Dent. J., Volume 12, Issue 3 (March 2024) – 40 articles

The purpose of this study was to identify changes in the temporomandibular joint disc affected by effusion by using texture analysis of magnetic resonance images (MRIs). Methods: A total of 223 images of the TMJ, 42 with joint effusion and 181 without, were analyzed. Three consecutive slices were then exported to MaZda software, in which two oval ROIs (one in the anterior band and another in the intermediate zone of the joint disc) were determined in each slice and eleven texture parameters were calculated by using a gray-level co-occurrence matrix. Spearman’s correlation coefficient test was used to assess the correlation between texture variables and to select variables for analysis. The Mann–Whitney test was used to compare the groups. Results: The significance level was set at 5%, with the results demonstrating that there was no high correlation between the parameter directions. It was possible to observe a trend between the average parameters, in which the group with effusion always had smaller values than the group without effusion, except for the parameter measuring the difference in entropy. Conclusion: The trend towards lower overall values for the texture parameters suggested a different behavior between TMJ discs affected by effusion and those not affected, indicating that there may be intrinsic changes. Full article

Autonomic nervous system (ANS) activity may be associated with dental anxiety; however, no studies exist on the topic. The aim of this study was to assess if ANS activity and dental anxiety are associated. Data were collected as part of a Northern Finland Birth Cohort Study, NFBC1966, at the age of 46 years with eligible data on 1905 participants. Dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS) categorized as follows: 19–25 = high, 10–18 = moderate, 5–9 = no to low dental anxiety. Heart rate variability (HRV) data were collected using an HR monitor and a standard lead-II electrocardiogram (ECG). Baroreflex sensitivity (BRS) was calculated from continuous ECG and blood pressure signals. Participants were categorized into three groups as follows: Low = the lowest 20th percentile, Mid = medium 21–79th percentile, and High = the highest 20th percentile according to their ANS variables. The associations between the MDAS and ANS activity parameters were evaluated using unordered multinomial logit models adjusted for comorbidities, β-blockers, BMI, smoking, and education. High heart rate, reduced HRV, low cardiac vagal modulation, and poor BRS were associated with moderate dental anxiety, and high cardiac vagal modulation and good BRS were associated with no to low dental anxiety. Poorer ANS activity might predispose some to dental anxiety, and better ANS activity might protect from dental anxiety. Full article

The objective of the study was to evaluate the long-term esthetic and radiographic results of implants placed in the anterior maxilla after ridge preservation, combining bovine xenograft with collagen matrix. Fifteen patients who required a single tooth extraction because of fracture, root resorption, or extended caries were included in the study. After extraction, all sites were grafted using Deproteinized Bovine Bone Mineral (DBBM) with collagen and covered by a resorbable collagen matrix (CM). Five months after socket grafting, implants were successfully installed. The implant diameter range was between 3.8 and 4.2 mm. All patients were monitored for over 7 years, both clinically and radiographically. Three independent observers evaluated the long-term esthetic outcome, employing the Pink Esthetic Score (PES) technique. Over a period exceeding seven years, a 100% survival rate was observed for all 15 implants, with minimal marginal bone loss. The mean PES was 11.40 (±1.44) at the first assessment and 11.38 (±1.63) at the second assessment. The difference was not statistically significant (p = 0.978), and the scores of PES measurements indicated excellent esthetic results even after seven years. Based on these preliminary results, it seems that placing collagen bovine bone in a fresh extraction socket, covered with a collagen matrix, can preserve the alveolar ridge and provide long-term stable esthetic results. Full article

This case report of an 11-year-old subject shows the digital workflow for the management of an impacted mandibular canine using Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology along with Temporary Anchorage Devices (TADs). The miniscrew insertion site was planned using software, and a surgical guide was digitally designed and 3D printed. Orthodontic traction was performed using a 3D-designed and -printed device. In a single sitting, the miniscrew was inserted and the disimpaction device was also delivered. The primary objective of recovery and the repositioning of the impacted mandibular canine in the axis with its eruptive path was achieved. The space available and the subject’s early stage of mixed dentition was considered favourable to a spontaneous eruption. This case report shows how CAD/CAM digital technology, combined with 3D printing, enables the creation of a surgical guide to position the miniscrew and the customized devices used for mandibular canine disimpaction. CAD/CAM surgical guides can help clinicians to position TADs with more accuracy and predictability, ensuring high quality bone support offering primary stability. Although orthodontic traction is the most complex therapeutic choice to implement, with the aid of CAD/CAM technology it is possible to proceed with accurate and minimally invasive orthodontic traction in order to recover a mandibular canine. Full article

Eight pediatric oral nutritional supplements (ONSs) and 0.5% fat bovine milk were examined in vitro regarding their effect on the adhesion of three caries-related bacteria, Streptococcus mutans (strain CCUG 11877T), Lactobacillus gasseri (strain CCUG 31451), and Scardovia wiggsiae (strain CCUG 58090), to saliva-coated hydroxyapatite, as well as their pH and capacity to withstand pH changes. Bacteria were cultivated and radiolabeled. The adhesion assays used synthetic hydroxyapatite coated with whole or parotid saliva. Measurements of pH and titration of the products with HCl and NaOH were conducted in triplicate. Three ONSs promoted the S. mutans adhesion to saliva-coated hydroxyapatite (increase from 35% to >200%), supporting caries risk enhancement. S. wigssiae and L. gasseri adhered only to one and no ONS, respectively. Most supplements had limited buffering capacity to counteract acidification changes, suggesting their low capacity to neutralize acids, and one ONS showed a significant capacity to counteract basic changes, suggesting a high erosive potential. S. mutans adhesion was influenced by the ONS pH and volume NaOH added to reach pH 10. L. gasseri and S. wiggsiae adhesion was influenced by the ONSs’ carbohydrate and fat content. Interdisciplinary efforts are needed to increase awareness and prevent the possible negative impact of ONSs on children’s oral health. Full article

This study aimed to assess and contrast the effects on the vertical marginal fit of full contour CAD/CAM-generated monolithic zirconia crowns at pre- and post-cementation levels with various occlusal reduction schemes (planar and flat) and cements. Forty sound human maxillary first premolars were sampled for this study. The samples were divided into two main groups with twenty samples in each group according to the occlusal reduction scheme as follows: Group A included a chamfer finishing line design with a planar occlusal reduction scheme and Group B included a chamfer finishing line design with a flat occlusal reduction scheme. Each group was sampled into two subgroups (n = 10) based on the type of cement as follows: resin-modified glass ionomer cement (Fuji Plus) for subgroups A1 and B1, and a universal adhesive system (Duo Estecem II) for subgroups A2 and B2. Marginal gaps were tested in four indentations using a Dino light stereomicroscope (230×). Paired T-tests and Student’s t-tests were used to analyze the data. Before cementation, subgroup A1 scored the lowest mean of vertical marginal gap values, while subgroup B2 scored the highest mean; following cementation, subgroup A1 scored the lowest mean of vertical marginal gap values, and subgroup B2 scored the highest mean of vertical marginal gap values. A chamfer finishing line design with a planar occlusal reduction scheme could be a preferable occlusal reduction scheme. Full article

Background: The use of a demineralized dentin matrix (DDM) has garnered substantial importance in dentistry. This study was carried out to evaluate the osteoinductive performance of DDM in comparison to nano-hydroxyapatite (n-HA) on calvarial critical-sized bone defect. Methods: Two critical-sized defects (CSDs) were bilaterally trephined in the calvarium of sixteen healthy white rabbits. The rabbits were categorized into four groups: in group 1, the defect was left empty; in group 2, defects were filled with sodium alginate (SA) hydrogel as a sole material; in group 3, defects were treated with nano-hydroxyapatite hydrogel (NHH); in group 4, defects were treated using demineralized dentin matrix hydrogel (DDMH). Histological and immunohistochemical analyses were carried out to evaluate the total areas of newly formed bone. Results: The DDMH group showed that new woven bone tissue progressively bridged the defect area while there was no bone in the control group. Collagen expression was significantly different in the DDMH- and NHH-treated groups compared to in the SA group at 4 and 8 weeks (p < 0.01). OCN expression was significantly higher in the DDMH group in comparison to in the NHH or SA groups at 8 weeks (p < 0.01). Conclusions: The DDMH group exhibited significantly higher levels of new bone formation compared to the NHH group at both 4 and 8 weeks post-surgically. Full article

The goal was to assess dental students’ perception of digital technologies after participating in a CAD/CAM exercise for scanning, designing, and manufacturing computer-aided provisional fixed dental restorations. A survey was conducted among second- (pre-D2 and post-D2), first- (D1, negative control), third-, and fourth-year dental students (D3 and D4, positive controls). Only OSU College of Dentistry students who completed the activity and completed the surveys were included. Seven questions were rated, which evaluated changes in knowledge, skill, interest, the importance of technology availability in an office, patients’ perception of technology, the importance of having the technology, and the expected frequency of clinics utilizing the technology. Statistical analysis was performed with a significance level of 0.05. A total of 74 pre-D2 and 77 post-D2 questionnaires were completed. Additionally, 63 D1, 43 D3, and 39 D4 participants responded to the survey. Significant differences were found for “knowledge” and “skill” between the pre-D2 and post-D2 and pre-D2 and control groups (p < 0.001). There was a significant difference between the post-D2 participants and all the controls in terms of “interest” (p = 0.0127) and preference for in-practice technology availability (p < 0.05). There were significant results between the post-D2 participants and all the controls regarding the importance of technology availability in an office (p < 0.001) and the expected frequency of clinics utilizing the technology (p = 0.01). No significance was found for “value of technology to patients” and “the importance of having the technology”. The presence of technology in practice and in educational academic environments significantly improved students’ interest and perception of their knowledge and skill. Full article

(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted. Full article

Panoramic radiography (OPG) evaluates mandibular third molar impaction (MTMI). This systematic review aimed to investigate the diagnostic accuracy of OPG in detecting bone loss distal to the lower second molars. The associated bone loss with different impaction positions and the most prevalent positions of MTMI were investigated as secondary outcomes. In January 2023, PubMed, Scopus, and Cochrane were searched to identify studies published between January 2012 and January 2023. Two examiners blindly selected the eligible studies for data extraction and quality assessment. Of 427 studies, 8 were suitable for data extraction. All studies reported bone loss distal to the second molar using OPG, ranging from 4.9 to 62.9%. The most frequent position of MTMI is mesioangular. The distal bone loss in the vertical and horizontal positions is statistically significant compared to typically positioned third molars and those that are fully erupted or impacted, but in a normal orientation (p-value 0.005 and 0.02, respectively). Bone loss was not statistically significant in the mesioangular position compared to other impacted positions (p-value 0.14). The risk of bias ranges between 66 and 88%. Despite its limitations, OPG is still considered a valuable tool to assess bone loss distal to the lower second molar in cases of an impacted mandibular third molar. Full article

We aimed to identify parents’ dental anxiety trajectories and the association of the trajectories with the number of parents’ and their children’s oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers’ trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers’ trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures. Full article

This study was conducted to compare the effects of an innovative plasma surface treatment device that does not need a gas supply for titanium disks with two different surface topographies: the prototypical machined surface (MAC) and one of the most diffused roughened ones (SL) obtained through grit blasting and acid etching. A total of 200-MAC and 200-SL titanium disks were used. Each group of disks was divided into four sub-groups of 40 samples each that were subjected to five different tests. Among these, 150-MAC and 150-SL were considered the test group, and they were treated with plasma for 15, 30, and 60 s after being removed from the sterile packaging. On the other hand, 50-MAC and 50-SL were considered the control group, and they were only removed from sterile plastic vials. The samples were analyzed to evaluate the capability of the plasma treatment in influencing protein adsorption, cell adhesion, proliferation, and microbial growth on the test group disks when compared to the untreated disks. Protein adsorption was significantly enhanced after 20 min of plasma treatment for 15 and 30 s on the MAC and SL disks. Plasma treatment for 15 and 30 s significantly increased the level of adhesion in both treated samples after 30 min. Furthermore, the MAC samples showed a significant increase in cell adhesion 4 h after plasma treatment for 15 s. The SEM analysis highlighted that, on the treated samples (especially on the MAC disks), the cells with a polygonal and flat shape prevailed, while the fusiform- and globular-shaped cells were rare. The encouraging results obtained further confirm the effectiveness of plasma treatments on cell adhesion and fibroblast activity. Full article

Oral mucosa inflammation can cause severe pain and interfere with eating, reducing quality of life. However, few options for self-care are available. An oral liquid bandage forms a protective film over the affected area. We aimed to assess the acid erosion risk when a newly developed oral liquid bandage (ORAPLA) is accidentally deposited on teeth and to examine the relative acid erosion risk at multiple time points of the maximum recommended duration of continuous use. ORAPLA was applied to both enamel and dentin blocks from 45 bovine anterior mandibular teeth, and an acid challenge was performed in a simulated oral cavity with artificial saliva, with one exposure cycle lasting 6 h. The enamel showed substantial defects and a decrease in Vickers hardness after nine cycles, with no change in surface roughness. Dentin showed an increase in parenchymal defects and surface roughness and a trend toward decreased Vickers hardness with increasing exposure time. We found no significant acid corrosion in enamel after up to nine times the upper limit of normal use time or in dentin after up to six times the upper limit. We conclude that the acid erosion risk due to accidental attachment to teeth is low, and in the human oral cavity with salivary buffering and remineralization, likely even lower. Full article

Dental caries in children is a frequent and debilitating condition, whose management is often challenging. The aim of this systematic review was to investigate the effectiveness of ozone applications for the treatment of caries in primary dentition. According to PRISMA guidelines, a systematic literature search was performed up to 6 January 2024. Clinical studies using ozone to treat caries of deciduous teeth were considered for inclusion. Out of the 215 records retrieved, seven studies were eventually included in the review, all of which used gaseous ozone. Four studies were judged at high risk of bias, two at low risk, and one of some concerns. The great heterogeneity of designs, outcomes, and protocols made it impossible to conduct a meta-analysis. Despite some limitations, the evidence yielded by the included studies suggests that ozone application, regardless of the protocol applied, is comparable to other interventions in terms of clinical outcomes and anti-bacterial activity, with no reported adverse effects and good patient acceptance. Therefore, ozone application may be a non-invasive approach to treat caries in primary dentition, especially in very young and poorly cooperative patients. Further standardized and rigorous studies are, however, needed to identify the best clinical protocols for this specific field. Full article

Post-curing is the process of applying extra light to complete the polymerization process of 3D printing. The mechanical properties of light-cured three-dimensional (3D) printed resin can be improved by decreasing the oxygen concentrations during post-curing, and nitrogen-saturated post-curing has been applied for this purpose. This study aimed to evaluate and compare the color stability of 3D-printed resin crowns that were post-cured in both normal air and nitrogen-saturated conditions. Crowns were fabricated with a 3D printer and post-cured in normal air (control group; air) or nitrogen-saturated conditions (experimental group; nitrogen). The specimens in each group were subdivided into four subgroups, each exposed to different discoloration agents: distilled water, coffee, wine, and curry. Post-immersion color changes were measured using a digital spectrophotometer and analyzed using repeated-measures ANOVA. Fourier transform infrared (FT-IR) spectroscopy evaluated the degree of conversion of resin over immersion times for both post-curing conditions. Upon comparing the effects of post-curing conditions, a significant difference between the control and experimental groups in terms of immersion time in the wine and curry subgroups was found. FT-IR analysis showed a significant difference in the degree of conversion between the air and nitrogen groups from 10 to 300 s. These findings suggest that nitrogen-saturated post-curing can potentially enhance the conversion rate of 3D-printed resin crowns, thereby improving their color stability. Full article

This study aimed to determine the effect of photobiomodulation therapy induced by semiconductor laser irradiation on human dental pulp stem cell (hDPSC) proliferation and their differentiation into odontoblast-like cells (OLCs). The effects of various semiconductor laser irradiation conditions on hDPSCs were examined. Three groups were evaluated: a single laser irradiation at 6 h post-seeding, multiple laser irradiations up to four times every 4 days after the first dose, and a control with no laser irradiation. The cells were irradiated at 10, 30, and 150 mW using a semiconductor laser. The effect of laser irradiation on hDPSC differentiation into OLCs was also determined. Four groups were evaluated, including co-culture using basic medium and dentin discs, simple culture using OLC differentiation-inducing medium, co-culture using OLC differentiation-inducing medium and dentin discs, and control culture with basic medium. The expression of the nestin, ALP, DSPP, and DMP-1 genes was measured using real-time PCR. The multiple irradiation group irradiated at 30 mW exhibited significantly more cell proliferation than the control. The expression of nestin associated with differentiation into OLCs during each culture period tended to be lower, whereas DSPP and ALP expression was higher compared with that of the control. Multiple laser irradiations at a low power of 30 mW induced significant hDPSC proliferation and might induce differentiation into OLCs. Full article

Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when the coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to when it is used in hospital-based settings. The updated Dutch PPSA guidelines have increased costs and raised concerns about the accessibility of specialized high-quality dental care for children in the Netherlands. This study aimed to investigate the impact of the updated 2017 guidelines on the occurrence rate of adverse events during PPSA in twelve Dutch dental clinics. Methods: The data of 25,872 children who were treated at twelve dental clinics between 1997 and 2019 were analyzed. A logistic two-level mixed-effects model was used to estimate the updated guidelines’ impacts on adverse events. Results: The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64–0.89) after the implementation of the updated guidelines. This outcome was significant with p = 0.001, indicating a protective effect. Conclusions: Our findings demonstrate that there was a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adhering to evidence-based practices in out-of-hospital dental clinics. Full article

Fluoridation (Fl) is effective in preventing caries; however, it is unclear to what extent its use is counteracted by misinformation on the internet. This study aimed to evaluate the information provided on professional websites of German dental practices regarding fluoridation. A systematic search was performed by two independent examiners, utilizing three search engines, from 10 September 2021 to 11 December 2021. Modified, validated questionnaires (LIDA, DISCERN) were used to evaluate technical and functional aspects, generic quality, and risk of bias. Demographic information and statements about Fl were also collected. The intra- and inter-rater reliability assessments were excellent. Of the 81 websites analyzed, 64 (79%) mentioned Fl, and 31 (38%) indicated it as a primary focus. Most websites met at least 50% of the LIDA (90%) and DISCERN criteria (99%), indicating that the general quality was good. Thirty (37%) of the websites explained the impact of Fl, and forty-five (56%) indicated an opinion (for/against) on Fl. The practice location and the clinical focus were not associated with the overall quality of websites. Only a minority of websites explained the effects of Fl. Taken together, this study highlights that there is a distinct lack of good-quality information on FL. Full article

Modern toothpastes are complex formulations with various ingredients. The aim of this study was to analyze the improvement of toothpaste formulations from 1900 to 2023 focusing on active ingredients with remineralizing, antibacterial, or plaque-removing effects, and to discuss their influence on caries prevention. For this, worldwide patent applications were searched using the international database Espacenet from the European Patent Office. Additionally, toothpaste products were searched using the Mintel product database from 1996 to 2023. The searched ingredients were (in alphabetical order): calcium carbonate, calcium phosphates, hydrated silica, sodium fluoride, sodium lauryl sulfate, triclosan, xylitol, and zinc salts as they are known from the scientific literature to be remineralizing or antibacterial/antiplaque agents. It was shown that the number of patent applications containing these ingredients significantly increased since the 1970s. As these ingredients have remineralizing, antibacterial, or plaque-removing effects, they all can contribute to caries prevention. In conclusion, and within the limitations of this approach, this study shows that toothpaste formulations have greatly improved over the past decades by using various active anticaries ingredients. Full article

This study aims to evaluate the clinical, cognitive, and psychomotor changes that emerged among patients with gingivitis and patients with periodontitis via mobile application assistance. Forty subjects were randomly and evenly distributed into test and control groups and were administered a professional mechanical plaque removal (PMPR) procedure. The clinical parameters examined were bleeding on probing (BoP), probing pocket depth (PPD), and the oral hygiene index (OHI-S). The test group was administered a mobile application intervention, namely PerioUICare, which provided users with continuous education and motivation and served as a daily dental hygiene reminder. The comparative results of the mean values of all parameters between the groups (inter-group) and within the groups (intra-group) after one- and three-month evaluations were analyzed. A one-month inter-group evaluation uncovered significant differences in the BoP, PPD, cognitive, and psychomotor scores of subjects with gingivitis and the BoP, OHI-S, cognitive, and psychomotor scores of subjects with periodontitis. A three-month inter-group evaluation revealed significant differences across all parameters except for PPD in subjects with periodontitis. The results of the intra-group comparison demonstrated statistically significant differences in all parameters in the test group but no significant differences in the cognitive and psychomotor scores of the control group. This study revealed that mobile application-based support for periodontal treatment can be considered effective. Full article

Background: We compared the repeatability of the shade determination of resin composite restorations and acrylic teeth in light and darker shades at baseline and after an aging process through two digital tooth color-matching methods: using a Trios 3Shape intraoral scanner and using a Vita Easyshade Compact spectrophotometer. Material and Methods: Forty upper central incisor acrylic teeth in the shade A1 (n = 10) and A3 (n = 10) were randomly assigned to be restored with Filtek Bulk Fill in the shade A1 (n = 10) or A3 (n = 10). Subsequently, 20 Class V cavities were prepared in a standardized manner (mesio-distal = 3.0 mm, cervical–occlusal = 2.0 mm, depth = 1.5 mm). Cavities were restored using an universal adhesive system and resin composite in two increments and were light-cured. The shade difference between the resin composite Class V restorations in acrylic teeth of the A1 and A3 shades was evaluated at baseline and after aging. Aging was simulated using ultraviolet light for 120 h. An Easyshade device and an intraoral scanner were used under D65 illumination. Measurements were taken five times, on top of the restoration and on the acrylic teeth, in a randomized manner. Results: Data analysis was on the calculation of the arithmetic mean for the percentage of repeatability conducted by the Trios scanner and the Easyshade device. There was no statistically significant comparison between the shade measurement devices (p > 0.05). At baseline, the repeatability for both the Trios intraoral scanner and the Vita Easyshade Compact device for artificial teeth in the shades A1 and A3 was 100%. After aging, the trueness recorded by the intraoral scanner and the Easyshade device for artificial teeth in the shade A1 was 80%. For Class V restoration with shade A1, the intraoral scanner recorded 80% trueness and the Easyshade device recorded 60% trueness at baseline. For shade A3, the intraoral scanner recorded 60% trueness and the Easyshade device recorded 60% trueness. Conclusions: The intraoral scanner and Easyshade device are reliable for baseline shade selection, but their accuracy decreases after aging, particularly for darker shades. Full article

Background: This study compared the influence of crystallization on marginal gap adaptation by using computer-aided design and manufacturing (CAD-CAM) for producing monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns. Methods: A total of 25 plastic teeth were scanned using a Primescan intra-oral scanner (IOS), and ZLS crowns were ground. For each unit (abutment and crown), the marginal gap was evaluated pre crystallization and post crystallization at four regions of interest through the use of a scanning electron microscope (SEM). To compare the marginal gap between the two groups, a Kolmogorov–Smirnov test performed on the study variables indicated a normal distribution (p > 0.05) followed by paired samples T-tests (α = 0.0005). Results: After crystallization, there were significantly higher circumferential marginal gaps (CMGs) for all four surfaces (distal (p = 0.0005), mesial (p = 0.0005), palatal (p = 0.0005), and buccal (p = 0.0005)). The total mean marginal gap (MMG) revealed a significantly higher result for the post-crystallization group (79.82 ± 7.86 μm) compared to the pre-crystallization group (24.25 ± 5.49 μm). Conclusions: The post-crystallization group showed a significantly higher marginal gap compared to the pre-crystallization group in all parameters, but both groups were in the clinically accepted threshold (<120 microns). In terms of the marginal gap, it is arguable whether to carry out post-crystallization for CELTRA^® DUO crowns and achieve better mechanical properties but significantly increase the marginal gap. Full article

(1) Objective: This scoping review evaluates the effects of miniscrew-assisted rapid palatal expansion (MARPE) on different regions of the upper airway in adult patients and investigates various methods of measurement. (2) Methods: The search encompassed Pubmed, Cochrane Library, Scopus and Web of Science. This review was conducted following the PRISMA_ScR guidelines, and the inclusion criteria for examined studies were chosen in accordance with the PICOS framework. (3) Results: Seven studies were included in this review, comprising four retrospective studies, one prospective and two case reports. All studies involved the use of Cone Beam Computed Tomography (CBCT) for measurements of the areas of interest. The percentage of increase in the volume of the nasal cavity varied between 31% and 9.9%, depending on the study. Volumetric variations in the nasopharynx were reported as increases between T0 (before expansion) and T1 (immediately after expansion) of 6.4%, 20.7% and 14.1%. All studies considered T0 before expansion and T1 immediately after expansion. Only one study evaluated remote follow-up to assess if the results were maintained after one year. (4) Conclusions: MARPE appears to lead to a statistically significant increase in the upper airway, especially in the nasal cavity and nasopharynx immediately after expansion. However, further prospective and retrospective trails with long-term controls are required to verify the effects of MARPE on the upper airway. Full article

This study aimed to assess the impact of different laser irradiation modes and photosensitizer types on the bactericidal efficacy of antimicrobial photodynamic therapy (aPDT). Dentin plates were prepared by sectioning the crown dentin of bovine teeth infected with Streptococcus sobrinus (n = 11). Nine aPDTs involving the combination of three 1% solutions of photosensitizers (brilliant blue, BB; acid red, AR; and methylene blue, MB) and three irradiation modes of semiconductor lasers (50 mW for 120 s, 100 mW for 60 s, and 200 mW for 30 s) were performed for each infected dentin plate, and the control consisted of the specimens not applied with aPDT. The bactericidal effects in 10 groups were evaluated using both assays of the colony count (colony-forming-unit: CFU) and adenosine triphosphate (ATP) (relative-light-unit: RLU). The data obtained were analyzed using the Kruskal–Wallis test (α = 0.05). The most aPDT groups exhibited significantly lower RLU and CFU values compared with the control (p < 0.05). The effect of irradiation modes on RLU and CFU values was significant in the aPDT group using BB (p < 0.05) but not in the aPDT group using AR or MB. The aPDT performed with AR or MB exerted a remarkable bactericidal effect. Full article

The objective was to systematically review studies that evaluated the effect of charcoal-based dentifrices (CbDs) and conventional whitening toothpastes (CWTs) on the color stability (CS) and/or surface roughness (SR) of composite resin (CR). The question we focused on was “Do CbD and CWT affect the CS and/or SR of CR?” Indexed databases were searched without language and time restrictions up to and including May 2023 using different keywords. Original experimental studies were included. The risk of bias (RoB) was assessed using the Quality Assessment Tool for In Vitro Studies. Ten in vitro studies performed on CR were included. The number of CR samples assessed ranged between 18 and 200. In one study, CbDs altered the CS and SR of CR, whereas another study showed no difference in changes in the SR and CS of CR when CbDs were compared with CWTs. One study showed that compared with CWTs, CbDs caused changes in the CS of CR but changes in SR were similar between the two dentifrices. One study showed that CbDs and CWTs improved the overall color and enhanced the SR of CR. Three studies had a high RoB, five had a medium RoB, and two had a low RoB. Compared to CWTs, CbDs appeared to affect the CS of CR, but the SR of CR induced by both dentifrices remained consistent. Further well-designed and power-adjusted studies are needed. Full article

This study assessed the masticatory function of participants wearing clear aligners in order to determine whether these devices can be worn even when eating and therefore worn to extend treatment time and boost treatment effectiveness. An intercontrol test was conducted on 20 patients who received Invisalign^® treatment. Each participant was instructed to chew two pieces of Hue-Check Gum^® chewing gum (one pink and the other blue) in 5, 10, and 20 cycles both with and without aligners. After being removed from the oral cavity, the gum was dried and pressed using a 1 × 50 × 50 mm model that was 3D printed with a transparent layer in between. After being scanned on both sides with a flatbed scanner at 600 dpi, the samples were saved as jpg files and subjected to an optoelectronic examination using ViewGum software. To validate the procedure, a control group from a different institution (University of Bern) was used. A statistical analysis of the data was carried out. The Shapiro–Wilk test was used to confirm the normality of the samples. A one-way ANOVA test, a homogeneity of variance test, and a t-test did not reveal statistically significant differences between the two control groups, thus validating the methodology employed. In summary, clear aligners do not radically change the masticatory function while they are worn. As a result, clinicians can exploit the aligners for chewing to obtain a better fit of the plastic material to the dental surface and to attachments. Treatment times for patients could also be shorter. Full article

Previous research has demonstrated that the human papillomavirus (HPV) can infect a wide range of human tissues, including those within the oral cavity. High-risk oral HPV strains have been associated with the development and progression of oral cancers, including oral squamous cell carcinomas. Although many studies have examined the prevalence of the high-risk strains HPV16 and HPV18, far fewer have assessed the prevalence of other high-risk HPV strains. An approved study protocol was used to identify HPV52 and HPV58 among clinical samples (n = 87) from a saliva biorepository. Quantitative polymerase chain reaction (qPCR) and validated primers for HPV52 and HPV58 were used to facilitate this screening. This screening demonstrated that a total of n = 4/45 or 8.9% of adult saliva samples harbored high-risk HPV52, and n = 2/45 or 4.4% tested positive for high-risk HPV58. In addition, a total of n = 6/42 or 14.3% of the pediatric saliva samples tested positive for high-risk HPV, including n = 5/42 or 11.9% with HPV52 and n = 3/42 or 7.1% for HPV58. These data demonstrate the presence of the high-risk oncogenic HPV52 and HPV58 strains among both adult and pediatric clinical patient samples. More detailed longitudinal research must be conducted to determine whether this prevalence may be increasing or decreasing over time. In addition, these data strongly support public health prevention efforts, such as knowledge and awareness of the nine-valent HPV vaccine covering additional high-risk strains, including HPV52 and HPV58. Full article

The newly developed mineral carbonated apatite has recently been proposed as a bone graft material for bone regenerative treatment in implant therapy. This case series details the clinical and radiographic outcomes of ridge preservation and ridge augmentation using only carbonated apatite as bone graft material for implant treatment. Twenty patients (36 sites) who required bone regeneration and implant placement were retrospectively assessed. Simultaneous carbonated apatite implant placement was performed using the simultaneous ridge preservation or augmentation approach on 24 sites in 13 patients with sufficient bone quantity for primary stabilization based on preoperative evaluation results. A staged ridge preservation or augmentation approach was used for the remaining 12 sites in seven patients with insufficient bone quantity. The mean regenerated bone height for each treatment method was as follows: simultaneous preservation, 7.4 ± 3.3 mm; simultaneous augmentation, 3.6 ± 2.3 mm; staged preservation, 7.2 ± 4.5 mm; and staged augmentation, 6.1 ± 2.7 mm. The mean regenerated bone width for each treatment method was as follows: simultaneous preservation, 6.5 ± 2.9 mm; simultaneous augmentation, 3.3 ± 2.5 mm; staged preservation, 5.5 ± 1.7 mm; and staged augmentation, 3.5 ± 1.9 mm. Ultimately, the use of carbonated apatite alone as a bone graft material in implant therapy resulted in stable and favorable bone regeneration. Full article

The objective of this study was to investigate the effect of the incorporation of 2, 4 or 6 wt% of amorphous nano- or micro-silica (Aerosil^® OX 50 or Aeroperl^® 300 Pharma (Evonik Operations GmbH, Essen, Germany), respectively) on the net setting time and microhardness of Ketac™ Molar (3M ESPE, St. Paul, MN, USA) and Fuji IX GP^® (GC Corporation, Tokyo, Japan) glass–ionomer cements (GICs) (viz. KM and FIX, respectively). Both silica particles were found to cause a non-linear, dose-dependent reduction in setting time that was within the clinically acceptable limits specified in the relevant international standard (ISO 9917-1:2007). The microhardness of KM was statistically unaffected by blending with 2 or 4 wt% nano-silica at all times, whereas 6 wt% addition decreased and increased the surface hardness at 1 and 21 days, respectively. The incorporation of 4 or 6 wt% nano-silica significantly improved the microhardness of FIX at 1, 14 and 21 days, with no change in this property noted for 2 wt% addition. Micro-silica also tended to enhance the microhardness of FIX, at all concentrations and times, to an extent that became statistically significant for all dosages at 21 days. Conversely, 4 and 6 wt% additions of micro-silica markedly decreased the initial 1-day microhardness of KM, and the 21-day sample blended at 4 wt% was the only specimen that demonstrated a significant increase in this property. Scanning electron microscopy indicated that the nano- and micro-silica particles were well distributed throughout the composite structures of both GICs with no evidence of aggregation or zoning. The specific mechanisms of the interaction of inorganic nanoparticles with the constituents of GICs require further understanding, and a lack of international standardization of the determination of microhardness is problematic in this respect. Full article

The aim of this study was to evaluate the concordance of parents’ assessments of their child’s dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children’s Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother–father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen’s Kappa coefficients were used in the analyses. The concordance of parents’ assessments was poor (Kappa range 0.072–0.258). The majority of parents replied “No Experience” to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child’s fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent’s assessment, and whether or not the child has experience with the question asked should also be considered. Full article