Dentistry Journal

14 pages, 4315 KB

Open AccessArticle

The Use of Flowable Decellularized Human Placental Connective Tissue Matrix in Alveolar Ridge Preservation: A Split-Mouth Pilot Study

by Bachar Husseini, Ronald Younes, Nabil Ghosn, Robert Miller, Georges Khoury, Robert Hariri and Michel Dard

Dent. J. 2025, 13(11), 545; https://doi.org/10.3390/dj13110545 - 20 Nov 2025

Viewed by 399

Abstract

Background/Objectives: Tooth extraction is known to cause both bone loss and soft tissue collapse, changes that can complicate implant placement. While alveolar ridge preservation techniques have been proposed to limit these alterations, they often fail to maintain both hard and soft tissue dimensions [...] Read more.

Background/Objectives: Tooth extraction is known to cause both bone loss and soft tissue collapse, changes that can complicate implant placement. While alveolar ridge preservation techniques have been proposed to limit these alterations, they often fail to maintain both hard and soft tissue dimensions at the same time. Placental-derived extracellular matrices offer a biologically active adjuvant, providing structural proteins that may support healing. The purpose of this study was to assess whether a flowable decellularized Human Placental Connective Tissue Matrix (HPCTM), combined with an allogeneic bone substitute, could improve ridge preservation by addressing changes in soft tissue as the primary outcome and underlying bone volume as the secondary outcome. Methods: In a split-mouth, randomized pilot trial, hopeless teeth in opposite quadrants were atraumatically extracted. Test sockets were grafted with allograft mixed with HPCTM, while control sockets received allograft alone. Healing was followed clinically and digitally using intra-oral scans; standardized photographs at 10, 21, and 30 days post-operatively; and cone-beam computed tomography at 4 months post-operatively. Results: Ten patients completed the study (10 test sites and 10 control sites). Sites treated with HPCTM showed faster and more stable healing. Gingival shrinkage was consistently reduced at test sites, with Hodges–Lehmann median differences of 0.50 mm at Day 10 (95% CI: 0.29–0.62; p = 0.0039), 0.54 mm at Day 21 (95% CI: 0.42–0.65; p = 0.002), and 0.54 mm at Day 30 (95% CI: 0.39–0.68; p = 0.002). Radiographically, test sites lost significantly less bone volume (28.24 ± 2.43%) compared with controls (38.85 ± 1.29%; p = 0.019). Conclusions: Within the limits of this study, HPCTM appears to support better preservation of both gingival architecture and alveolar bone after extraction. Full article

(This article belongs to the Section Dental Implantology)

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14 pages, 736 KB

Open AccessArticle

Symphyseal Morphology in Sagittal Skeletal Discrepancies: A Retrospective Observational Study

by Francesca Squillace, Rosanna Guarnieri, Rachele Podda, Gabriella Galluccio, Roberto Di Giorgio and Ersilia Barbato

Dent. J. 2025, 13(11), 544; https://doi.org/10.3390/dj13110544 - 20 Nov 2025

Viewed by 277

Abstract

Background: The aim of this study was to evaluate the correlation between skeletal class and morphological patterns of the mandibular symphysis. Methods: The sample consisted of 90 patients with an average age of 18 years (44 > x > 12). In order to [...] Read more.

Background: The aim of this study was to evaluate the correlation between skeletal class and morphological patterns of the mandibular symphysis. Methods: The sample consisted of 90 patients with an average age of 18 years (44 > x > 12). In order to investigate any correlation between skeletal class and morphological patterns of the mandibular symphysis, the following tests were used: Pearson’s correlation test, Spearman’s test, and the analysis of variance test (ANOVA) followed by Tukey’s post hoc HDS test. The significance level was set at 0.050. Results: Pearson’s correlation test and ANOVA showed a weak negative correlation between malocclusion and symphyseal height. Therefore, as ANB increases, symphyseal height decreases (r = −0.25, p < 0.01). In addition, a strong positive correlation was found between ANB and IMPA (r = 0.47, p < 0.01). So, as ANB increases, IMPA increases. No statistically significant association was found between symphyseal morphology and IMPA (Spearman’s test). Conclusions: The analysis revealed a weak but statistically significant negative correlation between ANB angle and symphysis height, indicating that as sagittal discrepancy increases (higher ANB), the symphysis tends to be shorter (r = −0.25, p < 0.01). A moderate positive correlation was also found between ANB and IMPA (r = 0.47, p < 0.01), suggesting that a more pronounced Class II skeletal pattern is associated with greater incisor proclination. However, no significant relationship was observed between symphysis type (A/B/C) and IMPA. When comparing skeletal classes, Class III subjects displayed significantly greater symphyseal height than Class II subjects (p < 0.001), while Class II subjects showed the highest IMPA values (p < 0.001). Full article

(This article belongs to the Special Issue Digital Dentures: 2nd Edition)

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13 pages, 1116 KB

Open AccessArticle

Optical Coherence Tomography for Assessing the Severity of Dental Caries: An In Vitro Validation Study

by In-Kyung Hwang, Sun-Young Kim and Tae-Il Kim

Dent. J. 2025, 13(11), 543; https://doi.org/10.3390/dj13110543 - 20 Nov 2025

Viewed by 402

Abstract

Background/Objectives: Differentiating initial from moderate non-cavitated occlusal caries using intraoral radiography is challenging. This in vitro study aimed to verify the ability of Optical Coherence Tomography (OCT) to discern the extent of demineralization in non-cavitated carious lesions and discriminate between the exact [...] Read more.

Background/Objectives: Differentiating initial from moderate non-cavitated occlusal caries using intraoral radiography is challenging. This in vitro study aimed to verify the ability of Optical Coherence Tomography (OCT) to discern the extent of demineralization in non-cavitated carious lesions and discriminate between the exact caries stages. Methods: In total, 110 extracted molars and premolars with occlusal caries were examined by two calibrated examiners using OCT and radiography. Histological sections stained with acid red were used as the reference standard. Diagnostic accuracy was calculated by comparing OCT- and radiograph-based diagnoses with the histologic reference standard. Results: OCT demonstrated superior sensitivity (0.83), specificity (0.76), and overall diagnostic accuracy (0.79) for distinguishing moderate from initial lesions, outperforming intraoral radiography, which achieved a sensitivity of 0.48, specificity of 0.84, and accuracy of 0.70. McNemar’s test showed a significant difference in sensitivity (p < 0.05), but not in specificity (p > 0.05), between the two diagnostic methods. Conclusions: These findings confirm that OCT can visualize caries progression with sufficient precision to distinguish between the initial and moderate lesion stages in an in vitro setting. Further validation in clinical trials is necessary to support OCT’s application for routine caries diagnosis. Full article

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12 pages, 403 KB

Open AccessArticle

Reference Values for Permanent-Tooth Emergence in Hungarian Children: A Cross-Sectional Study

by Zsuzsa Kapusi-Papp, János Máth and Judit Ágnes Nemes

Dent. J. 2025, 13(11), 542; https://doi.org/10.3390/dj13110542 - 18 Nov 2025

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Abstract

Background/Objectives: Population-specific data on permanent-tooth eruption are essential for accurate diagnosis, treatment planning, and public health strategies. In Hungary, current clinical practice relies on outdated international eruption standards. The aim of this study was to determine the timing and sequence of permanent [...] Read more.

Background/Objectives: Population-specific data on permanent-tooth eruption are essential for accurate diagnosis, treatment planning, and public health strategies. In Hungary, current clinical practice relies on outdated international eruption standards. The aim of this study was to determine the timing and sequence of permanent tooth emergence in Hungarian children and provide sex-specific eruption standards. Methods: A cross-sectional study was conducted based on dental screening records of 2948 children aged 4–15 years in Debrecen, Hungary, during the 2015–2016 school year. Probit regression was used to estimate median eruption times and percentiles, and eruption sequences were assessed by sex and jaw. Results: Girls exhibited earlier eruption than boys for all teeth except mandibular central incisors (difference: 1.9–8.9 months; p < 0.05). Mandibular teeth generally preceded maxillary teeth, though premolars in boys showed the opposite trend. Eruption sequences varied by sex, particularly in the canine-premolar region. The 5th-95th percentile eruption range was widest for second molars (4.8 years) and narrowest for maxillary central incisors (2.3 years). Conclusions: This study provides the first modern eruption standards for Hungarian children. These sex-specific reference values are clinically useful for assessing delayed eruption, guiding radiographic decisions, and optimizing the timing of preventive and orthodontic interventions. Full article

(This article belongs to the Special Issue Current Advances in Pediatric Odontology)

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18 pages, 1082 KB

Open AccessReview

Desquamative Gingivitis and the Oral Microbiome: Insights into Immune–Microbial Interactions in Mucosal Inflammation

by Bruno Špiljak, Ana Andabak Rogulj, Božana Lončar Brzak, Vlaho Brailo, Ivana Škrinjar, Petar Ozretić and Danica Vidović Juras

Dent. J. 2025, 13(11), 541; https://doi.org/10.3390/dj13110541 - 17 Nov 2025

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Abstract

Desquamative gingivitis (DG) is a clinical presentation characterized by erythema, epithelial desquamation, and mucosal fragility, commonly associated with immune-mediated diseases such as oral lichen planus (OLP), mucous membrane pemphigoid (MMP), and pemphigus vulgaris (PV). While traditionally viewed as a manifestation of immune dysregulation, [...] Read more.

Desquamative gingivitis (DG) is a clinical presentation characterized by erythema, epithelial desquamation, and mucosal fragility, commonly associated with immune-mediated diseases such as oral lichen planus (OLP), mucous membrane pemphigoid (MMP), and pemphigus vulgaris (PV). While traditionally viewed as a manifestation of immune dysregulation, growing evidence suggests that the oral microbiome may modulate disease onset, persistence, and severity. This review summarizes current knowledge on the oral microbiota in DG and its underlying diseases, explores mechanistic links between dysbiosis and immune activation, and discusses clinical and research implications. A narrative literature review was conducted using PubMed and Scopus, focusing on studies analyzing the oral microbiome in OLP, MMP, and PV. Emphasis was placed on molecular microbiology techniques, immune profiling, and functional or longitudinal approaches. In OLP, microbial dysbiosis is consistently reported, including reduced diversity and increased abundance of pro-inflammatory genera such as Fusobacterium, Prevotella, and Capnocytophaga. These shifts correlate with epithelial barrier disruption and inflammatory cytokine production. Although data on MMP and PV are limited, early findings suggest microbial involvement in sustaining inflammation, delaying healing, and possibly amplifying autoimmune responses. Dysbiosis may activate Toll-like receptors, skew T cell responses, and contribute to the breakdown of immune tolerance. DG may reflect a dynamic interplay between immune mechanisms and microbial ecology. While evidence is strongest for OLP, preliminary data suggest broader microbial contributions across DG-associated diseases. Microbiome-informed approaches could enhance diagnostic accuracy and support the development of adjunctive therapies. Full article

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31 pages, 4258 KB

Open AccessReview

From Industry to Dentistry: A Comprehensive Review of Zeolite as a Next-Generation Multifunctional Filler for Enhanced Mechanical Reinforcement and Antimicrobial Efficacy

by Sohaib Fadhil Mohammed, Mohd Firdaus Yhaya, Abdul Fattah Nongman, Matheel Al-Rawas, Marwan N. Arbilei and Tahir Yusuf Noorani

Dent. J. 2025, 13(11), 540; https://doi.org/10.3390/dj13110540 - 14 Nov 2025

Viewed by 740

Abstract

Zeolites are becoming potentially important multifunctional fillers in dentistry, providing a distinctive blend of mechanical reinforcement, remineralization, and antimicrobial properties. Their crystalline aluminosilicate frameworks offer ion-exchange capacity, the controlled release of therapeutic ions (Ag⁺, Zn²⁺, Ca²⁺, Sr [...] Read more.

Zeolites are becoming potentially important multifunctional fillers in dentistry, providing a distinctive blend of mechanical reinforcement, remineralization, and antimicrobial properties. Their crystalline aluminosilicate frameworks offer ion-exchange capacity, the controlled release of therapeutic ions (Ag⁺, Zn²⁺, Ca²⁺, Sr²⁺, Cu²⁺), and compatibility with various dental composites. Sustainable and cost-effective zeolite production has become possible due to recent developments in synthetic strategies. These include the valorization of industrial and agricultural residues that are abundant in Si and Al. The incorporation of zeolites into dental adhesives, restorative composites, glass ionomer cements, root canal sealers, prosthetic materials, and implant coatings has been shown to improve mechanical stability and remineralization potential, and enhance antibacterial protection. The unique advantage of zeolites in integrating multifunctionality within a single system is emphasized when compared with other fillers, such as hydroxyapatite nanoparticles and bioactive glass. Nevertheless, obstacles persist with respect to clinical validation, regulatory pathways, and long-term biocompatibility. This review critically assesses the structure–function relationships, synthesis strategies, and dental applications of zeolites, while also delineating future perspectives for their translation into clinically approved, sustainable dental biomaterials. Full article

(This article belongs to the Topic Advances in Biomaterials—2nd Edition)

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10 pages, 924 KB

Open AccessArticle

CBCT Evaluation of Cortical Bone Thickness in the Nasal Floor and Lateral Wall: Considerations for Implant Anchorage—A Retrospective Multicentre Study

by Fodor Romulus Calin, Bartosz Dalewski, Stefan Ihde, Marta Czuczwał, Vitomir S. Konstantinovic, Vivek Gaur, Jacek Kotuła and Łukasz Pałka

Dent. J. 2025, 13(11), 539; https://doi.org/10.3390/dj13110539 - 14 Nov 2025

Viewed by 375

Abstract

Background/Objectives: Primary implant stability depends on cortical bone thickness. While alveolar cortices are well studied, little is known about the nasal floor and lateral wall, which may provide alternative anchorage in atrophic maxillae. Methods: This retrospective, multicenter study analyzed 149 anonymized CBCT scans [...] Read more.

Background/Objectives: Primary implant stability depends on cortical bone thickness. While alveolar cortices are well studied, little is known about the nasal floor and lateral wall, which may provide alternative anchorage in atrophic maxillae. Methods: This retrospective, multicenter study analyzed 149 anonymized CBCT scans (83 women, 66 men; mean age 52.6 ± 13.5 years). Cortical thickness was measured at six reproducible anatomical points (A–F) defined by chosen landmarks. Measurements were taken on coronal planes aligned with implant anchorage point of interest (POI) using gray-value thresholding. Intra- and inter-observer reliability was excellent (ICC = 0.89 and 0.84). Post hoc power analysis confirmed >80% power to detect 0.15 mm differences. Non-parametric tests and mixed-effects models assessed variability and risk factors. Results: Thickness varied significantly by site (p < 0.001). The thickest cortices were at point A (median 1.36 mm, IQR 1.10–1.61) and point F (1.35 mm, 1.14–1.57), the thinnest at point B (1.15 mm, 0.96–1.32). Cortical thickness was slightly lower in men (p = 0.048) and decreased with age (−0.005 mm/year, p = 0.010). No significant associations were detected with smoking, diabetes, or thyroid disease. Conclusions: The anterior nasal spine and lateral wall near the sinus junction provide the greatest cortical thickness, supporting their use as potential implant anchorage sites in atrophic maxillae. Full article

(This article belongs to the Special Issue Dentistry in the 21st Century: Challenges and Opportunities)

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15 pages, 5915 KB

Open AccessArticle

Identification of Optimal Decalcification Method and Tissue Preparation Protocol for RNAscope In Situ Hybridization in Rodent Incisor Tooth

by János Konkoly, Árpád Kunka, Attila Szentágotai, Erika Lisztes, Rita Marincsák, Márk Racskó, Judit Bohács, Erika Pintér, Balázs Gaszner, Balázs István Tóth and Viktória Kormos

Dent. J. 2025, 13(11), 538; https://doi.org/10.3390/dj13110538 - 14 Nov 2025

Viewed by 479

Abstract

Background: RT-qPCR is the gold standard for quantitative gene expression analysis, but it requires homogenized tissue and thus loses spatial information. RNA in situ hybridization (ISH) preserves tissue localization but is technically challenging, especially in calcified tissues such as bone and teeth, where [...] Read more.

Background: RT-qPCR is the gold standard for quantitative gene expression analysis, but it requires homogenized tissue and thus loses spatial information. RNA in situ hybridization (ISH) preserves tissue localization but is technically challenging, especially in calcified tissues such as bone and teeth, where decalcification can damage RNA. RNAscope, an advanced ISH method with high sensitivity and specificity, has been applied successfully to bone, but its use in dental pulp remains largely unexplored despite the pulp’s crucial role in tooth function and health. Our goal was to identify the optimal decalcification process of mouse tooth samples for RNAscope ISH, which preserves RNA integrity in mouse tooth pulp. Methods: We tested five different decalcification procedures (EDTA, Plank-Rychlo solution, 5% formic acid, ACD decalcification buffer and Morse solution) on tooth samples from 3-month-old male C57BL/6J mice. Micro-CT and hematoxylin-eosin (HE) staining was performed to evaluate the decalcification, the quality and the microstructure of the sections. RNAscope ISH was used to examine mRNA integrity by analyzing the expression patterns of three housekeeping genes with different expression levels (low, medium and high). Results: All five decalcification methods demonstrated well-preserved tissue structure based on HE staining, but RNA integrity was only preserved in the case of mouse dental pulp using the ACD decalcification buffer and Morse’s solution. Conclusions: We successfully identified the optimal decalcification procedures preserving RNA integrity in mouse tooth samples, which may be useful for any target RNA examinations by RNAscope ISH in the future. Full article

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24 pages, 4857 KB

Open AccessSystematic Review

Accuracy of Navigation and Robot-Assisted Systems for Dental Implant Placement: A Systematic Review

by Daria Pisla, Vasile Bulbucan, Mihaela Hedesiu, Calin Vaida, Alexandru Pusca, Rares Mocan, Paul Tucan, Cristian Dinu and Doina Pisla

Dent. J. 2025, 13(11), 537; https://doi.org/10.3390/dj13110537 - 14 Nov 2025

Viewed by 859

Abstract

Background: Computer-assisted implant surgery (CAIS) aims to improve placement accuracy versus freehand drilling. We compared the three-dimensional accuracy of robot-guided CAIS (r-CAIS), dynamic navigation (d-CAIS), static-template guidance (s-CAIS), and freehand (FH) in clinical and in vitro settings. Methods: We searched PubMed/MEDLINE, [...] Read more.

Background: Computer-assisted implant surgery (CAIS) aims to improve placement accuracy versus freehand drilling. We compared the three-dimensional accuracy of robot-guided CAIS (r-CAIS), dynamic navigation (d-CAIS), static-template guidance (s-CAIS), and freehand (FH) in clinical and in vitro settings. Methods: We searched PubMed/MEDLINE, Scopus, and Web of Science (1 January 2019–2025). Eligible populations were adults receiving conventional or zygomatic implants in vivo, plus validated in vitro human-jaw models using plan-versus-placement workflows; studies had to report study-level means with dispersion for ≥1 primary outcome with ≥5 implants per arm. Interventions were r-CAIS, d-CAIS, or s-CAIS; with a baseline as the freehand technique. Risk of bias used RoB 2 (RCTs), ROBINS-I (non-randomized clinical), and QUIN (in vitro). Because of heterogeneity in definitions and workflows, we performed a descriptive synthesis by modality (no meta-analysis). Registration: OSF. Results: Forty-three studies (7 RCTs, 10 non-randomized clinical, 26 in vitro) reported more than 4000 implants. Across studies, typical study-level means for global linear deviation clustered around < 1 mm (r-CAIS), ~1 mm (d-CAIS), ~1.3 mm (s-CAIS), and ~1.8 mm (FH). In clinical contexts, d-CAIS often showed slightly lower angular deviation than s-CAIS. Conclusions: CAIS improves accuracy versus freehand. d-CAIS and s-CAIS show similar linear accuracy, with d-CAIS frequently yielding slightly lower angular deviation; r-CAIS exhibits tight error clusters in our dataset, but limited comparative clinical evidence precludes superiority claims. Limitations: non-uniform registration/measurement, variable operator experience, and absence of meta-analysis. Full article

(This article belongs to the Special Issue Dental Public Health Landscape: Challenges, Technological Innovation and Opportunities in the 21st Century)

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11 pages, 3747 KB

Open AccessCase Report

Management of a Mandibular Odontogenic Keratocyst with Enucleation, Piezotome-Assisted Peripheral Ostectomy, and Platelet-Rich Fibrin—A Case Report

by Ehab Abdelfadil, Maha Alsharif, Alla T. Alsharif and Samah Mourad

Dent. J. 2025, 13(11), 536; https://doi.org/10.3390/dj13110536 - 14 Nov 2025

Viewed by 513

Abstract

Background/Objectives: Odontogenic keratocyst (OKC) is a benign yet locally aggressive intraosseous lesion with a high recurrence rate, posing significant challenges for clinical management. This present case report describes a combined surgical management approach for an OKC, involving enucleation with piezotome-assisted peripheral ostectomy, followed [...] Read more.

Background/Objectives: Odontogenic keratocyst (OKC) is a benign yet locally aggressive intraosseous lesion with a high recurrence rate, posing significant challenges for clinical management. This present case report describes a combined surgical management approach for an OKC, involving enucleation with piezotome-assisted peripheral ostectomy, followed by adjunctive application of platelet-rich fibrin (PRF) to the osseous defect. Methods: A 54-year-old patient presented with a mandibular unilocular radiolucency that was diagnosed histopathologically as an OKC. The lesion was managed using a combined surgical approach involving enucleation and peripheral ostectomy with a piezotome. To optimize healing, PRF was applied to the bone defect. Results: At 18- and 36-month follow-up, the patient demonstrated complete postoperative bone remodeling of the cystic bone defect, with no evidence of recurrence. Conclusions: This case highlights the low morbidity associated with enucleation and piezotome-assisted peripheral ostectomy, which may be preferable to other aggressive OKC treatment modalities in selected cases. Additionally, PRF use was associated with favorable postoperative healing, with minimal pain, swelling, and inflammation. Radiographic stability at 36 months supports the feasibility of this approach; however, larger studies are needed to compare recurrence risk with other interventions. Full article

(This article belongs to the Section Oral and Maxillofacial Surgery)

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16 pages, 1078 KB

Open AccessSystematic Review

Biocompatibility of Denture Adhesives: Effects on Oral Tissues and Inflammatory Responses—Literature Review

by Paula Aleksandra Łasica, Urszula Wnorowska, Robert Bucki and Teresa Sierpińska

Dent. J. 2025, 13(11), 535; https://doi.org/10.3390/dj13110535 - 14 Nov 2025

Viewed by 731

Abstract

Background: This article describes the biocompatibility of denture adhesives, focusing on their cytotoxicity towards oral fibroblasts, their influence on biofilm formation and microbial infections, and their potential to induce inflammatory responses in oral tissues. By examining these factors, we aim to shed light [...] Read more.

Background: This article describes the biocompatibility of denture adhesives, focusing on their cytotoxicity towards oral fibroblasts, their influence on biofilm formation and microbial infections, and their potential to induce inflammatory responses in oral tissues. By examining these factors, we aim to shed light on the effectiveness and safety of denture adhesives, providing clinicians with helpful advice and highlighting important topics for further research. Methods: A systematic literature review was conducted using the Medline (PubMed) and SCOPUS databases. The search strategy included the following MeSH terms: denture adhesives, complete dentures, cytotoxicity, inflammation, and biofilm formation. Only peer-reviewed articles were included. Results: Studies have shown that denture adhesives may have cytotoxic effects on oral mucosal fibroblasts, as well as on biofilm formation and adhesion. Moreover, there is still little research on the effect of denture adhesives on inflammation of the denture-bearing area and cytokine production. Conclusions: The obtained results highlight the need for long-term patient investigations, and thorough clinical trials are absolutely essential to evaluate the actual safety of denture adhesives. Since this aspect is still under investigation, particular focus should be placed on understanding the inflammatory reactions these compounds induce. Improving the safety profile of denture adhesives will require cooperation among manufacturers, dental practitioners, and researchers to ensure that patients are adequately informed and that product formulations are improved for biocompatibility. Full article

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15 pages, 839 KB

Open AccessFeature PaperArticle

Perceptibility and Acceptability of Tooth and Gingival Shade Modifications in Digital Smile Images: A Comparative Study Among Laypeople, General Dentists, and Specialists

by Nikola Petričević, Natalija Prica, Asja Čelebić and Sanja Peršić-Kiršić

Dent. J. 2025, 13(11), 534; https://doi.org/10.3390/dj13110534 - 13 Nov 2025

Viewed by 275

Abstract

Background: This study aimed to evaluate the agreement among different evaluators in assessing smile esthetics from frontal-view photographs of the lower third of the face during smiling, and afterwards to determine thresholds of perceptibility and acceptability of tooth and gingival shade changes on [...] Read more.

Background: This study aimed to evaluate the agreement among different evaluators in assessing smile esthetics from frontal-view photographs of the lower third of the face during smiling, and afterwards to determine thresholds of perceptibility and acceptability of tooth and gingival shade changes on a single modified digital photograph. Methods: Sixty photographs of the lower third of the face of individuals with pleasing smiles were obtained. Evaluator groups included laypeople, general dentists, and specialists in periodontology, orthodontics, and prosthodontics. Esthetic assessment was performed using seven items from the Orofacial Esthetic Scale (OES). One photograph was digitally manipulated by altering the shade of the first maxillary incisor and the gingiva of the right maxillary second incisor. Perceptibility thresholds and acceptability of these modifications were assessed by all evaluator groups. Results: Specialists in periodontology and prosthodontics, although rating 60 photographs as more esthetically pleasing, detected changes in tooth and gingival color earlier and judged such deviations as unacceptable sooner than general dentists and laypeople, particularly for shifts in lighter shades. Laypeople noticed color changes later but classified them as unacceptable almost immediately showing greater tolerance for lighter shades. Conclusions: The study shows that laypeople prioritize brighter tooth shades, whereas dental specialists value a more natural appearance. Specialists’ early detection of subtle shade changes and discerning judgments reflects their clinical training and awareness of the challenges in achieving perfect esthetics. In contrast, laypeople, seeking bright teeth influenced by social esthetic norms, noticed changes later but judged them as unacceptable more quickly. Full article

(This article belongs to the Special Issue Advances in Esthetic Dentistry)

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15 pages, 7808 KB

Open AccessArticle

In Vitro Comparison of Trueness and Precision of an AI-Driven Real-Time Library Matching Protocol with Irregular Geometry Scan Bodies for Full-Arch Implant Scanning

by Adam Brian Nulty, Cameron Kelly, Oliver Ambridge, Mark Ambridge, Rick Ferguson and Ashtyn Hoffer

Dent. J. 2025, 13(11), 533; https://doi.org/10.3390/dj13110533 - 13 Nov 2025

Viewed by 1258

Abstract

Background: Accurate digital transfer of implant positions is critical for the long-term success of full-arch prosthetic rehabilitation. Photogrammetry remains the benchmark for accuracy, but its high cost and complexity limit clinical adoption. Artificial intelligence (AI)-driven intraoral scanning protocols incorporating real-time library matching [...] Read more.

Background: Accurate digital transfer of implant positions is critical for the long-term success of full-arch prosthetic rehabilitation. Photogrammetry remains the benchmark for accuracy, but its high cost and complexity limit clinical adoption. Artificial intelligence (AI)-driven intraoral scanning protocols incorporating real-time library matching and irregular, individually coded scan bodies have been proposed as accessible alternatives to improve accuracy and reproducibility. Methods: This in vitro study evaluated the trueness and precision of a full-arch implant scanning workflow using an AI-assisted real-time library matching system in combination with irregular multi-geometry titanium scan bodies. A high-accuracy structured-light scanner served as the reference standard. Six implant positions (35, 33, 31, 41, 43, 45) were scanned across 20 datasets (n = 120). Mean surface deviations were calculated against the reference STL using CloudCompare v.2.14. and a two-way ANOVA (α = 0.05) in SPSS tested the effects of implant position and scan iteration. Results: The workflow achieved a mean deviation of 13.55 ± 9.70 μm (range 0.77–43.46 μm) across all positions. Anterior sites showed the lowest deviations (e.g., position 31: 3.95 μm; 45: 5.96 μm), while posterior sites exhibited higher deviations (e.g., position 43: 26.15 μm). No mean deviation exceeded 30 μm, and no individual measurement surpassed 45 μm. Implant position significantly affected accuracy (p < 0.001), whereas scan iteration did not (p > 0.05). Conclusions: Within the limitations of this in vitro model, an AI-assisted real-time library matching workflow used in conjunction with irregular multi-geometry scan bodies achieved accuracy levels well within clinically acceptable ranges for full-arch implant impressions. Although comparable to values reported for photogrammetry under laboratory conditions, clinical equivalence should not be assumed. Further in vivo validation is required to confirm performance under routine clinical conditions. Full article

(This article belongs to the Special Issue Digital Implantology in Dentistry)

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10 pages, 940 KB

Open AccessArticle

Low-Level Laser Therapy in Maxillofacial Trauma: A Prospective Single-Arm Observational Study

by Raissa Dias Fares, Jonathan Ribeiro da Silva, Sylvio Luiz Costa De-Moraes, Jose Mauro Granjeiro and Monica Diuana Calasans-Maia

Dent. J. 2025, 13(11), 532; https://doi.org/10.3390/dj13110532 - 13 Nov 2025

Viewed by 458

Abstract

Background: Surgical management of trauma in the maxillofacial complex can result in iatrogenic nerve injuries, particularly involving the infraorbital, inferior alveolar, and mental nerves. Paresthesia is a common postoperative complication, often attributed to the anatomical positioning of these nerve structures, making them vulnerable [...] Read more.

Background: Surgical management of trauma in the maxillofacial complex can result in iatrogenic nerve injuries, particularly involving the infraorbital, inferior alveolar, and mental nerves. Paresthesia is a common postoperative complication, often attributed to the anatomical positioning of these nerve structures, making them vulnerable to injury. Among current therapeutic options for nerve injuries, low-level laser therapy (LLLT) has shown promising results in published studies. Objectives: This prospective observational study evaluated the effects of LLLT on nerve recovery following maxillofacial trauma surgery. Methods: A total of 21 participants, with a median age of 35 years and no gender-based selection criteria, were enrolled. Cases included zygomaticomaxillary complex and mandibular osteosynthesis; analyses were within-subject across time. Postoperative laser therapy was administered to both groups using the DUO MMO device (MMOptics, São Carlos, Brazil), delivering infrared light along the pathways of the inferior alveolar, infraorbital, and mental nerves. Nerve function was assessed regularly using a Visual Analog Scale (VAS) and the Brush Stroke Direction (BSD) test to evaluate sensory recovery. Results: Compared with baseline (15 days post-op, pre-LLLT), VAS scores showed significant reductions at sessions 7 and 10, and BSD responses increased over time. Conclusion: After multiplicity control, only the session 10 comparison remained significant. These observational findings support the feasibility of multi-session LLLT after maxillofacial trauma; controlled trials are warranted to determine efficacy. Full article

(This article belongs to the Special Issue Laser Dentistry: The Current Status and Developments)

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15 pages, 2315 KB

Open AccessArticle

Clinician-Led Development and Feasibility of a Neural Network for Assessing 3D Dental Cavity Preparations Assisted by Conversational AI

by Mohammed El-Hakim, Haitham Khaled, Amr Fawzy and Robert Anthonappa

Dent. J. 2025, 13(11), 531; https://doi.org/10.3390/dj13110531 - 13 Nov 2025

Viewed by 876

Abstract

Introduction: Artificial intelligence is emerging in dental education, but its use in preclinical assessment remains limited. Large language models like ChatGPT^® V4.5 enable non-programmers to build AI models through real-time guidance, addressing the coding barrier. Aim: This study aims to empower clinician-led, [...] Read more.

Introduction: Artificial intelligence is emerging in dental education, but its use in preclinical assessment remains limited. Large language models like ChatGPT^® V4.5 enable non-programmers to build AI models through real-time guidance, addressing the coding barrier. Aim: This study aims to empower clinician-led, low-cost, AI-driven assessment models in preclinical restorative dentistry and to evaluate the technical feasibility of using a neural network to score 3D cavity preparations. Methods: Twenty mandibular molars (tooth 46), each with two carious lesions, were prepared and scored by two expert examiners using a 20-point rubric. The teeth were scanned with a Medit i700^® and exported as .OBJ files. Using Open3D, the models were processed into point clouds. With ChatGPT’s guidance, the clinician built a PointNet-based neural model in PyTorch, training it on 20 cases and testing it on 10 unseen preparations. Results: In training, the model achieved an MAE of 0.82, RMSE of 1.02, and Pearson’s r = 0.88, with 66.7% and 93.3% of the predictions within ±5% and ±10% of the examiner scores, respectively. On the test set, it achieved an MAE of 0.97, RMSE of 1.16, and r = 0.92, with 50% and 100% of scores within ±5% and ±10%, respectively. These results show a strong alignment with examiner scores and an early generalizability for scoring preclinical cavity preparations. Conclusions: This study confirms the feasibility of clinician-led, low-cost AI development for 3D cavity assessment using ChatGPT, even without prior coding expertise. Full article

(This article belongs to the Special Issue Dental Education: Innovation and Challenge)

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17 pages, 1162 KB

Open AccessArticle

Modified CAMBRA Protocol for Caries Risk Assessment in Children Aged 6 to 14 Years

by Esther Pérez de Mora, Ángel Luis Formoso-Veloso, Marcela Arenas-González, Asunción Mendoza-Mendoza and David Ribas-Pérez

Dent. J. 2025, 13(11), 530; https://doi.org/10.3390/dj13110530 - 12 Nov 2025

Viewed by 608

Abstract

Background/Objectives: This study aimed to propose a modified CAMBRA protocol for caries risk analysis in a pediatric population, adapted to their needs and habits. Methods: A descriptive and analytical observational study was conducted after obtaining approval from the Ethics Committee. Caries [...] Read more.

Background/Objectives: This study aimed to propose a modified CAMBRA protocol for caries risk analysis in a pediatric population, adapted to their needs and habits. Methods: A descriptive and analytical observational study was conducted after obtaining approval from the Ethics Committee. Caries risk was determined using the CAMBRA Questionnaire and the modified University of Seville Questionnaire (CAMBRA-OP Questionnaire). Results: The final study sample consisted of 300 patients aged 6 to 14 years, of whom 54% were boys and 46% were girls. The distribution of caries risk according to CAMBRA was as follows: 33% low, 7% moderate, 48.6% high, and 11.3% extreme. The distribution of caries risk according to the CAMBRA-OP was as follows: 27.7% low, 12.3% moderate, 48.7% high, and 11.3% extreme. Correlating both tests, a statistically significant association was observed between the caries risk determined by the CAMBRA and CAMBRA-OP, observing a strong correlation between both systems (p = 0.001; Cramer’s V = 0.826). The two diagnostic models exhibited high concordance (0.815 [p = 0.001]) using Cohen’s Kappa index. Conclusions: This tool is focused on this age group and is easily interpretable by professionals, thus contributing to more effective and personalized prevention of dental caries in childhood. Full article

(This article belongs to the Section Preventive Dentistry)

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11 pages, 1220 KB

Open AccessArticle

Clinical and Radiological Evaluation of a Fully Tapered Implant Design Following Immediate Placement with Immediate Provisionalization in the Esthetic Area: A Prospective Case Series Study

by Daniele Cardaropoli, Lorenzo Tamagnone, Alessandro Roffredo, Lorena Gaveglio and Alfonso Alejandro García Huerta

Dent. J. 2025, 13(11), 529; https://doi.org/10.3390/dj13110529 - 12 Nov 2025

Viewed by 317

Abstract

Background: Implant placement after single-tooth extraction in the esthetic zone may be a challenge for clinicians. Immediate placement with immediate restoration may represent a valuable alternative in order to obtain a positive esthetic outcome. In such situations, proper insertion torque represents a clinical [...] Read more.

Background: Implant placement after single-tooth extraction in the esthetic zone may be a challenge for clinicians. Immediate placement with immediate restoration may represent a valuable alternative in order to obtain a positive esthetic outcome. In such situations, proper insertion torque represents a clinical need, and fully tapered implants have been shown to be beneficial, as they can provide high primary stability values. The aim of this case study was to assess the esthetic and radiological treatment outcomes following the placement of a fully tapered implant in immediate post-extraction sites with an immediate restoration of single-tooth gap replacement in the esthetic area. Methods: A total number of 24 consecutive patients requiring single-tooth implant-supported prosthetic rehabilitation in the esthetic area, presenting an intact site, were selected. All implants were immediately restored using an immediate screw-retained prosthetic rehabilitation. Probing Depth (PD) and Bleeding on Probing (BoP) were assessed for four aspects of the implants and measured at 3 and 12 months, together with Marginal Bone Level (MBL), which was measured at day 0 (baseline) and at 3 and 12 months, while Pink Esthetic Score (PES) was measured at 0 (baseline) and 12 months. Results: PD at 3 months was 3.04 mm ± 0.69 mm, while at 12 months it was 2.82 mm ± 0.51 mm. MBL was 2.44 ± 0.64 mm at baseline, 2.25 ± 0.61 mm at 3 months, and 2.16 ± 0.60 mm at 12 months. PES was 11.08 ± 0.86 at baseline and 11.48 ± 0.77 at 12 months. Conclusions: Within the limits of the present study, immediate implant placement with immediate restoration seems to be a reliable procedure for replacing single teeth with a proper case selection. Full article

(This article belongs to the Special Issue New Perspectives in Periodontology and Implant Dentistry)

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16 pages, 3009 KB

Open AccessArticle

Influence of Composite Polishing Pastes on Surface Roughness and Their Stability After Simulated Tooth Brushing

by Panagiotis Ntovas, Bora Korkut, Nikolaos Loumprinis, Ioulianos Rachiotis and Christos Rahiotis

Dent. J. 2025, 13(11), 528; https://doi.org/10.3390/dj13110528 - 10 Nov 2025

Viewed by 685

Abstract

Background/Objectives: Achieving and maintaining a smooth restoration surface is clinically significant, as surface roughness is linked to plaque accumulation, staining, and wear. This study aimed to evaluate in vitro the effect of different polishing paste systems on reducing surface roughness and to assess [...] Read more.

Background/Objectives: Achieving and maintaining a smooth restoration surface is clinically significant, as surface roughness is linked to plaque accumulation, staining, and wear. This study aimed to evaluate in vitro the effect of different polishing paste systems on reducing surface roughness and to assess their performance after simulated post-operative maintenance through toothbrushing. Methods: A total of 128 cylindrical, flat-surface specimens were fabricated from a nanohybrid composite (Filtek Supreme XTE, 3M, USA) using a standardized metal mold. All specimens were finished with silicon carbide paper and polished with a two-step rubber disc system (Hi-Luster, Kerr, USA). They were then randomly assigned to 16 groups (n = 8) according to the polishing protocol. One group was polished with a prophylaxis paste, while the other fifteen groups were treated with pastes indicated for composite and/or ceramic materials. Polishing was performed with a flat buff wheel. To simulate clinical maintenance, specimens underwent a standardized toothbrushing cycle equivalent to three months of use. Surface roughness parameters (Sa and Sq) were measured at three stages with an optical profilometer: after initial polishing, after paste application, and after simulated toothbrushing. Results: Mean Sa values ranged from 0.065 to 0.560 and Sq values from 0.075 to 0.676. Significant differences were found among pastes for both parameters (p < 0.05). Two-way ANOVA revealed significant differences after polishing paste application, both before and after toothbrushing (p < 0.05). Toothbrushing increased roughness in most groups (p < 0.05), although no significant deterioration was observed for nine pastes in Sa and eight in Sq (p ≥ 0.05). Conclusions: Polishing pastes vary in effectiveness, and not all produce measurable improvements in surface smoothness. Their efficiency appears to be unrelated to the abrasive or the number of steps. Simulated toothbrushing over a three-month period may reduce the initial benefits, emphasizing the importance of careful clinical selection. Full article

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21 pages, 1162 KB

Open AccessArticle

Oral Health Care for Institutionalized Elderly in Romania: Needs, Barriers, and Legislative Gaps

by Raluca Mioara Cosoroabă, Şerban Talpoş, Ştefania Dinu, Sergio Liga and Alina Doina Tănase

Dent. J. 2025, 13(11), 527; https://doi.org/10.3390/dj13110527 - 10 Nov 2025

Viewed by 361

Abstract

Background: Elderly individuals living in Romanian long-term care facilities encounter substantial challenges in accessing oral healthcare, despite the high prevalence of dental disease and prosthetic needs. This study aimed to evaluate the oral health status, treatment needs, and access barriers among elderly [...] Read more.

Background: Elderly individuals living in Romanian long-term care facilities encounter substantial challenges in accessing oral healthcare, despite the high prevalence of dental disease and prosthetic needs. This study aimed to evaluate the oral health status, treatment needs, and access barriers among elderly residents in a long-term care facility in Timișoara, Romania, while also analyzing the current legislative framework and public funding mechanisms for geriatric dental care. Methods: A cross-sectional clinical and interview-based study was conducted among 70 residents aged 65–89 years from a residential center. Data collection included intraoral examinations, caregiver-assisted surveys, and individual interviews. Outcomes included oral health status (edentulism, caries, prosthetic use), service utilization, perceived barriers, and quality of life impact. The results were compared to existing literature and analyzed within the framework of Romanian and European healthcare legislation. Results: Total edentulism was found in 66.6% of participants, with only 28% having functional dentures. Caries and periodontal disease were prevalent, and 84% of residents lacked financial resources for dental care. Only 17% had accessed any dental services in the past year. Structural limitations, including the absence of mobile dental services and the lack of institutional protocols, further restricted access. Romanian Law no. 17/2000 guarantees healthcare in residential settings, but oral health is not explicitly included. Conclusions: The study highlights a critical gap in the provision of oral healthcare to institutionalized elderly in Romania. Neglect compromises nutrition, autonomy, and psychosocial well-being, underscoring the urgent need for legislative clarity, dedicated funding, mobile dental services, and integration into geriatric care. Full article

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14 pages, 768 KB

Open AccessArticle

Evaluation of the Impact of Probiotic Supplementation on Gingival Inflammation in Subjects Undergoing Orthodontic Treatment with Fixed Appliances or Clear Aligners: A Randomized, Single-Blind Pilot Study

by Jacopo Lanzetti, Serena Queirolo, Giulia Furini Evans, Umberto Gibello, Andrea Deregibus and Francesco Pera

Dent. J. 2025, 13(11), 526; https://doi.org/10.3390/dj13110526 - 10 Nov 2025

Viewed by 532

Abstract

Objectives: Orthodontic patients are prone to developing gingivitis and require additional tools for maintaining oral hygiene and ensuring plaque control. The present study aimed to evaluate the effects of Bifidobacterium animalis subs. lactis HN019 on plaque accumulation and gingival bleeding in orthodontic patients. [...] Read more.

Objectives: Orthodontic patients are prone to developing gingivitis and require additional tools for maintaining oral hygiene and ensuring plaque control. The present study aimed to evaluate the effects of Bifidobacterium animalis subs. lactis HN019 on plaque accumulation and gingival bleeding in orthodontic patients. Materials and Methods: This study is a randomized, single-blind controlled trial. Orthodontic patients were grouped into two groups: subjects undergoing fixed orthodontic treatment and subjects undergoing treatment with a clear aligner. For each group, patients were divided into a test group (probiotic intake) and a control group (no probiotic intake). Patients took the probiotic for one month following a professional oral hygiene session, suspended its intake for 30 days, and then resumed it for another month. Full Mouth Plaque Score (FMPS) and Full Mouth Bleeding Score (FMBS) were collected at all timesteps. Results: In fixed orthodontics patients, the results show that the average FMPS improved at every timestep in both groups, especially for the test group, decreasing from 56.20 ± 27.7 to 36.47 ± 23.90. The data show a worsening FMBS during the period when patients do not take the probiotic, from 3.13 ± 3.50 to 6.53 ± 7.42. For the clear aligner patients, the comparison between groups suggests that the plaque index particularly improves for the test group during the period when patients are taking the probiotic, from 43.45 ± 19.52 to 25.93 ± 15.67 and from 26.60 ± 15.79 to 18.93 ± 17.99, respectively. For the bleeding index, data analysis shows a progressive improvement in FMBS at all timesteps in the test group, from 6.93 ± 7.00 to 2.60 ± 2.75. Conclusions: The intake of probiotics is useful in decreasing bacterial plaque accumulation and gingival bleeding in orthodontic patients. Full article

(This article belongs to the Section Oral Hygiene, Periodontology and Peri-implant Diseases)

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12 pages, 1162 KB

Open AccessArticle

Retrospective Clinical Evaluation of Non-Engaging Abutments Used for Multi-Unit Screw-Retained Fixed Prosthesis

by Paolo De Angelis, Margherita Giorgia Liguori, Edoardo Rella, Davide Piccirillo, Alessandro Donato Tescione, Alberto Staffieri and Paolo Francesco Manicone

Dent. J. 2025, 13(11), 525; https://doi.org/10.3390/dj13110525 - 10 Nov 2025

Viewed by 449

Abstract

Background/Objectives: This retrospective study aimed at evaluating the clinical performance of non-engaging abutments in multi-unit implant-supported prostheses and assessing the influence of abutment combinations and clinical variables on biological and technical outcomes. Methods: Forty patients with 90 implants and 40 fixed [...] Read more.

Background/Objectives: This retrospective study aimed at evaluating the clinical performance of non-engaging abutments in multi-unit implant-supported prostheses and assessing the influence of abutment combinations and clinical variables on biological and technical outcomes. Methods: Forty patients with 90 implants and 40 fixed dental prostheses were involved. The study population was divided into three groups: 17 patients (8 males, 9 females) in the first group, 16 patients (7 males, 9 females) in the second, and 7 patients (2 males, 5 females) in the third. All patients received multi-unit implant restorations in a private practice between January 2021 and December 2023, and each prosthesis was in function for one year after delivery, with a mean follow-up of 2.17 ± 0.32 years. Restorations involved non-engaging abutments alone or in combination with engaging abutments or multi-unit abutments. Clinical parameters included implant and prosthesis survival rates, probing pocket depth, bleeding on probing, marginal bone loss, and the prevalence of biological and technical complications. For the comparison between the three groups, the analysis of variance was used to compare group means. When appropriate, Tukey’s post hoc test was applied for multiple comparisons. The significance level was set at p < 0.05. Results: The implant and prosthesis survival rates were both 100%. Mean marginal bone loss was 0.53 ± 0.33 mm, and mean probing pocket depth was 4.2 ± 0.75 mm. No cases of peri-implantitis were observed. Mucositis prevalence was 11.11% at the implant level. No significant differences were found among different abutment combinations for biological outcomes or complications. The technical complication rate was 5%. Conclusions: Non-engaging abutments demonstrated favorable short-term clinical outcomes with minimal biological and technical complications. They may represent a reliable option for the restoration of multi-unit prostheses, although long-term studies are needed. Full article

(This article belongs to the Special Issue Dental Materials Design and Innovative Treatment Approach)

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15 pages, 10423 KB

Open AccessCase Report

Clinical Implementation of a Fully Digital Workflow for the Fabrication of a Maxillary Complete Denture: A Case Report

by Carlos Roberto Luna-Domínguez, Ana Cecilia Luna-Vega, Marco Felipe Salas-Orozco, Rogelio Oliver-Parra, Carlos Alberto Luna-Lara and Jorge Humberto Luna-Domínguez

Dent. J. 2025, 13(11), 524; https://doi.org/10.3390/dj13110524 - 10 Nov 2025

Viewed by 843

Abstract

Background/Objectives: Edentulism is a prevalent chronic condition among older adults, and conventional complete dentures remain the standard of care. However, their fabrication often involves multiple clinical sessions and operator-dependent steps that may compromise fit and comfort. Digital workflows using CAD/CAM technologies have emerged [...] Read more.

Background/Objectives: Edentulism is a prevalent chronic condition among older adults, and conventional complete dentures remain the standard of care. However, their fabrication often involves multiple clinical sessions and operator-dependent steps that may compromise fit and comfort. Digital workflows using CAD/CAM technologies have emerged as viable alternatives, offering improved efficiency, precision, and patient-centered outcomes. This case report aims to present a fully digital workflow for maxillary complete dentures and describe clinical efficiency and patient-reported outcomes. Case Presentation: A 73-year-old edentulous male patient underwent maxillary rehabilitation using a fully digital workflow. The protocol included intraoral scanning; the design and 3D printing of a custom tray with occlusal rims; border-molded functional impressions; virtual articulation; and CAD/CAM fabrication. A digitally designed Try-In denture was 3D printed for clinical evaluation, followed by adjustments. The definitive prosthesis was milled from high-performance PMMA discs using a five-axis milling machine. The workflow reduced the number of appointments and laboratory steps. At six-month follow-up, the patient reported high satisfaction with esthetics, retention, phonetics, and masticatory performance. No significant post-delivery adjustments were required. Conclusions: This case demonstrates that fully digital workflows for maxillary complete dentures are clinically viable, providing excellent precision, patient satisfaction, and time efficiency compared to conventional methods. The reproducible protocol described may support the broader integration of CAD/CAM technologies in edentulous rehabilitation. Full article

(This article belongs to the Special Issue Dental Materials Design and Application)

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11 pages, 255 KB

Open AccessArticle

Moral Reasoning and Final-Year Undergraduate Dentistry Students in Australia: A Cross-Sectional Questionnaire Study

by Maurice J. Meade, Xiangqun Ju, David Hunter and Lisa Jamieson

Dent. J. 2025, 13(11), 523; https://doi.org/10.3390/dj13110523 - 7 Nov 2025

Viewed by 310

Abstract

Background/Objectives: Proficiency in moral reasoning is essential for healthcare providers to successfully navigate ethically challenging decision-making. It is critical that student dentists about to enter practice have well-developed moral reasoning skills to ensure optimal patient care. The aim of the present study was [...] Read more.

Background/Objectives: Proficiency in moral reasoning is essential for healthcare providers to successfully navigate ethically challenging decision-making. It is critical that student dentists about to enter practice have well-developed moral reasoning skills to ensure optimal patient care. The aim of the present study was to investigate the moral reasoning ability of students undertaking their final year of the undergraduate Bachelor of Dental Surgery (BDS) programme at the University of Adelaide (UofA) in Australia. Methods: Sixty-six final-year BDS students were invited to participate in an e-survey which included the Defined Issues Test 2 (DIT-2), a validated instrument for measuring moral reasoning. Calculated DIT-2 scores incorporatedthe postconventional (P) score and N2 score. Data analysis of demographic details and scores related to the DIT-2 included the use of t-tests, Mann–Whitney and the Spearman rank correlation coefficient tests. Results: A response rate of 45.5% (n = 30) was recorded. The mean (95% CI) P and N2 scores were 37.80 (32.04, 43.56) and 42.12 (37.72, 46.53), respectively. Scores for females and for those who had undertaken the majority of their pre-BDS studies outside of Australia and New Zealand were higher, but the differences were not statistically significant (p > 0.05). A Spearman Correlation Coefficient test indicated that age was moderately associated (r = 0.41; 95% CI: 0.01, 0.65; p = 0.04) with N2 scores. Conclusions: Moral reasoning scores were comparable to studies among similar cohorts conducted in other countries but were less than the scores considered optimal for a healthcare provider to proficiently manage challenges to ethical decision-making. Consideration should be given to the introduction of appropriate formal training in ethics to better manage these challenges. Full article

(This article belongs to the Section Dental Education)

14 pages, 1117 KB

Open AccessArticle

Oral Health Status Among Children and Adolescents from Vulnerable Populations: A Cross-Sectional Study in Seville, Spain

by Rodolfo Esteban Reyes-Lara, Adrián Curto, David Ribas-Perez, Ignacio Barbero-Navarro, Diego Rodriguez-Menacho, Javier Flores-Fraile and Antonio Castaño-Séiquer

Dent. J. 2025, 13(11), 522; https://doi.org/10.3390/dj13110522 - 7 Nov 2025

Viewed by 715

Abstract

Background/Objectives: The aim of this study was to evaluate the oral health status of socially vulnerable children and adolescents in Seville and to examine its associations with behavioral and sociodemographic determinants. We hypothesized that greater social vulnerability and suboptimal behaviors would be [...] Read more.

Background/Objectives: The aim of this study was to evaluate the oral health status of socially vulnerable children and adolescents in Seville and to examine its associations with behavioral and sociodemographic determinants. We hypothesized that greater social vulnerability and suboptimal behaviors would be associated with higher caries experience. Methods: A cross-sectional analytical study was conducted on 250 participants aged 2 to 17 years attending the Luis Séiquer Social Dentistry Foundation between January and March 2025. Clinical examinations followed the WHO Oral Health Surveys: Basic Methods (5th edition, 2013) and were performed by a calibrated dentist. Variables included dental caries indices (dft, DMFT), pulpal treatment needs, and oral hygiene practices. Statistical analyses included Kruskal–Wallis, Mann–Whitney U, Fisher’s exact tests, and multivariate regression models (significance level p < 0.05). Results: Caries prevalence was high across all age groups, particularly in primary dentition (mean dft = 3.05 ± 3.80; DMFT = 2.99 ± 3.66; p < 0.001). Pulp therapy needs were significantly higher among preschoolers (mean = 2.22 ± 2.31). Factors such as low parental education, migrant background, insufficient toothbrushing frequency, and frequent sugar intake were strongly associated with poorer oral health outcomes. Although fluoridated toothpaste use was widespread (>94%), dental floss use remained limited (34.8%). Multivariate analyses confirmed a strong association between social inequalities and oral disease burden. Conclusions: Children and adolescents from vulnerable groups in Seville experience a high prevalence of dental caries and substantial unmet treatment needs. Findings highlight marked oral health disparities linked to socioeconomic status, emphasizing the urgent need for early preventive programs, culturally adapted oral health education, and equitable access to dental care. Full article

(This article belongs to the Topic Preventive Dentistry and Public Health)

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10 pages, 2036 KB

Open AccessArticle

An Updated Digital Approach to Regional Anesthesia: A Pilot Study on Computer-Guided Maxillary Nerve Block via the Greater Palatine Canal

by Ioannis Fotopoulos, Anastasia Fardi, Vasileios Zisis, Athanasios Poulopoulos, Nikolaos Dabarakis and Theodoros Lillis

Dent. J. 2025, 13(11), 521; https://doi.org/10.3390/dj13110521 - 6 Nov 2025

Viewed by 665

Abstract

Objectives: Maxillary nerve block via the greater palatine canal (GPC) offers the potential for profound regional anesthesia of the maxilla but remains underutilized due to anatomical variability and technical complexity. The aim of this study was to explore the clinical feasibility, accuracy, and [...] Read more.

Objectives: Maxillary nerve block via the greater palatine canal (GPC) offers the potential for profound regional anesthesia of the maxilla but remains underutilized due to anatomical variability and technical complexity. The aim of this study was to explore the clinical feasibility, accuracy, and anesthetic effectiveness of a computer-guided approach by using CBCT-based surgical guides to access the pterygopalatine fossa via the GPC. Methods: Thirty-one patients underwent the procedure with patient-specific guides designed from cone-beam computerized tomography (CBCT) and intraoral scans. A 27G needle was directed through the guide to deliver 1.8 mL of 2% lidocaine with epinephrine 1:80.000. Pulpal anesthesia was assessed via electric pulp testing (EPT), and soft tissue anesthesia via pressure algometry at predefined oral and facial sites. Success was defined as absence of EPT response at maximum output and pressure pain threshold ≥ 700 g. To assess variations in anesthetic efficacy among multiple related groups, Cochran’s Q test and McNemar’s test were employed. Results: Successful needle placement was achieved in 30 out of 31 patients (96.7%) using the computer-guided approach, with a mean of 1.45 insertion attempts per case. Complete palatal soft tissue anesthesia was achieved in all subjects across the tested sites (100%). Pulpal anesthesia was most effective in posterior teeth, with success rates of 96.7% for first molars and 93.3% for first premolars, while the central incisor showed a reduced success rate of 50%. Transient visual disturbances occurred in three patients (10%), with no other adverse effects reported. Conclusions: These findings support the use of computer-guided GPC block as a method for achieving maxillary nerve anesthesia. Although anesthetic spread to anterior and buccal regions was limited, the technique demonstrated consistent effectiveness in the posterior maxilla, highlighting its potential utility in complex dental and surgical interventions requiring deep and long-lasting regional anesthesia. Full article

(This article belongs to the Special Issue New Trends in Digital Dentistry)

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13 pages, 929 KB

Open AccessArticle

Digital Support for Daily Oral Hygiene: A Mobile Application to Improve Patients’ Adherence and Management of Periodontitis—Initial Implementation and User Feedback

by Vlad-Mihai Morariu, Andrada Soancă, Alexandra Roman, Silviu Albu, Anda Gâta, Ștefan Vesa, Petra Șurlin, Diana Tăut, Marius Negucioiu and Andreea Cândea

Dent. J. 2025, 13(11), 520; https://doi.org/10.3390/dj13110520 - 6 Nov 2025

Viewed by 378

Abstract

Background: Maintaining daily optimal dental hygiene, especially in medically vulnerable patients with periodontitis, remains challenging in dental practice. Mobile apps and other digital tools might offer useful support alongside traditional advice. Objectives: This study aimed to develop a mobile health app, PerioSupportPro, [...] Read more.

Background: Maintaining daily optimal dental hygiene, especially in medically vulnerable patients with periodontitis, remains challenging in dental practice. Mobile apps and other digital tools might offer useful support alongside traditional advice. Objectives: This study aimed to develop a mobile health app, PerioSupportPro, that helps patients improve their daily plaque control habits. It also reports on the pilot testing of the app’s usability and users’ perception in a small patient group. Methods: The app was created by a mixed team including periodontists, psychologists, developers, and data protection specialists. The first version included reminders, gamified elements, video tutorials, and motivational messages. After internal testing, a group of 18 patients tested the app and completed a feedback questionnaire that assessed usability (Q3–Q5), educational impact (Q6–Q8), motivation (Q9–Q11), and overall satisfaction (Q12–Q14). Cronbach’s alpha was used to check internal consistency, and non-parametric tests were applied for basic statistical comparisons. Results: The motivation section of the questionnaire showed acceptable consistency (α = 0.784), while usability and educational impact had lower values (α = 0.418 and 0.438). No clear differences were found between age groups. Satisfaction was positively associated with reminders and motivational items. Most appreciated features included reminders, the simple interface, and short videos. Based on the input provided by the questionnaire, a few improvements were made, and a second version of the app was prepared. Conclusions: Early user responses show that PerioSupportPro may help motivate and guide patients in their oral hygiene routine. While still in an early phase, the app seems well-received and ready for future clinical validation with more users. Full article

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19 pages, 466 KB

Open AccessReview

Potential Antimicrobial Use of Cannabidiol in Dentistry: A Scoping Review

by Matias Mederos, Alejandro Elizalde-Hernández, Alejandro Francia, Luiz Alexandre Chisini, Cristina Pereira Isolan, Rafael R. Moraes, Rafael Guerra Lund and Carla David

Dent. J. 2025, 13(11), 519; https://doi.org/10.3390/dj13110519 - 6 Nov 2025

Viewed by 503

Abstract

Background/Objectives: The use of cannabidiol (CBD) as an antimicrobial and antifungal agent has gained interest in medicine, with studies suggesting potential against various microorganisms. However, its effectiveness against oral pathogens remains underexplored in dental research, highlighting the need for further studies. This scoping [...] Read more.

Background/Objectives: The use of cannabidiol (CBD) as an antimicrobial and antifungal agent has gained interest in medicine, with studies suggesting potential against various microorganisms. However, its effectiveness against oral pathogens remains underexplored in dental research, highlighting the need for further studies. This scoping review summarizes current evidence on the antimicrobial properties of CBD in dental and oral health. Methods: A systematic search was conducted across seven databases (PubMed, the Cochrane Library, Scopus, Embase, Web of Science, SciELO, and LILACS) up to January 2025. The inclusion criteria encompassed studies that explored the effects of CBD on oral microbiology (in vitro and in vivo in animal models), regardless of language or year of publication. The gray literature was evaluated in the Google Scholar database. Results: A total of 1284 articles were identified, of which 10 met the inclusion criteria for this scoping review. These studies, published between 2019 and 2025, primarily focused on bacterial and fungal cultures. The most commonly used methods were the minimum inhibitory concentration test and counting colony-forming units. The contact methods between CBD and bacterial/fungal cell cultures were either dilution or direct contact. Conclusions: CBD shows promising antimicrobial properties against a range of oral bacteria and fungi, suggesting its potential application in managing oral health conditions. Full article

(This article belongs to the Special Issue Feature Review Papers in Dentistry)

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30 pages, 994 KB

Open AccessSystematic Review

Natural Compounds in Oral Microbiota Modulation and Caries Prevention: A Systematic Review

by María del Pilar Angarita-Díaz, Lilia J. Bernal-Cepeda, Jéssica María Sarmiento-Ordoñez, Yohan Yañez-Navas, Karen Garcia-Plazas, Hermann Gutierrez-Reyes and Laura Correa-Guataquira

Dent. J. 2025, 13(11), 518; https://doi.org/10.3390/dj13110518 - 5 Nov 2025

Viewed by 1275

Abstract

Background/Objectives: Certain components of natural products help maintain the oral microbiota balance, thereby promoting oral health. This study aimed to identify natural components with anticariogenic properties by analyzing evidence from in vivo studies. Methods: A systematic review was conducted in accordance with [...] Read more.

Background/Objectives: Certain components of natural products help maintain the oral microbiota balance, thereby promoting oral health. This study aimed to identify natural components with anticariogenic properties by analyzing evidence from in vivo studies. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed across multiple databases and included English-language studies published between 2013 and 2025. The review included intervention and comparative studies that examined the effects of dietary habits involving natural components in participants of any age, with or without dental caries. Results: A total of 77 studies were included in the review, most of which were clinical trials conducted in pediatric populations. To assess the impact of the interventions, most studies measured outcomes such as Streptococcus mutans levels, dental caries incidence, and salivary pH, among other parameters. The most frequently studied components included probiotics, plant extracts, sugar substitutes, propolis, arginine, dairy products, among others. Significant effects were most reported on biological risk factors (72.8%). In addition, 16.9% of the studies reported a statistically significant reduction in clinically diagnosed dental caries. Conclusions: This review identified preliminary evidence suggesting that certain natural compounds may play a role in modulating cariogenic factors. However, further high-quality studies are needed to strengthen the evidence base and confirm these findings. The protocol for this review was registered on the Open Science Framework platform. Full article

(This article belongs to the Section Preventive Dentistry)

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24 pages, 5426 KB

Open AccessArticle

Retrospective Evaluation of Invisalign^® Mandibular Advancement in Growing Patients: Cephalometric, PAR and 3D Molar Displacement Outcomes

by Teresa Pinho, Carolina Clemente, Inês de Castro and Maria dos Prazeres Gonçalves

Dent. J. 2025, 13(11), 517; https://doi.org/10.3390/dj13110517 - 5 Nov 2025

Viewed by 752

Abstract

Background: Class II malocclusion is one of the most prevalent dentoskeletal disorders, usually caused by mandibular retrusion. The Invisalign^® Mandibular Advancement System is an aesthetic, comfortable alternative to conventional braces for growing patients allowing mandibular projection and dental alignment. This retrospective [...] Read more.

Background: Class II malocclusion is one of the most prevalent dentoskeletal disorders, usually caused by mandibular retrusion. The Invisalign^® Mandibular Advancement System is an aesthetic, comfortable alternative to conventional braces for growing patients allowing mandibular projection and dental alignment. This retrospective study assessed the effectiveness of the Invisalign^® Mandibular Advancement (MA) System in growing patients with mandibular retrognathia. Methods: At treatment onset, seventeen patients were divided into the following two groups according to the aligner system used and cervical vertebral maturation stage: the Invisalign^® First group (CVM2), and the Invisalign^® Teen group (CVM3, some transitioning to CVM4), all treated with the Comprehensive Package. Treatment efficacy was evaluated through cephalometric analysis, occlusal classification, and three-dimensional tooth movement assessment. Cephalometric evaluations were performed pre-(T0) and post-treatment (TF). In addition, a clinical follow-up during the retention period was conducted to assess post-treatment stability. Results: Significant dentoalveolar and skeletal changes were observed in both groups. The Teen group showed greater mesial movement of the lower molars (3.57 ± 1.26 mm) compared to the First group (1.34 ± 0.48 mm; p < 0.001). Conversely, the First group showed greater distal movement of the upper molars (2.24 ± 0.64 mm) compared to the Teen group (1.35 ± 0.69 mm; p = 0.002). The PAR index showed significant reductions in both groups (p < 0.001), and although the Teen group achieved greater improvements, the First group demonstrated a clinically relevant reduction (23.60 vs. 19.43 points), despite two severe cases that did not achieve full Class II correction. Conclusions: Both the Invisalign^® First and Comprehensive Package for teens systems improved occlusion and skeletal patterns. These findings support the MA System as an effective option for correcting Class II malocclusion during growth. Full article

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Open AccessReview

Facially Driven Full-Arch Implant Rehabilitation with Stackable Metallic and Magnetic Surgical Guides and Immediate Loading: Our Clinical Experience and Scoping Review

by Ioan Sîrbu, Vladimir Nastasie, Andreea Custura, Adelin Radu, Alexandra Tuţă, Valentin Daniel Sîrbu, Bogdan Andrei Bumbu, Tareq Hajaj, Robert Avramut, Gianina Tapalaga and Serban Talpos

Dent. J. 2025, 13(11), 516; https://doi.org/10.3390/dj13110516 - 5 Nov 2025

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Abstract

Background: Stackable metallic or magnetic multi-template systems translate a prosthetically (facially) driven plan into each surgical phase of full-arch rehabilitation. Our objective was to map and critically describe the clinical applications, accuracy, and short-term outcomes of stackable/sequential guides and to illustrate the [...] Read more.

Background: Stackable metallic or magnetic multi-template systems translate a prosthetically (facially) driven plan into each surgical phase of full-arch rehabilitation. Our objective was to map and critically describe the clinical applications, accuracy, and short-term outcomes of stackable/sequential guides and to illustrate the operational steps with a standardized magnet-retained case. Methods: Following a prospectively registered protocol (OSF, June 2025), we performed a scoping review in accordance with and PRISMA guidance. PubMed, Scopus and Embase were searched to 26 June 2025 for primary human studies using stackable or sequential static guides to place ≥4 implants per arch with immediate (≤72 h) loading. Duplicate-independent screening and data-charting captured guide design, planning platform, surgical accuracy, implant survival, prosthetic outcomes and patient-reported measures. A single non-analytic clinical vignette was included solely to illustrate the facially driven stackable workflow. Results: Eight studies (five countries, 2021–2025) encompassing 351 implants and one additional clinical case met the inclusion criteria. Mechanical indexing predominated (7/9 protocols); only two papers, including our case, used magnetic retention. Mean coronal and angular deviations, reported in two cohorts, were 0.95 mm/2.8° and 0.87 mm/2.67°, respectively—well within accepted thresholds for full-arch guided surgery. Immediate loading was achieved in 100% of arches; cumulative implant survival was 97.1% after 3–12 months. Patient-reported satisfaction exceeded 90 mm on VAS scales when measured. Our case demonstrated 0.90 mm/2.95° accuracy, 100% implant stability ≥ 35 N cm and uneventful provisionalisation at 12 weeks. Conclusions: Early clinical reports show clinically acceptable accuracy and high short-term survival with streamlined workflow. However, evidence remains heterogeneous and short-term; prospective multi-centre studies with standardized accuracy metrics, ≥3-year follow-up, validated PROMs, and cost-effectiveness analyses are still needed. Full article

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Dent. J., Volume 13, Issue 11 (November 2025) – 62 articles

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