Oral, Volume 5, Issue 3 (September 2025) – 17 articles

Objective: This systematic review and meta-analysis aimed to evaluate the effects of moisture control strategies (including wet-bonding techniques, universal adhesives, and etching type) on dentin bonding performance in restorative dentistry. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, following PRISMA guidelines. Only in vitro and ex vivo studies comparing wet- and dry-bonding protocols, using human dentin substrates, and reporting microtensile bond strength (μTBS) were included. The data were synthesized using a random-effects meta-analysis and the methodological quality was assessed using the MINORS tool. Certainty of evidence was evaluated using the GRADE framework. Results: Nine studies met the inclusion criteria, eight of which were included in this meta-analysis. The moisture control strategies significantly influenced the bonding outcomes, with ethanol and acetone wet bonding yielding higher μTBS and enhanced hybrid layer morphology. The universal adhesives performed effectively under both moist and dry conditions, although their performance varied by the adhesive composition and solvent system. The meta-analysis revealed a statistically significant advantage for hydrated dentin (SMD = +1.20; 95% CI: 0.52 to 1.86; p < 0.001), with the moist and ethanol-treated substrates outperforming the dry and over-wet surfaces. The long-term durability was better preserved with ethanol and acetone pretreatments and the adjunctive use of chlorhexidine. Conclusions: Moisture conditions influence dentin bond strength, but modern universal adhesives show consistent bonding performance across different moisture conditions. Solvent-wet-bonding protocols, particularly with ethanol or acetone, enhance the immediate and long-term performance. While the current evidence is limited by the in vitro designs and heterogeneity, the findings demonstrate protocol flexibility and highlight strategies to optimize adhesion in clinical practice. Future clinical trials are necessary to validate these approaches under real-world conditions. Full article

Background: Mandibular advancement devices (MADs) are considered an effective therapeutic option for managing obstructive sleep apnea syndrome (OSAS) in adults. Obstructive sleep apnea (OSA) is associated with a range of comorbidities, notably cardiovascular disease. The aim of the present retrospective study is to evaluate respiratory and cardiovascular parameters in OSA patients treated with a MAD. Methods: A total of 64 adults with OSA from moderate-to-severe OSAS underwent split-night polysomnography (SN-PSG) at baseline (T0) and after three months of treatment with a MAD (T1) and were subsequently analyzed using statistical methods for a comparative evaluation. Results: After 3 months of treatment, patients showed a significant decrease in mean heart rate (p < 0.05), maximum heart rate (p < 0.01) and in both the AHI and ODI (p < 0.01), along with a significant increase in minimum heart rate (p < 0.05).Conclusions: These findings indicate that MAD therapy may contribute to improvements in both respiratory efficiency and cardiovascular function in individuals with OSAS, offering a valuable integrated treatment strategy for patients with coexisting cardiovascular conditions. Full article

Background: Obesity and periodontitis are two chronic inflammatory diseases with a bidirectional relationship possibly mediated by microbial and immunologic signaling pathways. This narrative review aims to investigate how microbial dysbiosis and inflammation link these diseases, focusing on the interactions between the oral and gut microbiomes. Materials and methods: Peer-reviewed studies (2015–2024) from PubMed, MEDLINE, Ovid and Google Scholar were selected for their relevance to microbial dysbiosis and inflammation, prioritizing clear methodology. Non-peer-reviewed sources or studies lacking microbial/inflammatory data were excluded. Conflicting results and methodological differences, including sampling and study design, were assessed qualitatively on the basis of coherence and methodological rigor. Results: Obesity has been shown to significantly alter the composition of the oral microbiome, characterized by reduced diversity and an increased Firmicutes/Bacteroidetes ratio. At the same time, periodontal pathogens such as Porphyromonas gingivalis can invade the gut, impair barrier function and promote systemic inflammation. Both diseases share common inflammatory pathways involving adipokines and immune-system dysregulation, creating a feedback loop that exacerbates disease progression in both conditions. Obesity also appears to impair the effectiveness of conventional periodontal treatments. Conclusions: The microbial axis between the oral cavity and the gut represents a central pathway in the complex interactions between obesity and periodontitis. This relationship involves microbial dysbiosis, bacterial translocation and shared inflammatory mechanisms that collectively contribute to disease progression. Clinical relevance: A better understanding of the relationship between obesity and periodontitis supports the development of customized treatment strategies for obese patients with periodontal disease. Future research should focus on developing targeted interventions that address both conditions simultaneously to improve patient outcomes and develop more effective prevention and treatment strategies. Full article

Background: The purpose of alveolar ridge preservation (ARP) is to minimise the physiological alveolar ridge reduction occurring after dental extraction, which can prevent the need for future alveolar ridge augmentation. Biologic materials (biologics) promote tissue regeneration based on their effect on wound healing at a cellular level. By integrating biologics into ARP biomaterials, there is a potential to enhance the regeneration of both hard and soft tissues with greater efficacy. Aim: This narrative review aims to evaluate the clinical efficacy of the addition of biologics to existing ARP materials on the physiological changes following ARP of an extraction site. Methods: A search of the PubMed electronic database was conducted, and relevant articles were examined. Sixty-three articles met the inclusion and exclusion criteria and were included in this review. Results and Conclusions: A review of the existing literature found that the combination of biologics with ARP materials resulted in similar dimensional changes when compared to using ARP materials alone. Existing research has identified an enhancement in bone density, increased wound healing capacity of soft and hard tissue, and a reduction in post-operative pain. Whilst the addition of biologics to ARP materials has shown an increase in bone density, its effectiveness in improving implant outcomes and reducing the need for future alveolar ridge augmentation is unclear. Recognising the limitations within the existing literature, along with the risk of bias and heterogeneity, renders it unwise to make definite conclusions about the benefits of integrating biologics with ARP materials. This narrative review found possible benefits in the use of biologics in ARP to optimise patient-related and treatment outcomes, indicating the need for additional research. Full article

Background/Objectives: Brown tumors are bone manifestations of hyperparathyroidism, and they are characterized by histologic similarities with Central Giant Cell Granuloma (CGCG). Their diagnosis requires clinical, microscopic, macroscopic, and serologic correlation, as there is usually an elevation in parathormone levels due to the underlying metabolic disorder. Methods: This case describes a patient with a left mandibular lesion and a history of CGCG. Results: Through the joint analysis of clinical, histologic, and serologic findings, the diagnosis of a brown tumor associated with hyperparathyroidism was confirmed. Conclusions: This case highlights the importance of a comprehensive evaluation of oral and systemic features for accurate diagnoses and appropriate patient management. Full article

Background: Newborns with Pierre Robin Sequence (PRS) usually show varying degrees of upper airway obstruction and difficulty feeding due to severe micrognatia. Mandibular distraction osteogenesis has become popular as an alternative treatment option when other medical or surgical techniques are unsatisfactory. The aim of this study is to test a three-dimensional (3D) cephalometric method in computed tomography (CT) to measure effective mandibular and midface length, and maxillomandibular ratio (Md/Mx ratio), as a mode of growth normalization expression in PRS patients before and after Fast and Early Mandibular Osteo-distraction (FEMOD), for assessing the diagnostic method and the efficacy of surgical treatment. Methods: In this retrospective pilot study, six PRS patients treated via the FEMOD surgical protocol were included. The measurements of effective maxillary and mandibular length were performed on 3D reconstructions from pre-surgical (T1) and post-surgical CT (T2). The growth disparity between the mandible and the maxilla was verified in T1 and was compared with the measurements obtained from the adaptation of the McNamara Norms; the correction of growth disproportion after FEMOD was assessed. Results: In T1, the PRS patients’ mandibular length and the Md/Mx ratio were smaller than the expected mandibular length (p = 0.029) and the expected Md/Mx ratio (p = 0.028). In T2, the PRS patients’ mandibular length and the Md/Mx ratio did not show significant differences from the expected results (p = 0.461 and p = 0.400). Conclusions: The 3D cephalometric analysis identifies the disproportion in pre-surgical maxillomandibular growth between PRS and reference measurements, and demonstrates that FEMOD allows the achievement of proportionality in the growth of the maxillomandibular complex in PRS patients. Full article

Objectives: Ameloblastoma is a locally aggressive odontogenic tumor of the jaws characterized by a high recurrence rate. This work aims to present our clinical experience in managing patient oral rehabilitation following an extensive mandibular ameloblastoma, with a specific focus on mandibular reconstruction using a fibula free flap, followed by dental implant placement and prosthetic rehabilitation in a female patient. Additionally, we provide a comprehensive review of the current evidence on surgical management, reconstruction techniques, and long-term outcomes in ameloblastoma treatment. Methods: A 44-year-old female patient presented with a painless swelling in the left mandible. Orthopantomography (OPG) and computed tomography (CT) demonstrated a well-defined radiolucent lesion extending from the canine to the second premolar. An incisional biopsy was performed, and histopathological examination confirmed the diagnosis of mandibular ameloblastoma. The patient underwent segmental resection of the left mandibular body, followed by immediate reconstruction using a vascularized fibular free flap. Eighteen months postoperatively, four dental implants were placed. One implant failed during the osseointegration phase and was removed. Due to residual hard and soft tissue deficiency, prosthetic rehabilitation was achieved with a metal-reinforced resin overdenture, restoring both function and aesthetics. Results: At the three-year follow-up, clinical and radiographic examinations revealed no evidence of tumor recurrence. The patient remained asymptomatic, reporting neither pain nor functional discomfort. Prosthetic rehabilitation with the metal-reinforced resin overdenture was successfully completed, achieving satisfactory masticatory function and aesthetics. Conclusions: The use of the fibula free flap for mandibular reconstruction after ameloblastoma resection provides excellent flexibility, enabling effective bone integration of dental implants. Full article

Background: Autism spectrum disorder (ASD) represents a neurobiological disorder with a high prevalence in the children’s population. The aim of the present review was to assess the current evidence on the use of salivary biomarkers for the early diagnosis of ASD. Materials and methods: A search was conducted on the electronic databases PUBMED/Medline, Google Scholar and Scopus for the retrieval of articles concerning the study topic. Results: A total of 22 studies have been included in the present review considering 21 articles identified from databases and 1 article included using a manual search. A wide range of biomarkers have been proposed for early detection of ASD diseases including nonspecific inflammation markers like interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor α (TNFα), oxidative stress markers like superoxide dismutase and glutathione peroxidase, hormones such as cortisol and oxytocin, various microRNAs including miR-21, miR-132 and miR-137, and exosomes. The techniques used for biomarke detection may vary according to molecule type and concentration. Conclusions: salivary biomarkers could represent a potential useful tool for the primary detection of several systemic diseases including ASD, taking advantage of non-invasiveness and cost-effective capability compared to other biofluid-based diagnostic techniques. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent disorder in both pediatric and adult populations, characterized by substantial morbidity encompassing cardiovascular, neurocognitive, and metabolic impairments. Management strategies vary by age group and underlying etiology, with orthodontic and non-orthodontic interventions playing key roles. This narrative review synthesizes the current evidence on orthodontic and non-orthodontic therapies for OSA in pediatric and adult populations, emphasizing individualized, multidisciplinary care approaches and highlighting future research directions. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify studies on diagnosis and management of OSA in children and adults from 2000 to 2025. Results: In pediatric patients, treatments such as rapid maxillary expansion (RME), mandibular advancement devices (MADs), and adenotonsillectomy have shown promising outcomes in improving airway dimensions and reducing apnea–hypopnea index (AHI). For adults, comprehensive management includes positive airway pressure (PAP) therapy, oral appliances, maxillomandibular advancement (MMA) surgery, and emerging modalities such as hypoglossal nerve stimulation. Special attention is given to long-term treatment outcomes, adherence challenges, and multidisciplinary approaches. Conclusions: The findings highlight the need for individualized therapy based on anatomical, functional, and compliance-related factors. As the understanding of OSA pathophysiology evolves, orthodontic and adjunctive therapies continue to expand their role in achieving durable and patient-centered outcomes in sleep apnea management. Full article

Objectives: Torus mandibularis (TM) is a benign bony exostosis on the lingual surface of the mandible, typically developing from the third decade of life with slow progression; its etiology remains unclear. As TM excision causes no functional or aesthetic disadvantages, its use as autologous bone graft material (e.g., for pre-implant or sinus lift augmentation) has been suggested. In this study, we investigate the prevalence and expression of TM in a southern German population with regard to age and gender. Additionally, we examine whether TM undergoes dynamic changes over time, with the hypothesis that TM may show temporal growth. Material and Methods: A retrospective analysis of CBCT scans from 210 randomly selected patients (105 males, 105 females) was performed. Patients were divided into three age groups (≤40, 41–60, ≥61 years; 70 per group), and TM was measured using OsiriX MD. For the longitudinal study, 146 CBCTs from 73 patients were compared over intervals of 2–9 years. Surface changes were assessed via 3D overlay using GOM Inspect. Results: TM was found in 30.5% of patients, and its prevalence was significantly higher in males (38%) than females (23%), with no age-related differences identified. Most TMs measured <2 mm (n = 51); only five exceeded this size. No dynamic growth was observed over time. Conclusion and Clinical Implications: TM is a common anatomical variant, more frequently detected through 3D imaging than clinical examination. In most cases, size remains minimal (<2 mm), limiting its clinical use as augmentation material in rare individual cases. Full article

Background: Stable post-surgical wound healing surrounding teeth and dental implants is essential for achieving excellent clinical outcomes, both during the initial phases of treatment and over the long term. Objectives: This work follows the new emerging trend of case-based literature reviews. The aim of this review includes providing clinical findings from case series that demonstrate the efficacy of using blue^®m oxygen treatment to promote post-surgical wound healing in patients that underwent periodontal and dental implant surgeries. In addition, a systematic review of the literature aimed to answer the focused research question: “In periodontal and implant surgeries, what are the aftercare protocols used to maintain optimal wound healing?” Case Presentation: One clinical case report involved the presentation of complex periodontal surgery. The other two cases focused on advanced implant surgeries. All patients were treated post-surgically with the local application of an oxygen-based therapy (blue^®m) gel. This therapy was further emphasized during the wound-healing phase by instructing patients to maintain thorough dental hygiene using toothpaste and mouthwash containing a similar oxygen-release formulation (blue^®m). Patients achieved satisfactory treatment outcomes. Systematic Review: PubMed and EMBASE were used in order to search for relevant studies in the scientific literature published up until June 2025. Only human clinical studies that used a specific protocol in regard to aftercare wound healing after periodontal or dental implant surgeries were included. As a result, 27 clinical studies were included. The outcome data were categorized and summarized. Conclusions: The use of local oxygen-based therapy showed a positive effect as a conventionally used aftercare modality in maintaining optimal post-surgical wound healing, following periodontal and implant surgeries. Further clinical studies are needed. Full article

Background/Objectives: Emerging evidence links diabetes to increased cancer risk. This study aimed to assess the association between diabetes mellitus (DM)(type 1, type 2, or gestational) and the development of head and neck cancer. Methods: An umbrella review was conducted using systematic searches in Cochrane, EBSCO, Wiley, ScienceDirect, and PubMed (January 2000–January 2024), registered in PROSPERO (CRD42024512151). Included were systematic reviews (SRs) and meta-analyses (MAs) of observational studies. Article selection followed the PRISMA guidelines; the quality and risk of bias of the selected studies were assessed with the Joanna Briggs Institute Checklist. The GROOVE tool was used to identify double counting. Two independent reviewers screened studies, with a third resolving disagreements. Results: Seven SRs were included. While DM has been widely examined in cancer research, few studies specifically targeted head and neck cancers. Of the 20 associations between various cancer sites and diabetes types, 9 (45%) showed a statistically significant positive correlation. The strongest evidence was for overall cancer risk (RR = 1.22, 95% CI: 1.16–1.29, p < 0.001). Oral cancer showed elevated risks (RRR = 1.13, p = 0.009; OR = 1.32, p < 0.001; HR = 1.73, p < 0.05; RR = 1.28, p < 0.05). Increased risks were also observed for oropharyngeal (RR = 1.18; HR = 1.53), head and neck (HR = 1.47), and nasopharyngeal cancer (OR = 1.40), all p < 0.05. Heterogeneity was low in two reviews, unreported in one, and high in four. Five SRs reported associated risk factors. Conclusions: While some associations between DM and cancer appear significant, evidence remains limited and inconsistent, particularly for oral cancer. Further standardized, high-quality research is needed to clarify the link across head and neck cancer subtypes. Full article

Background: Periodontitis is a chronic inflammatory disease influenced by host aging, yet the specific effects of aging on disease susceptibility remain unclear. Objective: This study aimed to evaluate whether aging increases susceptibility to Porphyromonas gingivalis (P. gingivalis)-induced periodontitis in a murine model. We formulated the null hypothesis that age does not affect susceptibility to periodontal bone loss. Methods: Young (8 weeks) and aged (78 weeks) male C57BL/6 mice were randomly assigned into four groups: young control, young infected, old control, and old infected (n = 8 per group, except for old control, where n = 7). Experimental periodontitis was induced by oral application of P. gingivalis suspended in 5% carboxymethylcellulose (CMC), administered every other day, for a total of three applications. Alveolar bone loss was assessed 39 days after the last inoculation using histomorphometric measurement of buccal distance from the cemento-enamel junction to the alveolar bone crest (CEJ–ABC distance) and micro-computed tomography (μCT) at mesial and distal interdental sites. Bonferroni’s correction was applied to the Mann–Whitney U Test to determine statistical significance. A p-value of less than 0.05 was considered statistically significant. Results: Morphometric analysis showed significantly greater buccal bone loss in infected mice versus controls in both age groups (young: 0.193 mm vs. 0.100 mm, p < 0.01; old: 0.262 mm vs. 0.181 mm, p < 0.01). μCT analysis revealed that interdental bone loss was significant only in aged infected mice (mesial: 0.155 mm vs. 0.120 mm, p < 0.05; distal: 0.185 mm vs. 0.100 mm, p < 0.01), and not significant in young infected mice. Conclusions: Aging significantly exacerbates P. gingivalis-induced alveolar bone loss, particularly in interdental regions. These results allowed us to reject the null hypothesis. This study validates a clinically relevant murine model for analyzing age-related periodontitis and provides a foundation for investigating underlying molecular mechanisms and potential therapeutic interventions. Full article

Background: The aim of this study was to assess the experiences and attitudes of dentists toward treating patients with mental disorders and to investigate how these attitudes correlate with factors such as sex, age, and years of clinical experience. Methods: A cross-sectional pilot study was conducted from March to July 2021 via an online questionnaire. The questionnaire consisted of four sections: demographic information, self-assessment of experiences and attitudes toward treating patients with mental disorders, knowledge of psychotropic drugs and their interactions, and personal experiences with patient care. Results: Overall, 101 dentists, mostly females (78.22%), completed the questionnaire, of which 65.35% consistently checked whether their patients were taking psychotropic drugs and 48.51% inquired about mental disorders when taking medical history. Still, 39.60% reported unpleasant experiences when treating such patients—mostly female dentists—and as many as 14.85% of all dentists refused to treat them. More than 94% of dentists recognized that patients with mental disorders are at greater risk for poor oral health and in need of early referral and professional support. Older dentists demonstrated better knowledge of oral manifestations and drug interactions relevant to dental treatment. Conclusions: Our findings highlight the need for improved training, an interdisciplinary approach, and greater dissemination of new scientific evidence for managing patients with mental disorders in dental practice. Considering that this is a pilot study using a combination of non-probabilistic convenience and snowball sampling method, the findings should be considered preliminary and interpreted with caution, as the sampling method limits the ability to make statistical inferences. Full article

Objectives: This review examines the efficacy of each laser type in the field of periodontal surgery and analyzes published articles that focus on the use of lasers in periodontal surgery. Methods: Automatic and manual searches were made in 3 separate databases (PubMed, Embase, and Cochrane) with the aim of finding all published articles of the last 15 years up until December 2023 that describe the clinical manipulation of diode, erbium:yttrium-aluminum-garnet (Er:YAG), erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG), neodymium yttrium-aluminum-garnet (Nd:YAG), and carbon dioxide (CO₂) lasers for periodontal surgical procedures in humans. Results: A total of 18 studies were selected for inclusion, all of which compared the usage of a laser type to conventional periodontal surgical techniques with their main follow-ups being in 3, 6, or 9 months. Conclusions: There are a variety of laser types, each with different settings and wavelengths, that can be applied to the established aspects of resective and regenerative periodontal surgeries. A significant majority of the publications, 10 of the 12 studies, that include diode lasers as an adjunctive show an improvement in clinical results compared to traditional surgical techniques alone, while 2 articles studied the Er:YAG laser and 1 article studied the Er,Cr:YSGG laser, with all 3 of them failing to completely test their therapeutic capabilities and indicating similar results to conventional surgery. The Nd:YAG laser was featured in 3 studies, with 1 study showing superior results for the laser group, another study showing the negative influence of the laser, and the 3rd study being inconclusive. The CO₂ laser was used in 1 study and showed better clinical results for the laser group. Diode lasers have been proven to produce additional therapeutic results, but there is a need for further investigation of erbium family lasers along with the Nd:YAG and CO₂ lasers, as the current provided literature contradicts their potential healing capabilities. Full article

Background/Objectives: Craniofacial microsomia (CFM), previously known as hemifacial microsomia, is a congenital condition involving structures derived from the first and second pharyngeal arches. CFM is characterized by asymmetrical craniofacial growth, affecting the mandible, ear, orbit, soft tissues, and facial nerve. Functional therapy is among the treatment options for mild to moderate cases. This study aimed to assess the effect of functional therapy on mandibular growth in patients with CFM by comparing mandibular and condylar height on the affected and unaffected sides, using pre- and post-treatment panoramic radiographs. Methods: A retrospective longitudinal study was conducted on 14 patients treated with functional therapy with the Asymmetrical Functional Activator (AFA) appliance. Mandibular ramus height (Co-Go) and condylar height (Co-Is) were measured bilaterally on pre- (T0) and post-treatment (T1) panoramic radiographs. Growth differences and rates were analyzed using descriptive and inferential statistics. Results: A significant increase in the mandibular ramus height (Co-Go) and in condylar height (Co-Is) was observed on the affected side from T0 to T1. The increase in mandibular ramus height was significantly greater on the affected side compared to the unaffected side (p = 0.0016). Although condylar height increased significantly on both sides over time, the difference in growth rate between sides was not statistically significant (p = 0.7148). Conclusions: Functional therapy may contribute to reducing mandibular asymmetry in CFM patients by enhancing the growth of the affected mandibular ramus, but the asymmetry may still be present at the end of treatment. These findings support its use in the early management of mild to moderate CFM. Full article

Background: Due to limitations of fluoride (F) treatment as a main caries preventive measure, it is important to consider the use of other dental caries preventive measures to reduce caries prevalence, especially in its early stages. Recently, new remineralizing agents appeared on the market, with their commercial availability in a variety of oral care products. Objectives: The purposes include providing a scoping review that represents caries remineralizing efficacies of only commercially available products and their existing adverse effects (if it is presented) and ensuring that only evidence-based approved products are included. Methods: The following databases were used in searching scientific literature on 28 October 2024: PubMed, PubMed Advanced Search, MeSH database, and PubMed Clinical Queries. The study selection criteria were as follows: for laboratory, in vitro, and/or in situ—remineralization of enamel-scanning electron microscopy, spectroscopy, microhardness test, light microscopy, profilometry, transverse microhardness microradiography, integrated mineral loss, light microscopy, photothermal radiometry; if it was a randomized controlled trial—CONSORT protocol, ICDAS system (to detect dental caries), diagnostic additional devices; antibacterial ability-colony forming units, DNA-based sequencing, scanning electron microscopy, crystal violet staining, and confocal laser scanning microscopy. Results: This review includes 98 papers: 14 of them describing the current status of caries patterns in the world, 60 studies (45 laboratory studies and 15 RCTs), and 24 systematic reviews were analyzed in order to detect whether new remineralizing agents can replace fluoride in further caries prevention. Conclusions: All reviewed new remineralization agents could be used without additives to treat early caries lesions, but the combination with F promotes better remineralization. Only HAP demonstrated its potential to serve as an alternative to fluoride in oral care products. However, further clinical studies are needed to prove its role in the remineralizing process of initial caries lesions. One also needs to ensure that both the clinical trials and in vitro lab studies use the best gold standards to validate any changes in the tooth structure, both remineralization and demineralization. Full article