Dentistry Journal

12 pages, 1722 KiB

Open AccessArticle

Evaluation of Internal and Marginal Shrinkage Stress in Adhesive Class III Cavities Restored with Different Resin Composite Combinations—A 3D-FEA Study

by Elisa Donaria Aboucauch Grassi, Guilherme Schmitt de Andrade, Ana Beatriz Gomes de Carvalho, Roberta Gasparro, Mauro Mariniello, Angelo Aliberti, Pietro Ausiello and Alexandre Luiz Souto Borges

Dent. J. 2025, 13(8), 367; https://doi.org/10.3390/dj13080367 - 14 Aug 2025

Abstract

Objectives: To study the effects of internal and marginal polymerization shrinkage stress and distribution in different resin composite class III dental restorations in relation to the restorative technique using numerical finite element analysis (FEA). Methods: A 3D model of a human hemi-maxilla with [...] Read more.

Objectives: To study the effects of internal and marginal polymerization shrinkage stress and distribution in different resin composite class III dental restorations in relation to the restorative technique using numerical finite element analysis (FEA). Methods: A 3D model of a human hemi-maxilla with a sound maxillary central incisor were created. Four class III distal cavities were shaped and differently restored. Four groups of resin composite combinations were analyzed: group C (three increments of conventional composite); group B (two increments of bulk-fill composite); group FC (flowable base + three increments of conventional composite); and group FB (flowable bulk-fill base + two increments of conventional composite). The resulting four models were exported to FEA software for static structural analysis. Polymerization shrinkage was simulated using thermal analogy, and stress distribution was analyzed using the Maximum Principal Stress criterion at the marginal and internal cavity interfaces. Results: Group FC showed the highest stress at the level in the proximal region (9.05 MPa), while group FB showed the lowest (4.48 MPa). FB also exhibited the highest internal dentin stress, indicating potential risks for long-term bond degradation. In the cavo-surface incisal angle, the average peak stress across all groups was 3.76 MPa. At the cervical cavo-surface angle, stress values were 3.3 MPa (C), ~3.36 MPa (B), 3.41 MPa (FC), and 3.27 MPa (FB). Conclusions: Restorative technique did not significantly influence marginal stress distribution in class III composite restorations. However, the bevel area at the cervical margin showed the highest concentration of shrinkage stress. Full article

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12 pages, 341 KiB

Open AccessSystematic Review

Charting New Territory: AI Applications in Dental Caries Detection from Panoramic Imaging

by Man Hung, Daniel Yevseyevich, Milan Khazana, Connor Schwartz and Martin S. Lipsky

Dent. J. 2025, 13(8), 366; https://doi.org/10.3390/dj13080366 - 12 Aug 2025

Abstract

Introduction: Dental caries remains a public health concern, and early detection prevents its progression and complications. Panoramic radiographs are essential diagnostic tools, yet the interpretation of panoramic X-rays varies among practitioners. Artificial intelligence (AI) presents a promising approach to enhance diagnostic accuracy in [...] Read more.

Introduction: Dental caries remains a public health concern, and early detection prevents its progression and complications. Panoramic radiographs are essential diagnostic tools, yet the interpretation of panoramic X-rays varies among practitioners. Artificial intelligence (AI) presents a promising approach to enhance diagnostic accuracy in detecting dental caries. This scoping review examines the current literature on the use of AI programs to analyze panoramic radiographs for the diagnosis of dental caries. Methods: This scoping review searched PubMed, Scopus, Web of Science, and Dentistry and Oral Sciences Source, adhering to PRISMA guidelines. The review included peer-reviewed, original research published in English that investigated the use of AI to diagnose dental caries. Data were extracted on the AI model characteristics, advantages, disadvantages, and diagnostic performance. Results: Seven studies met the inclusion criteria. The Deep Learning Model achieved the highest performance (specificity 0.9487, accuracy 0.9789, F1 score 0.9245), followed by Diagnocat and Tooth Type Enhanced Transformer. Models such as CranioCatch and CariSeg showed moderate performance, while the Dental Caries Detection Network demonstrated the lowest. Benefits included improved diagnostic support and workflow efficiency, while limitations involved dataset biases, interpretability challenges, and computational demands. Conclusions: Applying AI technologies to panoramic X-rays demonstrates the potential for enhancing caries diagnosis, with some models achieving near-expert performance. However, future research must address the generalizability, transparency, and integration of AI models into clinical practice. Future research should focus on diverse training datasets, explainable AI development, clinical validation, and incorporating AI training into dental education and training. Full article

(This article belongs to the Special Issue Updates and Highlights in Cariology)

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25 pages, 6503 KiB

Open AccessReview

Evaluating the Success of Immediate Implants in the Esthetic Zone: A Narrative Review with Case Illustration

by Carlos A. Jurado, Francisco Garcia-Torres, Silvia Rojas-Rueda, Kiarash Karimi and Mark Adam Antal

Dent. J. 2025, 13(8), 365; https://doi.org/10.3390/dj13080365 - 12 Aug 2025

Abstract

Background: Immediate implant therapy is a highly effective solution for replacing non-restorable teeth, particularly in the esthetic zone, where achieving optimal results can be challenging. In this area, even small imperfections can significantly affect a patient’s satisfaction due to the high visibility [...] Read more.

Background: Immediate implant therapy is a highly effective solution for replacing non-restorable teeth, particularly in the esthetic zone, where achieving optimal results can be challenging. In this area, even small imperfections can significantly affect a patient’s satisfaction due to the high visibility of the teeth involved. This narrative review provides an overview of findings from case reports and systematic reviews that highlight the success of immediate implant therapy in the esthetic zone. Additionally, it includes a case illustration to emphasize how meticulous planning, combined with advanced techniques, can achieve successful outcomes. Methods: A comprehensive literature review was conducted to evaluate the effectiveness of immediate implant placement and loading for non-restorable teeth in the esthetic zone. Key factors identified for success include atraumatic tooth extraction, precise implant placement, and effective soft tissue management to achieve natural esthetics and long-term stability. To illustrate these principles, the review features a clinical case involving the replacement of a maxillary right central incisor rendered non-restorable due to trauma. Treatment incorporated advanced digital planning, atraumatic extraction, immediate implant placement, and provisionalization. The final restoration involved soft tissue contouring and ceramic veneers on adjacent teeth, enhancing the patient’s overall smile and confidence. Results: Evidence from the literature indicates that well-planned immediate implant therapy achieves high success rates and long-term stability. In the clinical case presented, the workflow met the patient’s esthetic and functional needs, resulting in a natural, harmonious smile, and improved patient satisfaction. Conclusions: Immediate implant therapy in the esthetic zone is highly effective when critical considerations—such as bone preservation, guided implant placement, soft tissue shaping, and appropriate restoration—are meticulously addressed. Advanced techniques and careful planning are essential for fulfilling both esthetic and functional patient needs, ultimately delivering predictable and successful outcomes. Full article

(This article belongs to the Section Dental Implantology)

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11 pages, 1173 KiB

Open AccessReview

The Areca Nut and Oral Submucosal Fibrosis: A Narrative Review

by Kimia Kazemi, Asmaa Fadl, Felipe F. Sperandio and Andrew Leask

Dent. J. 2025, 13(8), 364; https://doi.org/10.3390/dj13080364 - 12 Aug 2025

Abstract

The areca nut (AN) is chewed by approximately 600 million people worldwide. Among AN chewers, ~5% develop oral submucosal fibrosis (OSF), a progressive fibrotic disorder of the oral cavity. OSF is characterized by subepithelial fibrosis and mucosal rigidity, leading to restricted mouth opening, [...] Read more.

The areca nut (AN) is chewed by approximately 600 million people worldwide. Among AN chewers, ~5% develop oral submucosal fibrosis (OSF), a progressive fibrotic disorder of the oral cavity. OSF is characterized by subepithelial fibrosis and mucosal rigidity, leading to restricted mouth opening, difficulty in mastication, deglutition, and speech. These impairments severely compromise oral hygiene and routine dental care, diminishing patients’ quality of life. At least 4% of OSF patients develop oral cancer. The prevalence of OSF correlates with AN chewing, particularly when accompanied by other risk factors such as tobacco use. The International Agency for Research on Cancer has identified chronic chemical and mechanical irritation of the oral mucosa from AN chewing as a major cause of OSF. The active chemical ingredients of AN include alkaloids such as arecoline, flavonoids, and tannins. Of these, arecoline is considered the most potent fibrogenic agent. In vitro, arecoline induces cultured fibroblasts to differentiate into highly contractile α-smooth muscle actin (α-SMA)-expressing myofibroblasts, the effector cells of fibrosis, and to express profibrotic markers and mediators, including transforming growth factor-β 1 (TGF-β1) and cellular communication network factor 2 (CCN2), which is associated with malignant progression of OSF. In vivo, mice exposed to AN extract or arecoline show submucosal collagen accumulation and myofibroblast differentiation, concomitant with upregulated pro-fibrotic gene (TGF-β1, Col1A1, α-SMA) expression. Although myofibroblasts can be seen in OSF patient-derived samples, substantial disease heterogeneity exists, which has thus far hindered the generation of high-quality data necessary to gain insights into underlying mechanisms and disease progression. Consequently, treatment options for OSF are limited and primarily symptomatic. Collectively, evidence from human and animal studies establishes OSF as an AN-induced fibrotic disorder and underscores the urgent need for mechanism-focused research to identify reliable diagnostic markers and therapeutic targets to address its growing global burden. Full article

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

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14 pages, 2205 KiB

Open AccessArticle

Optimizing Preclinical Skill Assessment for Handpiece-Naïve Students: A Strategic Approach

by Reinhard Chun Wang Chau, Szabolcs Felszeghy, Maria F. Sittoni-Pino, Santiago Arias-Herrera, Sompop Bencharit, Margrit Maggio, Murat Mutluay, David P. Rice, Walter Yu Hang Lam, Sıla Nur Usta, Barry F. Quinn, Jorge Tricio, Masako Nagasawa, Mihaela Pantea, Marina Imre, Ana Maria Cristina Tancu, Amitha Ranauta, Arzu Tezvergil-Mutluay, Satu Korpisaari, Kaisa Leinonen, Mikko Liukkonen, Outi S. Huhtela, Ulf T. Örtengren and Peter Lingström Show full author list Hide full author list

Dent. J. 2025, 13(8), 363; https://doi.org/10.3390/dj13080363 - 11 Aug 2025

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Abstract

Background: Preclinical dental training requires simulation-based tools to develop fine motor skills, but traditional models like plastic teeth often lack realistic tactile feedback, and systematic evaluations of multi-layered drilling plates are scarce. This study aimed to evaluate the educational utility and perceived [...] Read more.

Background: Preclinical dental training requires simulation-based tools to develop fine motor skills, but traditional models like plastic teeth often lack realistic tactile feedback, and systematic evaluations of multi-layered drilling plates are scarce. This study aimed to evaluate the educational utility and perceived realism of a novel multi-layered drilling plate designed to simulate enamel, dentin, and pulp, with null hypotheses that it would not differ in realism from natural dental tissues or in educational utility from existing tools. Methods: Seventy dental educators (mean preclinical teaching experience: 112.9 ± 116.7 months) from 14 institutions across four continents assessed the plates using standardized protocols. Statistical analysis (Mann–Whitney U Test) was performed to analyze the results. Results: Quantitative ratings (1–10 scale) showed high mean scores for drilling quality (enamel: 7.80 ± 1.55, dentin: 7.27 ± 1.94, pulp: 7.48 ± 2.33), surface smoothness (enamel: 8.17 ± 1.55, dentin: 8.17 ± 1.57), and ergonomic visibility (8.56 ± 1.58), with 90% passing grades, rejecting the null hypothesis of no difference in educational utility. Tissue transition scores (enamel/dentin: 7.09 ± 2.56; dentin/pulp: 6.86 ± 2.46) showed significant differences (p < 0.05) in realism from natural tissues, rejecting the null hypothesis of no difference. Inter-rater reliability was poor (Krippendorff’s alpha: 0.449 for failing scores, 0.211 for passing scores). Qualitative feedback praised ease of use but noted limitations in dentin haptic simulation. Conclusions: The drilling plate shows promise for skill development, though without controlled comparisons to existing tools, its relative efficacy remains preliminary. Further research on student outcomes and tool refinement is needed to validate its use in dental education. Full article

(This article belongs to the Special Issue Advancing Dental Education: Synergizing Virtual Reality, Haptics, AI, and Conventional Training for Green Clinical and Community Competence and Sustainability)

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11 pages, 253 KiB

Open AccessArticle

Oral Manifestations, Dental Interventions, and Clinical Outcomes in Hospitalized COVID-19 Patients: A Two-Year Cohort Study in São Paulo, Brazil

by Marcelo Ivander Andrade Wanderley, Leticia Rodrigues-Oliveira, Teresa Cristina Dias Cunha Nascimento, Luiz Francisco Cardoso, Thaís Bianca Brandão, Alan Roger Santos-Silva and Ana Carolina Prado-Ribeiro

Dent. J. 2025, 13(8), 362; https://doi.org/10.3390/dj13080362 - 11 Aug 2025

Viewed by 132

Abstract

Objectives: To investigate the demographic, epidemiological, and medical profiles of hospitalized COVID-19 patients who received dental care, and to identify their main oral health needs. Methods: This retrospective, descriptive cohort study analyzed medical and dental records of patients hospitalized with COVID-19 at a [...] Read more.

Objectives: To investigate the demographic, epidemiological, and medical profiles of hospitalized COVID-19 patients who received dental care, and to identify their main oral health needs. Methods: This retrospective, descriptive cohort study analyzed medical and dental records of patients hospitalized with COVID-19 at a private tertiary hospital in São Paulo, Brazil, from January 2020 to March 2022. The data collected included demographic variables, comorbidities, length of hospitalization, need for respiratory support, clinical outcomes, dental diagnoses, and procedures performed. Results: A total of 129 medical records were reviewed. The sample included 93 males (72%) and 36 females (28%), with a mean age of 72 years. Comorbidities were present in 92% of cases, most frequently a prior COVID-19 infection (59%), diabetes (36%), and depression (31%). The mean hospital stay was 51 days, with a median of 33 days. Most patients (91%) required ICU care; among these, 87% received invasive mechanical ventilation. Dental consultations were most commonly requested for oral assessments (88%), lesions (58%), and opportunistic infections (8%). The most frequent diagnoses were trauma-related lesions from orotracheal intubation (63%), opportunistic infections (45%), and odontogenic or periodontal infections (15%). Primary treatments included oral hygiene procedures (89%), photobiomodulation therapy (67%), and tooth extractions (6%). Patients received an average of eight dental consultations. The overall mortality rate was 26%. Conclusions: Older male patients with COVID-19 frequently required intensive dental care during hospitalization. Oral trauma and opportunistic infections were common, highlighting the need for specialized dental management in critically ill populations. Full article

(This article belongs to the Special Issue Preventive Dental Care, Chairside and Beyond)

18 pages, 3393 KiB

Open AccessFeature PaperReview

The 2018 Classification of Periodontitis: Challenges from Clinical Perspective

by Marek Chmielewski, Andrea Pilloni, Alessandro Cuozzo, Giuseppe D’Albis, Gerarda D’Elia, Piero Papi and Lorenzo Marini

Dent. J. 2025, 13(8), 361; https://doi.org/10.3390/dj13080361 - 8 Aug 2025

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Abstract

Objectives: The objective of this narrative review was to evaluate the clinical challenges encountered in the application of the 2018 AAP/EFP Classification of Periodontitis. Methods: Electronic and manual searches were conducted to identify studies reporting diagnostic accuracy and inter- and intra-examiner [...] Read more.

Objectives: The objective of this narrative review was to evaluate the clinical challenges encountered in the application of the 2018 AAP/EFP Classification of Periodontitis. Methods: Electronic and manual searches were conducted to identify studies reporting diagnostic accuracy and inter- and intra-examiner agreement when using the 2018 Classification, both with and without the aid of implementation tools. Results: Eleven studies were included, encompassing a total of 459 clinical cases. Overall, 852 examiners participated, with 31 gold-standard examiners providing the reference diagnoses. General dentists often exhibited lower diagnostic accuracy and consistency compared to students and periodontal experts. Diagnostic challenges were observed in staging, particularly distinguishing between Stage III/IV and gingivitis/Stage I. Grading reliability was reduced in the absence of longitudinal data and high-level modifying factors. This review also explored difficulties in reporting ‘hopeless teeth’ and assigning the extent of periodontitis. Education, training, and implementation tools substantially improved diagnostic accuracy and consistency, increasing the agreement with reference diagnosis and strengthening inter- and intra-examiner agreement. Conclusions: The application of the 2018 Classification showed notable variability in diagnostic accuracy and inter- and intra-examiner agreement. Improving clinician experience and training and incorporating diagnostic aids and emerging AI technologies has the potential to enhance diagnostic accuracy and consistency, which are essential for precisely estimating periodontitis prevalence, interpreting research findings, and determining prognosis and treatment needs. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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12 pages, 924 KiB

Open AccessArticle

Houttuynia cordata Exhibits Anti-Inflammatory Activity Against Interleukin-1β-Induced Inflammation in Human Gingival Epithelial Cells: An In Vitro Study

by Ryo Kunimatsu, Sawako Ikeoka, Yuma Koizumi, Ayaka Odo, Izumi Tanabe, Yoshihito Kawashima, Akinori Kiso, Yoko Hashii, Yuji Tsuka and Kotaro Tanimoto

Dent. J. 2025, 13(8), 360; https://doi.org/10.3390/dj13080360 - 7 Aug 2025

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Abstract

Background/Objectives: Periodontitis is a chronic infectious inflammatory disorder that affects the supporting structures of the teeth. The gingival epithelium plays a crucial role as a physical and immunological barrier, producing pro-inflammatory cytokines in response to microbial pathogens. Modulation of gingival epithelial function [...] Read more.

Background/Objectives: Periodontitis is a chronic infectious inflammatory disorder that affects the supporting structures of the teeth. The gingival epithelium plays a crucial role as a physical and immunological barrier, producing pro-inflammatory cytokines in response to microbial pathogens. Modulation of gingival epithelial function has been proposed as a therapeutic strategy to prevent the progression of periodontal disease. Houttuynia cordata, a perennial herb traditionally used in Asian medicine, is recognized for its anti-inflammatory properties, with documented benefits in the cardiovascular, respiratory, and gastrointestinal systems. However, its potential therapeutic role in oral pathologies, such as periodontitis, remains underexplored. This study aimed to investigate the anti-inflammatory effects of H. cordata extract on interleukin (IL)-1β-stimulated primary gingival keratinocytes (PGKs) subjected to IL-1β-induced inflammatory stress, simulating the conditions encountered during orthodontic treatment. Methods: Inflammation was induced in PGKs using IL-1β, and the impact of H. cordata extract pretreatment was assessed using quantitative real-time reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, and immunoblotting. Results: H. cordata extract significantly downregulated the mRNA and protein expression levels of tumor necrosis factor-alpha, IL-8, and intercellular adhesion molecule-1 in IL-1β-stimulated PGKs without inducing cytotoxicity. Conclusions: These findings suggest that H. cordata holds promise as a preventive agent against periodontitis by attenuating inflammatory responses in gingival epithelial tissues. We believe that our findings will inform the development of prophylactic interventions to reduce periodontitis risk in patients undergoing orthodontic therapy. Full article

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

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11 pages, 483 KiB

Open AccessArticle

Consequences of Untreated Dental Caries on Schoolchildren in Mexico State’s Rural and Urban Areas

by José Cuauhtémoc Jiménez-Núñez, Álvaro Edgar González-Aragón Pineda, María Fernanda Vázquez-Ortíz, Julio César Flores-Preciado, María Eugenia Jiménez-Corona and Socorro Aída Borges-Yáñez

Dent. J. 2025, 13(8), 359; https://doi.org/10.3390/dj13080359 - 7 Aug 2025

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Abstract

Background/Objectives: Dental caries is the most prevalent oral condition worldwide. Consequences of untreated dental caries (CUDC) can range from pulp damage and soft tissue ulceration due to root debris to more severe issues, such as fistulas and abscesses. Rural communities might be [...] Read more.

Background/Objectives: Dental caries is the most prevalent oral condition worldwide. Consequences of untreated dental caries (CUDC) can range from pulp damage and soft tissue ulceration due to root debris to more severe issues, such as fistulas and abscesses. Rural communities might be more vulnerable to CUDC because of lower socioeconomic status, poorer access to healthcare, and lower education levels. The objective of this study was to evaluate and compare the prevalence of CUDC in rural and urban areas in schoolchildren aged 8 to 12 years in the State of Mexico. Methods: A cross-sectional study was conducted using the PUFA index, considering the presence of pulp involvement (P), soft tissue ulcerations due to root remnants (U), fistulas (F), and abscesses (A). The independent variable was the geographic area (rural or urban), and the covariates were nutritional status, hyposalivation, having one’s own toothbrush, and having received topical fluoride in the last year. Logistic regression models were fitted, calculating odds ratios (ORs) and 95% confidence intervals (CIs). Results: The prevalence of CUDC (PUFA > 0) was 42.9% in rural areas and 25.9% in urban areas. Residing in a rural area (OR: 2.15, 95% CI 1.38–3.34, p = 0.001), hyposalivation (OR: 1.93, 95% CI 1.11–3.37, p = 0.020), and professional fluoride application (OR: 0.15, 95% CI 0.07–0.32, p < 0.001) were associated with the prevalence of CUDC. Conclusions: To prevent caries and its clinical consequences due to the lack of treatment, it is important to promote timely care seeking and access to dental care services, considering the conditions of each geographic area. Full article

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12 pages, 3874 KiB

Open AccessArticle

Comparison of the Marginal Integrity of Sectional Non-Invasive Laminate Veneers Versus Sectional Minimally Invasive Laminate Veneers Under Artificial Aging

by Polykarpos Papanagiotou, Phophi Kamposiora, George Papavasiliou and Spiros Zinelis

Dent. J. 2025, 13(8), 358; https://doi.org/10.3390/dj13080358 - 7 Aug 2025

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Abstract

Background/Objectives: To compare the marginal integrity of sectional non-invasive laminate veneers versus sectional minimally invasive laminate veneers. Methods: A total of eighty (80) intact maxillary and mandibular frontal teeth (central incisors) were randomly divided into four groups (n = 20). [...] Read more.

Background/Objectives: To compare the marginal integrity of sectional non-invasive laminate veneers versus sectional minimally invasive laminate veneers. Methods: A total of eighty (80) intact maxillary and mandibular frontal teeth (central incisors) were randomly divided into four groups (n = 20). Two groups received non-invasive veneers made of feldspathic porcelain (Feldspathic Non-Invasive—FNI) and lithium disilicate (Lithium Disilicate Non-Invasive—LNI) accordingly. Groups FP and LP received minimally invasive veneers manufactured by feldspathic porcelain and lithium disilicate, respectively. Following cementation, three grooves with mesio-distal orientation on the labial surface of teeth of each sample, at the incisal, middle, and cervical third, were made. Before and after artificial aging, the mesio-distal distance between the end of the groove on the tooth and the edge of each veneer was measured in micrometers (μm) employing an SEM immediately after cementation (T₀), after simulated artificial aging equivalent to four months of everyday brushing (T₁), and after twelve months of everyday brushing (2 times per day) (T₂) to identify the wear of veneers. In the same manner, the horizontal dimension of the cement layer extending from its edge till the margin of the veneer was measured for all the groups at T₀, T₁, and T₂, respectively. The statistical analysis was performed employing non-parametric Kruskal–Wallis ANOVA and Dunn’s test. Results: No significant differences from T₀ to T₁ and from T₁ to T₂, as well as from T₀ to T₂, were identified for all the groups tested. No significant differences were allocated among all groups for the dimensional changes in the cement. Conclusions: All the groups responded similarly to aging factors, regardless of the non-invasive or minimally invasive approach, or the material used to fabricate the veneers. Full article

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

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20 pages, 1448 KiB

Open AccessFeature PaperArticle

In Vitro Evaluation of Chemical and Microhardness Alterations in Human Enamel Induced by Three Commercial In-Office Bleaching Agents

by Berivan Laura Rebeca Buzatu, Atena Galuscan, Ramona Dumitrescu, Roxana Buzatu, Magda Mihaela Luca, Octavia Balean, Gabriela Vlase, Titus Vlase, Iasmina-Mădălina Anghel, Carmen Opris, Bianca Ioana Todor, Mihaela Adina Dumitrache and Daniela Jumanca

Dent. J. 2025, 13(8), 357; https://doi.org/10.3390/dj13080357 - 6 Aug 2025

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Abstract

Background/Objectives: In-office bleaching commonly employs high concentrations of hydrogen peroxide (HP) or carbamide peroxide (CP), which may compromise enamel integrity. This in vitro paired-design study aimed to compare the chemical and mechanical effects of three commercial bleaching agents—Opalescence Boost (40% HP), Opalescence [...] Read more.

Background/Objectives: In-office bleaching commonly employs high concentrations of hydrogen peroxide (HP) or carbamide peroxide (CP), which may compromise enamel integrity. This in vitro paired-design study aimed to compare the chemical and mechanical effects of three commercial bleaching agents—Opalescence Boost (40% HP), Opalescence Quick (45% CP), and BlancOne Ultra+ (35% HP)—on human enamel. The null hypothesis assumed no significant differences between the control and treated samples. Given the ongoing debate over pH, active ingredients, and enamel impact, comparing whitening systems remains clinically important. Methods: Forty-two extracted teeth were assigned to three experimental groups (n = 14) with matched controls. Each underwent a single bleaching session per manufacturer protocol: Opalescence Boost (≤60 min), Opalescence Quick (15–30 min), and BlancOne Ultra+ (three light-activated cycles of 8–10 min). Enamel chemical changes were analyzed by Fourier transform infrared (FTIR) spectroscopy (phosphate and carbonate bands), and surface hardness by Vickers microhardness testing. Paired t-tests (α = 0.05) assessed statistical significance. Results: FTIR analysis revealed alterations in phosphate and carbonate bands for all agents, most notably for Opalescence Boost and BlancOne Ultra+. Microhardness testing showed significant reductions in enamel hardness for Opalescence Boost (control: 37.21 ± 1.74 Hv; treated: 34.63 ± 1.70 Hv; p = 0.00) and Opalescence Quick (control: 45.82 ± 1.71 Hv; treated: 39.34 ± 1.94 Hv; p < 0.0001), whereas BlancOne Ultra+ showed no significant difference (control: 51.64 ± 1.59 HV; treated: 51.60 ± 2.34 Hv; p = 0.95). Conclusions: HP-based agents, particularly at higher concentrations, caused greater enamel alterations than CP-based products. While clinically relevant, the results should be interpreted cautiously due to in vitro limitations and natural enamel variability. Full article

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

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16 pages, 2934 KiB

Open AccessArticle

Chronology and Sequence of Permanent Tooth Eruption in a Multi-Ethnic Urban Population

by Olivia Micheli, Maria Athanasiou, Victor Kristof and Gregory S. Antonarakis

Dent. J. 2025, 13(8), 356; https://doi.org/10.3390/dj13080356 - 6 Aug 2025

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Abstract

Objective: This study aimed to evaluate the mean age of eruption of permanent teeth and their clinical emergence sequence in a longitudinal sample of children from a multi-ethnic urban population. Methods: A total of 854 children (413 females and 441 males), aged between [...] Read more.

Objective: This study aimed to evaluate the mean age of eruption of permanent teeth and their clinical emergence sequence in a longitudinal sample of children from a multi-ethnic urban population. Methods: A total of 854 children (413 females and 441 males), aged between 4 and 13 years, were examined annually for a minimum of 4 consecutive years, as part of their annual dental screening appointment. The presence of permanent teeth was recorded at each examination. Mean and median ages, with standard deviations, of individual tooth eruption were calculated, in addition to the eruption sequence, and the analysis of the data was performed using the lognormal distribution model. Regarding the error of the method, two examiners reviewed all relevant dental screening forms, and any discrepancies were resolved through consultation with the senior author. Results: The sequence of permanent tooth eruption followed a consistent pattern across sexes, with distinct differences between the maxillary and mandibular arches. In the maxilla, eruption began with the first molar, while in the mandible, it started with the central incisor. Mandibular teeth generally erupted earlier than maxillary teeth, with girls experiencing earlier eruption than boys, with some exceptions, and prolonged eruption periods. No statistically significant differences were found in the timing of eruption between contralateral homologous teeth. Conclusions: Based on the present data, the observed sequence of tooth eruption in a multi-ethnic urban population showed similar patterns across sexes. Mandibular teeth generally erupt earlier than maxillary teeth, with girls experiencing earlier eruption than boys. Full article

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

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15 pages, 1228 KiB

Open AccessReview

Antimicrobial Effect of Graphene in Dentistry: A Scoping Review

by Ricardo Martuci, Susana João Oliveira, Mateus Martuci, José Reis-Campos and Maria Helena Figueiral

Dent. J. 2025, 13(8), 355; https://doi.org/10.3390/dj13080355 - 5 Aug 2025

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Abstract

Background/Objectives: The functionalization of various forms of graphene, such as graphene nanoplatelets, graphene oxide, and reduced graphene oxide, in biomaterials is a promising strategy in dentistry, particularly regarding their antimicrobial potential. However, conclusive studies on the toxicity and biocompatibility of graphene-based materials [...] Read more.

Background/Objectives: The functionalization of various forms of graphene, such as graphene nanoplatelets, graphene oxide, and reduced graphene oxide, in biomaterials is a promising strategy in dentistry, particularly regarding their antimicrobial potential. However, conclusive studies on the toxicity and biocompatibility of graphene-based materials remain limited, and standardized guidelines for their production, handling, and dental applications are still lacking. This scoping review aims to map the available studies on various types of graphene, synthesize evidence on their antimicrobial effectiveness, and describe the main biological responses when functionalized in dental biomaterials. Methods: An electronic search was conducted in the Clarivate, PubMed, and Scopus databases using the descriptors as follows: ‘graphene’ AND ‘antimicrobial effect’ AND ‘bactericidal effect’ AND (‘graphene oxide’ OR ‘dental biofilm’ OR ‘antibacterial properties’ OR ‘dental materials’). Article screening and eligibility assessment were performed based on predefined inclusion and exclusion criteria, following the PRISMA-ScR guidelines. Results: The search identified 793 articles. After removing duplicates, applying the eligibility criteria, and performing a full-text analysis of 64 articles, 21 studies were included in the review. Graphene oxide, particularly at low concentrations, was the most commonly studied graphene variant, demonstrating significant antimicrobial efficacy against S. mutans, S. faecalis, E. coli, P. aeruginosa, and C. albicans. Both mechanical and chemical mechanisms have been linked to the biological responses of graphene-doped biomaterials. The biocompatibility and cytotoxicity of these compounds remain controversial, with some studies reporting favorable outcomes, while others raise significant concerns. Conclusions: Graphene shows great promise as an antimicrobial agent in dental biomaterials. Despite encouraging results, more in vitro and in vivo studies are needed to better understand its biocompatibility and cytotoxicity in dental applications. Additionally, standardized production protocols, clearly defined clinical applications in dentistry, and regulatory guidelines from the World Health Organization concerning handling procedures and occupational risks remain necessary. Full article

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

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11 pages, 1037 KiB

Open AccessArticle

Bonding to Demineralized Dentin: Impact of Immediate and Delayed Dentin Sealing over Time

by Erika Pérez-Soto, Rim Bourgi, Louis Hardan, Carlos Enrique Cuevas-Suarez, Ana Josefina Monjáras-Ávila, Miguel Ángel Fernández-Barrera, Nicolas Nassar, Monika Lukomska-Szymanska, Rima Daoui, Naji Kharouf and Youssef Haikel

Dent. J. 2025, 13(8), 354; https://doi.org/10.3390/dj13080354 - 5 Aug 2025

Viewed by 216

Abstract

Background/Objectives: Immediate dentin sealing (IDS) has been widely investigated in sound dentin; however, its efficacy on demineralized dentin remains insufficiently explored. This in vitro experimental study aimed to evaluate the shear bond strength (SBS) of indirect composite resin restorations bonded to demineralized dentin [...] Read more.

Background/Objectives: Immediate dentin sealing (IDS) has been widely investigated in sound dentin; however, its efficacy on demineralized dentin remains insufficiently explored. This in vitro experimental study aimed to evaluate the shear bond strength (SBS) of indirect composite resin restorations bonded to demineralized dentin using IDS, assessed at 24 h and after 6 months of aging. Methods: Twenty-five extracted premolars were randomly divided into five groups: (1) control (no sealing), (2) IDS applied to sound dentin (sound-IDS), (3) IDS applied to demineralized dentin (carious-IDS), (4) delayed dentin sealing (DDS) on sound dentin (sound-DDS), and (5) DDS on demineralized dentin (carious-DDS). SBS values were analyzed using a three-way analysis of variance (ANOVA) with dentin condition (sound vs. demineralized), aging time (24 h vs. 6 months), and sealing strategy (control, IDS, DDS) as independent variables. Statistical analyses were performed using SigmaPlot 12.0, with significance set at p < 0.05. Results: The results showed that IDS led to significantly higher SBS than DDS (p < 0.05). Bond strength was significantly influenced by dentin condition (p < 0.05), and all interactions between variables—particularly between dentin condition and sealing strategy, and between aging time and treatment—were statistically significant (p < 0.001). Overall, bond strength was higher at 24 h than after 6 months. IDS showed optimal performance in sound dentin, while DDS resulted in better long-term outcomes in demineralized dentin. Conclusions: These findings suggest that DDS may be the more effective approach in cases of carious or demineralized dentin. Full article

(This article belongs to the Section Restorative Dentistry and Traumatology)

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13 pages, 248 KiB

Open AccessArticle

The Prevalence and Impact of Dentinal Hypersensitivity on Adults’ Quality of Life in Saudi Arabia

by Haya Alayadi, Omar Alsadon, Maram Ali Alwadi, Alaa A. Alkhateeb, Deema Alroweilly, Zainab Alassmi and Wedad Alshehri

Dent. J. 2025, 13(8), 353; https://doi.org/10.3390/dj13080353 - 4 Aug 2025

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Abstract

Background: Dentinal hypersensitivity (DH) significantly impacts oral health-related quality of life. While global prevalence estimates range from 10–15%, region-specific data from Saudi Arabia remain limited. This study also aligns with Saudi Vision 2030’s mental health initiatives, as DH-associated anxiety impacts overall well-being. This [...] Read more.

Background: Dentinal hypersensitivity (DH) significantly impacts oral health-related quality of life. While global prevalence estimates range from 10–15%, region-specific data from Saudi Arabia remain limited. This study also aligns with Saudi Vision 2030’s mental health initiatives, as DH-associated anxiety impacts overall well-being. This study assessed DH prevalence and quality of life impact among Saudi adults. Methods: A cross-sectional online survey was conducted among 748 Saudi adults aged ≥ 18 years between April and May. Data were collected using a validated Arabic Dentinal Hypersensitivity Experience Questionnaire (DHEQ) alongside socio-demographic variables. Participants reporting DH symptoms within 12 months were included in impact analyses. Descriptive statistics and one-way ANOVA examined associations between DHEQ scores and participant characteristics. Results: Self-reported DH prevalence was 54.3% (n = 406), substantially exceeding global estimates. Among affected individuals, mean DHEQ score was 0.56 ± 0.19, indicating moderate-to-substantial quality-of-life impact. Functional limitations were most affected, particularly enjoyment of eating and drinking (0.72 ± 0.21). Significant associations were identified between higher DHEQ scores and age extremes (<18 and >35 years; p < 0.001), higher income levels (p = 0.032), fewer teeth (p = 0.040), and dental pain presence (p = 0.009). Sex, residence, education, and employment showed no significant associations. Conclusions: More than half of Saudi adults reported DH symptoms, representing a significant public health concern with substantial quality of life implications. Prevalence substantially exceeds global estimates, highlighting the need for targeted interventions. Age, income, tooth count, and pain presence emerged as key factors. These findings support developing population-specific prevention strategies, particularly targeting younger and older adults with tooth loss. Full article

(This article belongs to the Special Issue Dentinal Hypersensitivity)

13 pages, 2273 KiB

Open AccessArticle

Impact of Shades and Thickness on the Polymerization of Low-Viscosity Bulk-Fill Composites in Pediatric Restorations: An In Vitro Study

by Gennaro Musella, Stefania Cantore, Maria Eleonora Bizzoca, Mario Dioguardi, Rossella Intini, Lorenzo Lo Muzio, Federico Moramarco, Francesco Pettini and Andrea Ballini

Dent. J. 2025, 13(8), 352; https://doi.org/10.3390/dj13080352 - 1 Aug 2025

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Abstract

Background/Objectives: This study aimed to investigate the influence of shade and thickness on the polymerization of SDR^® flow+, a low-viscosity bulk-fill composite, by assessing its degree of conversion (DC). Methods: An in vitro study was conducted using SDR^® flow+ composite resin. [...] Read more.

Background/Objectives: This study aimed to investigate the influence of shade and thickness on the polymerization of SDR^® flow+, a low-viscosity bulk-fill composite, by assessing its degree of conversion (DC). Methods: An in vitro study was conducted using SDR^® flow+ composite resin. Specimens were prepared at two thicknesses (2 mm and 4 mm) and four shades (Universal, A1, A2, A3). Polymerization was performed using a high-intensity LED curing unit. The DC was assessed using Fourier-transform infrared spectroscopy (ATR-FTIR). Results: Both shade and thickness significantly influenced DC. Thicker specimens (4 mm) exhibited reduced polymerization compared to thinner specimens (2 mm). Darker shades, particularly A3, demonstrated the lowest DC values due to their higher chroma, which limits light penetration. In contrast, the Universal shade achieved higher DC values, even at increased depths, likely due to its greater translucency. Conclusions: Shade and thickness play a critical role in the polymerization of bulk-fill composites. Ensuring adequate polymerization is essential for the longevity of pediatric restorations. Further in vivo research is needed to confirm these findings and assess their clinical implications. Full article

(This article belongs to the Special Issue Women's Research in Dentistry)

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17 pages, 14783 KiB

Open AccessArticle

Behavior of Osteoblastic Lineage Cells When in the Presence of Tamoxifen: In Vitro and In Vivo Studies on Osseointegration

by Luiz Guilherme Fiorin, Emanuela Galliera, Henrique R. Matheus, Dolaji Henin, Edilson Ervolino, Gabriela Carrara Simionato, Juliano Milanezi de Almeida and Claudia Dellavia

Dent. J. 2025, 13(8), 351; https://doi.org/10.3390/dj13080351 - 1 Aug 2025

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Abstract

Background/Objectives: Tamoxifen, a selective estrogen receptor modulator widely used as an adjunct in the treatment of breast cancer, has known effects on bone metabolism, although its impact on osseointegration and cellular responses during early bone healing remains unclear. Understanding these effects is essential [...] Read more.

Background/Objectives: Tamoxifen, a selective estrogen receptor modulator widely used as an adjunct in the treatment of breast cancer, has known effects on bone metabolism, although its impact on osseointegration and cellular responses during early bone healing remains unclear. Understanding these effects is essential given the increasing use of dental implants in cancer survivors. The study aimed to observe the influence of tamoxifen on human osteosarcoma (SAOS-2) cells lines, as well on the osseointegration of titanium implants in ovariectomized female rats. Methods: SAOS-2 cells were incubated with Dulbecco’s modified growth medium. Six titanium (Ti) disks were used at each time point. The samples were divided into groups with the presence (TAM, n = 36) or not (CTR, n = 36) of tamoxifen in a concentration of 2 μM. In vivo, 72 animals were divided in groups with bilateral ovariectomy or SHAM and tamoxifen administration or not (15 mg/kg). Cell viability, mineralization rate, and collagen synthesis were assessed, as well as bone/implant contact (BIC) and bone ingrowth (BIN). Results: Tamoxifen caused a decrease in SAOS-2 viability, although an increase in the mineralization rate was observed. In vivo, the TAM groups presented higher BIC and BIN when compared to their control, but a lower percentage of mature collagen cells. Conclusions: Based on our findings, in vitro, the therapy with TAM slightly reduced the viability of SAOS-2 cells while significantly increasing the mineralization rate. In vivo, the therapy positively influenced BIC and BIN during the osseointegration phase. Full article

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12 pages, 4568 KiB

Open AccessArticle

Histomorphometric Evaluation of Gingival Phenotypic Characteristics: A Cross-Sectional Study

by Dimitrios Papapetros, Karin Nylander and Sotirios Kalfas

Dent. J. 2025, 13(8), 350; https://doi.org/10.3390/dj13080350 - 31 Jul 2025

Viewed by 179

Abstract

Objectives: This study aims to explore the histological dimensions of the gingiva and the alveolar mucosa and to evaluate their associations with gingival phenotypic parameters, including gingival thickness (GT), keratinized tissue width (KTW), and gingival transparency. Methods: Histological and clinical assessments were [...] Read more.

Objectives: This study aims to explore the histological dimensions of the gingiva and the alveolar mucosa and to evaluate their associations with gingival phenotypic parameters, including gingival thickness (GT), keratinized tissue width (KTW), and gingival transparency. Methods: Histological and clinical assessments were performed on 45 healthy volunteers. Gingival and mucosal tissue samples were collected from the mucogingival junction region of one maxillary central incisor. Histomorphometric analysis included measurements of gingival and mucosal thickness, epithelial thickness, connective tissue thickness, epithelial papilla length and density, and keratinization. Clinical parameters included KTW and probe visibility upon insertion into the gingival sulcus. Correlations were statistically analyzed between clinical and histological parameters. Results: Probe visibility showed no significant correlations with any assessed parameter. Histological gingival thickness strongly correlated with gingival connective tissue thickness, moderately with epithelial thickness and papilla length, and weakly with papilla density. Mucosal thickness was strongly associated with connective tissue thickness and moderately with keratinization, but not with other parameters. KTW exhibited weak correlations with epithelial thickness and papilla length. Conclusions: Variability in gingival and mucosal thickness is primarily determined by connective tissue thickness, with a smaller contribution from the epithelium. Increased thickness is associated with longer, sparser epithelial papillae and with a tendency toward higher keratinization. KTW is significantly associated with epithelial thickness and papilla length, underscoring its relevance in gingival phenotype characterization. Full article

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11 pages, 1298 KiB

Open AccessTechnical Note

Ultrasound Imaging: Advancing the Diagnosis of Periodontal Disease

by Gaël Y. Rochefort, Frédéric Denis and Matthieu Renaud

Dent. J. 2025, 13(8), 349; https://doi.org/10.3390/dj13080349 - 29 Jul 2025

Viewed by 279

Abstract

Objectives: This pilot study evaluates the correlation between periodontal pocket depth (PPD) measurements obtained by manual probing and those derived from an AI-coupled ultrasound imaging device in periodontitis patients. Materials and Methods: Thirteen patients with periodontitis underwent ultrasonic probing with an [...] Read more.

Objectives: This pilot study evaluates the correlation between periodontal pocket depth (PPD) measurements obtained by manual probing and those derived from an AI-coupled ultrasound imaging device in periodontitis patients. Materials and Methods: Thirteen patients with periodontitis underwent ultrasonic probing with an AI engine for automated PPD measurements, followed by routine manual probing. Results: A total of 2088 manual and 1987 AI-based PPD measurements were collected. The mean PPD was 4.2 mm (range: 2–8 mm) for manual probing and 4.5 mm (range: 2–9 mm) for AI-based ultrasound, with a Pearson correlation coefficient of 0.68 (95% CI: 0.62–0.73). Discrepancies were noted in cases with inflammation or calculus. AI struggled to differentiate pocket depths in complex clinical scenarios. Discussion: Ultrasound imaging offers non-invasive, real-time visualization of periodontal structures, but AI accuracy requires further training to address image artifacts and clinical variability. Conclusions: The ultrasound device shows promise for non-invasive periodontal diagnostics but is not yet a direct alternative to manual probing. Further AI optimization and validation are needed. Clinical Relevance: This technology could enhance patient comfort and enable frequent monitoring, pending improvements in AI reliability. Full article

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

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11 pages, 209 KiB

Open AccessArticle

Knowledge and Awareness of Dental Students and Practitioners About the Utilization of Endocrown

by Raneem Alfahad, Maryam Quritum, Lamia Hakami, Maha Aldandan, Osama Alharbi, Omar Almasoud, Abdullah Alasafirah and Passent Ellakany

Dent. J. 2025, 13(8), 348; https://doi.org/10.3390/dj13080348 - 29 Jul 2025

Viewed by 275

Abstract

Background/Objectives: The aim of this study was to evaluate the level of awareness among dental students and practitioners regarding the utilization of endocrowns in clinical settings, along with any differences in knowledge based on gender, educational level, and workplace. Methods: A [...] Read more.

Background/Objectives: The aim of this study was to evaluate the level of awareness among dental students and practitioners regarding the utilization of endocrowns in clinical settings, along with any differences in knowledge based on gender, educational level, and workplace. Methods: A cross-sectional online survey-based study was conducted, including 1154 participants from various dental institutions across Saudi Arabia. The questionnaire included demographic data and closed-ended questions focused on knowledge and awareness of endocrowns. Data was analyzed using statistical tests, including chi-square, to see any significant differences. Results: Most participants (81%) had knowledge about endocrowns, mainly from their colleagues. Knowledge levels and preferences (like the use of lithium disilicate and adhesive resin cement) differed based on gender, educational level, and workplace. Male participants and undergraduates showed better awareness in some areas. Faculty members mostly depend on college training, while private practitioners obtain most of their information from workshops. Conclusions: Males showed significant superiority in knowledge about endocrown usage. Colleges were the most prevalent source of information regarding endocrown restorations. Significant molar tooth loss and restricted inter-arch space were the most common reasons for utilizing endocrowns. Moreover, endocrowns were considered a viable alternative to traditional post and core. Full article

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

12 pages, 1313 KiB

Open AccessArticle

Chair-Time During Polishing with Different Burs and Drills After Cement Customized Brackets Bonding: An In Vitro Comparative Study

by Javier Flores-Fraile, Alba Belanche Monterde, Oscar Alonso-Ezpeleta, Cosimo Galletti and Álvaro Zubizarreta-Macho

Dent. J. 2025, 13(8), 347; https://doi.org/10.3390/dj13080347 - 28 Jul 2025

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Abstract

Introduction: Digital planning and evolution of technology is allowing dentistry to be more efficient in time than before. In orthodontics the main purpose is to obtain fewer patient visits and to reduce the bonding time. For that, indirect bonding planned with CAD-CAM softwares [...] Read more.

Introduction: Digital planning and evolution of technology is allowing dentistry to be more efficient in time than before. In orthodontics the main purpose is to obtain fewer patient visits and to reduce the bonding time. For that, indirect bonding planned with CAD-CAM softwares is used to obtain a shorter treatment period, in general, and less chair-time. This waste of chair-time should also be reduced in other fields of dentistry such as endodontics, surgery, prosthodontics, and aesthetics. Methods: A total of 504 teeth were embedded into epoxy resin models mounted as a dental arch. Customized lingual multibracket appliances were bonded by a current adhesion protocol. After that, they were debonded, the polishing of cement remnants was performed with three different burs and two drills. The polishing time of each group was recorded by an iPhone 14 chronometer. Results: Descriptive and comparative statistical analyses were performed with the different study groups. Statistical differences (p < 0.005) between diamond bur and tungsten carbide and white stone burs and turbine were obtained, with the first being the slowest of them. Discussion: Enamel roughness was widely studied in orthodontics polishing protocol as the main variable for protocols establishment. However, in lingual orthodontics, due the difficulty of the access to the enamel surfaces, the protocol is not clear and efficiency should be considered. It was observed that the tungsten carbide bur is the safest bur. It was also recommended that a two-step protocol of polishing by tungsten carbide bur be followed by polishers. Conclusions: A tungsten carbide bur mounted in a turbine was the most efficient protocol for polishing after lingual bracket debonding. Full article

(This article belongs to the Special Issue Malocclusion: Treatments and Rehabilitation)

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17 pages, 574 KiB

Open AccessSystematic Review

Hydrogen Peroxide-Free Color Correctors for Tooth Whitening in Adolescents and Young Adults: A Systematic Review of In Vitro and Clinical Evidence

by Madalina Boruga, Gianina Tapalaga, Magda Mihaela Luca and Bogdan Andrei Bumbu

Dent. J. 2025, 13(8), 346; https://doi.org/10.3390/dj13080346 - 28 Jul 2025

Viewed by 734

Abstract

Background: The rising demand for aesthetic dental treatments has spurred interest in peroxide-free color correctors as alternatives to traditional hydrogen peroxide formulations, which are associated with tooth sensitivity and potential enamel demineralization. This systematic review evaluates the whitening efficacy and safety profile of [...] Read more.

Background: The rising demand for aesthetic dental treatments has spurred interest in peroxide-free color correctors as alternatives to traditional hydrogen peroxide formulations, which are associated with tooth sensitivity and potential enamel demineralization. This systematic review evaluates the whitening efficacy and safety profile of hydrogen peroxide-free color corrector (HPFCC) products, focusing on color change metrics, enamel and dentin integrity, and adverse effects. Methods: Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science throughout January 2025 for randomized controlled trials, observational studies, and in vitro experiments comparing HPFCC to placebo or peroxide-based agents. The data extraction covered study design, sample characteristics, intervention details, shade improvement (ΔE00 or CIE Lab), enamel/dentin mechanical properties (microhardness, roughness, elastic modulus), and incidence of sensitivity or tissue irritation. Risk of bias was assessed using the Cochrane tool for clinical studies and the QUIN tool for in vitro research. Results: Six studies (n = 20–80 samples or subjects) met the inclusion criteria. In vitro, HPFCC achieved mean ΔE00 values of 3.5 (bovine incisors; n = 80) and 2.8 (human molars; n = 20), versus up to 8.9 for carbamide peroxide (p < 0.01). Across studies, HPFCC achieved a mean ΔE00 of 2.8–3.5 surpassing the perceptibility threshold of 2.7 and approaching the clinical acceptability benchmark of 3.3. Surface microhardness increased by 12.9 ± 11.7 VHN with HPFCC (p < 0.001), and ultramicrohardness rose by 110 VHN over 56 days in prolonged use studies. No significant enamel erosion or dentin roughness changes were observed, and the sensitivity incidence remained below 3%. Conclusions: These findings derive from one clinical trial (n = 60) and five in vitro studies (n = 20–80), encompassing violet-pigment serums and gels with differing concentrations. Due to heterogeneity in designs, formulations, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. Although HPFCC ΔE00 values were lower than those of carbamide peroxide, they consistently exceeded perceptibility thresholds while maintaining enamel integrity and causing sensitivity in fewer than 3% of subjects, supporting HPFCCs as moderate but safe alternatives for young patients. Full article

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15 pages, 642 KiB

Open AccessArticle

MIH and Cavities as Markers of Oral Health Inequality in Children from Southwest Andalusia (Spain)

by Leidy Bech Barcaz, David Ribas-Pérez, Paloma Villalva Hernandez-Franch, Luis El Khoury-Moreno, Julio Torrejón-Martínez and Antonio Castaño-Séiquer

Dent. J. 2025, 13(8), 345; https://doi.org/10.3390/dj13080345 - 26 Jul 2025

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Abstract

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral [...] Read more.

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

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

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12 pages, 1341 KiB

Open AccessArticle

Effect of Storage Temperature and Storage Time on the pH and Oxidation–Reduction Potential of Commercial Oral Moisturizers

by Mamoru Murakami, Sara Komabashiri, Kae Harada, Takaharu Shimizu and Masahiro Nishimura

Dent. J. 2025, 13(8), 344; https://doi.org/10.3390/dj13080344 - 24 Jul 2025

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Abstract

Background/Objective: The criteria for selecting and managing oral moisturizers have yet to be clearly defined. The purpose of this study was to examine the effects of storage temperature and storage time on the pH and oxidation–reduction potential (ORP) of oral moisturizers. Methods [...] Read more.

Background/Objective: The criteria for selecting and managing oral moisturizers have yet to be clearly defined. The purpose of this study was to examine the effects of storage temperature and storage time on the pH and oxidation–reduction potential (ORP) of oral moisturizers. Methods: The pH and ORP of 20 commercially available oral moisturizers stored at 37 °C, 25 °C, and 4 °C were measured immediately after opening (0M) and at 1 month (1M), 3 months (3M), and 6 months (6M) post-opening. The data were analyzed using Fisher’s exact test based on the critical pH of enamel and dentin, two-way repeated-measures analysis of variance (ANOVA), and Pearson’s correlation analysis. Results: At 0M, 25% of the products had pH values below the critical threshold for enamel, and 75% fell below that for dentin. The distribution of products significantly differed based on critical pH thresholds (p < 0.05). The two-way repeated-measures ANOVA showed that the pH was significantly affected by the storage time (p < 0.05), but not by the storage temperature or its interaction with time. By contrast, ORP was significantly affected by the storage temperature, storage time, and their interaction (p < 0.05). The Pearson’s correlation analysis revealed a significant negative correlation between pH and ORP at 4 °C (6M), 25 °C (1M, 3M, 6M), and 37 °C (all time points) (p < 0.05). Conclusions: Many oral moisturizers exhibit acidic pH values, indicating that products with a pH of 6.7 or higher should be selected. Additionally, to minimize degradation, oral moisturizers should be stored at 4 °C and used within 3 months of opening. Full article

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15 pages, 504 KiB

Open AccessArticle

Reliability of Large Language Model-Based Chatbots Versus Clinicians as Sources of Information on Orthodontics: A Comparative Analysis

by Stefano Martina, Davide Cannatà, Teresa Paduano, Valentina Schettino, Francesco Giordano and Marzio Galdi

Dent. J. 2025, 13(8), 343; https://doi.org/10.3390/dj13080343 - 24 Jul 2025

Viewed by 328

Abstract

Objectives: The present cross-sectional analysis aimed to investigate whether Large Language Model-based chatbots can be used as reliable sources of information in orthodontics by evaluating chatbot responses and comparing them to those of dental practitioners with different levels of knowledge. Methods: [...] Read more.

Objectives: The present cross-sectional analysis aimed to investigate whether Large Language Model-based chatbots can be used as reliable sources of information in orthodontics by evaluating chatbot responses and comparing them to those of dental practitioners with different levels of knowledge. Methods: Eight true and false frequently asked orthodontic questions were submitted to five leading chatbots (ChatGPT-4, Claude-3-Opus, Gemini 2.0 Flash Experimental, Microsoft Copilot, and DeepSeek). The consistency of the answers given by chatbots at four different times was assessed using Cronbach’s α. Chi-squared test was used to compare chatbot responses with those given by two groups of clinicians, i.e., general dental practitioners (GDPs) and orthodontic specialists (Os) recruited in an online survey via social media, and differences were considered significant when p < 0.05. Additionally, chatbots were asked to provide a justification for their dichotomous responses using a chain-of-through prompting approach and rating the educational value according to the Global Quality Scale (GQS). Results: A high degree of consistency in answering was found for all analyzed chatbots (α > 0.80). When comparing chatbot answers with GDP and O ones, statistically significant differences were found for almost all the questions (p < 0.05). When evaluating the educational value of chatbot responses, DeepSeek achieved the highest GQS score (median 4.00; interquartile range 0.00), whereas CoPilot had the lowest one (median 2.00; interquartile range 2.00). Conclusions: Although chatbots yield somewhat useful information about orthodontics, they can provide misleading information when dealing with controversial topics. Full article

(This article belongs to the Special Issue Smart Data, Smart Care: Shaping the Digital Dental Patient in the Age of AI)

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9 pages, 676 KiB

Open AccessArticle

Thermal Effects of Pulsed Infrared Lasers on Zirconia Implants at Different Temperatures In Vitro

by George Kokkinos, Maryam Hafeez, Joseph De Leon and Georgios E. Romanos

Dent. J. 2025, 13(8), 342; https://doi.org/10.3390/dj13080342 - 24 Jul 2025

Viewed by 190

Abstract

Objectives: The aim of this study was to determine the differential temperature produced on ceramic implants using laser irradiation on a pulsed setting of intrabony defects in vitro. Methods: A ceramic (Zr) dental implant (Zeramex, 4.8 × 12 mm) was placed into a [...] Read more.

Objectives: The aim of this study was to determine the differential temperature produced on ceramic implants using laser irradiation on a pulsed setting of intrabony defects in vitro. Methods: A ceramic (Zr) dental implant (Zeramex, 4.8 × 12 mm) was placed into a bovine bone block. A three-wall intrabony defect (6 × 4 × 3 mm) was created to mimic an osseous peri-implant defect. Thermocouples were placed on the apical and coronal areas to measure temperature changes (∆T) during 60 s of laser irradiation. The bovine block was heated to 37 °C, and the defect walls were irradiated with the CO₂ and Er,Cr:YSGG laser. The settings used were pulsed mode for both lasers, with 30 Hz and 1.5 W for the Er,Cr:YSGG laser and 70 Hz and 2 W for the CO₂ laser. The same laser settings were repeated at room temperature (RT, 23 °C). Twenty trials were performed for each experimental group at room and body temperature for assessment of ∆T. Paired t-test were used to compare the measurements between 37 °C and 23 °C for the Er,Cr:YSGG, and CO₂ laser, respectively. Results: The CO₂ laser resulted in the highest ∆T (°C) at the coronal (15.22 ± 0.28/8.82 ± 0.21) and apical (5.84 ± 0.14/2.30 ± 0.28) level when this laser was used in both room temperature and body temperature, respectively. The highest ∆T (°C) for the Er,Cr:YSGG laser at body temperature at the coronal thermocouple was 7.64 ± 0.55, while for the CO₂ laser, at body temperature was 8.82 ± 0.21. Conclusion: Within the limitations of our study, the use of CO₂ laser and Er,Cr:YSGG laser on peri-implant defects generally appears to be safe in treating peri-implant defects around zirconia implants in vitro. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Laser in Periodontology, Implantology and Prevention)

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16 pages, 2558 KiB

Open AccessArticle

Bonding Orthodontic Attachments to 3D-Printed Photosensitive Definitive Resin: An In Vitro Study

by Omaika Victoria Criollo-Barrios, Carlos Roberto Luna-Domínguez, Carlos Alberto Luna-Lara, Ricardo de Jesus Figueroa-López, Ronaldo Câmara Cozza and Jorge Humberto Luna-Domínguez

Dent. J. 2025, 13(8), 341; https://doi.org/10.3390/dj13080341 - 24 Jul 2025

Viewed by 279

Abstract

Background/Objectives: The increasing clinical integration of 3D-printed definitive resins requires a comprehensive understanding of their physicochemical properties and adhesive behavior. However, there is limited evidence regarding the optimal surface treatment and bonding strategies for clear aligner composite attachments on these materials. This [...] Read more.

Background/Objectives: The increasing clinical integration of 3D-printed definitive resins requires a comprehensive understanding of their physicochemical properties and adhesive behavior. However, there is limited evidence regarding the optimal surface treatment and bonding strategies for clear aligner composite attachments on these materials. This study aimed to characterize a 3D-printed definitive resin, evaluate the effects of surface treatments on its surface topography, and compare the shear bond strength (SBS) of the bonded attachments using different adhesive systems, both before and after thermocycling. Methods: A total of 120 rectangular specimens were fabricated from a 3D printed dental resin (Crowntec^®, SAREMCO Dental AG—Mexico City, Mexico). For physicochemical characterization, six samples underwent scanning electron microscopy/energy-dispersive spectroscopy, X-ray diffraction, and thermogravimetric analysis. To evaluate surface topography, 42 polished specimens were assigned to three groups: untreated (control), etched with 4% hydrofluoric acid (HFA), or sandblasted with 50 µm Al₂O₃ (AA). Each group was subdivided for SEM observation and surface roughness (Ra) measurement. For SBS testing, 72 additional samples received the same surface treatments and were further subdivided according to the adhesive system: Transbond™ XT Primer (TXT) or Single Bond Universal (SBU). Results: The AA group showed the highest Ra (2.21 ± 0.30 µm), followed by HFA (0.81 ± 0.20 µm) and control (0.07 ± 0.30 µm) (p < 0.001). The highest SBS was observed in the AA + SBU group, followed by AA + TXT. Conclusions: Sandblasting with Al₂O₃ particles, combined with a universal adhesive, significantly improved bond strength, suggesting a viable protocol for 3D printed definitive composites in aligner attachment applications. Full article

(This article belongs to the Section Dental Materials)

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14 pages, 1322 KiB

Open AccessSystematic Review

Neuroimaging Signatures of Temporomandibular Disorder and Burning Mouth Syndrome: A Systematic Review

by Sarah Fischer, Charalampos Tsoumpas, Pavneet Chana, Richard G. Feltbower and Vishal R. Aggarwal

Dent. J. 2025, 13(8), 340; https://doi.org/10.3390/dj13080340 - 24 Jul 2025

Viewed by 294

Abstract

Background: Chronic primary orofacial pain (COFP) affects approximately 7% of the population and often leads to reduced quality of life. Patients frequently undergo multiple assessments and treatments across healthcare disciplines, often without a definitive diagnosis. The 2019 ICD-11 classification of chronic primary pain [...] Read more.

Background: Chronic primary orofacial pain (COFP) affects approximately 7% of the population and often leads to reduced quality of life. Patients frequently undergo multiple assessments and treatments across healthcare disciplines, often without a definitive diagnosis. The 2019 ICD-11 classification of chronic primary pain clusters together COFP subtypes based on chronicity and associated functional and emotional impairment. Objective: This study aimed to evaluate whether these subtypes of COFP share common underlying mechanisms by comparing neuroimaging findings. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Searches were performed using Medline (OVID) and Scopus up to April 2025. Inclusion criteria focused on MRI-based neuroimaging studies of participants diagnosed with COFP subtypes. Data extraction included participant demographics, imaging modality, brain regions affected, and pain assessment tools. Quality assessment used a modified Coleman methodological score. Results: Fourteen studies met the inclusion criteria, all utilising MRI and including two COFP subtypes (temporomandibular disorder and burning mouth syndrome). Resting- and task-state imaging revealed overlapping alterations in several brain regions, including the thalamus, somatosensory cortices (S1, S2), cingulate cortex, insula, prefrontal cortex, basal ganglia, medial temporal lobe, and primary motor area. These changes were consistent across both TMD and BMS populations. Conclusions: The findings suggest that chronic primary orofacial pain conditions (TMD and BMS) may share common central neuroplastic changes, supporting the hypothesis of a unified pathophysiological mechanism. This has implications for improving diagnosis and treatment strategies, potentially leading to more targeted and effective care for these patients. Full article

(This article belongs to the Topic Oral Health Management and Disease Treatment)

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11 pages, 3472 KiB

Open AccessCase Report

The Use of a Digitally Generated Matrix for Consistent Shade Recording in Tooth Bleaching—A Case Report

by Cristian Abad-Coronel, Guissell Vallejo-Yupa, Paulina Aliaga, Nancy Mena-Córdova, Jorge Alonso Pérez-Barquero and José Amengual-Lorenzo

Dent. J. 2025, 13(8), 339; https://doi.org/10.3390/dj13080339 - 24 Jul 2025

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Abstract

Objectives: The aim of this study was to evaluate the effectiveness of spectrophotometers for objective tooth color measurement, particularly in bleaching procedures enhanced by digital positioning templates. Methods: Tooth color registration was conducted using both subjective methods with shade guides and objective methods [...] Read more.

Objectives: The aim of this study was to evaluate the effectiveness of spectrophotometers for objective tooth color measurement, particularly in bleaching procedures enhanced by digital positioning templates. Methods: Tooth color registration was conducted using both subjective methods with shade guides and objective methods with spectrophotometers. Spectrophotometers were chosen for their ability to provide objective, quantifiable, and reproducible results, crucial for monitoring color modifications accurately. Digital workflows were implemented to enhance the registration process further. These workflows included providing a precise positioning matrix for spectrophotometer sensors and optimizing working models to ensure high-quality therapeutic splints. Results: The use of spectrophotometers demonstrated superior performance in registering tooth color objectively compared to subjective shade guides. Digital workflows significantly improved the precision and efficiency of spectrophotometer measurements through a digital matrix, enhancing the quality of therapeutic splints obtained. Conclusions: Spectrophotometers are recommended for objective and precise tooth color registration, particularly in bleaching procedures. Integrating a digital positioning matrix enhances measurement accuracy and reliability, supporting effective monitoring and treatment outcomes. Full article

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

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14 pages, 1895 KiB

Open AccessArticle

MicroRNA Signatures in Dental Pulp Stem Cells Following Nicotine Exposure

by David Vang, Leyla Tahrani Hardin, Nabil Abid, Der Thor and Nan Xiao

Dent. J. 2025, 13(8), 338; https://doi.org/10.3390/dj13080338 - 23 Jul 2025

Viewed by 306

Abstract

Background and Objectives: Nicotine is the most well-studied toxic substance in cigarette smoke and e-cigarette vape. However, smoke and vape are composed of other components that have a negative impact on health. The objective of this study is to investigate whether nicotine has [...] Read more.

Background and Objectives: Nicotine is the most well-studied toxic substance in cigarette smoke and e-cigarette vape. However, smoke and vape are composed of other components that have a negative impact on health. The objective of this study is to investigate whether nicotine has a distinctive impact on molecular mechanisms in stem cells. Methods: The cellular impact of nicotine on the regenerative capacity of human dental pulp stem cells (DPSCs) and the microRNA (miRNA) profile was examined. Bioinformatic analysis was performed to identify miRNA-regulated cellular pathways associated with nicotine exposure. These pathways were then compared to those induced by cigarette smoke condensate (CSC). Results: Prolonged exposure to nicotine significantly impaired the regeneration of DPSCs and changed the expression of miRNAs. Nicotine upregulated the expression of hsa-miR-7977, hsa-miR-3178, and hsa-miR-10400-5p compared to vehicle control. Interestingly, nicotine did not change the expression of hsa-miR-29b-3p, hsa-miR-199b-5p, hsa-miR-26b-5p, or hsa-miR-26a-5p compared to the control. However, the expressions of these miRNAs were significantly altered when compared to CSC treatment. Further analysis revealed that nicotine was distinctively associated with certain miRNA-targeted pathways including apoptosis, ErbB, MAPK signaling, PI3K-Akt, TGF-b signaling, and Wnt signaling. Conclusions: Our work provides evidence on the distinctive miRNA signature induced by nicotine. The information will be important for identifying the unique molecular pathways downstream of nicotine from smoking and vaping in different individuals, providing a new direction for personalized disease prevention, prognosis, and treatment. Full article

(This article belongs to the Special Issue Recreational Drugs, Smoking, and Their Impact on Oral Health)

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Dent. J., Volume 13, Issue 8 (August 2025) – 36 articles

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