practices and their psychosocial impacts to improve overall well-being.

Dentistry Journal doi: 10.3390/dj14080514

Authors: Maria Clara dos Reis Pedro Paulo Menezes Scariot Leonardo Henrique Dalcheco Messias

Background/Objectives: Oral diseases are a major public health challenge and share behavioral and socioeconomic determinants with other noncommunicable diseases. Although physical activity has been proposed as one of these shared determinants, evidence at the population level remains limited. This study investigated the association between physical activity and oral health indicators using nationwide Brazilian surveillance data. Methods: An ecological study was conducted using aggregated data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) and the Brazilian National Oral Health Survey (SB Brasil) (2022–2023). Physical activity participation and weekly volume were evaluated against untreated dental caries, toothache, pain intensity, tooth loss, and the Decayed, Missing, and Filled Teeth (DMFT) index. Weighted multivariable linear regression models with heteroskedasticity-consistent standard errors were applied. Results: The analysis included 28,707 VIGITEL participants and 14,753 SB Brasil observations. After adjustment, physical activity participation was inversely associated with untreated dental caries, whereas weekly physical activity volume showed no association with any oral health outcome. No significant associations were observed for tooth loss, dental pain, pain intensity, or the DMFT index. Conclusions: Higher population-level participation in physical activity was associated with a lower prevalence of untreated dental caries but not with other oral health indicators. These findings may suggest that physical activity and oral health share common behavioral and social determinants, supporting integrated public health strategies targeting upstream risk factors.

Dentistry Journal doi: 10.3390/dj14080513

Authors: Joyce Michel Mora Bayas Luis Chauca Bajaña Carol Ortiz Bustamante Andrea Ordoñez Balladares Laly Viviana Cedeño Sánchez Ricardo Saltos Noboa Diana Carolina Sandoval Benalcázar Thalia Gabriela Alvarez Centeno Ivonne Carrion Bustamante Carlos Salazar Minda David Alfredo Flor Ronquillo Byron Velasquez Ron

Background: CAD/CAM dental ceramics are widely used for indirect restorations because of their favorable esthetic properties, biocompatibility, and mechanical performance. However, long-term exposure to thermal fluctuations, moisture, and cyclic loading may compromise their structural integrity. This systematic review and meta-analysis evaluated the effect of artificial aging protocols on the mechanical properties of CAD/CAM dental ceramics. Methods: A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, LILACS, Google Scholar, and ProQuest from inception to June 2026. In vitro studies evaluating CAD/CAM ceramics subjected to thermocycling and/or artificial aging protocols were included. The primary outcomes were flexural strength and fracture resistance. Random-effects meta-analyses were performed using standardized mean differences (SMDs) or pooled means with 95% confidence intervals (CIs). Subgroup analyses were conducted according to ceramic category, and sensitivity analyses were performed using a leave-one-out approach. Results: Five studies comprising 16 independent comparisons were included in the flexural strength meta-analysis, while five studies contributed 11 comparisons to the fracture resistance analysis. Artificial aging protocols significantly reduced the flexural strength of CAD/CAM ceramics (SMD = −1.68; 95% CI: −2.28 to −1.08; p < 0.00001). The greatest reduction was observed in zirconia-based ceramics (SMD = −3.31), followed by hybrid/PICN ceramics (SMD = −1.37) and lithium disilicate/lithium silicate ceramics (SMD = −1.25). Feldspathic and glass-based ceramics showed no significant reduction. The pooled fracture resistance after aging was 1312.85 N (95% CI: 1131.59–1494.10 N), indicating that most CAD/CAM ceramics maintained clinically relevant fracture resistance despite aging. Conclusions: Artificial aging protocols adversely affect the flexural strength of CAD/CAM dental ceramics, particularly zirconia-based materials. Nevertheless, fracture resistance generally remains within clinically acceptable ranges. Material composition plays a critical role in determining susceptibility to aging-related degradation, highlighting the importance of ceramic selection for long-term restorative performance.

Dentistry Journal doi: 10.3390/dj14080512

Authors: Carlos A. Jurado Franklin Garcia-Godoy Brian R. Morrow Mark A. Antal

Background/Objectives: This in vitro study evaluated the fracture resistance of computer-aided design and computer-aided manufacturing (CAD-CAM) resin-matrix ceramic crowns cemented with three adhesive resin cements and three novel resin-modified glass ionomer cements. Methods: Ninety crowns representing a maxillary left central incisor were milled from a resin-based nanoceramic hybrid material (Cerasmart, GC) using a chairside CAD-CAM system (Primescan). The typodont preparation included 1.5-mm incisal reduction, 1.5-mm axial reduction, and a 1.0-mm chamfer finish line. Crowns were cemented onto 3D-printed dies of the preparation and assigned to six groups (n = 15 per group) according to cement type: Multilink Automix (ReMu), Panavia V5 (RePa), RelyX Unicem 2 (ReUn), RelyX Luting Plus (GiLu), GC FujiCem Evolve (GiEv), and Meron Plus QM (GiMe). The cemented restorations were subjected to artificial aging with 10,000 thermocycles at 5 to 55 °C with a dwell time of 30 s. Specimens were loaded in compression to fracture. Scanning electron microscopy (SEM) was used to evaluate fracture patterns. Fracture load was analyzed using one-way ANOVA and post hoc Tukey honestly significant difference (HSD) test (p = 0.001). Results: Fracture resistance differed significantly among cement types. Crowns cemented with adhesive resin cements exhibited higher fracture resistance than those cemented with resin-modified glass ionomer cements. The highest fracture resistance was observed for ReUn, followed by RePa and ReMu, whereas GiEv and GiLu showed the lowest values. Conclusions: CAD-CAM hybrid crowns fabricated from a resin composite–ceramic material demonstrated higher fracture resistance when cemented with adhesive resin cements than with the novel resin-modified glass ionomer cements tested. Among the six cements, ReUn produced the highest fracture resistance, whereas GiEv produced the lowest.

Dentistry Journal doi: 10.3390/dj14080511

Authors: Yuanyuan Li Peipei Wang Anqi Liu Chen Zhang Limin Zhao Liming Yu Gang Yang Wei Zhang Bingjiao Zhao Xiaoyan Li Yuehua Liu

Background/Objectives: Pediatric obstructive sleep apnea (OSA), particularly when accompanied by mandibular retrognathia, presents as a complex, multifactorial condition. Dentofacial orthopedic treatment (DOT) has gained increasing clinical attention; however, high-level evidence specifically demonstrating its efficacy in pediatric OSA remains scarce. This study aimed to evaluate the efficacy of DOT and AT in managing mild to moderate OSA in children with mandibular retrognathia. Methods: This open-label, randomized controlled clinical trial recruited 93 children aged 7–10 years with mild to moderate OSA (an AHI of 1–10 events per hour) and mandibular retrognathia (ANB angle ≥ 4.5°). Participants were randomly allocated to four groups: pharmacotherapy, DOT (combined maxillary expansion and mandibular advancement appliance), AT (adenotonsillectomy under general anesthesia), and AT & DOT groups. The primary outcome was the change in apnea–hypopnea index (AHI) from baseline to 7 months post-treatment. Secondary outcomes included assessments of dentofacial development and volumetric changes in the upper airway. Results: Because of the high dropout/loss-to-follow-up rates in the pharmacotherapy and AT plus DOT groups, the final analysis was restricted to the DOT and AT groups, in which the overall dropout/loss-to-follow-up rate was 19.6%. Among the 43 participants allocated to the DOT (8 girls and 15 boys) and AT groups (8 girls and 12 boys), 36 completed the follow-up, the median baseline AHI was 3.7 events/h [IQR, 1.9–4.4]. Per protocol analysis revealed a mean reduction in AHI of 1.6 events/h in the DOT group and 1.3 events/h in the AT group, with no significant difference between the groups (−0.43 [95% CI, −1.48 to 0.61], p = 0.40). DOT significantly promoted sagittal mandibular growth without inducing a vertical clockwise rotation tendency, whereas AT had no significant effect on dentofacial development. Total upper airway volume increased significantly in both groups, with the increase concentrated in different regions of the upper airway depending on the group. Conclusions: In children with mild to moderate OSA and mandibular retrognathia, DOT demonstrated comparable efficacy to AT, which may be attributable to favorable anatomical remodeling of the upper airway.

Dentistry Journal doi: 10.3390/dj14080510

Authors: Gabriela Almeida Souza Leão Simonton Pamela Barbosa dos Santos Lorrayne Cesario Maria Gabriel Pereira Nunes Maria Helena Monteiro de Barros Miotto

Background/Objectives: Dental trauma is recognized as a global public health problem due to its prevalence and psychosocial consequences. This study aimed to verify the prevalence of traumatic dental injuries in practitioners of combat sports and whether they were associated with sociodemographic and sports variables in a capital city in southeastern Brazil. Methods: This cross-sectional observational study included 284 athletes over 18 years of age from 17 academies that offered combat sports. Data collection was performed by a single examiner through individual interviews and a questionnaire addressing sociodemographic profile, access to oral health services, sport modality, experience with dental trauma during combat sports, mouthguard use, and guidance on dental injuries. Descriptive analyses, frequency tables, the Chi-square test (p < 0.05), and Odds Ratio were used. Results: Most participants were male (n = 203; 71.48%), aged up to 25 years (n = 75; 26.41%). The most practiced sports were Jiu-Jitsu (n = 79; 27.82%) and Kickboxing (n = 77; 27.11%). Among participants who suffered dental trauma (n = 19; 6.69%), single episodes predominated (n = 9; 47.37%), enamel fractures were most frequent (n = 7; 36.84%), and anterior teeth were the most affected (n = 9; 47.36%). Most were not using a mouthguard at the time of trauma (n = 15; 78.95%), although they considered mouthguard use important (n = 229; 80.63%), and most had not received guidance on dental trauma (n = 237; 83.45%). Age group was significantly associated with dental trauma (p = 0.016; OR = 3.33; 95% CI: 1.167–9.524). Conclusions: The prevalence of dental trauma among fighters was low. Mouthguard adherence was inconsistent, post-trauma management was inadequate, and most respondents had never received guidance on dental trauma. Public health policies should strengthen awareness and prevention of dental injuries in sports.

Dentistry Journal doi: 10.3390/dj14080509

Authors: Yasser Alsayed Tolibah Nada Bshara Osama Aljabban Chaza Kouchaji Thuraya Lazkani Mohammad Tamer Abbara Marwan Alhaji Ziad D. Baghdadi

Background/Objectives: Pulp necrosis in immature permanent teeth arrests root development, leaving an open apex, thin, divergent dentinal walls, and an unfavorable crown-to-root ratio that predisposes the tooth to fracture and complicates endodontic management. An apical barrier using hydraulic calcium silicate cements has become the first-line orthograde approach for these teeth when regenerative procedures are not indicated or feasible. This narrative review synthesizes current evidence on the complete clinical pathway for apical barrier placement in immature permanent teeth, with particular emphasis on the procedural determinants of barrier formation. It also critically appraises where the evidence is robust and where it remains uncertain. Methods: The relevant English-language literature on root development, the etiology of pulp necrosis in immature teeth, diagnosis, isolation, apical barrier methods, calcium silicate materials, and treatment outcomes was reviewed through targeted searches of PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar through June 2026. The literature search was completed in June 2026; therefore, studies published after this date were not included. Evidence was narratively synthesized according to the clinical sequence of diagnosis, treatment selection, isolation, disinfection, barrier formation, restoration, follow-up, and evidence gaps. Throughout, an explicit distinction was maintained between clinical and laboratory evidence. Results: Sensibility testing is widely considered unreliable in immature teeth, complicating diagnosis. Isolation is often challenging because of traumatic crown loss. Successful treatment depends on adequate chemical disinfection, judicious minimal instrumentation, a well-condensed apical barrier of at least 4–5 mm, and a definitive coronal seal that also addresses the weak cervical dentin. Calcium silicate cements—principally MTA, Biodentine, and pre-mixed bioceramic putties—achieve high clinical success. Observational evidence further suggests, as a hypothesis requiring prospective confirmation, that material choice may be less decisive than operator experience and the quality of the coronal restoration. Conclusions: Apical barrier placement with hydraulic calcium silicate cements is a predictable orthograde preservation approach for non-vital immature permanent teeth, particularly when regenerative endodontic procedures are not indicated, not feasible, or unlikely to yield predictable clinical outcomes. Well-designed randomized clinical trials with standardized reporting are needed.

Dentistry Journal doi: 10.3390/dj14080508

Authors: Manuela Lalu Marius Sorin Pop Dana Carmen Zaha

Temporomandibular disorders are frequently associated with orofacial pain, functional limitations, and psychosocial factors that may contribute to persistent symptoms. Kinesiophobia, or fear of movement, may influence mandibular function and rehabilitation outcomes. This scoping review aimed to map the available evidence on the psychometric properties and cross-cultural adaptations of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD) and to identify gaps in the current literature. Literature searches were conducted in PubMed, Scopus, and the Web of Science Core Collection in March 2026. Reference lists of the included studies were also manually screened. English-language peer-reviewed studies reporting at least one measurement property of the TSK-TMD were included. The methodological quality of the included studies was assessed using the COSMIN Risk of Bias checklist for PROMs by applying the relevant measurement-property boxes and the “worst score counts” principle. The database searches identified 117 records; after removing 56 duplicates, 61 records were screened. Five full-text articles identified through database searching and one additional article identified through manual reference screening met the eligibility criteria, resulting in six included studies. The TSK-TMD appears to be a promising condition-specific patient-reported outcome measure, although measurement error, responsiveness, minimal important change, interpretability, and cross-cultural measurement invariance remain insufficiently investigated.

Dentistry Journal doi: 10.3390/dj14080507

Authors: Ivan Hristov Arabadzhiev Eber Luis Lima Steolo Carsten Nix

Background and Objectives: Achieving optimal soft-tissue aesthetics is a paramount challenge during an apicoectomy of the maxillary central incisors. This article presents a novel modification of the Eskici Vertical Flap, designed to minimize scar formation, preserve the architectural integrity of the sub-mucosal fibers, and eliminate the risk of marginal gingival recession. Methods: The Transfrenular-Single Incision (TrSI) flap is elevated via a precise two-step process. First, a sagittal incision is carried out through the mucosa along the midline of the maxillary labial frenulum. Blunt lateral tunnel preparation is then performed toward the targeted tooth apex, and a subsequent deep periosteal incision with bony contact provides localized access to the periapical lesion. Following Paraendodontic Surgical Intervention (PSI), a two-layer suturing technique is implemented: the deep layer utilizes resorbable sutures to restore periosteal integrity and reposition the basal fibers of the frenular connective tissue, while the superficial layer promotes accurate mucosal edge adaptation. Results: The surgical access provided by the TrSI flap provides clinically sufficient exposure to perform precise osteotomy, retrograde root-end preparation, and biocompatible sealing. The evaluated clinical cases demonstrated optimal healing kinetics, the complete absence of visible scar tissue, and zero marginal gingival recession. Conclusions: The TrSI flap modification constitutes a highly predictable and effective option for PSI in the aesthetically critical anterior maxilla. Although its application spectrum is primarily limited to the central incisors, its capacity to prevent aesthetic deformities warrants its consideration in selected surgical protocols.

Dentistry Journal doi: 10.3390/dj14080506

Authors: Iwona Ordyniec-Kwaśnica Anna Kudra Mateusz Lampkowski Damian Muszyński

Introduction: One of the fundamental principles of modern medicine, including dentistry, is prevention. However, if treatment is not initiated, tooth loss can occur, necessitating the use of dental prostheses to restore the function and aesthetics of the stomatognathic system. The oral microbiome is a complex ecosystem that is sensitive to external factors, including the biomaterials used to manufacture dental prostheses. Objectives: This narrative literature review aims to identify and compare the effects of various metal alloys used in dentistry, specifically high-precious (gold), precious (silver–palladium) and base (cobalt–chromium and nickel–chromium) alloys, as well as titanium, on the balance of the oral microbiome and biofilm formation. Results: The analysis indicates that gold, silver and palladium alloys demonstrate the most favourable biocompatibility and antibacterial properties, significantly reducing biofilm accumulation. Titanium and titanium-based alloys generally exhibit neutral properties under healthy conditions, although their biocorrosion products can alter the microbial environment in pathological states such as peri-implantitis. In contrast, base metal alloys (cobalt–chromium and nickel–chromium) are highly susceptible to biocorrosion in acidic environments, which can encourage the growth of bacteria that cause tooth decay and inflammation, potentially exacerbating oral dysbiosis. Conclusions: The selection of materials plays a critical role in maintaining oral microbial homeostasis and preventing plaque-related diseases. High-noble alloys and titanium are more biocompatible than base metal alloys. However, further long-term clinical trials and multi-species biofilm models are needed to fully understand these interactions between materials and microbes.

Dentistry Journal doi: 10.3390/dj14080505

Authors: Adina Feher Larisa Bora Diana Ungureanu (Similie) Corina Danciu Ștefania Dinu Ștefana Avram Cristina Adriana Dehelean Ramona Amina Popovici

Background: Geranium robertianum L. (GR) is a perennial herbaceous plant that belongs to the Geraniaceae family, widely distributed across temperate regions of Europe, Asia, North Africa, and America. It has been used in traditional ethnomedicine for its antibacterial, haemostatic, and anti-allergic properties in the treatment of oropharyngeal conditions, wounds, and inflammatory diseases. Beyond these traditional applications, pharmacological studies have documented several biological activities of its extracts and constituents. Objective: The aim of this review is to evaluate the therapeutic potential of GR by examining the phytochemical composition and the pharmacological properties relevant to dental medicine. Methods: A literature screening was conducted (PubMed, Google Scholar, PubMed Central), with focus on studies concerning phytochemical composition, pharmacological effects, and potential applications of GR and its major bioactive constituents in oral health. Results: Phytochemical analysis reveals that GR is characterized by a rich content of polyphenols, particularly tannins, flavonoids, and phenolic acids, with geraniin, ellagic acid, gallic acid, quercetin, and kaempferol identified as its principal bioactive constituents. Recent studies have confirmed that these constituents are responsible for the plant’s therapeutic potential in oral medicine. These compounds possess a variety of effects, from antibacterial and anti-inflammatory properties to antifungal and antiviral activities, as well as antioxidant, wound-healing, and anticancer benefits relevant to dental medicine. Conclusions: Despite its long-standing traditional use, GR remains largely underexplored in the context of oral health. This gap in the literature highlights GR as a promising phytotherapeutic candidate, calling for further in vitro and in vivo studies in order to investigate its efficacy and establish its mechanism of action in dental medicine.

Dentistry Journal doi: 10.3390/dj14080504

Authors: Sara Albasarah Bader Albader Mishali Alsharief Khalid Almas Faisal E. Aljofi

Background/Objectives: Dental implant and guided bone regeneration (GBR) procedures rely on successful bone healing and remodeling. Systemic metabolic factors, including vitamin D deficiency and elevated low-density lipoprotein cholesterol (LDL-C), may adversely affect osseointegration and bone regeneration. This study aimed to investigate the association between implant/GBR failure and serum vitamin D and LDL-C levels. Methods: A retrospective clinical study was conducted on 40 patients treated with dental implants and/or GBR procedures between 2023 and 2025 in the Eastern Province of Saudi Arabia. Twenty patients with failed outcomes and twenty patients with successful outcomes were included. Smokers, immunocompromised patients, individuals with a history of radiotherapy or chemotherapy, and patients with uncontrolled diabetes mellitus (HbA1c > 6.5%) were excluded. Failure was defined as progressive bone loss, loss of osseointegration, implant mobility, graft resorption, or persistent infection and was categorized as early or late failure. Serum vitamin D and LDL-C levels were obtained after treatment and analyzed using bivariate and exploratory multinomial logistic regression analyses. Results: Significant differences in serum vitamin D and LDL-C levels were observed among failure groups. Mean vitamin D levels were highest in the non-failure group (91.3 ± 47.9 nmol/L), followed by early failure (53.3 ± 33.7 nmol/L) and late failure (28.3 ± 11.3 nmol/L) (p = 0.001). Mean LDL-C levels increased progressively from the non-failure group (107.0 ± 26.8 mg/dL) to early failure (137.6 ± 47.3 mg/dL) and late failure groups (161.3 ± 57.0 mg/dL) (p = 0.003). Vitamin D status and LDL-C category were significantly associated with failure type (p = 0.001 and p = 0.012, respectively). Conclusions: Lower serum vitamin D levels and higher LDL-C levels were associated with implant and GBR failure, particularly in late failure cases. However, because serum vitamin D and LDL-C levels were measured after treatment outcomes and the study was limited by its retrospective design and relatively small sample size, these findings should be interpreted with caution and do not establish a causal relationship. Larger prospective studies are needed to determine whether preoperative assessment and optimization of vitamin D and lipid status may improve implant and regenerative treatment outcomes.

Dentistry Journal doi: 10.3390/dj14080503

Authors: Terence Lau Albert Yaacoub Stephen Cox Mafaz Ullah

Background/Objectives: One of the most common oral surgery procedures performed in dentistry is the removal of third molar teeth (3M). Complications of both retention and removal of third molars are associated with potentially preventable hospitalisations (PPH). This study aims to systematically review the published literature to identify demographics, aetiology, incidence, associated factors, length of hospital stay (LOS) and variables influencing the outcomes of PPH arising from 3M. Methods: An electronic literature search was performed using Medline and Embase via Ovid in May 2024, and relevant studies were analysed for demographics, aetiology, incidence, related factors and LOS associated with PPH resulting from 3M. Results: Nineteen publications with sample sizes ranging from 37 to 3549 patients per study were identified. Two studies reported 101 patients described PPH specifically related to 3M. The remaining 17 studies described 6153 oral health-related PPH, predominantly arising from broader odontogenic infection cohorts, of which 1654 (26.9%) PPH were associated with 3M. The mandibular 3M was implicated in 98.5% of 3M-related PPH. Pericoronitis and postoperative infections following 3M removal were reported as the leading causes of hospitalisation, whereas data on dental caries were not reported. Similarly, most studies did not report detailed information on demographics, aetiology, or outcomes specific to third molars. Conclusions: Available indirect data shows that 3M-related dental infections, including post operative infections, contribute to oral health-related PPH. There are significant evidence gaps in third molar-specific PPH data. Further studies with standardised reporting focusing on third molar-related hospitalisations are required to identify factors influencing clinical outcomes and to inform evidence-based clinical decision-making regarding the removal or retention of third molars.

Dentistry Journal doi: 10.3390/dj14080502

Authors: Hadar Better Thabet Asbi Gavriel Chaushu Keren Better Joshua Moshonov Doron Haim

Background/Objectives: Meta-analyses of endodontic microsurgery (EMS) report pooled success rates of 90–94%, which is now a reference point for clinical decisions. These estimates are often applied beyond the follow-up intervals and imaging conditions in which they were derived. This review defines the temporal and imaging boundaries within which such a rate can be applied with confidence. Methods: We reviewed the core meta-analyses establishing these benchmarks, together with primary studies comparing periapical radiography (PA) and cone-beam computed tomography (CBCT) within the same cohort or across follow-up intervals. Sources from MEDLINE, Embase, and the Cochrane Library were selected purposively, not by systematic screening. Results: Reported success varied with both imaging modality and follow-up time. In within-cohort comparisons, PA consistently yielded higher success than CBCT, being less sensitive to residual cancellous defects; in one cohort, CBCT found a defect in 28% of sites PA had judged healed. A long-term meta-analysis reported 91.3% success in randomized trials but 78.4% in prospective cohorts over 2 to 13 years, with 5 to 25% of early successes later reverting. Conclusions: Success after EMS is neither temporally stable nor modality-neutral. Meta-analytic estimates are valid within their stated follow-up and imaging context; applying them outside that context risks misclassification with direct consequences for clinical decision-making.

Dentistry Journal doi: 10.3390/dj14080501

Authors: Peter Kiefner Mirela Gules Marina Bunea Michael Ban

Background/Objectives: This study evaluated the adaptation of a novel filling material, Odne®Fill (ODNE, Dübendorf, Switzerland), to instrumented root canal walls using micro-computed tomography. Methods: Fourteen extracted human molars (six maxillary and eight mandibular), comprising a total of 32 root canals, were included in this study. Following preparation, all root canals were filled with Odne®Fill according to the manufacturer’s instructions. The extent of the root canal area coverage by the novel filling material was assessed using both periapical radiographs and micro-CT. The filling material adaptation to the canal walls was quantified through image segmentation and statistically analyzed. Results: The percentage of canal wall coverage ranged from 93.31% to 99.98%. The mean coverage rate was 97.63% (standard deviation: 1.70%), with a median value of 98.23%, indicating a high degree of adaptation of the filling material to the ex vivo prepared canal walls. Conclusions: Within the limitations of this ex vivo study, Odne®Fill demonstrated high adaptation values to the prepared root canal walls. These findings should be interpreted with caution. Further comparative studies and long-term investigations are required to determine the clinical significance and performance of the studied material under in vivo conditions.

Dentistry Journal doi: 10.3390/dj14080500

Authors: Andrea Ordoñez Balladares Luis Chauca-Bajaña Dario Adolfi Míriam Teulé-Trull Tiago Reis José Martín-Cruces

Objectives: To systematically evaluate the influence of connector design and pontic span length on the mechanical performance of zirconia fixed dental prostheses (FDPs). Methods: A systematic review was conducted according to PRISMA 2020 guidelines (8). Electronic searches were performed in PubMed, Scopus, Web of Science, and Embase. In vitro and finite element analysis (FEA) studies evaluating zirconia FDPs were included. Results: A total of 11 studies were included. Across all studies, connector regions were consistently identified as the primary site of fracture initiation. Reduced connector dimensions significantly decreased fracture resistance and fatigue life, whereas increased cross-sectional area and optimized geometry improved stress distribution and mechanical performance. Longer pontic spans were associated with increased stress concentration and reduced structural stability. Conclusions: Connector design and pontic span length are critical determinants of the biomechanical behavior of zirconia FDPs. Clinical significance: Optimization of connector dimensions and geometry is essential to improve the longevity and reliability of zirconia FDPs.

Dentistry Journal doi: 10.3390/dj14080499

Authors: Chau Bao Ho Truong Thien Tran Lan Thi-Quynh Ngo

Background/Objectives: Glass-hybrid and high-viscosity glass ionomer systems were developed to address limitations of conventional glass ionomer cements. This in vitro study compared post-thermocycling Vickers hardness and microleakage of a coated glass-hybrid system and a coated high-viscosity glass ionomer system in conservative Class II cavities. Methods: Thirty extracted human maxillary first premolars each received both systems in standardized mesio-occlusal and disto-occlusal cavities, enabling paired within-tooth comparisons. Following thermocycling and methylene blue immersion, Vickers hardness was measured on polished restoration cross-sections at occlusal and gingival locations. Microleakage was quantified using a continuous microleakage index and ordinal dye penetration scores. Results: The EQUIA Forte HT system had a higher tooth-level mean Vickers hardness than the Gold Label IX Extra system (95.05 ± 6.58 HV vs. 91.33 ± 7.50 HV), with a mean paired difference of 3.72 HV (95% CI, 0.32 to 7.11; p = 0.033; Cohen’s dz = 0.41, 95% CI, 0.03 to 0.78). The location-specific mixed model also showed an effect of restorative system (p = 0.025), whereas neither testing location nor the system × location interaction was significant. No significant between-system difference was detected for the microleakage index or for either ordinal dye penetration score. Conclusions: Within the limitations of this in vitro study, the EQUIA Forte HT system had a modestly higher post-thermocycling tooth-level mean Vickers hardness than the Gold Label IX Extra system, although the clinical relevance of the difference remains uncertain. No between-system differences were detected in dye penetration outcomes.

Dentistry Journal doi: 10.3390/dj14080498

Authors: Sarah Fita Tracey Whitley Robin Henderson Onur Kadioglu Steven Pan

Background/Objectives: Gingival recession frequently affects the anterior mandibular region. Anatomical features, such as thin buccal bone, narrow keratinized gingiva, and root proximity, increase susceptibility to periodontal disease. Recession can progress over time and may be exacerbated by orthodontic treatment. However, it remains uncertain whether the severity of crowding before treatment contributes to recession after orthodontic therapy The present study aimed to determine whether a relationship exists between the degree of mandibular anterior crowding before orthodontic treatment and the development or progression of gingival recession after treatment completion. Methods: This retrospective study was conducted on 269 participants with pre- and post-treatment records. The Little’s irregularity index was used to assess the degree of crowding. Clinical photographs of the six mandibular anterior teeth (1614 sites) were digitally calibrated permit millimeter-based assessment of gingival recession and keratinized tissue (KT) width. Oral hygiene (OH) was also evaluated at both time points. Results: Post-treatment recession was detected in 76 teeth. (4.7% of sites) among 48 participants (17.8%). Pretreatment crowding severity was not significantly associated with the occurrence of recession after treatment. Pretreatment mucogingival deformities were independently associated with post-treatment gingival recession. Mandibular central incisors demonstrated the highest prevalence of post-treatment gingival recession. Conclusions: Pretreatment mandibular anterior did not appear to predict gingival recession at treatment completion. Periodontal characteristics may play a more important role in recession development, supporting careful periodontal evaluation before and throughout orthodontic care.

Dentistry Journal doi: 10.3390/dj14080497

Authors: Hussein Imad Al-Ghurairi Hussain Al-Huwaizi

Background/Objective: Root canal debridement is limited by complex anatomy and the apical vapor lock phenomenon, reducing smear layer removal. This study evaluated the effect of a 5 µm zirconia microparticle suspension used with sonic, passive ultrasonic irrigation (PUI), or erbium, chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) laser activation on smear layer removal across the root canal thirds. Methods: Sixty single-rooted human teeth were prepared to size F4 (40/0.06) using 5.25% NaOCl and randomly assigned to six groups (n = 10) combining activation modality (sonic, PUI, or Er,Cr:YSGG laser) and irrigant type (distilled water or 5 µm zirconia suspension) over a 5 min interrupted cycle. Smear layer removal was scored using scanning electron microscopy (SEM) and the Hülsmann grading system. Data were analyzed via Kruskal–Wallis and Friedman tests with post hoc pairwise comparisons (α = 0.05). Results: Inter-rater reliability was strong (Cohen’s κ = 0.736–0.822; p < 0.001). Smear layer removal varied significantly across root thirds (p < 0.001). Ultrasonic + Zirconia demonstrated superior removal in the middle third compared with Sonic + Distilled Water (p = 0.005), and in the coronal third compared with Laser + Distilled Water (p = 0.003) and Sonic + Distilled Water (p = 0.026). Coronally, Ultrasonic + Distilled Water outperformed Laser + Distilled Water (p = 0.041). No significant differences occurred apically (p > 0.05). Conclusions: Incorporating 5 µm zirconia microparticles with passive ultrasonic activation improved smear layer removal, particularly in the coronal and middle thirds of the root canal under the conditions of this ex vivo study.

Dentistry Journal doi: 10.3390/dj14080496

Authors: Péter Komora Orsolya Vámos Gergely Agócs Boglárka Lilla Szentes Péter Hegyi Eszter Ágnes Szalai Alexander Schulze Wenning Gábor Varga János Vág Beáta Kerémi

Background: Achieving a three-dimensional seal of the root canal system is considered essential for long-term endodontic success. Because no clinically acceptable threshold for void formation has been established, comparisons with clinically validated reference materials are needed to interpret the sealing quality of newer calcium silicate-based sealers (CSBSs). AH Plus is a well-established epoxy resin-based sealer (ERBS) with documented long-term clinical performance. This systematic review and meta-analysis compared the quality of root canal fillings produced with CSBSs and AH Plus using different obturation techniques in permanent mature extracted and artificial teeth. Methods: MEDLINE (PubMed), EMBASE, Cochrane Library, and Web of Science were systematically searched for randomized in vitro studies up to 1 July 2025. The primary outcomes were the percentages of void volume or area. Mean values and mean differences (MDs) with corresponding 95% confidence intervals (CIs) were calculated for the total filling volume and, where available, for the apical, middle, and coronal thirds of the root canal. Risk of bias and certainty of evidence were assessed. Results: Twenty-one studies met the eligibility criteria, and 18 articles were included in the quantitative analysis. No statistically significant differences were observed in total void volume between CSBSs placed with the single-cone technique and AH Plus used with either the single-cone or warm vertical compaction technique in extracted teeth. Similarly, no significant differences were observed between the investigated groups in the apical, middle, or coronal thirds of the root canal. Evidence for other obturation techniques and artificial teeth was limited. Conclusions: Within the limitations of the available in vitro evidence, no statistically significant differences in void formation were detected between the investigated sealer–technique combinations. Further standardized in vitro studies and well-designed clinical investigations are warranted.

Dentistry Journal doi: 10.3390/dj14080494

Authors: Yixuan Zhang Naoki Toyama Mohammad Nurhamim Momoko Nakahara Daiki Fukuhara Takayuki Maruyama Daisuke Ekuni

Background/Objectives: This study aimed to investigate the effects of oral Bacillus subtilis (BS) on alveolar bone loss, intestinal morphology, and gut microbiota in a mouse model of ligature-induced periodontitis. Methods: A total of 24 male C57BL/6J mice (6 weeks old) were allocated to control, periodontitis (P), BS, and BS+P groups. Periodontitis was induced by bilateral ligation of maxillary second molars, and BS was orally administered for 18 consecutive days. Gut microbiota composition was analyzed by 16S rDNA sequencing, alveolar bone loss and gut morphology were evaluated using ImageJ version 1.54g, and ELISA-detectable serum vitamin D metabolite concentrations were measured using an enzyme-linked immunosorbent assay. Results: Compared with the P group, the BS+P group showed reduced bone loss. Serum vitamin D metabolite concentrations, small-intestine villus height, and villus height-to-crypt depth ratios were higher in the BS+P group. In gut microbiota, alpha diversity differed significantly among groups based on the Shannon index. Bray–Curtis-based beta diversity differed significantly among groups. Conclusions: Oral supplementation of BS attenuated the progression of ligature-induced periodontitis in a mouse model, and changes in gut microbiota may be associated with this effect.

Dentistry Journal doi: 10.3390/dj14080495

Authors: Yi Xia Jingze Lu Xingmei Feng

Temporomandibular disorders (TMD) comprise a heterogeneous group of pain and dysfunction conditions involving the temporomandibular joint, masticatory muscles, and related structures. Although occlusal interference has long been discussed in relation to TMD, current evidence does not support an occlusion-centered etiological model for most patients. Within the contemporary biopsychosocial framework embodied by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), occlusal interference is better regarded as one of several potential peripheral biomechanical inputs that may interact with individual pain susceptibility, parafunctional loading, inflammatory status, and psychosocial factors. This review synthesizes evidence on how peripheral biomechanical and inflammatory inputs may engage masticatory muscle–nerve signaling, trigeminal nociceptor activation, and neurogenic inflammation. We discuss altered masticatory muscle activity, proprioceptive and nociceptive afferent signaling, neuropeptide release, neurovascular and mast cell–nerve interactions, and glial activation within trigeminal pain pathways. Molecular mechanisms, including TRP channel and P2X3 receptor activation, voltage-gated ion channel dysregulation, MAPK, PI3K/Akt/mTOR, cAMP/PKA/CREB signaling, and epigenetic regulation, are reviewed as candidate pathways linking peripheral input to pain-related plasticity. These mechanisms are further considered in relation to hyperalgesia, mechanical allodynia, pain memory, emotional and cognitive modulation, and sex-related differences in pain processing. Finally, we evaluate translational implications, including mechanism-oriented animal models, exploratory biomarkers, human-derived experimental systems, and mechanism-informed interventions, while emphasizing their current limitations. Overall, this review proposes a cautious mechanistic framework in which peripheral inputs may contribute to TMD-related pain amplification in selected contexts, but clinical translation requires validated phenotyping, longitudinal evidence, and integration with conservative, reversible, and patient-centered standard-of-care management.

Dentistry Journal doi: 10.3390/dj14080493

Authors: Omar A. El Meligy Ahmed O. Elmeligy

Background/Objective: Artificial intelligence (AI) is increasingly transforming healthcare and has emerged as a promising tool in pediatric dentistry. This narrative review examines the methodological foundations, current applications, limitations, and future directions of AI in pediatric dental practice. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant English-language publications from database inception through to May 2026, using predefined search terms and eligibility criteria. Following screening and full-text assessment, 72 unique publications were retained for the narrative synthesis. Results: AI applications in pediatric dentistry include early childhood caries detection and risk prediction, dental plaque assessment, identification of mesiodens and supernumerary teeth, dental age estimation, automated tooth detection, fissure-sealant evaluation, and craniofacial growth prediction. Several imaging-based models demonstrated performance comparable to experienced clinicians. However, many studies relied on retrospective, single-center datasets and lacked external or prospective validation. Additional concerns included algorithmic bias, data privacy, limited interpretability, and infrastructure requirements. Conclusions: AI has considerable potential to improve diagnostic efficiency, consistency, and personalized preventive care in pediatric dentistry. However, it should be used as a clinical decision-support tool rather than a replacement for professional judgment. Future research should prioritize prospective multicenter validation, multimodal and explainable systems, standardized reporting, and ethical clinical implementation.

Dentistry Journal doi: 10.3390/dj14080492

Authors: Alice Murariu Livia Bobu Gianina Iovan Gabriela Luminița Gelețu Laura Ioana Leon Alexandra Cornelia Teodorescu Diana Zapodeanu Bianca-Andreea Onofrei Dragoș Nicolae Frățilă Costin Iulian Lupu Elena-Raluca Baciu

Background/Objectives: Individuals with autism spectrum disorder (ASD) represent a special population whose characteristics may adversely affect both their own and their families’ quality of life. These characteristics include poor oral health, sensory hypersensitivity, restrictive and repetitive behaviours, communication difficulties, medication-related adverse effects, and associated comorbidities. This scoping review aimed to evaluate the oral health-related quality of life (OHRQoL) of children and adolescents with ASD, as perceived by their parents/caregivers, and to identify the factors associated with these outcomes. Methods: Literature searches were conducted in the MEDLINE/PubMed, Scopus, Web of Science, Embase, and Google Scholar databases. Studies published between 2016 and May 2026 were considered for inclusion. Results: Of the 799 records identified, 23 studies met the eligibility criteria. Among these, 15 used the Parental-Caregiver Perceptions Questionnaire (P-CPQ), an instrument specifically developed for children with cognitive impairments. Most studies reported statistically significant associations between poorer OHRQoL and dental caries experience, lower household income, older age, male sex, and lower parental oral health literacy. Conversely, preventive interventions and comprehensive dental rehabilitation performed under general anaesthesia were associated with improvements in the quality of life of both children and their families. Parents of children with ASD also reported a greater emotional burden, primarily related to responsibility for toothbrushing, dental attendance, the child’s general health status, and the family’s financial situation. Conclusions: The majority of the included studies indicate that, according to parental reports, children and adolescents with ASD experience poor OHRQoL, particularly in the domains of emotional well-being, social well-being, functional limitations, and oral symptoms. These findings highlight the need for targeted preventive strategies and multidisciplinary interventions aimed at improving both oral health and overall quality of life in this vulnerable population.

Dentistry Journal doi: 10.3390/dj14080491

Authors: Ofir Rosner Adar Polonsky Katz Joseph Nissan Ela Shir Aghov Diva Lugassy Yifat Manor Gil Ben-Izhack

Background: The aim of this in vitro study was to examine the effect of the sterilization process on two different two-piece intra-oral scan bodies (ISBs) using three-dimensional (3D) analysis. Methods: Two identical 3D-printed models with three analogs in positions #12, #13, and 14# were used: two-piece titanium (Ti-Ti) and two-piece poly-ether-ether-ketone (PEEK) and Ti (PEEK-Ti) ISBs. Each model was scanned once before sterilization. A laboratory scanner (LBS) produced a reference stereolithography (STL) file, followed by 30 scans with an intra-oral scanner (IOS), producing 30 STL files. Both ISBs underwent three cycles of sterilization followed by thirty scans using an IOS, producing another 30 STL files. Each STL file was superimposed on the LBS reference STL file using 3D analyzing software, and the following parameters were calculated: inter-implant distance, intra-implant distance, inter-implant angle, and intra-implant angle. The Kolmogorov–Smirnov test indicated non-normal distribution; therefore, Wilcoxon signed-rank tests and Mann–Whitney tests were performed (p < 0.05). Results: Within groups, after sterilization, the mean errors of the Ti-Ti ISB were significantly increased regarding inter-implant distance 12_13 (p < 0.05), intra-implant distance 14 (p = 0.0005), inter-implant angle 12_13 (p = 0.0005), inter-implant angle 13_14 (p = 0.001), intra-implant angle 13 (p = 0.005), and intra-implant angle 14 (p < 0.05). Within groups, after sterilization, the mean errors of the PEEK-Ti ISB were significantly increased regarding inter-implant distance 12_13, 13_14, and 12_14 (p = 0.0005), intra-implant distance 12 (p < 0.05), intra-implant distance 13 and 14 (p = 0.0005), inter-implant angle 12_13 (p = 0.0005), and inter-implant angle 13_14 (p = 0.005). Between groups, after sterilization, the mean errors for the PEEK-Ti ISB were significantly higher (p < 0.0005) regarding all parameters compared to the Ti-Ti ISB. Conclusions: Both PEEK-Ti and Ti-Ti ISBs showed significant changes in most parameters after three cycles of sterilization, with the PEEK-Ti ISB exhibiting greater changes compared to the Ti-Ti ISB. Therefore, three cycles of sterilization affect axes and distances for both PEEK-Ti and Ti-Ti ISBs.