Journal Description
Dentistry Journal
                    Dentistry Journal 
                    is an international, peer-reviewed, open access journal on dentistry published monthly online by MDPI.
                - Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
 - High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, and other databases.
 - Journal Rank: JCR - Q1 (Dentistry, Oral Surgery and Medicine) / CiteScore - Q2 (General Dentistry)
 - Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.5 days after submission; acceptance to publication is undertaken in 3.5 days (median values for papers published in this journal in the first half of 2025).
 - Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
 
                                            Impact Factor: 
                        3.1 (2024);
                        5-Year Impact Factor: 
                        3.3 (2024)
                                    
                
                                
            Latest Articles
                
    
        
                    
    
        
    
    Diagnostic Performance of Autofluorescence for Oral Lesions: A Comparison Between a Postgraduate and an Expert Clinician
                        
    
                
        
                
        Dent. J. 2025, 13(11), 512; https://doi.org/10.3390/dj13110512 - 3 Nov 2025
    
                            
    
                    
        
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            Background/Objectives: Autofluorescence (AF) is a widely used adjunctive tool in the detection of oral potentially malignant disorders (OPMDs) and malignant lesions, but its performance can be influenced by clinicians’ experiences. This study aimed to examine how AF influences diagnostic decision-making and performances
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            Background/Objectives: Autofluorescence (AF) is a widely used adjunctive tool in the detection of oral potentially malignant disorders (OPMDs) and malignant lesions, but its performance can be influenced by clinicians’ experiences. This study aimed to examine how AF influences diagnostic decision-making and performances of a novice clinician compared with those of an experienced examiner. Methods: A total of 80 patients with oral lesions participated in this cross-sectional study. Each underwent a standard oral examination (OE) followed by an assessment with the VELscope® System Vx (LED Medical Diagnostics Inc., Burnaby, BC, Canada), independently conducted by an expert clinician (E) and a postgraduate dentist (PD), both blinded to each other’s results. Biopsy and histopathological analysis provided the reference diagnosis. After every examination, lesions were categorized as either “Risk of Malignancy” (RM) or “No Risk of Malignancy” (NRM). Results: Based on OE, PD identified 39 RM lesions, while E 29. AF with VELscope® identified an additional 12 RM lesions for the PD and 7 for the E that were not suspected on OE alone. Combining OE with VELscope® improved sensitivity (PD: 90.9%; E: 95.4%) and negative predictive value (PD: 91.7%; E: 97.6%), while decreasing specificity (PD: 37.9%; E: 70.7%) and positive predictive value (PD: 35.7%; E: 55.3%) compared with OE alone. Conclusions: AF increases diagnostic sensitivity, particularly for less experienced clinicians, while offering moderate advantages for experts. Nevertheless, the corresponding decline in specificity emphasizes the need for cautious interpretation. AF should be incorporated as a complementary tool within structured diagnostic pathways, accompanied by adequate training, and cannot replace histopathological confirmation or clinical expertise.
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                    (This article belongs to the  Special Issue Oral Pathology: Current Perspectives and Future Prospects)
            
        
        
    Open AccessArticle
    
    Assessing Pediatric Endodontic Referrals to University-Based Clinics: A Retrospective Chart Review
                        
            by
                    Alice P. Chen, Civon Gewelber, Helpis Youssef, Jacob Marx and Man Hung        
    
                
        
        Dent. J. 2025, 13(11), 511; https://doi.org/10.3390/dj13110511 - 3 Nov 2025
    
                            
    
                    
        
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            Background: Timely dental care is essential to prevent complications and preserve natural teeth, yet inefficient referral practices, low reimbursement rates and systemic barriers continue to disproportionately affect Medicaid-enrolled children. This study assessed the appropriateness of root canal therapy (RCT) referrals to a University-based
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            Background: Timely dental care is essential to prevent complications and preserve natural teeth, yet inefficient referral practices, low reimbursement rates and systemic barriers continue to disproportionately affect Medicaid-enrolled children. This study assessed the appropriateness of root canal therapy (RCT) referrals to a University-based Advanced Education in General Dentistry (AEGD) program and examined diagnostic and treatment characteristics of referred cases. Methods: A retrospective review was conducted of pediatric patients aged 6–17 years who were referred by external dental providers to two AEGD clinics in Nevada, United States, between February and August 2024 for endodontic evaluation of carious permanent teeth. Demographic, tooth-type, pulp-status, and treatment outcome data were analyzed using descriptive statistics, chi-square tests, Kruskal–Wallis comparisons, and multivariable logistic regression models. Results: Among 154 referred patients, 96.8% (n = 149) were Medicaid beneficiaries. A total of 247 teeth were evaluated; 74.1% were molars. Pulp testing showed that 41.3% had healthy pulps and 16.6% had reversible pulpitis, while only 37.2% of teeth required RCT. Age differed significantly across pulp diagnoses (p = 0.0012), and older age independently predicted appropriate referral (adjusted OR = 1.18, 95% CI 1.07–1.31). Gender was not associated with follow-up compliance (p = 0.47). By November 2024, 53.4% of referred teeth had completed treatment, and 9.3% had no follow-up. Conclusions: More than half of the referral teeth did not require RCT, indicating a high rate of potentially avoidable referrals and highlighting gaps in diagnostic confidence and decision-making at the primary care level. Practical Implications: Enhancing diagnostic training and decision support for general dentists, particularly in vital pulp therapy for young permanent teeth, along with improving Medicaid reimbursement and standardizing referral protocols, may reduce inappropriate specialty referrals. In combination with broader policy reforms, these measures can improve system efficiency and expand access to timely, equitable pediatric dental care.
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    Open AccessSystematic Review
    
    Maxillary First Premolars’ Internal Morphology: A Systematic Review and Meta-Analysis
                        
            by
                    Thomas Gerhard Wolf, Dilara Sare Ulugöl, Richard Johannes Wierichs, Agnes Klara Maria Holtkamp, Gianrico Spagnuolo, David Donnermeyer and Andrea Lisa Waber        
    
                
        
        Dent. J. 2025, 13(11), 510; https://doi.org/10.3390/dj13110510 - 3 Nov 2025
    
                            
    
                    
        
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            Objectives: This systematic review analyzed the root canal morphology and configuration (RCC) of maxillary first premolars (Mx1Ps) and sex-specific differences based on existing literature. Methods: Registered in PROSPERO (CRD42023394460) and following PRISMA guidelines, systematic searches were conducted in five databases (Cochrane, Embase, LILACS,
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            Objectives: This systematic review analyzed the root canal morphology and configuration (RCC) of maxillary first premolars (Mx1Ps) and sex-specific differences based on existing literature. Methods: Registered in PROSPERO (CRD42023394460) and following PRISMA guidelines, systematic searches were conducted in five databases (Cochrane, Embase, LILACS, Scopus, MEDLINE via PubMed) using predefined MeSH terms. Additional studies were identified through cross-referencing. Studies on Mx1P RCCs were included, assessed using the AQUA tool. Data extraction focused on RCC prevalence, sex differences, root variations, and examination methods. Results: Of 865 studies, 86 were included, analyzing 31,325 teeth. The most common RCCs were 2-2-2/2 (IV, frequencies between 0.6–80.5%) and 1-1-1/1 (I, 1.1–72.0%). Mx1Ps primarily had two roots (7.1–96.2%) or one root (3.8–93.2%), with three-rooted variants being rare (0.4–6.5%). Males more frequently exhibited two- or three-rooted Mx1Ps with RCCs like 2-2-2/2 (IV; OR = 1.39 [1.22, 1.58]), and 1-1-3/3 (VIII; OR = 2.22 [1.59, 3.11]). Females showed higher frequencies of RCCs like 1-1-1/1 (I; OR = 0.71 [0.53, 0.96]), 2-2-1/1 (II; OR = 0.66 [0.57, 0.77]), 1-2-1/1 (III; OR = 0.70 [0.59, 0.83]), and 1-1-2/2 (V; OR = 0.81 [0.70, 0.95]). Conclusions: Mx1Ps predominantly have two roots and a 2-2-2/2 (IV) RCC. CBCT was the most used method, followed by staining and clearing. Clinicians should consider sex-specific and morphological variations.
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Open AccessArticle
    
    Comparative Evaluation of the Intratubular Penetration Ability of Two Retrograde Obturation Techniques in Micro-Endodontic Surgical Procedure: An In Vitro Study with Confocal Laser Scanning Microscopy
                        
            by
                    Alberto Casino Alegre, Michell Ramírez López, Manuel Monterde Hernández, Susana Aranda Verdú, Jorge Rubio Climent and Antonio Pallarés Sabater        
    
                
        
        Dent. J. 2025, 13(11), 509; https://doi.org/10.3390/dj13110509 - 3 Nov 2025
    
                            
    
                    
        
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            Background: The development of calcium silicate materials and new techniques have resulted in significant clinical benefits in endodontics and microapical surgery. The objective of this investigation was to analyze the percentage of dentinal tubule penetration of two retrograde obturation techniques in microapical surgery,
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            Background: The development of calcium silicate materials and new techniques have resulted in significant clinical benefits in endodontics and microapical surgery. The objective of this investigation was to analyze the percentage of dentinal tubule penetration of two retrograde obturation techniques in microapical surgery, namely the conventional technique and the lid technique. Methods: 60 single-root human teeth were selected, which were divided into two groups (n = 30). These teeth were subjected to an endodontic procedure using the single-cone technique. They were prepared with apicoectomy and 3 mm apical retrocavity and then obturated using two retrograde obturation techniques with bioceramic materials: TotalFill RRM fast set Putty® (RRM) using the conventional technique and TotalFill BC Sealer HiFlow® (HiFlow) and RRM using the lid technique. The teeth were selected and evaluated using 1 mm portions in the apical third. In each case, the images were obtained using a Leica TCS SP8 Confocal Microscope (CLSM). The extent of penetration into the dentinal tubule regions was measured using AutoCad®. Results: Statistical analyses were performed using the Levene test (p ≤ 0.05) and Student’s t-test (p ≤ 0.05). Analysis of the penetration area of calcium silicate materials into the dentinal tubules revealed that the relative penetration percentages were higher when using the conventional technique with the RRM than the lid technique with RRM + HiFlow in the apical third evaluated. Conclusion: The conventional technique yields significantly better outcomes, showing statistically significant differences in the percentage of penetration into the intratubular area compared to the lid technique.
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                    (This article belongs to the  Special Issue Present Status and Future Directions in Endodontics)
            
        
        
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Open AccessArticle
    
    Statistical Method for Dental Clinics for Determining Presence and Stage of Periodontitis with aMMP-8 Mouth Rinse Point-of-Care Test and Digital Reader
                        
            by
                    Miika Penttala, Ismo T. Räisänen, Dimitra Sakellari, Andreas Grigoriadis and Timo Sorsa        
    
                
        
        Dent. J. 2025, 13(11), 508; https://doi.org/10.3390/dj13110508 - 3 Nov 2025
    
                            
    
                    
        
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            Background/Objectives: This study proposes a framework for building a statistical prediction model for dental clinics to facilitate the diagnosis of periodontitis and its stages. The method is based on active-matrix metalloproteinase-8 (aMMP-8) mouth rinse point-of-care testing (POCT). Methods: A complete model was created
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            Background/Objectives: This study proposes a framework for building a statistical prediction model for dental clinics to facilitate the diagnosis of periodontitis and its stages. The method is based on active-matrix metalloproteinase-8 (aMMP-8) mouth rinse point-of-care testing (POCT). Methods: A complete model was created within a three-step modeling scenario: (i) the first function differentiates healthy patients from those with periodontitis; (ii) the second function differentiates stage I and II patients from stage III patients; and (iii) the third function separates stage I and II patients from each other. The model was developed using logistic regression analysis, and the aMMP-8 POCT results utilized in the predictive functions were obtained from an Oralyzer digital reader. Sample data comprised 149 adult patients who visited dental clinics in Thessaloniki, Greece. Results: Patients without periodontitis were identified in 74.2% of cases (95% CI: 55.1–87.5%). Patients with periodontitis were revealed with a success rate of 94.1% (95% CI: 87.7–97.4%), and of these, the correct stage was determined in 71.2% of cases (95% CI: 61.7–79.2%). The complete model was tested on the same patient data from which it was formed. Conclusions: The results of the study showed that logistic regression can be used in the development of a model for dental clinics to reveal and stage periodontitis with sufficient accuracy. In the complete model created, aMMP-8 mouth rinse POCT results in ng/mL, visible plaque index (VPI), and the information on the patient’s missing teeth were statistically important factors in determining the presence and stage of periodontitis.
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                    (This article belongs to the  Special Issue Dentistry in the 21st Century: Challenges and Opportunities)
            
        
        
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Open AccessPerspective
    
    The Nallan–Nickel Effect: A Mechanistic Perspective on Burning Sensations and Lichenoid Reactions in Long-Serving Porcelain-Fused-to-Metal Restorations
                        
            by
                    Nallan C. S. K. Chaitanya, Nada Tawfig Hashim, Vivek Padmanabhan, Md Sofiqul Islam, Rasha Babiker, Riham Mohammed and Muhammed Mustahsen Rahman        
    
                
        
        Dent. J. 2025, 13(11), 507; https://doi.org/10.3390/dj13110507 - 3 Nov 2025
    
                            
    
                    
        
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            Porcelain-fused-to-metal (PFM) crowns continue to serve as a cornerstone of restorative dentistry owing to their strength, affordability, and esthetics. However, late-onset complications such as oral burning and lichenoid reactions have been observed in long-serving PFMs, suggesting complex host–material interactions that extend beyond simple
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            Porcelain-fused-to-metal (PFM) crowns continue to serve as a cornerstone of restorative dentistry owing to their strength, affordability, and esthetics. However, late-onset complications such as oral burning and lichenoid reactions have been observed in long-serving PFMs, suggesting complex host–material interactions that extend beyond simple mechanical wear. This Perspective introduces the Nallan–Nickel Effect, a theoretical model proposing that a host- and environment-dependent threshold of bioavailable nickel ions (Ni2+), once exceeded, may trigger a neuro-immune cascade culminating in a burning phenotype. Within this framework, slow corrosion at exposed PFM interfaces releases Ni2+ into saliva and crevicular fluid, facilitating epithelial uptake and activation of innate immune sensors such as TLR4 and NLRP3. The resulting cytokine milieu (IL-1β, IL-6, TNF-α) drives NF-κB, mediated inflammation and T-cell activation, while neurogenic mediators—including nerve growth factor (NGF), substance P, and CGRP—sensitize TRPV1/TRPA1 nociceptors, establishing feedback loops of persistent burning and neurogenic inflammation. Modifying factors such as low salivary flow, acidic oral pH, mixed-metal galvanic coupling, and parafunctional stress can lower this threshold, whereas replacement with high-noble or all-ceramic materials may restore tolerance. The model generates testable predictions: elevated local free Ni2+ levels and increased expression of TLR4 and TRPV1 in symptomatic mucosa, along with clinical improvement following substitution of nickel-containing restorations. Conceptually, the Nallan–Nickel Effect reframes PFM-associated burning and lichenoid lesions as threshold-governed, neuro-immune phenomena rather than nonspecific irritations. By integrating corrosion chemistry, mucosal immunology, and sensory neurobiology, this hypothesis offers a coherent, testable framework for future translational research and patient-centered management of PFM-related complications.
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                    (This article belongs to the  Section Dental Materials)
            
        
        
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Open AccessArticle
    
    Malocclusion Complexity in Patients with Dental Anomalies—A Case–Control Study
                        
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                    María Fernanda Romero-Noh, José Rubén Herrera-Atoche, Iván Daniel Zúñiga-Herrera, Bertha Arelly Carrillo-Ávila, Víctor Manuel Martínez-Aguilar and Laura Beatriz Pérez-Traconis        
    
                
        
        Dent. J. 2025, 13(11), 506; https://doi.org/10.3390/dj13110506 - 3 Nov 2025
    
                            
    
                    
        
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            Background/Objectives: This study aimed to evaluate the impacts of various dental anomalies on the complexity of malocclusion. Methods: This retrospective cross-sectional study employed a case–control design. The sample comprised 140 patients, 59 cases, and 81 controls. The Index of Complexity Outcome
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            Background/Objectives: This study aimed to evaluate the impacts of various dental anomalies on the complexity of malocclusion. Methods: This retrospective cross-sectional study employed a case–control design. The sample comprised 140 patients, 59 cases, and 81 controls. The Index of Complexity Outcome and Need (ICON) was used to calculate a score indicating the complexity of the malocclusion. According to the ICON score, the level of malocclusion complexity was classified into easy, mild, moderate, difficult, and very difficult. The cases were subdivided into three groups based on their dental anomaly type (number, shape, or eruption anomalies). A chi-square test was used to compare the distribution of cases and controls across the ICON levels (p < 0.05). A t-test and an ANOVA with Tukey’s post hoc test were used to evaluate the differences in the ICON scores among groups (p < 0.05). Results: The mean values of the ICON score were 56.77 ± 17.1 for the cases and 47.44 ± 17.54 for the controls (p = 0.002). Most patients in the case group were within the highest three ICON levels, while most controls were in the lowest three (p = 0.022). Patients with eruption anomalies had a higher ICON score, compared to the controls and those in other dental anomaly groups (p = 0.001). Conclusions: The presence of dental anomalies increases the complexity of malocclusion. Eruption anomalies are more complex to resolve than number and shape anomalies, due to their impact on occlusion and aesthetics.
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                    (This article belongs to the  Special Issue Impacted Teeth: Biological Heritage or Clinical Limit?)
            
        
        
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Open AccessArticle
    
    Periodontitis and Mild Cognitive Impairment Risk in Diabetic Patients: Insights from an Exploratory Analysis
                        
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                    Aulia Ramadhani, Kumiko Minagawa, Sachiko Takehara, Noboru Kaneko, Takaho Yamada, Masaru Kitazawa, Hirohito Sone, Yusran Ady Fitrah, Kaname Nohno and Hiroshi Ogawa        
    
                
        
        Dent. J. 2025, 13(11), 505; https://doi.org/10.3390/dj13110505 - 3 Nov 2025
    
                            
    
                    
        
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            Background: Cognitive impairment, including dementia, is a growing global health challenge, particularly as populations age. Previous studies have identified periodontitis and diabetes mellitus as modifiable risk factors for dementia, potentially linked through systemic inflammation. We hypothesize that systemic inflammation induced by periodontitis may
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            Background: Cognitive impairment, including dementia, is a growing global health challenge, particularly as populations age. Previous studies have identified periodontitis and diabetes mellitus as modifiable risk factors for dementia, potentially linked through systemic inflammation. We hypothesize that systemic inflammation induced by periodontitis may contribute to an increased risk of cognitive impairment. Therefore, this study aims to explore the correlation between periodontal inflammation and the risk of Mild Cognitive Impairment (MCI) in type II diabetes mellitus. Materials and Methods: Baseline data analysis was performed as an analytical cross-sectional study among diabetic patients aged 40 and older who met the inclusion criteria from a randomized controlled trial (RCT) from November 2020 to April 2023. Periodontal inflammation was measured using the Periodontal Inflamed Surface Area (PISA) score. The MCI risk score was calculated using blood samples to assess eight protein markers correlated to MCI (ApoA1, TTR, C3, Albumin, ApoC1, A1BG, A2AP, and HPX). Fisher’s exact test and Spearman’s correlation analysis were performed. Results: 29 T2DM patients were included in the study. There was a significant difference in MCI risk score between the low and high PISA levels group (p < 0.05). Patients with low PISA scores tend to have a lower risk of MCI (p < 0.00). Variables correlated with MCI risk are PISA (ρ = 0.37; p < 0.05) and TTR levels (ρ = −0.51; p < 0.01). ApoA1 has a correlation with CRP (ρ = 0.42; p < 0.05) and IL-6 (ρ = 0.43; p < 0.05), and C3 (ρ = 0.42; p < 0.05) was correlated with CRP. Conclusions: This study found that periodontal inflammation status has a potential correlation to the risk of MCI.
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                    (This article belongs to the Topic Preventive Dentistry and Public Health)
        
        
            
        
        
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Open AccessArticle
    
    Linear Geometric Analysis of Maxillary Expansion in Mixed Dentition: Rapid Palatal Expander Versus Invisalign First System
                        
            by
                    Francesca Gaffuri, Francesca Zara, Laura Grassi and Cinzia Maspero        
    
                
        
        Dent. J. 2025, 13(11), 504; https://doi.org/10.3390/dj13110504 - 3 Nov 2025
    
                            
    
                    
        
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            Objectives: This study aimed to evaluate maxillary arch width increase in juvenile patients requiring space gain, but without skeletal transverse discrepancies necessitating orthopedic expansion. The comparison focused on the effects of Rapid Maxillary Expansion (RME) using Hyrax expanders and dentoalveolar expansion via
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            Objectives: This study aimed to evaluate maxillary arch width increase in juvenile patients requiring space gain, but without skeletal transverse discrepancies necessitating orthopedic expansion. The comparison focused on the effects of Rapid Maxillary Expansion (RME) using Hyrax expanders and dentoalveolar expansion via Invisalign First. Methods: This retrospective longitudinal study analyzed digital dental models of 38 patients (19 males and 19 females, aged 8 ± 2 years) undergoing maxillary expansion at the Department of Biomedical, Surgical, and Dental Science, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico (Milan, Italy). Patients were divided into two groups: one treated with Hyrax expanders (n = 19) and the other with Invisalign First (n = 19). Intraoral scans were taken before (T0) and after treatment (T1), and measurements were performed using Mimics Materialize 21.0 software. Statistical analysis included t-tests, ANOVA, and regression models to assess differences in maxillary expansion between groups. Results: Both groups showed statistically significant transverse arch increases (p < 0.01). Hyrax achieved greater expansion at the deciduous canine level, while Invisalign showed more at the deciduous molar level. First permanent molar expansion was similar. ICC for reliability was excellent (>0.97). No significant differences in sex or Angle class distribution were observed. Conclusions: Hyrax and Invisalign First both produce measurable maxillary expansion, but they serve distinct roles. While Hyrax expanders provide rapid skeletal expansion, Invisalign First offers a less invasive alternative for dentoalveolar widening with controlled force application. They should not be used interchangeably. Appliance selection must be tailored to the severity and nature of the transverse deficiency.
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                    (This article belongs to the  Section Preventive Dentistry)
            
        
        
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Open AccessSystematic Review
    
    Liver Disease and Periodontal Pathogens: A Bidirectional Relationship Between Liver and Oral Microbiota
                        
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                    Mario Dioguardi, Eleonora Lo Muzio, Ciro Guerra, Diego Sovereto, Enrica Laneve, Angelo Martella, Riccardo Aiuto, Daniele Garcovich, Giorgia Apollonia Caloro, Stefania Cantore, Lorenzo Lo Muzio and Andrea Ballini        
    
                
        
        Dent. J. 2025, 13(11), 503; https://doi.org/10.3390/dj13110503 - 31 Oct 2025
    
                            
    
                    
        
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            Background: Periodontal dysbiosis contributes to liver injury through systemic inflammation, oral–gut microbial translocation, and endotoxemia. Lipopolysaccharides (LPSs) and virulence factors derived from periodontal pathogens, particularly Porphyromonas gingivalis (P. gingivalis) activate Toll-like receptor (TLR) signaling, trigger NF-κB-mediated cytokine release (e.g., TNF-α, IL-1β,
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            Background: Periodontal dysbiosis contributes to liver injury through systemic inflammation, oral–gut microbial translocation, and endotoxemia. Lipopolysaccharides (LPSs) and virulence factors derived from periodontal pathogens, particularly Porphyromonas gingivalis (P. gingivalis) activate Toll-like receptor (TLR) signaling, trigger NF-κB-mediated cytokine release (e.g., TNF-α, IL-1β, IL-6), and promote oxidative stress and Kupffer cell activation within the liver. The present systematic review summarized clinical evidence supporting these mechanistic links between periodontal pathogens and hepatic outcomes, highlighting the role of microbial crosstalk in liver pathophysiology. Methods: A PRISMA-compliant systematic review was conducted by searching PubMed, Scopus, and the Cochrane library, as well as gray literature. Eligible study designs were observational studies and trials evaluating P. gingivalis and other periodontal pathogens (Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Tannerella forsythia) for liver phenotypes (Non-Alcoholic Fatty Liver Disease [NAFLD]/Metabolic Dysfunction-Associated Steatotic Liver Disease [MASLD], fibrosis/cirrhosis, acute alcoholic hepatitis [AAH], and Hepatocellular carcinoma [HCC]). Risk of bias was assessed using the Newcastle–Ottawa Scale adapted for cross-sectional studies (NOS-CS) for observational designs and the RoB 2 scale for single randomized controlled trials (RCTs). Due to the heterogeneity of exposures/outcomes, results were summarized narratively. Results: In total, twenty studies (2012–2025; ~34,000 participants) met the inclusion criteria. Population-level evidence was conflicting (no clear association between anti-P. gingivalis serology and NAFLD), while clinical cohorts more frequently linked periodontal exposure, particularly to P. gingivalis, to more advanced liver phenotypes, including fibrosis. Microbiome studies suggested stage-related changes in oral communities rather than the effect of a single pathogen, and direct translocation into ascitic fluid was not observed in decompensated cirrhosis. Signals from interventional and behavioral research (periodontal therapy; toothbrushing frequency) indicate a potential modifiability of liver indices. The overall methodological quality was moderate with substantial heterogeneity, precluding meta-analysis. Conclusions: Current evidence supports a biologically plausible oral–liver axis in which periodontal inflammation, often involving P. gingivalis, is associated with liver damage. Causality has not yet been proven; however, periodontal evaluation and treatment may represent a low-risk option in periodontitis-associated NAFLD. Well-designed, multicenter prospective studies and randomized trials with standardized periodontal and liver measurements are needed.
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Graphical abstract
Open AccessArticle
    
    Relationship Between Virulence Factor Activities, Cytotoxicity of Candida albicans Strains Isolated from Oral Cavity, and Cytokine Production by Oral Keratinocytes Exposed to Those Strains
                        
            by
                    Kanako Yano, Hiromi Nishi, Hideo Shigeishi, Yoshino Kaneyasu, Yoshie Niitani, Honami Kitasaki, Hiroyuki Kawaguchi, Megumi Takamoto, Fumie Shiba, Toshinobu Takemoto and Kouji Ohta        
    
                
        
        Dent. J. 2025, 13(11), 502; https://doi.org/10.3390/dj13110502 - 29 Oct 2025
    
                            
    
                    
        
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            Objectives: Oral candidiasis is commonly caused by Candida albicans, which possesses virulence factors and shows cytotoxic activity that affects oral keratinocytes. On the other hand, oral keratinocytes are known to induce immune responses against C. albicans infection. The aim of the present
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            Objectives: Oral candidiasis is commonly caused by Candida albicans, which possesses virulence factors and shows cytotoxic activity that affects oral keratinocytes. On the other hand, oral keratinocytes are known to induce immune responses against C. albicans infection. The aim of the present study was to investigate the relationships of various cytokines produced from oral keratinocytes with virulence factor activities and cytotoxicity of C. albicans strains. Methods: Following the determination of the amounts of cytokines (IL-1β, IL-8, TNF-α, CCL20, CXCL1, GM-CSF) produced by oral keratinocytes when exposed to 87 different C. albicans strains, relationships of the amounts of those cytokines from oral keratinocytes with biofilm formation, phospholipase production, and C. albicans cytotoxicity were examined using Spearman correlation analysis. Results: Positive correlations of the amount of IL-8 with CXCL1 (rs = 0.295, p = 0.0055) and IL-1β (rs = 0.35, p = 0.0009) were noted, while a positive correlation was also found between amounts of GM-CSF and IL-8 (rs = 0.306, p = 0.004), as well as IL-1β (rs = 0.38, p = 0.0003). In contrast, there were no significant correlations among biofilm formation, phospholipase production, or amounts of various cytokines produced by oral keratinocytes. Furthermore, a positive correlation was noted between cytotoxicity to oral keratinocytes and amounts of IL-1β (rs = 0.736, p < 0.0001) and IL-8 (rs = 0.371, p = 0.0004). Conclusions: The differential cytotoxicity of various C. albicans strains has an influence on the production of specific cytokines from oral keratinocytes. Additionally, cytokines produced by oral keratinocytes may be mutually involved with similar signaling activation and/or autocrine/paracrine functions.
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Open AccessArticle
    
    Awareness of Gingival Recession and Its Causes and Consequences Among Adults in Saudi Arabia
                        
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                    Marwa Madi, Eman Aljoghaiman, Shahad T. Alameer, Mohammed Albander, Muntathir Alahmed, Mujtaba Almuallim, Ahmed Elakel and Maha Abdelsalam        
    
                
        
        Dent. J. 2025, 13(11), 501; https://doi.org/10.3390/dj13110501 - 28 Oct 2025
    
                            
    
                    
        
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            Background/Objectives: Gingival recession (GR), characterized by the apical displacement of the gingival margin leading to root exposure, risk of root caries, dentine hypersensitivity (DH), and plaque accumulation. This study aimed to evaluate the awareness, causes, and consequences of gingival recession among adults
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            Background/Objectives: Gingival recession (GR), characterized by the apical displacement of the gingival margin leading to root exposure, risk of root caries, dentine hypersensitivity (DH), and plaque accumulation. This study aimed to evaluate the awareness, causes, and consequences of gingival recession among adults in Saudi Arabia. Methods: A cross-sectional self-reported survey was conducted from September 2023 to December 2024, involving 619 participants (51.53% male). Participants were recruited through dental clinics, community centers, and online platforms across multiple regions in Saudi Arabia to ensure diverse demographic and socioeconomic representation. A validated 27-question survey collected data on demographics, oral hygiene practices, and GR awareness and related factors. Statistical analysis was performed using SAS 9.4, with significance set at p < 0.05. Results: The prevalence of GR was 26.66%, dental plaque was the most frequently reported causing factor, followed by medical conditions (45.4%). Aesthetic concerns were the most recognized consequence (78.4%) followed by periodontitis and tooth mobility and tooth loss (58.5%). Medical disease (Odds Ratio OR = 2.149, p < 0.0001), trauma (OR = 1.515, p = 0.0078), and rough brushing (OR = 1.431, p = 0.0233) were identified as significant risk factors for gingival recession. The association between gingival recession (GR) and its perceived consequences was generally not statistically significant. However, a significant relationship was observed with dental caries (p = 0.0472). Conclusions: Gingival recession awareness among Saudi adults was influenced by age, gender, smoking, and oral hygiene factors. The findings emphasize the importance of raising awareness and promoting preventive strategies targeting modifiable risk factors to reduce GR prevalence and clinical impact.
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Open AccessArticle
    
    Effect of Antibiotic Prophylaxis in Dental Implant Surgery: A Randomized Controlled Clinical Trial
                        
            by
                    Fernando Bravo-Olmedo, Candela Reyes-Botella, Francisco Manuel Ocaña-Peinado, Francisco Javier Manzano-Moreno, Maria de Nuria Romero-Olid and Maria Victoria Olmedo-Gaya        
    
                
        
        Dent. J. 2025, 13(11), 500; https://doi.org/10.3390/dj13110500 - 28 Oct 2025
    
                            
    
                    
        
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            Background: The problem of antibiotic resistance is becoming increasingly serious worldwide due to uncontrolled prescription of antibiotics. Studies show conflicting results on the use or not of antibiotic prophylaxis associated with dental implant placement; its benefits are unclear, and its use is
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            Background: The problem of antibiotic resistance is becoming increasingly serious worldwide due to uncontrolled prescription of antibiotics. Studies show conflicting results on the use or not of antibiotic prophylaxis associated with dental implant placement; its benefits are unclear, and its use is increasingly questioned. The aim of this randomized controlled clinical trial (RCT) was to compare early implant failure and postoperative infectious complications between two groups of healthy, non-penicillin-allergic patients who received a single prophylactic dose of 2 g amoxicillin versus placebo 1 h before surgery for implants placed in a single operative field. Methods: A double-blind, parallel-group, single-center RCT was conducted. One hundred patients met the inclusion criteria and were randomly assigned to the amoxicillin (n = 50) or placebo (n = 50) group. The primary endpoints analyzed were early implant failure and the presence of postoperative infection at 7, 14, 30 and 90 days. The recommendations of the CONSORT 2025 statement for RCT reporting were followed. Results: A total of 151 implants were placed in 96 patients and 12 implants failed; 6 implants in the antibiotic group (7.7%) and 6 implants in the placebo group (8.2%), so no statistically significant differences were observed between groups in the rate of early implant failure. In contrast, 11 implants developed postoperative infection; 2 in the antibiotic group (2.6%) and 9 in the placebo group (12.3%), reaching statistically significant differences (p = 0.028). Conclusions: The use of antibiotic prophylaxis in healthy patients is not necessary to prevent early failure of implants placed in a single operative field; however, the higher rate of infectious complications in patients without antibiotic therapy still raises a question that requires further investigation.
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                    (This article belongs to the  Section Dental Implantology)
            
        
        
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    Functional and Aesthetic Restoration After Surgical Treatment of Oral Squamous Cell Carcinoma Using Radial Forearm Free Flap: Case Report
                        
            by
                    Silviu Vultur, Dániel Száva, Alexandra Mihaela Stoica and Mara Vultur        
    
                
        
        Dent. J. 2025, 13(11), 499; https://doi.org/10.3390/dj13110499 - 28 Oct 2025
    
                            
    
                    
        
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            Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, often necessitating extensive surgical resection. Such interventions may result in complex intraoral defects requiring immediate reconstruction to restore function and aesthetics. Objective: This case report highlights the surgical
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            Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, often necessitating extensive surgical resection. Such interventions may result in complex intraoral defects requiring immediate reconstruction to restore function and aesthetics. Objective: This case report highlights the surgical management of a patient with OSCC involving the tongue, floor of the mouth and mandibular ridge, reconstructed using a radial forearm free flap (RFFF). Case report: A 51-year-old male with a history of heavy smoking presented with a necrotic lesion affecting the left mandibular alveolar ridge, floor of the mouth, and tongue. Methods: Histopathological examination confirmed a diagnosis of moderately differentiated keratinizing OSCC (G2). After oncologic resection and selective neck dissection, the defect was reconstructed using an RFFF harvested from the left forearm. The facial artery and anterior jugular vein served as recipient vessels for microvascular anastomosis. A split-thickness skin graft (STSG) was used to close the donor site. Results: The postoperative course was generally favorable. Minor complications, including a localized hematoma and neck wound dehiscence, were conservatively managed. Functional outcomes such as oral intake and wrist mobility were successfully restored with rehabilitation. The RFFF provided durable, well-vascularized coverage over exposed mandibular bone, critical for minimizing the risk of osteoradionecrosis in the context of planned adjuvant radiotherapy. Conclusions: The radial forearm free flap remains a reliable reconstructive option for complex oral defects post-OSCC resection. Multidisciplinary collaboration and meticulous surgical technique are essential to achieve optimal oncologic, functional, and aesthetic outcomes.
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                    (This article belongs to the  Special Issue Dental Oncology)
            
        
        
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Open AccessArticle
    
    Surface Roughness and Microbial Adhesion on Four Provisional Prosthodontic Restorative Materials
                        
            by
                    Ola Al Hatem, Joe C. Ontiveros, Donald M. Belles, Maria D. Gonzalez and Ransome van der Hoeven        
    
                
        
        Dent. J. 2025, 13(11), 498; https://doi.org/10.3390/dj13110498 - 27 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Objective: The aim of this study was to evaluate surface roughness (Ra) and microbial adhesion on four provisional prosthodontic materials in comparison to zirconium oxide. Methods: Four provisional prosthodontic restorative materials were evaluated in this study: poly methyl methacrylate (PMMA) acrylic
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            Objective: The aim of this study was to evaluate surface roughness (Ra) and microbial adhesion on four provisional prosthodontic materials in comparison to zirconium oxide. Methods: Four provisional prosthodontic restorative materials were evaluated in this study: poly methyl methacrylate (PMMA) acrylic resin (ALIKE; GC America Inc., Alsip, IL, USA), dimethacrylate (Bis-acryl) resin (Integrity; Dentsply Sirona, Charlotte, NC, USA), 3D-printed temporary crown and bridge resin (Formlabs Inc., Somerville, MA, USA), prepolymerized poly methyl methacrylate (milled PMMA) (Harvest Dental Laboratory Products, Brea, CA, USA), and zirconium oxide (Ivoclar Vivadent AG, Liechtenstein, Germany). A total of 90 samples were prepared and divided into two groups per material (treated and untreated). Provisional material samples were prepared per manufacturer’s instructions, polished with the same sequence using acrylic burs followed by Acrylipro silicone polishers (Brasseler, Savannah, GA, USA), and pumice with a goat brush. Zirconia was polished with a green grinding stone (ZR Grinders; Brassseler, Savannah, GA, USA), followed by a feather lite (Dialite ZR polisher; Brasseler, Savannah, GA, USA). The Ra of all samples was measured using a digital profilometer. Sterilized samples were incubated in Todd Hewitt yeast extract (THY) broth containing Candida albicans SC5314 and Streptococcus mutans BM71 at 37 °C under anaerobic conditions for 72 h. Subsequently, the number of colony-forming units (CFU) adhered to each sample was determined by serial dilution plating. Normality and homoscedasticity were assessed prior to statistical analysis. Welch’s ANOVA was then performed to evaluate differences among all samples, followed by Games–Howell post hoc tests for pairwise comparisons. A p < 0.05 was considered significant in all experiments. Results: Zirconia demonstrated the lowest surface roughness and significantly reduced adhesion of S. mutans and C. albicans compared to all other materials (p < 0.001). Milled PMMA exhibited significantly lower roughness and microbial adhesion than conventional PMMA (p < 0.001), with no significant difference from Printed PMMA in microbial adhesion. Additional pairwise differences were observed between Bis-acryl and PMMA (p = 0.0425), Milled and Printed PMMA (p < 0.0001), and Bis-acryl and Printed PMMA (p < 0.0001). Conclusions: Zirconia and milled PMMA showed superior surface properties and reduced microbial adhesion, supporting their use in long-term provisional restorations. Materials with higher microbial retention, such as self-curing PMMA, bis-acryl, and 3D-printed resins, may be less suitable for extended use. These findings guide material selection to improve clinical outcomes and highlight the need for further in vivo research.
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                    (This article belongs to the  Section Dental Materials)
            
        
        
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Open AccessArticle
    
    Position of Maxillary Lateral Incisor and First Premolar in Impaction of Maxillary Canines: A Controlled Clinical CBCT and 3D Study Model Analysis
                        
            by
                    Maja Hočevar, Maja Ovsenik and Aljaž Golež        
    
                
        
        Dent. J. 2025, 13(11), 497; https://doi.org/10.3390/dj13110497 - 27 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Objectives: This study examined the link between impacted maxillary canines and changes in the position of adjacent lateral incisors (LIs) and first premolars (FPs), as well as opposite canines. It also explored the relationship between the position of impacted canines and the
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            Objectives: This study examined the link between impacted maxillary canines and changes in the position of adjacent lateral incisors (LIs) and first premolars (FPs), as well as opposite canines. It also explored the relationship between the position of impacted canines and the presence of palpable mucosal bulges. Methods: The clinical study involved 62 participants (35 females, 27 males; average age: 14.7 years), split equally into impacted canine (n = 31) and control (n = 31) groups. The study included 26 palatally impacted canines, 5 buccally impacted canines, 31 non-impacted contralateral canines, and 62 control canines. Three-dimensional study models assessed LI and FP positions, while CBCT analyzed vertical and horizontal positions of impacted canines and dental follicles. Clinicians evaluated the presence of mucosal bulges, and distance was measured between impacted canines and outer cortical bone radiographically. Results: Compared to controls, the LIs next to impacted canines showed significantly more rotation (13°), mesiodistal angulation (11.5°), and buccopalatal angulation. FPs showed increased rotation (10.0°) and mesiodistal angulation (8.7° more) but no change in buccopalatal inclination. Contralateral canines had significantly more rotation (11.3°) than controls. Buccally impacted canines led to greater positional differences in the LIs compared to palatally impacted canines. Follicle thickness had a moderate correlation with FP rotation and mesiodistal angulation but did not relate to LI malposition. Visible mucosal bulges indicated distances of 1.2 mm or less between the canine and cortical bone. Conclusions: This study found positional differences in lateral incisors showed altered rotation, angulation, and inclination, while first premolars had increased rotation and angulation. Buccally impacted canines showed more discrepancies for lateral incisors. A mucosal bulge may indicate impacted canine location if the impacted canine is close to the outer bone surface. Follicle thickness affected premolar position but not incisors.
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                    (This article belongs to the  Special Issue Impacted Teeth: Biological Heritage or Clinical Limit?)
            
        
        
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    The Effect of Different White Spot Lesion Treatments on the Enamel Microhardness—An In Vitro Pilot Study
                        
            by
                    Milena Milanović, Miloš Beloica, Zoran Mandinić, Jelena Juloski, Miloš Petrović, Dušan Kosanović, Miloš Todorović, Maja Dimitrijević, Aleksandar Jakovljević, Miloš Vorkapić and Dragan Stanimirović        
    
                
        
        Dent. J. 2025, 13(11), 496; https://doi.org/10.3390/dj13110496 - 27 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Background/Objectives: Dental caries, one of the most common oral diseases worldwide, represents a major public health concern. Contemporary dentistry has established several non-invasive approaches and resin infiltration, as a micro-invasive path, in the treatment of white spot lesions (WSLs). This study aimed to
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            Background/Objectives: Dental caries, one of the most common oral diseases worldwide, represents a major public health concern. Contemporary dentistry has established several non-invasive approaches and resin infiltration, as a micro-invasive path, in the treatment of white spot lesions (WSLs). This study aimed to evaluate the effect of different WSL treatments on enamel surface microhardness. Materials and Methods: Seventy-five intact human premolars extracted upon orthodontic indication and the demineralizing solution composed of acetic acid, monopotassium phosphate and calcium chloride with pH = 4.4 and exposure time 96 h were used. The samples were randomly divided into five groups (n = 15): I—intact enamel (control group); II—artificial white spot lesion; III—artificial WSL treated with fluoride varnish; IV—artificial WSL treated with casein phosphopeptide—amorphous calcium phosphate (CPP-ACP) paste; V—resin-infiltrated artificial WSL. The surface microhardness was determined using the Oliver–Pharr method and a spherical indenter (Shimadzu Indenter, Kyoto, Japan). One-way analysis of variance (ANOVA) followed by a Post Hoc test (Bonferroni) was used with a level of significance set at p < 0.05. Results: Resin-infiltrated white spot lesions showed comparable microhardness mean value as the control group: 68.23 (±21.45) and 63.57 (±18.89), respectively (p > 0.05). Also, resin infiltration increased enamel microhardness compared to WSL values, with a statistically significant difference (p < 0.05). Fluoride varnish and CPP-ACP treatment resulted in equivalent values (50.84 ± 14.35 and 50.99 ± 15.31, respectively). Conclusions: Different WSL treatments (fluoride varnish, CPP-ACP and resin infiltration) produced comparable enamel microhardness values. Among the tested agents, resin infiltration resulted in higher microhardness values, while fluoride varnish and CPP-ACP demonstrated equivalent outcomes.
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                    (This article belongs to the  Section Dental Materials)
            
        
        
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Open AccessArticle
    
    Challenges of Future Patient Recruitment: A Cross-Sectional Study in Conservative Dentistry Teaching
                        
            by
                    Marco M. Herz, Michael Scharl, Diana Wolff and Valentin Bartha        
    
                
        
        Dent. J. 2025, 13(11), 495; https://doi.org/10.3390/dj13110495 - 25 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Background: Direct clinical training on real patients is essential in dental education. However, the declining patient inflow increasingly challenges this objective. This cross-sectional study aimed to assess patients’ experiences and preferences to derive recommendations for improving patient recruitment. Material and Methods: Over a
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            Background: Direct clinical training on real patients is essential in dental education. However, the declining patient inflow increasingly challenges this objective. This cross-sectional study aimed to assess patients’ experiences and preferences to derive recommendations for improving patient recruitment. Material and Methods: Over a period of one year, patients treated by students in the courses and final examinations at the dental school of conservative dentistry were questioned using a specially designed questionnaire and reviewed using their medical records. They were asked about their complete treatment process, and patient files were used to record socio-demographic as well as economic and appointment-specific data. Results: We analysed 297 patients (142 women, 47.8%; 155 men, 52.2%) treated by undergraduates across two semesters (four courses) and two final examinations. Median age was 57.0 years (IQR 46–67; mean 55.2, SD 15.2; range 14–85) with no sex-based difference (p > 0.05). Arrival was predominantly by car (72.7%, n = 216); median one-way distance was 20.5 km (IQR 11.2–32.1); and 58.4% were employed, while 41.6% were not employed (33.7% retired, 7.9% unemployed). The leading reason for course attendance was “satisfaction with previous treatments” (65.32%). Information sources were reported by 290/297 (98%); the most common was already being a course patient (143, 48.1%). Most patients attended one appointment (109, 36.7%). Median travel cost per appointment (including parking) was €17.0 (typically €10.0–€23.5). Of 285 respondents, 93.68% answered “Yes” to satisfaction with student treatment. Conclusions: Important steps include enhancing parking facilities, optimizing recall systems and appointment accessibility, and strengthening relationships with regular patients to encourage word-of-mouth referrals. The main focus is to maintain high clinical quality, ensure affordability, and further reduce patient copayments where possible.
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                    (This article belongs to the  Special Issue Dental Education: Innovation and Challenge)
            
        
        
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Open AccessArticle
    
    Bone Morphogenetic Protein 7 Promotes the Differentiation of Periodontal Ligament Fibroblasts into F-Spondin-Expressing Cementoblast-like Cells During Root Canal Treatment—An In Vivo Rat Pulpectomy Model and In Vitro Human Fibroblast Study
                        
            by
                    Hiroki Iwasawa, Yoshihiko Akashi, Kei Nakajima, Katsutoshi Kokubun, Masahiro Furusawa and Kenichi Matsuzaka        
    
                
        
        Dent. J. 2025, 13(11), 494; https://doi.org/10.3390/dj13110494 - 25 Oct 2025
    
                            
    
                    
        
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            Background/Objectives: The optimal healing process following root canal treatment involves biological apical sealing through new cementum formation. Bone morphogenetic protein 7 (BMP-7) has recently gained attention as a potential regulator of cementoblast differentiation and periodontal regeneration. However, its effects on periodontal ligament fibroblasts
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            Background/Objectives: The optimal healing process following root canal treatment involves biological apical sealing through new cementum formation. Bone morphogenetic protein 7 (BMP-7) has recently gained attention as a potential regulator of cementoblast differentiation and periodontal regeneration. However, its effects on periodontal ligament fibroblasts (PDLFs) and the underlying mechanisms remain incompletely understood. This study aimed to investigate whether BMP-7 induces cementoblast-like differentiation of PDLFs both in vivo and in vitro via the BMP-SMAD signaling pathway. Methods: In a rat pulpectomy model, root canals were treated with or without BMP-7 and examined histologically and immunohistochemically for F-spondin (Spon1) expression. In vitro, human PDLFs were stimulated with BMP-7, and analyses of mineralization, cementoblast marker expression, alkaline phosphatase activity, and SMAD-1/5/9 phosphorylation were conducted. Results: Immunohistochemical analysis revealed that Spon1-positive regions increased around the apical area following BMP-7 treatment, suggesting the induction of cementoblast-like differentiation. In vitro, BMP-7 enhanced the expression of cementoblast-associated genes and mineral deposition while activating SMAD-1/5/9 signaling. Phosphorylation was suppressed by the BMP receptor inhibitor LDN-193189, indicating canonical BMP-SMAD pathway involvement. Conclusions: Although the specific concentration range of maximal activity remains to be determined, the findings collectively suggest that BMP-7 can promote cementoblast-like differentiation of PDLFs and may contribute to apical healing through cementum-related mechanisms. These results provide mechanistic and biological insights that support the potential of BMP-7 as a modulator for biologically favorable periapical tissue regeneration following root canal therapy.
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Open AccessArticle
    
    Association of Herpes Virus Type 1, Cytomegalo Virus and Epstein–Barr Virus to the Pathogenesis of Peri-Implantitis: A Cross-Sectional Study
                        
            by
                    Ioana Suciu, Simona Ruta and George Suciu        
    
                
        
        Dent. J. 2025, 13(11), 492; https://doi.org/10.3390/dj13110492 - 25 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Background/Objectives: This study explores the potential relationship between herpesvirus infections and the severity and progression of peri-implantitis. A secondary goal is to investigate whether a virus–bacteria interaction may contribute to differences in bone loss patterns between periodontitis and peri-implantitis. Methods: Biological
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            Background/Objectives: This study explores the potential relationship between herpesvirus infections and the severity and progression of peri-implantitis. A secondary goal is to investigate whether a virus–bacteria interaction may contribute to differences in bone loss patterns between periodontitis and peri-implantitis. Methods: Biological samples, including blood, saliva, and peri-implant crevicular fluid, were collected for viral detection. Blood samples were processed at Queen Mary Laboratory in Bucharest, Romania, while saliva and peri-implant crevicular fluid samples were analyzed at the laboratory of ADD Laboral in Malden, the Netherlands. Sterile paper points were used to collect peri-implant crevicular fluid from the deepest peri-implant sites in 43 patients. A nearby tooth was sampled when present, with edentulous patients being the exception. Several clinical parameters were also considered, including implant and dentition status, smoking, gender, implant location, duration of functional loading, periodontal pocket depth (PPD), bleeding on probing (BoP), suppuration (SUP), and periodontal history. Results: Epstein–Barr virus (EBV) was detected in 30.2% of cases, Herpes virus (HSV) in 7.0%, and Cytomegalo virus (CMV) in 0%. EBV showed a moderate inverse correlation with probing depth (r = −0.48) in non-smokers with periodontal disease. Viral detection was highest on lingual and mesial surfaces. Peri-implantitis cases exhibited significantly deeper PPD, higher BoP (96.15%), and suppuration (96.15%) compared to healthy implants or teeth. Conclusions: An association was observed between the presence of Herpes viruses and increased peri-implantitis severity, suggesting a potential contributory role of viral pathogens in disease progression.
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                    (This article belongs to the  Section Dental Implantology)
            
        
        
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