Oral, Volume 5, Issue 2 (June 2025) – 14 articles

Background/Objectives: Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppressive agent used in the management of oral mucocutaneous diseases, particularly in autoimmune and inflammatory conditions, such as pemphigus vulgaris (PV), oral lichen planus (OLP), mucous membrane pemphigoid (MMP), systemic lupus erythematosus (SLE), erythema multiforme (EM) and recurrent aphthous stomatitis (RAS). This review consolidates the current evidence regarding MMF’s efficacy, safety and clinical applications across these conditions. Methods: A comprehensive review of literature was performed, focusing on the mechanism of action, dosing strategies, therapeutic outcomes and adverse effects associated with MMF therapy in oral mucocutaneous diseases. The potential of therapeutic drug monitoring (TDM) in optimizing MMF therapy and minimizing adverse effects was also explored. Results: The review demonstrates that MMF is effective in inducing disease remission in up to 80% of patients with PV, with notable steroid-sparing effects. In OLP, MMF provided significant clinical improvement, especially in patients with severe and refractory forms of the disease. For MMP, MMF showed an 89% response rate, particularly when combined with corticosteroids, though gastrointestinal side effects were noted in some patients. In SLE, MMF was effective in managing both renal and non-renal manifestations, with favorable remission rates observed in patients receiving MMF therapy. For EM, MMF’s effectiveness was limited, with only a small number of patients responding to therapy. In RAS, there is limited evidence of MMF’s efficacy, with only partial improvement in severe cases reported. MMF is a promising immunomodulatory therapy for oral mucocutaneous diseases, particularly in reducing corticosteroid dependence and improving patient outcomes. However, the variability in the study designs, dosages and patient populations complicates the generalization of these findings. Conclusions: There is a pressing need for randomized controlled trials to validate MMF’s efficacy and long-term safety across all disease categories. The integration of therapeutic drug monitoring (TDM) shows potential for improving disease control and minimizing adverse effects, making it a key consideration for future research. Full article

Background: Mandibular movement is inherently complex, involving both lateral and vertical components. In older adults, this complexity is compounded by diminished neuromuscular coordination and reduced proprioceptive feedback, often impairing effective mastication. Objectives: This study aimed to review dental literature on the influence of masticatory parameters in the formation of wear facets on acrylic resin denture teeth. Methods: A targeted literature review was conducted, analyzing peer-reviewed studies from 1991 to 2024 through PubMed and Scopus. The review focused on masticatory parameters, age-related neuromuscular adaptations, chewing patterns, and preferred-side denture tooth wear, affecting older adults using complete removable dentures. Results: Mandibular movement characteristics—particularly velocity, duration, and cycle frequency—were found to significantly influence denture tooth wear, often resulting in reduced bite force and masticatory efficiency. Contemporary denture materials demonstrated improved wear resistance, aiding in the regulation of chewing frequency and velocity. These factors are increasingly important as age-related changes impact the stomatognathic system. Notably, wear facets were most prominent on the maxillary first molars, regardless of the occlusal scheme. Conclusions: This review provided a comprehensive overview of existing research, analyzed current evidence, and offered insights into the role of masticatory function and wear characteristics in older complete denture wearers. Full article

Aim: This study aimed to assess the impact of rapid palatal expansion (RPE) treatment on vertical craniodentofacial characteristics and upper airway dimensions in individuals with crossbites and skeletal discrepancies. Subjects and Methods: The study involved 38 participants, including 15 boys and 23 girls who received treatment with RPE. Lateral cephalograms were taken before and after the treatment and were analyzed both before and after the treatment using the AudaxCeph version 6.6.12.4731 and Facad software version 3.15.0.1167. For airway dimensions, McNamara analysis was used, and for craniofacial characteristics, cephalometric analysis was used. The study measured 14 parameters in the standard cephalometric analysis and 6 parameters in the airway analysis. Results: The findings indicated a significant decrease in the mandibular angle (MeGoAr, p < 0.001). The angle between the cranial base and the nasal line (SNNL, p = 0.96), intermaxillary angle (p = 0.58), Björk’s polygon (p = 0.67) and the angle between the cranial base and the mandibular angle (SNGoGn, p = 0.96) did not change significantly. A significant increase in the upper pharynx was found after treatment in both the RPE group (p = 0.033) and the RPE + Face Mask (FM) group (p = 0.016) The increase in the upper airway in the RPE group was borderline significant (p = 0.048). Conclusion: No significant differences were found between the experimental groups for changes in airway dimensions after treatment. RPE treatment did not led to an increase in vertical craniodentofacial characteristics. Both RPE and RPE + FM treatments induced an increase in upper pharynx dimensions. Full article

Objective: This study aims to evaluate cell proliferation capacity and micronuclei incidence in the presence of nickel–chromium (Ni-Cr)-based dental alloys, with and without the addition of beryllium (Be). The use of these alloys in dental prosthetics is widespread; however, the potential risks associated with their genotoxicity and cytotoxicity require further investigation. The study seeks to provide insight into the safety of these materials and their long-term impact on the health of both patients and dental professionals. Methods: The study was conducted through a comparative analysis of genotoxicity and cytotoxicity using human lymphocyte cultures exposed to two types of Ni-Cr-based dental alloys, one containing beryllium and the other without beryllium. The evaluations were performed according to the OECD Test No. 487 guideline, employing the micronucleus assay and cell proliferation assay. Lymphocytes were exposed to three different alloy concentrations (5 mg/mL, 10 mg/mL, and 20 mg/mL), and the effects on genetic material were analyzed microscopically. Descriptive statistics (mean, standard deviation, and variance) were calculated, and one-way ANOVA was used to assess statistical significance between groups, with a significance threshold of p < 0.05. Results: A significant increase in cytotoxicity and micronuclei incidence was observed in the samples containing beryllium compared to those without beryllium. Statistical analysis revealed significant differences (p < 0.001) between the test and control groups and between different concentrations. Additionally, a direct proportional relationship was noted between alloy concentration and the intensity of genotoxic effects. Microscopic analysis confirmed genetic material damage, indicating a potentially increased risk associated with the use of this type of dental material. Conclusions: The data obtained suggest that Ni-Cr-based dental alloys containing beryllium may present a significant risk of genotoxicity and cytotoxicity. Therefore, the selection of materials used in dental prosthetics should be based on solid scientific evidence, and the use of these alloys should be approached with caution. The study highlights the need for further research to better understand the long-term impact of these materials on human health. Full article

Objectives: This study evaluated the dental and alveolar bone stress distribution of a mandibular Kennedy Class I restored with a bilateral implant-assisted removable partial denture (IARPD) compared with a conventional removable partial denture (CRPD) through the application of finite element analysis (FEA). Methods: Kennedy Class I plaster models were made, including teeth from the lower left first premolar and lower right canine. The models were scanned, resin-based replicated and digitized. Using Solidworks software, internal hexagonal implants (10 mm × 4 mm) were virtually placed at the level of the first molars. Each model was grouped into a unit, and a load of 200 N was applied, simulating masticatory forces. Von Mises stress distributions were calculated via FEA for the vertical, diagonal and combined forces. Results: In the IARPD, the stress generated in the alveolar bone by the vertical (4.2 Mpa), diagonal (12.2 MPa) and combined forces (12.3 MPa) was lower than that of the CRPD (7 MPa, 26.3 MPa and 32 MPa, respectively). Similarly, at the lower central incisor, the IARPD generated less stress than the CRPD due to the action of the vertical, diagonal and combined forces. Conclusions: Our preliminary data suggest that bilateral implant placement may result in less stress on bone and teeth during rehabilitation with a Kennedy Class I IARPD, with different orientations of the forces applied. Full article

Background: Dental fluorosis (DF) is an irreversible alteration of tooth enamel formation caused by excessive fluoride (F) consumption during tooth growth, leading to skeletal fluorosis development due to the high F content of tap water, which should be detected. Objective: To detect the signs of skeletal fluorosis by comparison of the bone mineral density (BMD) of the lumbar spine, femoral neck, and total femur, and the fluor (F) intake from water between adults without and with DF from northwestern Mexico. Methods: Participants were 36 adults without DF (G1) and 42 with DF (G2). Dean criteria, DEXA, and SPADNS methods were used to evaluate DF, BMD, and F content in water, respectively. Results. G1 participants consumed 0.789 ± 1.55 mg F/d from water with 0.385 ± 0.32 mg F/L, while G2 participants drank 2.42 ± 2.65 mg F/d from water with 1.46 ± 0.59 mg F/L. The binary variable DF and BMD values were not associated (p > 0.05); however, according to severity degree, questionable DF was associated with total femur BMD (p = 0.025). BMD in the evaluated regions was no different between both groups and could be related to actual moderate levels of F in the tap water and to the partial or total consumption of bottled water. Conclusions. There was no association between DF and the measured BMD to infer skeletal fluorosis. Bone region BMD was no different between both evaluated groups and could be related to adequate F intake, with moderate F levels in tap water, and the consumption of negligible F content bottled water. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a multifactorial condition defined as an adverse drug reaction that results in progressive jawbone destruction and necrosis in individuals treated with certain medications, occurring without a history of prior radiotherapy. These drugs are mainly bisphosphonates, denosumab, and other bone-modifying agents, anti-angiogenic agents such as anti-endothelial growth factor, tyrosine kinase inhibitors, and proteins classified as mammalian targets of rapamycin. The diagnosis of MRONJ is based on clinical (exposed jawbone, fistula with pus, hyperplasia of the mucosa overlying the necrotic bone tissue) and radiological evaluation. We report four cases of clinical and radiological evidence of osteonecrosis of the jaw that are unrelated to the use of antiresorptive or anti-angiogenic agents. In two instances, histological and microbiological evidence was also found (high concentration of Actinomyces, the microbe most commonly found in oral sites affected by MRONJ). These atypical cases are reported to highlight the possibility that other, previously undocumented, drugs may also contribute to the development of ONJ Full article

Background/Objectives: Artificial Intelligence (AI) is transforming dentistry by offering advanced solutions to improve diagnostic accuracy, optimize treatment planning, and advance patient care. However, as AI becomes more prevalent in dental practice, patients may have concerns and skepticism about its implementation. Therefore, this study aims to explore the impact of the perceived risks and benefits on patients’ willingness to accept AI in dental treatment. Methods: This cross-sectional study was conducted in two public dental hospitals, and 586 patients were invited to complete a 28-item questionnaire. In total, 511 questionnaires were completed, resulting in a response rate of 87%. Multiple regression analysis was performed to assess the impact of perceived risks and benefits on patients’ willingness to accept AI in dental treatment. Results: All dimensions of perceived benefits had higher mean scores compared to the perceived risks. Additionally, three perceived benefit dimensions had a significant positive influence on the willingness to accept AI: patient-enhanced experience (β = 47.1, p < 0.001), personalized dental care (β = 22.2, p < 0.001), and cost efficiency (β = 15.3, p < 0.001). Conclusions: The perceived risks had little impact on patients’ willingness to accept AI, suggesting patients may be unaware of or unconcerned about AI’s potential risks in dentistry. Future research should investigate these perceptions and other dimensions influencing AI acceptance. Full article

Aim: Class II Division I malocclusion poses significant challenges in orthodontics. The combination of a Herbst appliance and miniscrew anchorage emerged as a practical solution to improve skeletal and dental outcomes. This study employed finite element analysis to evaluate the biomechanical effects of a miniscrew-supported Herbst appliance on mandibular advancement and dentition movement. Methods: High-definition CBCT scans captured the maxilla and mandible’s detailed dental anatomy. The scans were stored in DICOM format for seamless integration with Mimics software (Mimics Innovation Suite research version 21.0, Materialise NV, Leuven, Belgium) for 3D reconstruction and model refinement. The appliance, designed with a maxillary fixed palatal arch and mandibular acrylic splint connected by telescoping rods, incorporated titanium TADs and elastic chains. STL models were optimized in Geomagic x Design for finite element analysis in Abaqus, assigning validated mechanical properties for materials. Tetrahedral meshing and realistic boundary conditions simulated biomechanical interactions. Tetrahedral C3D4 elements were used for meshing, ensuring a balance between computational efficiency and detailed anatomical representation. Tetrahedral meshing and realistic boundary conditions simulated biomechanical interactions. Dynamic simulations in CATIA evaluated mandibular movement. FEA analyzed displacement across dentoalveolar structures along the X, Y, and Z axes to assess treatment efficacy and biomechanical stability. Results: The Z displacement analysis revealed that the incisal edges of the lower central, lateral, and canines shifted lingually by 0.41, 0.4, and 0.47 mm, respectively. Additionally, the apices of the lower central, lateral, and canines displaced backwards by 0.05 mm, 0.05 mm, and 0.07 mm, respectively. Conclusions: The appliance facilitated mandibular advancement, bodily retracted the lower incisors, well-controlled the upper ones, and mesial-tipped the upper posterior teeth. In contrast with traditional functional appliances, it caused the lower anterior teeth to move backwards, while skeletal anchorage overcame some shortcomings of nonsurgical treatments. This method might be a good treatment option for growing skeletal Class II patients. Full article

Introduction: Salivary biomarkers have been extensively studied in relation to oral disease, such as periodontal disease, oral cancer, and dental caries, as well as systemic conditions including diabetes, cardiovascular diseases, and neurological disorders. Literature Review: A systematic literature review was conducted, analyzing recent advancements in salivary biomarker research. Databases such as PubMed, Scopus, and Web of Science were searched for relevant studies published in the last decade. The selection criteria included studies focusing on the identification, validation, and clinical application of salivary biomarkers in diagnosing oral and systemic diseases. Various detection techniques, including enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), mass spectrometry, and biosensor technologies, were reviewed to assess their effectiveness in biomarker analysis. Specific biomarkers, such as inflammatory cytokines, oxidative stress markers, and microRNAs, have been identified as reliable indicators of disease progression. Current Trends and Future Perspectives: Advances in proteomics, genomics, and metabolomics have significantly enhanced the ability to analyze salivary biomarkers with high sensitivity and specificity. Despite the promising findings, challenges remain in standardizing sample collection, processing, and analysis to ensure reproducibility and clinical applicability. Conclusions: Future research should focus on developing point-of-care diagnostic tools and integrating artificial intelligence to improve the predictive accuracy of salivary biomarkers. Full article

On 24 February 2024, Italian physicians, dentists and oral care specialists, students, nurses, psychologists, dental hygienists, and other professionals met (live or online) to discuss controversial issues about medication-related osteonecrosis of the jaw (MRONJ). One section hosted international experts who gave lectures about MRONJ experiences in North America, Europe, and Italy. A second section summarized the principal points of an Italian MRONJ position paper published in February 2024 by experts from the Italian Societies of Oral Pathology and Medicine (SIPMO) and Maxillofacial Surgery (SICMF). The following section collates expert opinions about open issues and required fields of research: different definitions of MRONJ and impact on staging; the assessment of individual MRONJ risk before the start of antiresorptive therapy; surgery and implantology in patients at risk for MRONJ; cancer patients without metastases and prevention of cancer-treatment-induced bone Loss (CTIBL); the role of dental hygiene professionals; combined (medical and surgical) and surgical therapy for MRONJ in-patients and out-patients; and legal aspects and claims related to MRONJ diagnosis and treatment. Scientific contributions from hospitals and universities all over Italy were presented in specific sessions (epidemiology; case series; special case reports; prevention experiences; MRONJ treatment). Conclusions: the conference confirmed the importance of the adequate imaging study of bone in the diagnosis and staging of MRONJ cases, the role of surgery in MRONJ treatment, and the value of oral hygiene in the MRONJ prevention. Full article

Three-dimensional (3D) printing is transforming dentistry by enabling precise and personalized treatments in prosthodontics, orthodontics, and endodontics. However, challenges such as high costs, material limitations, and post-processing requirements hinder its broader adoption. This scoping review aims to explore and map the breadth of evidence regarding the clinical applications, benefits, and limitations of 3D printing in these disciplines, while identifying research gaps and future opportunities. A scoping review was conducted following the PRISMA for scoping reviews framework. Research from PubMed, Google Scholar, and Scopus was systematically searched, covering studies from January 2006 to November 2024. Key topics included applications, material properties, and technological challenges in prosthodontics, orthodontics, and endodontics. Results: In prosthodontics, 3D printing facilitates the fabrication of crowns, bridges, and dentures with high accuracy, though material strength and stability remain challenges. Orthodontics benefits from 3D-printed aligners and diagnostic models, improving patient comfort and treatment precision, but issues with material durability persist. In endodontics, 3D-printed surgical guides and training models enhance procedural accuracy and educational outcomes. Across disciplines, 3D printing reduces production time and enhances customization but incurs high costs and requires significant post-processing. This scoping review highlights the transformative potential of 3D printing in dentistry, providing an overview of current and future advancements and limitations. While 3D printing has improved precision, efficiency, and patient satisfaction, material and cost-related barriers remain. Future research should address these challenges to expand its clinical applicability and enhance personalized dental care. Full article

The objective of this scoping review was to map out the cultural themes related to oral health practices, beliefs, and experiences in Nigeria; explore mythologies about oral health in Nigeria; identify the perceived cultural significance of oral health within the Nigerian communities; and determine the implications of study findings for oral health promotion and intervention strategies. This was a scoping review. A systematic literature search was conducted in PubMed, Cochrane Library, Web of Science, Google Scholar, and CINAHL. Published studies in peer-reviewed journals written in English that investigated culture and oral health were included. All forms of literature reviews, editorials, or opinion pieces were excluded. Information on the study characteristics and population characteristics, cultural determinants of oral health, oral health outcomes, and the methods used to assess cultural factors and oral health outcomes was extracted. A narrative synthesis of the findings was conducted to identify key themes in the literature. The 37 articles, published between 1998 and 2024, that met the eligibility criteria wrote on the prevalence of a culture of self-medication and self-care, myths that affect utilization of oral health services, cultures that expose people to increased risk of poor oral health, and cultural norms, beliefs, and practices that facilitate oral health. The findings emphasize the need for culturally tailored strategies to improve oral health literacy and reduce disparities. This review underscores the potential to foster community engagement, trust, and sustainable improvements in oral health outcomes by aligning oral health promotion efforts with Nigeria’s culture. In conclusion, cultural norms, beliefs, and practices can be barriers and facilitate oral health in Nigeria. Identifying and understanding the norms, beliefs, and practices that affect oral health can help improve oral health education and promotion so that they are culturally relevant and effective. Full article

Background: Mucostatic impressions have been always indicated in thin, sharp, or flabby ridges, and have been addressed for their beneficial effect on long-term residual ridge stability. Nonetheless, a purely mucostatic impression was not possible until intraoral scans became available. This provides an option for digital removable denture which is biologically sensible but might reduce retention in comparison with a mucocompressive impression with border molding. On the other hand, pressure applied to the mucosa may have harmful effects on the long-term residual ridge stability, causing higher resorption and ultimately reduced denture retention. Hence, the possibility to merge mucostatics and mucocompressive philosophies would be a clinically and biologically sensible option for oral rehabilitation in aging populations where patients will potentially wear dentures for longer periods. This possibility is demonstrated in this technical report with a cast-free digital workflow. Technique: Baseplates for occlusion rims, closely adapted to the mucosa, were designed on intraoral scans of edentulous arches and, once 3D-printed, used to register maxillomandibular relations and information for tooth arrangement, as well as to perform border molding. Occlusion rims were then scanned and, within the 3Shape Dental System 2024 software program, the intaglio surfaces of their baseplates were segmented and inverted to obtain the digital master casts which incorporated the precise reproduction of the molded borders. Then, denture design was performed and manufactured; no limitations regarding manufacturing options are applicable to the presented technique. Conclusions: The potential benefits (i.e., improved retention in the initial period after denture delivery and the preservation of tissues) of the presented digital cast-free workflow, based on merging mucostatic and mucocompressive philosophies to obtain dentures with a mucostatic intaglio surface and functional borders, are sensible clinical outcomes which recommend the clinical application of the technique, although further validation, especially in the long term, is required. Full article