Dentistry Journal

14 pages, 24836 KB

Open AccessArticle

In Vitro Assessment of Osteogenic Modulation and Molecular Responses Induced by Contemporary Endodontic Sealers in MC3T3-E1 Pre-Osteoblasts

by Yuka Miyamoto, Yuka Kato, Ryan Needle, Julie Yongsook Kim, Jin Koo Kim, Paul H. Krebsbach and Insoon Chang

Dent. J. 2026, 14(3), 160; https://doi.org/10.3390/dj14030160 - 11 Mar 2026

Abstract

Background/Objectives: Endodontic sealers can interact with periapical tissues through extrusion, yet the molecular mechanisms underlying their biological effects remain poorly defined. This study investigated how commonly used sealers influence mitogen-activated protein kinase (MAPK) signaling, cell viability, and osteogenic-associated responses in MC3T3-E1 pre-osteoblasts. [...] Read more.

Background/Objectives: Endodontic sealers can interact with periapical tissues through extrusion, yet the molecular mechanisms underlying their biological effects remain poorly defined. This study investigated how commonly used sealers influence mitogen-activated protein kinase (MAPK) signaling, cell viability, and osteogenic-associated responses in MC3T3-E1 pre-osteoblasts. Methods: Four commercial sealers, Calcium-silicate-based Bioceramic Sealer (EndoSequence^® BC Sealer, BC), Zinc oxide eugenol sealer (Kerr Pulp Canal Sealer, ZOE), Sealapex™, and AH26^®, were applied as standardized pellets, allowed to set, and cultured with MC3T3-E1 cells. Calcium deposition was assessed by Alizarin Red S (ARS) staining, and MAPK activation was evaluated by Western blotting. Due to excessive solubility (Sealapex™) or poor cell survival (AH26^®), mechanistic analyses were performed only for BC and ZOE. Osteogenic-associated gene expression was measured by qRT-PCR, and the functional role of MAPK signaling was assessed using ERK, JNK, and p38 inhibitors. Results: BC and Sealapex™ produced robust ARS staining, while ZOE and AH26^® produced minimal mineral-associated staining. Both BC and ZOE activated ERK, JNK, and p38, with ZOE inducing higher phosphorylation. However, BC maintained greater cell viability and increased Runx2 and Osx expression, whereas ZOE impaired early cell attachment and viability. MAPK inhibition in BC-treated cultures reduced osteogenic-associated gene expression and ARS staining, indicating MAPK involvement in BC-mediated responses. Conclusions: BC and ZOE elicit distinct MAPK activation patterns and cellular responses. Under the conditions tested, BC promoted a more favorable osteogenic-associated response, whereas ZOE compromised early cell viability. These mechanistic insights may help explain clinical differences in periapical tissue responses to sealer extrusion. Full article

(This article belongs to the Section Dental Materials)

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14 pages, 703 KB

Open AccessArticle

Experimental Comparative Analysis of the Effectiveness and Cleaning Performance of Conventional and Eco-Friendly Disinfectants Available in Romania

by Szidonia Krisztina Veress, László-István Bába, Attila Bitai, Bálint Botond Bögözi, Bernadette Kerekes-Máthé, Dániel Tamás Száva and Melinda Székely

Dent. J. 2026, 14(3), 159; https://doi.org/10.3390/dj14030159 - 11 Mar 2026

Abstract

Background/Objectives: To make a dental office more environmentally conscious, it is essential to use eco-friendly disinfectants without compromising patient safety. Our aim was to examine and compare the effectiveness of the commonly used conventional disinfectants in Romania with the effectiveness of available [...] Read more.

Background/Objectives: To make a dental office more environmentally conscious, it is essential to use eco-friendly disinfectants without compromising patient safety. Our aim was to examine and compare the effectiveness of the commonly used conventional disinfectants in Romania with the effectiveness of available eco-friendly disinfectants. Methods: Two traditional (Gigasept, Zeta 1 Ultra), and two eco-friendly (IDactiv, Sekusept Aktiv) disinfectants and an eco-friendly (gigazyme) cleaning agent were compared. For a thorough evaluation, minimal inhibitory and bactericidal concentration (MIC/MBC) tests were conducted, along with a Bradford assay to measure the concentration of residual proteins on instruments contaminated by controlled contamination and dental office use after disinfection. Results: During the MIC test, with the exception of Gigazyme^®, which is an enzymatic cleaner, all of the tested disinfectants were effective in the case of the bacterial reference strains used at the concentration prescribed by the manufacturers. After disinfection, the amount of protein remaining on the dental instruments did not exceed the maximum concentration according to the ISO 15883-5:2005 protocol, and the protein removal efficiency was between 96.04% and 99.03% for all disinfectants. In the MIC/MBC test, the peracetic acid-based Sekusept Aktiv was the most effective, while Gigazyme^® and BossKlein IDactiv^® showed the highest protein removal efficiency. Conclusions: The tested eco-friendly disinfectants meet the necessary performance criteria and thus offer a sustainable alternative to traditional disinfectants. Full article

(This article belongs to the Topic Advances in Dental Materials)

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26 pages, 1855 KB

Open AccessReview

Interpreting Endodontic–Periodontal Lesions: A Conceptual Framework Based on Pulpal and Periodontal Findings—A Narrative Review

by Shungo Komichi, Yusuke Takahashi, Takashi Kawahara, Takayoshi Nagahara and Mikako Hayashi

Dent. J. 2026, 14(3), 158; https://doi.org/10.3390/dj14030158 - 10 Mar 2026

Abstract

Background/Objectives: Endodontic–periodontal lesions (EPLs) represent complex pathological conditions arising from interactions between endodontic and periodontal infections. Existing classification systems primarily describe the etiology or periodontal tissue destruction but provide limited support for clinical interpretation, particularly pulp preservation and the sequencing of endodontic [...] Read more.

Background/Objectives: Endodontic–periodontal lesions (EPLs) represent complex pathological conditions arising from interactions between endodontic and periodontal infections. Existing classification systems primarily describe the etiology or periodontal tissue destruction but provide limited support for clinical interpretation, particularly pulp preservation and the sequencing of endodontic and periodontal management. This review aimed to propose a biologically informed conceptual framework intended to organize clinical reasoning considerations in EPL management. Methods: This narrative review integrates current knowledge regarding pulp vitality, pathways of infection, periodontal healing, and treatment sequencing reported in the endodontic and periodontal literature. Based on this synthesis, a conceptual framework was constructed using two clinical dimensions: the extent of remaining vital pulp and the presence or absence of coronal-originating infection (IC), defined as a potential coronal pathway of bacterial ingress that may contribute to lesion development. Results: The framework categorizes EPLs into four principal groups according to pulp vitality (vital/non-vital) and IC status (present/absent), with additional grading to describe the potential feasibility of pulp preservation and structural reassessment during initial management. Rather than prescribing specific therapies, the model organizes clinical interpretation related to pulp-preserving considerations, the timing of periodontal intervention, and evaluation of surgical management following nonsurgical treatment. Conclusions: This framework provides a biologically oriented conceptual model for understanding EPLs and structuring clinical reasoning. It is intended as a hypothesis-guided interpretive framework rather than a clinical practice guideline and is designed to support case interpretation, not to determine mandatory treatment decisions; thus, its clinical applicability requires further validation, and prospective multicenter studies are necessary before routine clinical implementation. Full article

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16 pages, 2355 KB

Open AccessArticle

The “Radicular Tank”: A Novel Concept in Endodontics Achieved with the MEA Inverse Taper^® Technique

by Giovanni Messina, Gaia Bonandi, Marta Marchica, Marta Longo, Luigi Stagno d’Alcontres, Lusien Distefano, Antonino Cacioppo, Pier Edoardo Maltagliati, Calogero Bugea, Eugenio Pedullà and Elena Bardellini

Dent. J. 2026, 14(3), 157; https://doi.org/10.3390/dj14030157 - 10 Mar 2026

Abstract

Background: Successful root canal treatment depends on the synergy between mechanical instrumentation and chemical disinfection. The internal canal geometry, particularly taper configuration, critically influences irrigant flow and penetration. Conventional taper designs tend to displace irrigants coronally, creating stagnation zones and limiting cleaning efficacy. [...] Read more.

Background: Successful root canal treatment depends on the synergy between mechanical instrumentation and chemical disinfection. The internal canal geometry, particularly taper configuration, critically influences irrigant flow and penetration. Conventional taper designs tend to displace irrigants coronally, creating stagnation zones and limiting cleaning efficacy. The MEA Inverse Taper^® technique introduces a reversed taper geometry designed to retain irrigant within the canal during shaping, forming a fluid reservoir termed the Radicular Tank (RT). This proof-of-concept study aimed to experimentally demonstrate the formation of the RT generated by the MEA Inverse Taper^® design and to compare its qualitative hydrodynamic and shaping behavior with a conventional rotary system (MTWO). Methods: Standardized transparent canal models were instrumented using either the MEA Inverse Taper^® or MTWO sequence. A 1% methylene blue dye served as a visual tracer to assess potential intracanal retention at successive shaping stages. Standardized photographic documentation and digital image superimposition were used to evaluate residual dye retention, canal morphology, and taper variation. Results: The MEA Inverse Taper^® sequence maintained residual dye in the coronal and middle thirds, confirming the formation of the RT. Compared with MTWO, it produced a more conservative taper, minimized coronal and apical displacement of dye, and preserved canal curvature, removing less coronal dentin. Conclusion: The MEA Inverse Taper^® technique creates a qualitative dye-retention phenomenon (Radicular Tank) that allows continuous instrumentation within a visually persistent dye environment. This novel concept may support disinfection efficiency, alongside preserving dentin structure and reducing mechanical stress on rotary instruments, representing a potential advancement in endodontic shaping and irrigation protocols. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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12 pages, 2002 KB

Open AccessReview

The Clinical Significance of Attached Gingiva in the Natural Dentition

by João Carnio, João Kreling Carnio and Paulo M. Camargo

Dent. J. 2026, 14(3), 156; https://doi.org/10.3390/dj14030156 - 9 Mar 2026

Abstract

Background: The attached gingiva (AG) is the portion of the gingiva firmly bound to the underlying alveolar bone and root cementum, rendering it immobile during functioning. Its dense connective tissue attachment contributes to resistance against mechanical challenges, stabilization of the gingival margin, and [...] Read more.

Background: The attached gingiva (AG) is the portion of the gingiva firmly bound to the underlying alveolar bone and root cementum, rendering it immobile during functioning. Its dense connective tissue attachment contributes to resistance against mechanical challenges, stabilization of the gingival margin, and dissipation of forces transmitted from the alveolar mucosa. Histologically, AG is characterized by a keratinized epithelium supported by dense collagen fiber bundles, which provide structural integrity to the dento–gingival unit. Clinically, the buccal and lingual width of AG is estimated by subtracting sulcus depth from the total width of keratinized tissue. Although periodontal health may be maintained with minimal AG under optimal plaque control, substantial evidence supports its role in preserving gingival architecture and resisting mechanical trauma. Practical Application: From a clinical perspective, an adequate width of attached gingiva has traditionally been considered necessary to protect the periodontium; however, clinical situations may exist in which its dimension is reduced or absent. Available evidence suggests that a minimal width of approximately 1 mm of attached gingiva may be sufficient to maintain periodontal health under conditions of effective plaque control and absence of inflammation. Nevertheless, when only this minimal dimension is present, the attachment is predominantly derived from the junctional epithelium, which may offer limited mechanical protection to the dento–gingival unit. Within the limits of current evidence, a keratinized tissue width of approximately 3 mm appears to represent a functional threshold associated with increased connective tissue fiber density and enhanced resistance to mechanical trauma. Methods: A narrative review of classical and contemporary literature was conducted to evaluate the morphology, histology, function, and clinical relevance of the attached gingiva. Results: Evidence indicates that when AG width is minimal, reliance on junctional epithelial attachment alone provides limited resistance to mechanical challenges. In contrast, a greater width of AG incorporating connective tissue fiber attachment is associated with improved gingival margin stability, enhanced mechanical protection, and periodontal tissue resilience. Based on this synthesis, a tissue-based clinical categorization of AG is proposed. Conclusions: This review integrates current biological and clinical concepts regarding the functional dimensions of attached gingiva. The proposed categorization offers a practical framework to support clinical decision-making and to identify conditions in which surgical augmentation may be indicated for the management of mucogingival deficiencies. Full article

(This article belongs to the Special Issue Feature Review Papers in Dentistry: 2nd Edition)

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16 pages, 2709 KB

Open AccessFeature PaperArticle

Accuracy of Guided Drilling, Partially Guided Trephination, and Fully Guided Trephination Within a Static Surgical Guide for Apicoectomy in Hard Bone: An In Vitro Study

by Fatima Jasim Humaid Alzaabi, Eszter Nagy, Dániel Gerhard Gryschka, Shishir Ram Shetty, Tarek Elsewify, Gábor Braunitzer, Hatem M. El-Damanhoury and Mark Adam Antal

Dent. J. 2026, 14(3), 155; https://doi.org/10.3390/dj14030155 - 9 Mar 2026

Abstract

Aim: Static guided computer-assisted apicoectomy has been shown to improve the precision of periapical surgery; however, limited data are available regarding its performance and accuracy in hard bone conditions. The primary aim of this study was to collect data on how this [...] Read more.

Aim: Static guided computer-assisted apicoectomy has been shown to improve the precision of periapical surgery; however, limited data are available regarding its performance and accuracy in hard bone conditions. The primary aim of this study was to collect data on how this technique functions in hard bone and to evaluate the accuracy of different guided approaches under these conditions. Specifically, the accuracy of three surgical instruments—a commercially available bone drill, a bone trephine (partially guided), and an endo-trephine with a stopper (fully guided)—was compared in hard bone. Materials and methods: Sheep mandibles were scanned using cone-beam computed tomography (CBCT) and an intraoral scanner (STL). Digital planning was performed using commercially available dental implant surgical planning software. Guided apicoectomy procedures were carried out with the aid of 3D-printed surgical guides. Following the interventions, matching metal cylinders were inserted into the prepared osteotomies, and post-operative CBCT scans were acquired. Apical deviation from the digitally planned endpoint and angular deviation were analyzed to assess accuracy in hard bone. Results: The drill demonstrated a statistically significantly higher apical deviation compared to the endo-stop trephine (p < 0.001). No statistically significant difference in apical deviation was found between the bone trephine and the endo-stop trephine. Additionally, no significant differences were observed among the three approaches in the mesiodistal (x) and buccolingual (y) directions or in angular deviation; however, a statistically significant difference was detected in the vertical (z) dimension. Conclusions: Within the limitations of this study, static guided apicoectomy proved to be a reliable technique in hard bone conditions. The fully guided trephine approach demonstrated the highest drilling accuracy, while partially guided trephination and drilling showed greater deviations. These findings provide valuable data on the behavior and precision of different endosurgical guided instruments in hard bone and support the use of fully guided systems when high accuracy is required. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

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16 pages, 259 KB

Open AccessArticle

Knowledge, Attitude, and Practice of Emergency Department Healthcare Professionals Towards Traumatic Dental Injuries Across Public Hospitals in Riyadh, Saudi Arabia

by Haifa AlAmro, Asma Alshahrani, Kiran Iyer, Latifah Almashabi, Hala Alanazi, Arwa Alshahrani and Nouf Alrawaf

Dent. J. 2026, 14(3), 154; https://doi.org/10.3390/dj14030154 - 9 Mar 2026

Abstract

Background/Objectives: Emergency department healthcare professionals are often the first to provide treatment, yet studies indicate limited knowledge in Traumatic Dental Injuries (TDIs) management among these providers. While research on TDI management in emergency departments exists globally, recent data from Saudi Arabia is [...] Read more.

Background/Objectives: Emergency department healthcare professionals are often the first to provide treatment, yet studies indicate limited knowledge in Traumatic Dental Injuries (TDIs) management among these providers. While research on TDI management in emergency departments exists globally, recent data from Saudi Arabia is lacking. This study aims to assess the knowledge, attitude, and practice of emergency department physicians, nurses, and Emergency Medical Services (EMS) regarding TDIs in three major hospitals in Riyadh, Saudi Arabia. Results: Physicians (46.4%) were significantly (p = 0.02) more likely to respond that they have sufficient knowledge about TDIs compared to nurses and EMS personnel. Of the 221 respondents, 136 (62%) were in the age group of 30–40 years, while females (OR 4.23, p = 0.00, CI 2.29–23.13) and nurses (OR 4.88, p = 0.00, CI 2.39–9.96) were more likely to say ‘No’ for any form of training they received in dental trauma during their education. Young (20–30 years old) professionals (OR 3.70, p = 0.04, CI 1.53–8.92) were less likely to feel confident in managing cases of dental trauma compared to their senior colleagues. Conclusions: In this study, nurses’ and EMS personnel’s knowledge of dental trauma management was poorer than that of physicians. Most respondents reported that dental trauma management was not part of their curriculum or training, which, in turn, was reflected in their low confidence in managing such cases. Full article

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10 pages, 642 KB

Open AccessArticle

Survey on Dental Students’ Knowledge of Infection Prevention and Control Rules

by Velina Stoeva, Tsonka Miteva-Katrandzhieva and Elizabeth Shamsee

Dent. J. 2026, 14(3), 153; https://doi.org/10.3390/dj14030153 - 9 Mar 2026

Abstract

Background/Objectives: This study evaluates the level of knowledge among dental students regarding infection prevention and control measures in dental practice. Methods: A total of 225 students from the Medical University of Plovdiv participated in an anonymous survey between November 2024 and March 2025. [...] Read more.

Background/Objectives: This study evaluates the level of knowledge among dental students regarding infection prevention and control measures in dental practice. Methods: A total of 225 students from the Medical University of Plovdiv participated in an anonymous survey between November 2024 and March 2025. The survey assessed knowledge about epidemiological factors, disinfection protocols, and procedures for infection prevention and control. Results: The survey results revealed that while most students demonstrated a high level of knowledge of the importance of protective equipment and impression disinfection, a few students reported incorrect or inconsistent practices. Gender differences were observed in adherence to disinfection procedures. Conclusions: The findings highlight the need for enhanced training in infection control within dental curricula to ensure safe clinical practice and minimize cross-infection risks. Full article

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13 pages, 565 KB

Open AccessFeature PaperArticle

Lip Pressure, Bite Force and Denture Use as Predictors of Oral Frailty in Physically Active Older Adults: A Cross-Sectional Study

by Catarina Colaço, Inês Caetano-Santos, José Brito, Vanessa Machado, Angel Lobito, José João Mendes, Selma Siessere, Simone Cecílio Hallak Regalo and Luciano Maia Alves Ferreira

Dent. J. 2026, 14(3), 152; https://doi.org/10.3390/dj14030152 - 9 Mar 2026

Abstract

Background: Oral frailty is an emerging determinant of late-life disability. While objective functional measures have been proposed as key indicators, their combined role in predicting frailty among physically active older adults remains unclear. Therefore, this study aimed to investigate the association between the [...] Read more.

Background: Oral frailty is an emerging determinant of late-life disability. While objective functional measures have been proposed as key indicators, their combined role in predicting frailty among physically active older adults remains unclear. Therefore, this study aimed to investigate the association between the presence of oral frailty and lip pressure, bite force, and denture use. Methods: This cross-sectional study included 192 participants aged 60 years or older from Brazil (n = 131) and Portugal (n = 61), all physically active and with ≥20 natural or rehabilitated teeth. Data were collected through a questionnaire on sociodemographic data and the Oral Frailty Index-8. The clinical assessment included lip pressure, bite force, and denture use. Multiple logistic regression identified independent predictors; model fit and discrimination were examined using the Hosmer–Lemeshow test and ROC curve. Results: Participants were mainly female (83.3%), mean age ≈72 years; 76% used dentures and frailty prevalence was ≈49%. Higher lip pressure (OR = 0.986, 95% CI = [0.973–0.999]) and higher bite force (OR = 0.925, 95% CI = [0.885–0.967) were independently protective, whereas denture use (OR = 6.898, 95% CI = [2.994–15.895]) markedly increased oral frailty odds. The model showed good discrimination (AUC 0.779). Conclusions: Even small increases in lip pressure and bite force reduced the likelihood of frailty, while denture use identified individuals at substantially higher risk. These findings highlight orofacial muscle strength and masticatory capacity as core components of oral frailty and support incorporating lip pressure and bite force testing into multidimensional frailty assessment and targeted rehabilitation. Full article

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10 pages, 239 KB

Open AccessArticle

Impact of Smear Layer Removal Using Etidronate- and EDTA-Based Irrigation Protocols on Root Canal Microbiota: An In Vivo Study

by Svetlana Razumova, Anzhela Brago, Anzhelika Kryuchkova, Zilolakhon Khakimova, Nazira Khabibova, Alexander Volkov, Haydar Barakat and Natalya Dikopova

Dent. J. 2026, 14(3), 151; https://doi.org/10.3390/dj14030151 - 7 Mar 2026

Abstract

Background: The effective elimination of root canal microbiota is essential for the treatment of apical periodontitis. The smear layer formed during instrumentation limits the penetration of irrigants into dentinal tubules, making chelation a critical component of irrigation protocols. While ethylenediaminetetraacetic acid (EDTA) [...] Read more.

Background: The effective elimination of root canal microbiota is essential for the treatment of apical periodontitis. The smear layer formed during instrumentation limits the penetration of irrigants into dentinal tubules, making chelation a critical component of irrigation protocols. While ethylenediaminetetraacetic acid (EDTA) is commonly used for smear layer removal, etidronate has been proposed as an alternative due to its chemical compatibility with sodium hypochlorite. The aim of this study was to compare the effectiveness of different irrigation protocols in eliminating microorganisms from the root canal system in patients with chronic apical periodontitis. Methods: Thirty patients aged 18–44 years diagnosed with chronic apical periodontitis (ICD-10 code K04.5) were included. Three irrigation protocols were evaluated: (1) 3% sodium hypochlorite followed by 17% EDTA; (2) 3% sodium hypochlorite followed by a 9% aqueous solution of etidronate; and (3) a 9% solution of etidronate dissolved in 3% sodium hypochlorite (continuous chelation). Microbiological samples were collected before and after root canal instrumentation and irrigation. Microbial analysis was performed using gas chromatography–mass spectrometry. Results: All protocols resulted in a reduction in microbial load. However, protocols using 3% sodium hypochlorite with 17% EDTA and continuous chelation with etidronate in sodium hypochlorite demonstrated a greater number of statistically significant reductions. Sequential irrigation with aqueous etidronate showed the lowest antimicrobial effectiveness. Conclusions: Continuous chelation with etidronate in 3% sodium hypochlorite showed promising antimicrobial performance and may represent a clinically feasible alternative irrigation strategy. Full article

17 pages, 5048 KB

Open AccessArticle

Differential Attachment of Engineered Oral Soft Tissues to Implant Surfaces

by Nour Jalaleddine, Emilia Barker, Kirsty Franklin, Mohamed Jamal, Momen A. Atieh, Zaid H. Baqain and Keyvan Moharamzadeh

Dent. J. 2026, 14(3), 150; https://doi.org/10.3390/dj14030150 - 6 Mar 2026

Abstract

Background/Objectives: The formation of a soft tissue seal through mucosal integration around dental implants is critical for potentially achieving long-term peri-implant health and clinical success. Understanding how different implant and abutment surfaces interact with individual layers of the oral mucosa remains limited. [...] Read more.

Background/Objectives: The formation of a soft tissue seal through mucosal integration around dental implants is critical for potentially achieving long-term peri-implant health and clinical success. Understanding how different implant and abutment surfaces interact with individual layers of the oral mucosa remains limited. This study aimed to compare the differential attachment of tissue-engineered oral epithelium, connective tissue, and full-thickness human oral mucosa to various implant and abutment materials and surface topographies. Methods: Sand-blasted, large-grit, acid-etched (TiZr-SLA), machined TiZr (TiZr-M), machined zirconia (ZrO₂-M), polished zirconia (ZrO₂-P), and machined PEEK rods, along with commercially available titanium and ZrO₂ healing abutments, were inserted into 3D oral mucosal models following a 4-mm punch biopsy. Inflammation was induced using Escherichia coli lipopolysaccharide. Analyses included histology, PrestoBlue viability assay, scanning electron microscopy, and ELISA quantification of cytokines IL-1β, IL-6, and IL-8. Results: Epithelial attachment was greater on TiZr-SLA, ZrO₂-P, and PEEK-M (p < 0.05 and p < 0.01) surfaces compared with TiZr-M and ZrO₂-M. TiZr-SLA exhibited the highest connective tissue attachment (p < 0.05). Commercial titanium and ZrO₂ healing abutments demonstrated the highest post-pull PrestoBlue viability and overall soft tissue attachment. SEM confirmed cell retention on all implant surfaces. Elevated IL-1β levels were detected in models exposed to ZrO₂-M and PEEK-M, whereas IL-6 and IL-8 levels were not influenced by any material or surface topography. Conclusions: In vitro epithelial and connective tissue responses are influenced by implant material, surface topography, and design. Rough TiZr-SLA surfaces promote superior connective tissue attachment, while smooth commercial abutments support optimal overall soft tissue integration. These findings highlight the importance of surface engineering in preclinical optimization of peri-implant soft tissue attachment. Full article

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

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10 pages, 1135 KB

Open AccessArticle

by Anthony Yihong Cheng, Yuanyuan Liu, Faith Miaomiao Zheng, Ivy Guofang Sun, Jieyi Chen and Chun Hung Chu

Dent. J. 2026, 14(3), 149; https://doi.org/10.3390/dj14030149 - 6 Mar 2026

Abstract

Objectives: This study aimed to characterize the age-related trends of caries experience among preschool children in Shenzhen, China. Methods: This cross-sectional study recruited 3- to 5-year-old preschool children in Shenzhen via a multistage random sampling method in 2024. Two calibrated examiners [...] Read more.

Objectives: This study aimed to characterize the age-related trends of caries experience among preschool children in Shenzhen, China. Methods: This cross-sectional study recruited 3- to 5-year-old preschool children in Shenzhen via a multistage random sampling method in 2024. Two calibrated examiners conducted oral examinations in kindergartens using disposable dental mirrors with LED illumination and ball-ended Community Periodontal Index probes. Caries experience was recorded using the dmft index, as recommended by the World Health Organization. Results: This study invited 4015 children from 27 selected kindergartens, and 3534 children (1886 boys, 53%) completed the survey. The response rate was 88%. The prevalence of caries experience was 31% at age 3, 49% at age 4, and 58% at age 5, representing a 27% higher prevalence in 5-year-olds than in 3-year-olds. The mean dmft scores (±SD) were 1.2 ± 2.5 for 3-year-olds, 2.2 ± 3.2 for 4-year-olds, and 2.8 ± 3.5 for 5-year-olds, indicating a 1.6 affected teeth higher mean dmft in 5-year-olds than in 3-year-olds. The upper central incisors were the most affected teeth (23%) in 3-year-olds and remained the most susceptible across all age groups, while the prevalence of caries in lower molars increased progressively from 7% at age 3 to 24% at age 5. Conclusions: Dental caries prevalence and severity among preschool children in Shenzhen increase significantly with age. These findings highlight the need for targeted preventive strategies focusing on high-risk teeth, including the upper central incisors and lower molars, to address the rising burden of early childhood caries in this population. Full article

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

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15 pages, 449 KB

Open AccessReview

Biomechanical Applications of Finite Element Analysis in Orthodontics: A Scoping Review of Force Distribution, Tooth Movement, and Mechanical Performance

by Valenciana-Solís Jesús Antonio, Gaitán-Fonseca César, Flores Héctor, Zavala-Alonso Verónica, Bermúdez-Jiménez Carlos, Martínez-Torres Carlos and Pozos-Guillén Amaury

Dent. J. 2026, 14(3), 148; https://doi.org/10.3390/dj14030148 - 6 Mar 2026

Abstract

Background/Objectives: Clinical and scientific professionalization in orthodontics requires a comprehensive understanding of the biomechanical principles governing force generation and distribution produced by orthodontic appliances, beyond purely esthetic considerations. In this context, finite element analysis (FEA) has emerged as a fundamental computational tool for [...] Read more.

Background/Objectives: Clinical and scientific professionalization in orthodontics requires a comprehensive understanding of the biomechanical principles governing force generation and distribution produced by orthodontic appliances, beyond purely esthetic considerations. In this context, finite element analysis (FEA) has emerged as a fundamental computational tool for the detailed evaluation of the biomechanical behavior of the dentoalveolar system. The aim of this study was to map and synthesize the available scientific evidence on the application of FEA in the assessment of force distribution, tooth movement, and the mechanical response of periodontal tissues during orthodontic treatment. Methods: Original studies published between 2020 and 2025 that relied exclusively on computational simulations using FEA were included. Eligible studies addressed orthodontic biomechanics, including tooth movement, appliance–tooth–periodontium interactions, or the mechanical evaluation of orthodontic attachments. Clinical studies, narrative reviews, and articles without finite element modeling were excluded. A systematic literature search was conducted in the PubMed and ScienceDirect databases to answer the following question: Which FEA methodologies have been used to evaluate the biomechanical behavior of orthodontic appliances? Results: Data were categorized according to key biomechanical variables. The findings indicate an increasing use of FEA as a supportive tool in orthodontic research. However, significant limitations were identified, including lack of methodological standardization, limited model validation, and insufficient correlation between computational outcomes and clinical evidence. Conclusions: Currently, FEA in orthodontics is used predominantly for descriptive purposes, particularly for visualizing stress and strain distributions. Greater standardization and validation are required to enhance its translational applicability in clinical relevance. Full article

(This article belongs to the Special Issue Accelerated Orthodontics: The Modern Innovations in Orthodontics)

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22 pages, 413 KB

Open AccessReview

Sex-Specific Oral Health: A Narrative Review of Hormonal Influences and Disease Patterns

by Agnes Holtkamp, Florian Beuer, Thomas Gerhard Wolf and Michael Naumann

Dent. J. 2026, 14(3), 147; https://doi.org/10.3390/dj14030147 - 6 Mar 2026

Abstract

This narrative review aims to analyze sex-specific differences in oral health, examine hormonal influences in women during puberty, pregnancy, and menopause, and compare oral health behaviors between men and women. Articles were selected based on: (1) sex-specific aspects of oral diseases, (2) hormonal [...] Read more.

This narrative review aims to analyze sex-specific differences in oral health, examine hormonal influences in women during puberty, pregnancy, and menopause, and compare oral health behaviors between men and women. Articles were selected based on: (1) sex-specific aspects of oral diseases, (2) hormonal influences on oral health, (3) comparative analyses between sexes, and (4) sex-disaggregated data on oral disease prevalence. Women experience hormonal vulnerabilities with estrogen deficiency causing xerostomia, mucosal atrophy, and increased caries susceptibility, showing parallels between oral and vaginal mucosa. Men demonstrate higher periodontitis prevalence (57% vs. 38%), utilize preventive services one-third less frequently, and show higher smoking rates (67% vs. 42%) and traumatic dental injuries (2:1 ratio). Women maintain better oral hygiene and treatment adherence. Sex-specific factors affecting both sexes remain unconsidered in dental practice. Women need targeted interventions during hormonal transitions, while men require improved preventive care engagement. Future research integrating sex-specific considerations is required to enable personalized oral health approaches for both sexes. Full article

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

25 pages, 335 KB

Open AccessArticle

Sources of Oral Health Activities Among Croatian University Students—A Pilot Study

by Diana Aranza, Tina Poklepović Peričić and Boris Milavić

Dent. J. 2026, 14(3), 146; https://doi.org/10.3390/dj14030146 - 5 Mar 2026

Abstract

Background: This cross-sectional designed study aimed to identify the sources of oral health activities (OHA) by introducing a new OHA sources questionnaire (OHAQ-S). Methods: The OHAQ-S was developed from a sample of 658 university students and included measurements from nine sources: scales for [...] Read more.

Background: This cross-sectional designed study aimed to identify the sources of oral health activities (OHA) by introducing a new OHA sources questionnaire (OHAQ-S). Methods: The OHAQ-S was developed from a sample of 658 university students and included measurements from nine sources: scales for parents, Dental medical doctors (DMDs), and primary school sources, as well as single-item measures for other sources. Using QHAQ-S measures, gender differences, determinants of OH activities, and differences between OH types were analysed. Results: Gender differences were observed in five OH sources (university, high school, self-learning, friends, and kindergarten). In both female and male subsamples, primary sources such as parents and DMD predicted overall OH activities, though with different secondary sources. In the female subsample, some differences in OHAQ-S sources appeared between the four OH types. The excellent OH type most notably differed from others by having higher reported incidence of self-learning—dental floss usage and DMD sources—and marginally higher reported use of university and parental sources. In the male subsample, multiple differences in OHAQ-S sources were found among the four OH types. The excellent OH type most distinguished itself by reporting higher levels of DMD, self-learning—dental floss usage, university—acquired OH knowledge, parental, and media and internet—health journal sources. Conclusions: Female students have differently expressed and more-pronounced OHA sources relative to male students and some sources encountered earlier (kindergarten and high school sources), and “independent” learning sources (self-learning versus friends sources). In both subsamples, predictive relationships of OHAQ-S measures with overall OH activities were verified. The findings on the elements of the discriminative and predictive validity of the pilot version of the questionnaire show that the OHAQ-S questionnaire represents a quality basis for constructing a questionnaire on sources of OH activities. Full article

(This article belongs to the Section Dental Education)

13 pages, 3123 KB

Open AccessArticle

Influence of Build Platform Position on the Trueness and Precision of LCD 3D-Printed Orthognathic Surgical Splints

by Siripatra Patchanee, Pokpong Amornvit, Aunchisa Sreatsiripakdee, Chantawat Tanapirom and Narissaporn Chaiprakit

Dent. J. 2026, 14(3), 145; https://doi.org/10.3390/dj14030145 - 5 Mar 2026

Abstract

Background/Objectives: Among vat polymerization technologies, liquid-crystal display (LCD) 3D printing has gained popularity in dentistry because of its affordability and acceptable resolution. However, the factors influencing the dimensional accuracy of LCD-printed surgical splints, particularly build platform position, remain insufficiently investigated. This study [...] Read more.

Background/Objectives: Among vat polymerization technologies, liquid-crystal display (LCD) 3D printing has gained popularity in dentistry because of its affordability and acceptable resolution. However, the factors influencing the dimensional accuracy of LCD-printed surgical splints, particularly build platform position, remain insufficiently investigated. This study aimed to evaluate the influence of build platform position on the trueness and precision of orthognathic surgical splints fabricated using LCD 3D printing technology. Methods: Thirty-six surgical splints were printed from a master digital file using an LCD 3D printer. All surgical splints were printed with a 90-degree layer orientation to the building platform. The layer thickness was set at 100 μm. The surgical splints were divided into three groups according to their printing position on the building platform: middle (M), left (Lt), and right (Rt). Each 3D-printed surgical splint was sprayed with an opaque scanning spray and then rescanned to create digital files for testing. A surface-based superimposition and deviation analysis was performed using specialized 3D software to evaluate accuracy of surgical splints. Root mean square error (RMSE) values were statistically analyzed. Results: There were no statistically significant differences in trueness among the middle, left, and right printing positions on the build platform (p > 0.05). In contrast, printing position significantly affected precision, with surgical splints printed at the center of the build platform demonstrating significantly lower RMSE values compared with those printed at the left and right positions (p < 0.001). In addition, no significant difference in precision was detected between the left and right positions. Conclusions: The printing position on the build platform significantly influences the precision of orthognathic surgical splints fabricated using LCD 3D printing technology. Splints printed at the central region of the build platform exhibited the highest precision, whereas trueness was not significantly affected by printing position. These findings suggest that preferential placement of surgical splints at the center of the build platform may improve fabrication consistency and predictability in digital orthognathic surgery workflows. Full article

(This article belongs to the Special Issue 3D Printing Technology in Dentistry)

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12 pages, 2784 KB

Open AccessArticle

Workforce Contributions to Advancing Oral Health Equity: Howard University’s Orthodontic Program

by Racine Ramanand, Kathy Marshall, Minxuan Lan, Marzia Mustamand, Bao Vu, Lobat Zainali, Marianne Siewe, Andrea D. Jackson, Indra Mustapha and Xinbin Gu

Dent. J. 2026, 14(3), 144; https://doi.org/10.3390/dj14030144 - 5 Mar 2026

Abstract

Background: Health disparities are differences in healthcare access influenced by factors such as race, socioeconomic status, and geography. Oral health disparities show similar patterns, with underrepresented minorities (URM) facing greater barriers to care. Racial concordance improves patient outcomes, yet minority representation in [...] Read more.

Background: Health disparities are differences in healthcare access influenced by factors such as race, socioeconomic status, and geography. Oral health disparities show similar patterns, with underrepresented minorities (URM) facing greater barriers to care. Racial concordance improves patient outcomes, yet minority representation in orthodontics remains low. This study examined how Howard University’s Orthodontic Residency Program influences workforce diversity and expands care for minority populations. Methods: A retrospective analysis of Howard University’s orthodontic graduates (Classes 2009–2024) was performed to collect demographic information, practice location, and board certification status. Practice addresses were evaluated for Health Professional Shortage Area (HPSA) designation, and geographic analysis identified the demographics of the practice areas. Results: Among the 94 graduates studied, thirty-seven (39.4%) worked in the surrounding Washington, D.C., Maryland, and Virginia (DMV) area. Currently, 30% of graduates practiced in HPSAs, and 53% practiced in majority-minority communities. Board certification rates showed an upward trend, culminating in 100% certification among 2024 graduates. Conclusions: Howard University’s Orthodontic Program has significantly advanced access to specialized care in majority-minority communities through the training of URM orthodontists. Alumni demographics, board certification rates, and placement in underserved areas demonstrate the program’s success in developing diverse professionals committed to clinical excellence and service. Full article

(This article belongs to the Section Dental Education)

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18 pages, 1106 KB

Open AccessReview

Mind–Body Movement-Based Interventions and Periodontal Health: A Scoping Review

by Marco M. Herz and Valentin Bartha

Dent. J. 2026, 14(3), 143; https://doi.org/10.3390/dj14030143 - 5 Mar 2026

Abstract

Background: Periodontitis is a highly prevalent chronic inflammatory disease characterized by a complex host–microbe interaction and modulated by systemic regulatory pathways, including stress-related neuroendocrine and immunological mechanisms. Mind–body movement-based interventions such as yoga, tai chi, and qigong have demonstrated beneficial effects on [...] Read more.

Background: Periodontitis is a highly prevalent chronic inflammatory disease characterized by a complex host–microbe interaction and modulated by systemic regulatory pathways, including stress-related neuroendocrine and immunological mechanisms. Mind–body movement-based interventions such as yoga, tai chi, and qigong have demonstrated beneficial effects on stress and inflammation in general medicine, yet their relevance for periodontal health has not been systematically mapped. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the PRISMA-ScR guidelines. Eligibility criteria included studies conducted in adult human participants examining mind–body movement-based interventions in relation to periodontal health. Sources of evidence comprised peer-reviewed studies identified through systematic searches in CINAHL, BIOSIS, Embase, PubMed/MEDLINE, the Cochrane Library, Web of Science, and LIVIVO. Data were charted using a standardized extraction form capturing key study characteristics and outcomes. Eligible studies reported clinical periodontal parameters and/or biological or psychosocial outcomes related to stress or inflammation. Results: Eleven studies investigating mind–body movement-based interventions and periodontal health were included. Interventions comprised yoga, pranayama, tai chi, and qigong, with study designs ranging from one randomized controlled trial to non-randomized interventional and observational studies. Most studies reported clinical periodontal parameters and/or periodontal-related biological markers, including inflammatory, oxidative, and immune markers, and several also assessed stress-related outcomes. The interventions were applied both as adjuncts to conventional periodontal therapy and as stand-alone approaches. Overall, the included studies reported short-term changes in periodontal parameters and stress-related measures that were generally directed towards associated with improvement; however, long-term periodontal outcomes were rarely assessed. Conclusions: Mind–body movement-based interventions, such as yoga and pranayama, have been examined in relation to periodontal health, with studies reporting periodontal clinical parameters, biological markers, and stress-related outcomes. The available evidence is heterogeneous and largely limited to short-term observations. Further methodologically rigorous studies with standardized outcome measures and longer follow-up periods are needed to better characterize the relationship between mind–body interventions and their potential adjunctive relevance in periodontal care, as current evidence does not allow conclusions regarding their routine adjunctive use. Full article

(This article belongs to the Special Issue Feature Review Papers in Dentistry: 2nd Edition)

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13 pages, 14782 KB

Open AccessArticle

In Vitro Comparison of Gingival Epithesis Materials: Color Stability, Surface Properties, and Microbial Adhesion After Staining

by Ellen Pick, Andrea Gubler, Thomas Attin and Patrick R. Schmidlin

Dent. J. 2026, 14(3), 142; https://doi.org/10.3390/dj14030142 - 4 Mar 2026

Abstract

Background: This in vitro study compared color stability, surface properties, and microbial adhesion of four gingival epithesis materials (silicone: Gingivamoll^®; nylon: Valplast^®; PETG-based high-performance polymer: Eldy Plus^®; PMMA: Palapress^®) after staining. Methods: Standardized [...] Read more.

Background: This in vitro study compared color stability, surface properties, and microbial adhesion of four gingival epithesis materials (silicone: Gingivamoll^®; nylon: Valplast^®; PETG-based high-performance polymer: Eldy Plus^®; PMMA: Palapress^®) after staining. Methods: Standardized specimens (10 × 10 × 2 mm; n = 18/material) underwent 15 or 30 staining cycles (sequential immersion in coffee, curry, tea, and 40% alcohol). Color (CIELAB) and color difference (ΔE00), gloss (G), and surface roughness (Ra) were measured at baseline and after 15 and 30 cycles; surface morphology was assessed by SEM. Microbial adhesion was assessed using a six-species biofilm model and quantified as log CFU at baseline and after 15 and 30 cycles. Results: All materials showed clinically relevant discoloration (ΔE00 > 2). Valplast^® exhibited the greatest color change (p < 0.05), while color change in other materials remained lower. Gingivamoll^® showed the lowest gloss and highest roughness, whereas other materials remained smoother; roughness increased significantly over time (p < 0.05). SEM revealed a coating on the hard materials and nodular agglomerates on silicone. Biofilm CFU did not differ over time or between materials (all p > 0.05). Conclusions: Staining induced material-dependent changes in color and surface properties, with Valplast^® most prone to discoloration and silicone showing high roughness and nodular surface changes, contrasting with coatings on hard materials. Microbial adhesion analysis yielded pilot-level results, intended to inform the design of future investigations. Full article

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