Editor’s Choice Articles

Background: Despite incidence rates and complications, the clinical management of xerostomia lacks guidelines. Aim: The aim of this overview is to summarize the clinical experience over the past 10 years of treating xerostomia using non-pharmacological interventions. Materials and Methods: A literature search was conducted across PubMed, EMBASE, Web of Science, ScienceDirect, and Google Scholar databases, covering publications from 1 January 2013 to 30 January 2023. Results: Topical therapies are the mainstays in cases of longstanding oral dryness. Their aim is to relieve oral discomfort by retaining mouth moisture. Macro-molecular lubricants were largely used in xerostomia due to radiotherapy for Head and Neck cancer (HNC) and xerostomia due to the chronic use of drugs. However, none of them provided stable relief for dry mouth. Traditional Medicine (TM), through the administration of different medicinal herbs and plants, has recently been evaluated against xerostomia in clinical trials. Matricaria chamomilla L., Linum usitatissimum, and Malva sylvestris L. together with Althea digitata Boiss, Licorice root, and Salvia Officinalis are among the most used compounds. They were formulated as water extracts with health benefits that are attributed to the presence of polyphenols. However, the low number of clinical evaluations represents the greatest limitation for validating the efficacy of TM against xerostomia. Regarding acupuncture, it did not show significant effects in the trials in comparison to the control groups. Further, electrostimulation, photo-biomodulation and hyperbaric therapy need more randomized clinical evaluations to effectively demonstrate their ability to relieve dry mouth. Conclusions: No topical treatment has shown stable relief of xerostomia. Consequently, the management of xerostomia and its devastating complications remain a significant void in daily clinical practice. Full article

Aim: Accurately identifying primary lesions in oral medicine, particularly elementary white lesions, is a significant challenge, especially for trainee dentists. This study aimed to develop and evaluate a deep learning (DL) model for the detection and classification of elementary white mucosal lesions (EWMLs) using clinical images. Materials and Methods: A dataset was created by collecting photographs of various oral lesions, including oral leukoplakia, OLP plaque-like and reticular forms, OLL, oral candidiasis, and hyperkeratotic lesions from the Unit of Oral Medicine. The SentiSight.AI (Neurotechnology Co.^®, Vilnius, Lithuania) AI platform was used for image labeling and model training. The dataset comprised 221 photos, divided into training (n = 179) and validation (n = 42) sets. Results: The model achieved an overall precision of 77.2%, sensitivity of 76.0%, F1 score of 74.4%, and mAP of 82.3%. Specific classes, such as condyloma and papilloma, demonstrated high performance, while others like leucoplakia showed room for improvement. Conclusions: The DL model showed promising results in detecting and classifying EWMLs, with significant potential for educational tools and clinical applications. Expanding the dataset and incorporating diverse image sources are essential for improving model accuracy and generalizability. Full article

Objectives: Dental implants have become a cornerstone of restorative dentistry, providing a long-lasting method for tooth replacement. The degree of osseointegration has a significant effect on biomechanical stability at the bone–implant contact (BIC), determining the continued efficacy of these implants. However, the exact consequences of changing osseointegration levels on different implant designs, especially in bones with variable densities, are not well known. Methods: This study used 3D finite element analysis (FEA) to look at the biomechanical performance of three short dental implants: BioMet 3iT3, Straumann^® Standard Plus Short-Regular Neck (SPS-RN), and Straumann^® Standard Plus Short-Wide Neck (SPS-WN). This paper tested the implants at four stages of osseointegration: 25%, 50%, 75%, and 100% in both high-density (bone type III) and low-density (bone type IV) cancellous bone. It also created and examined realistic CAD models under static occlusal loading conditions to assess stress distribution and major strains at the bone–implant contact. Results: The study discovered that as osseointegration increases, von Mises stress and principal strains go down significantly for all implant types. The SPS-WN implant had the lowest strain values, especially for bone with low density. These reductions demonstrate increased mechanical stability as the bone–implant interface becomes more capable of dispersing mechanical stresses, minimizing the potential for localized deformation and bone resorption. Conclusions: The results highlight the importance of achieving optimum osseointegration to reduce mechanical stress and increase the lifespan of dental implants. The SPS-WN type implant performed better in biomechanical tests than the others, especially when bone conditions were not ideal. This makes it a great choice for clinical applications that need long-term implant success. Full article

The effectiveness of a series of optically transparent aligners for orthodontic treatments depends on the anchoring of each tooth. In contrast with the roots, the crowns’ positions and orientations are measurable with intraoral scans, thus avoiding any X-ray dose. Exemplified by two patients, we demonstrate that three-dimensional crown movements could be determined with micrometer precision by registering weekly intraoral scans. The data show the movement and orientation changes in the individual crowns of the upper and lower jaws as a result of the forces generated by the series of aligners. During the first weeks, the canines and incisors were more affected than the premolars and molars. We detected overall tooth movement of up to about 1 mm during a nine-week active treatment. The data on these orthodontic treatments indicate the extent to which actual tooth movement lags behind the treatment plan, as represented by the aligner shapes. The proposed procedure can not only be used to quantify the clinical outcome of the therapy, but also to improve future planning of orthodontic treatments for each specific patient. This study should be treated with caution because only two cases were investigated, and the approach should be applied to a reasonably large cohort to reach strong conclusions regarding the efficiency and efficacy of this therapeutic approach. Full article

Objectives: The treatment of class II patients with mandibular retrusion often involves the use of a Herbst appliance, due to its efficiency and reduced need for compliance. Despite skeletal benefits, undesired dental effects, caused by anchorage loss, could reduce mandibular advancement, especially after the pubertal peak. Although the period between cervical vertebral maturation (CVM) 3 and CMV4 is considered the best choice to maximize the orthopedic outcome, clinicians cannot always treat patients during this ideal time window, as they present at their first visit later. The goal of this study is to evaluate whether the combination of an acrylic splint Herbst appliance with skeletal anchorage and elastic chains in both the upper and lower arch (Skeletal Therapy Manni Telescopic Herbst 4: STM4) could improve the efficiency of functional treatment also in CVM 5–6 patients. Methods: Lateral cephalograms of 10 consecutively treated patients taken at the beginning and at the end of the Herbst phase were analyzed and compared with those of 10 untreated patients of the same sex, age, malocclusion, and skeletal maturation. Results: According to the Pancherz analysis, the treated group of patients showed the significant advancement of the pogonion (4.75 mm), with a reduction in ANB (−3.3°) and Wits (−4.15 mm). The combination of miniscrews and elastic ligatures allowed the labial tipping of the upper incisors (+6.65°) and limited the labial flaring of the lower ones (+3.05°), maintaining the overjet needed for mandibular advancement. Conclusions: The STM4 technique might be an effective protocol for skeletal class II correction after the pubertal peak since it significantly reduces unfavorable dental compensations, increasing the skeletal effects and the esthetic outcome of the orthopedic treatment. Full article

(1) Objectives: The purpose of this review was to compare the effects of combining skeletal anchorage and Class II devices, both from an overall perspective and individually for each type of appliance, considering as main outcomes the vertical dimensions and the inclination of the mandibular and maxillary incisors. (2) Materials and Methods: A search without time restrictions was performed up to February 2024 in PubMed, PubMed Central, Scopus, and Medline for randomized controlled trials, as well as prospective and retrospective cohort studies, considering Class II patients treated with and without skeletal anchorage. The effect measure used for the meta-analytic evaluation was the standardized mean difference (SMD). The SMD calculation was obtained by subtracting the mean values of T1–T0 for each individual treatment and then calculating the SMD between the treatments involved. The meta-analysis was performed using the standardized mean difference of the mean difference of the T1–T0 change in the outcome between the different treatments evaluated as the effect size. (3) Results: A total of 1217 documents were initially retrieved. According to the PRISMA protocol, 18 studies comparing different skeletal anchorage protocols (upper/lower miniscrews and miniplates), combined with four appliances (Herbst, Forsus, Carriere Motion, and elastics), were included in the analysis. No significant difference in skeletal divergence was found between groups from an overall point of view (SMD: 0.19 (−0.48 to 0.83) according to the random-effects model). A statistically significant reduction in IMPA° was found in patients treated with temporary anchorage devices (TADs) (SMD of 5.58 (3.40 to 7.75)), except for the elastics group (SMD: 3.76 (−0.91 to 8.43)). The effect on the upper incisors’ inclination appeared to be strictly dependent on the type of anchorage (TADs in one or both of the arches). Some limitations must be considered when interpreting the results: the small number of studies included and the heterogeneity among them are among the limitations, and the temporal disparity among some studies; the ages of the patients were not always comparable; and, finally, the clinical relevance of the effects of TADs is sometimes questionable. (4) Conclusions: The vertical dimension seems not to be significantly affected by skeletal anchorage; instead, the proclination of mandibular incisors is generally reduced when TADs are used. Skeletal anchorage might be useful if lingual tipping of the upper incisors is required; however, it is influenced by the anchorage protocol. Full article

Purpose: The purpose of this study is to assess the effectiveness of the best performing interpretable machine learning models in the diagnoses of leukoplakia and oral squamous cell carcinoma (OSCC). Methods: A total of 237 patient cases were analysed that included information about patient demographics, lesion characteristics, and lifestyle factors, such as age, gender, tobacco use, and lesion size. The dataset was preprocessed and normalised, and then separated into training and testing sets. The following models were tested: K-Nearest Neighbours (KNN), Logistic Regression, Naive Bayes, Support Vector Machine (SVM), and Random Forest. The overall accuracy, Kappa score, class-specific precision, recall, and F1 score were used to assess performance. SHAP (SHapley Additive ExPlanations) was used to interpret the Random Forest model and determine the contribution of each feature to the predictions. Results: The Random Forest model had the best overall accuracy (93%) and Kappa score (0.90). For OSCC, it had a precision of 0.91, a recall of 1.00, and an F1 score of 0.95. The model had a precision of 1.00, recall of 0.78, and F1 score of 0.88 for leukoplakia without dysplasia. The precision for leukoplakia with dysplasia was 0.91, the recall was 1.00, and the F1 score was 0.95. The top three features influencing the prediction of leukoplakia with dysplasia are buccal mucosa localisation, ages greater than 60 years, and larger lesions. For leukoplakia without dysplasia, the key features are gingival localisation, larger lesions, and tongue localisation. In the case of OSCC, gingival localisation, floor-of-mouth localisation, and buccal mucosa localisation are the most influential features. Conclusions: The Random Forest model outperformed the other machine learning models in diagnosing oral cancer and potentially malignant oral lesions with higher accuracy and interpretability. The machine learning models struggled to identify dysplastic changes. Using SHAP improves the understanding of the importance of features, facilitating early diagnosis and possibly reducing mortality rates. The model notably indicated that lesions on the floor of the mouth were highly unlikely to be dysplastic, instead showing one of the highest probabilities for being OSCC. Full article

Background: Teeth are the anatomical tissue with the highest resistance to the action of chemical and physical agents. This is one of the reasons that make teeth particularly useful in the identification process of skeletonized and carbonized human remains. The aim of this research is to analyze the colorimetric changes in the enamel of teeth subjected to high temperatures to develop a reproducible colorimetric cataloging method. Methods: Six groups of 21 human teeth extracted from private clinics and from a Dental School for therapeutic reasons were used and subjected to three temperature ranges in a laboratory furnace: 400 °C, 700 °C, and 1000 °C. For each temperature, two time periods of 20 min and 60 min were chosen. Each group of dental elements was analyzed using a dental spectrophotometer to extract the colorimetric data of the crown. The obtained color coordinates were subsequently converted into Red–Green–Blue (RGB) values. The two predominant colors were also selected to create average colorimetric values, which demonstrate the change in color hue according to temperature. The groups of teeth subjected to 20 min at 400 °C exhibited a dark gray coloration, while the teeth subjected to 20 min at 700 °C showed a general increase in color brightness with beige–blueish hues. Results: The teeth subjected to 20 min at 1000 °C displayed progressively lighter shades with pinkish reflections. The teeth subjected to 60 min at the same temperatures demonstrated a general increase in brightness, making differentiation more challenging, except for the group of teeth burned at 400 °C, which showed light gray–blueish tones. Conclusions: This study further supports the existing literature on the correlation between colorimetric shifts in carbonized teeth and the maximum temperature reached, providing valuable assistance to forensic pathology and the forensic dental identification of burnt human remains. Additionally, this research has led to the development of a standardized colorimetric patented scale for the observation and examination of burnt human teeth. Full article

(1) Background: Head and neck cancer (HNC) is a major public health challenge worldwide, with oral squamous cell carcinoma (OSCC) being the predominant form. Despite advances in treatment, OSCC remains a major cause of morbidity and mortality due to delayed diagnosis and limited therapeutic efficacy. This study reviews omics technologies to assess new salivary biomarkers for the early detection of OSCC. (2) Methods: A comprehensive literature search in the last 20 years identified four relevant studies focusing on salivary biomarkers in OSCC. (3) Results: Proteomic and genomic analyses revealed significant changes in salivary composition between OSCC patients and healthy controls, suggesting promising diagnostic and prognostic biomarkers. However, studies showed varying degrees of bias, indicating the need for further research and improved standardization. (4) Conclusions: Saliva, with its advantages of ease of collection, minimal invasiveness, and potential for large-scale screening, is an emerging promising substrate for non-invasive biomarker research. Nonetheless, there is a need for improved biomarker sensitivity and specificity; currently, histological examination remains the golden standard. Full article

Digital models and three-dimensional technology in orthodontics have become an integral part of everyday clinical practice. Nevertheless, there is currently no consensus regarding in which cases a digital model is really necessary. Therefore, this scoping review aims to identify and assess which orthodontic procedures require a digital model. This review’s reporting was based on PRISMA guidelines. A literature search was undertaken using five electronic databases on 17 February 2024. A total of 87 studies met the inclusion criteria and were qualitatively analyzed by three reviewers. The following aspects of orthodontic treatment were identified and discussed with regard to digital model application: diagnosis, treatment procedures, retention, and outcome evaluation in orthodontics. Based on the studies assessed, despite some limitations regarding radiation exposure justification and the accuracy of the integration methods of 3D data, there is evidence that digital models lead to more accurate orthodontic diagnosis and treatment planning. In cases of impacted canines, aligner treatment, mini-implants insertion (when angle definition and orientation are essential), and primary care for cleft lip and palate, a partial digital model produced by an integration of some of the 3D data (face scan, intraoral scan, CBCT) that we can acquire is beneficial. A full digital model that combines all the 3D information should be used in orthognathic surgery cases, in which prediction and accurate performance are highly advocated. Full article

Background: The influence of medical and dental factors on jaw clicking within the South Australian population remains unexplored, and there is a lack of research on the impact of occlusal therapy on dynamic jaw movement parameters in this population. Purpose: This study investigated the potential significant associations between specific aspects of patient histories, occlusal therapy, and self-reported or observed jaw clicking in a population from the state of South Australia. Methods: Seventy individuals aged 18 to 65 participated in a cross-sectional study. Data collection included comprehensive medical, social, and dental histories, followed by evaluations of jaw function. Twenty-six out of the seventy individuals reported jaw clicking. Electrognathography assessed maximum mouth opening, surface electromyography evaluated masticatory muscle function, and joint vibration analysis measured individual joint vibration amplitudes and integrals. Logistic regression models analysed overall variable effects, while sub-models focused on predictors related to occlusal therapy, specifically orthodontic intervention. Independent t-tests and Mann–Whitney U tests compared jaw functions between participants who received occlusal therapy and those who did not. Results: The number of third molars extracted, vitamin D deficiency, and self-reported mental health disorders (R² = 0.414, p = 0.048) emerged as significant predictors for jaw clicking. Factors associated with occlusal therapy showed no significant association with jaw clicking (R² = 0.59, p = 0.027). Furthermore, there were no significant differences observed in mouth opening (t-stat = −0.439, p = 0.662), muscle activity, and joint vibration analysis between participants who underwent occlusal therapy and those who did not. Conclusions: Within the selected study population and limited sample size, the number of third molars extracted, vitamin D deficiency, and self-reported mental health disorders were associated with jaw clicking. Full article

The widespread application of CAD/CAM technology in contemporary dentistry led to the development of promising restorative materials, such as resin composite blocks (RCBs). Thus, the present study aims to evaluate the mechanical properties of RCBs, comparing this material to the direct composite resin from the same manufacturer. Samples retrieved from three CAD/CAM resin composite blocks (Tetric CAD (TC), Ivoclar Vivadent, Grandio blocs (GB), VOCO GmbH and Brilliant Crios (BC), Coltene/Whaledent) and four direct composite resins (Tetric EvoCeram (TEC), Ivoclar Vivadent, GrandioSO (GS), VOCO GmbH, Brilliant EverGlow Translucent (BET) and Universal Shade (BEU), Coltene/Whaledent) were submitted to three-point bending flexural test and Vickers microhardness test. The resulting data of the flexural strength were analyzed using one-way ANOVA considering Bonferroni correction for post hoc tests (α = 0.05). The flexural modulus and Vickers microhardness results were analyzed using Welch’s ANOVA considering Games–Howell correction for post hoc tests (α = 0.05). Regarding results, flexural strength and flexural modulus values ranged from 81.1 MPa (BEU) to 246.5 MPa (GB) and 10.6 GPa (BEU) to 20.3 GPa (GB), respectively. GS (121.2) and GB (136.2) groups were associated with the highest microhardness values. According to the post hoc tests, statistically significant differences in flexure strength were found in RCBs (BC, GB, and TC) compared to all direct composite resins. Flexural modulus and Vickers microhardness of RCBs (BC, GB, TC) were also significantly different from the direct composite resin (BET, BED, and TEC), except when comparing GS and GB for microhardness. In conclusion, differences between RCBs and direct composite resins were observed regarding flexural strength, flexural modulus, and microhardness, revealing that RCBs have enhanced mechanical properties compared to direct composite resins. Full article

Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for mini-screw insertion. Methods: The sample included 85 CBCT (cone beam computed tomography) records selected from the digital archive. Analysis focused on the buccal step area. Sections were obtained in axial view using reference lines, and measurements of cortical and total bone were taken at specific points M0 (starting point, 6 mm apical from CEJc—cementoenamel junction crest), M2 (located 2 mm posterior to M0 in the apical direction), and M4 (positioned 4 mm posterior to M0 in the apical direction) in both directions. Six measurements were recorded for each scan root plane, assessing cortical and total bone depth. Results: The thickness of the bone increases toward the inside of the mouth at all tested sites (M0, M2, M4), which is good for placing mini-screws. Cortical bone thickness decreases toward the inside of the mouth, with no significant differences among the sites except for M0 vs. M4. People with a particular jaw shape (hypo-divergent) have a thicker cortical bone, indicating that facial structure affects bone thickness. Conclusions: The posterior buccal step insertion site has biomechanical advantages and reduces the risk of damaging roots during mini-screw insertions. Full article

Objectives: This study was conducted to determine the erosive potential of various commercial energy drinks (EDs), sports drinks (SDs), and sugar sweetened beverages (SSBs) and to correlate quantitative changes in tooth enamel volume loss based on the pH and titratable acidity of the drinks. Methods: A flat plane on the facial surface of 36 human incisor teeth was created and embedded in sample holders using resin. After pre-scanning with a profilometer (Proscan 2000, Scantron, Ind Products Ltd., Taunton, UK), the six samples per group were immersed for 4 h into either Monster Energy™ (ED), Rockstar™ (ED), Red Bull™ (ED), or 5-h Energy™ (ED) and, for comparison with a sports drink, Gatorade™ (SD) and a sugar sweetened beverage, Coca-Cola^® (SSB). After immersion and post-scanning, the quantitative volume loss of the tooth enamel of the 36 samples was calculated (Proscan 3D software V2.1.1.15B), and the pH and titratable acidity (TA) of each drink was determined. Results: All drinks tested caused enamel volume loss. The actual amount varied among the different drinks, from 0.39 mm³ for Red Bull™, up to 1.01 mm³ for Gatorade™. The pH measurements differed for each drink, ranging from 2.6 to 3.7. There was a small reverse correlation of 0.326 between the pH of all drinks and volume loss. Among the energy drinks, titratable acidity was similar and there was only a weak correlation between TA and volume loss (0.319 at p = 0.53). Conclusions: Energy drinks, sugar sweetened beverages, and sport drinks all have the potential to cause enamel tooth surface loss resulting in demineralization. Therefore, the pH of a drink cannot be the sole determinant for choosing a less harmful commercial beverage. Full article

The oral health/systemic health connection has been an area of research interest that increased dramatically during the 1990s. Periodontal disease has been associated with a number of systemic conditions, including cardiovascular disease, diabetes, pre-term low-birth-weight infants, respiratory conditions, rheumatoid arthritis, cancer, and Alzheimer’s disease. Inflammation is the obvious link that connects periodontal disease with these conditions, but is this association casual or causal? We will address the biologic plausibility, evidence from human studies, evidence from animal studies, and therapeutic interventions as we review the current understanding of the link between periodontitis and Alzheimer’s disease. Full article

A partial or complete pulpotomy is a type of vital pulp therapy (VPT) that aims to remove the inflamed, infected pulp, leaving behind healthy, vital pulp that is capable of healing. VPT has gained renewed popularity as a treatment option in permanent mature posterior teeth with irreversible, moderate to severe pulpitis; its high success rates matching that of root canal treatment (RCT). There is currently no consensus regarding diagnostic and prognostic predictors of success of pulpotomies for managing such cases. Therefore, we conducted a scoping review to identify and analyze how these factors affect the outcome of treatment. A literature search using the PRISMA guidelines was undertaken using PubMed and Scopus on 7 July 2023. A total of 22 studies met the inclusion criteria and were qualitatively analyzed by two reviewers. The following diagnostic and prognostic factors were recognized and discussed; presenting signs and symptoms, periapical diagnosis, bleeding time, indicators of inflammation (bleeding time, concentration of inflammatory biomarkers), patient age and medical status, the depth, activity and location of caries, and restorative factors. Based on the studies assessed, there is limited evidence to support their prognostic value. Further research is necessary to identify solid predictors of outcome. Full article

Periodontitis is a common non-communicable inflammatory disease that leads to the destruction of periodontal tissues and tooth loss. Initiated by the plaque biofilm, there is a strong innate immune response with an abundance of neutrophils in the periodontium of affected individuals. Previous reports have shown that the intracellular concentration of glutathione in peripheral blood neutrophils from periodontitis patients and the chemotactic ability of these cells are compromised. Furthermore, other studies have described that in oxidative stress conditions neutrophil chemotaxis is aberrant and causes the glutathionylation of F-actin, a key player in chemotaxis. In this study, the effects of glutathione-modulating compounds were assessed in neutrophils isolated from healthy donors, showing that the perturbation of glutathione homeostasis decreases the chemotaxis of neutrophils. Following this, the intracellular glutathione status and chemotactic ability of neutrophils isolated from periodontitis patients was compared to that of age- and sex-matched controls. A decrease in glutathione and chemotactic ability were confirmed. Finally, the proteome of these neutrophils was explored, demonstrating a change in the abundance of proteins involved in glutathione homeostasis. Together these data suggest that peripheral blood neutrophils from periodontitis patients are compromised in their ability to cope with oxidative stress and move. Full article

Oral lichen planus (OLP) is classified as a potentially malignant disorder. Systematic reviews collating longitudinal observation studies provide evidence of the rate or proportion of malignant transformation. We conducted an umbrella study of published systematic reviews. An extensive English-language study search was carried out in several databases to identify relevant articles, providing systematic reviews on the malignant transformation of OLP. Data from eight systematic reviews published between 2014 and 2023 are presented. The reported proportions of malignant transformation ranged from 1.1% to 1.4%. A meta-analysis based on the 10 highest-quality studies yielded a higher proportion of malignant transformation (2.28%). We list some limitations found in several of these systematic reviews. Some studies reported an increased risk of malignancy in OLP lesions, demonstrating epithelial dysplasia. In view of the consistent evidence of the risk of oral malignancy, OLP patients should be monitored carefully to detect early cancer development. Full article

Photodynamic therapy facilitates the selective destruction of cancer tissue by utilizing a photosensitizer drug, the light near the absorbance wavelength of the drug, and oxygen. Methylene Blue, 5-aminolevulinic acid (the precursor of the photosensitizer, protoporphyrin IX), porphyrin, Foscan, Chlorin e6, and HPPH have been used successfully as photosensitizers in the treatment of oral verrucous hyperplasia, oral leukoplakia, oral lichen planus, and head and neck squamous cell carcinoma. “Theranostic” liposomes can deliver a contrast agent for magnetic resonance imaging and a photosensitizer for the image-guided photodynamic therapy of head and neck cancer. Liposomes incorporating photosensitizers can be targeted to cell surface markers overexpressed on cancer cells. Novel porphyrinoids have been developed in our laboratories that are highly effective as photosensitizers. Tribenzoporphyrazines encapsulated in cationic liposomes have produced IC₅₀ values up to 50 times lower compared to the free photosensitizers. It is anticipated that targeting these drugs to cancer stem cells, using upconversion nanoparticles for the near-infrared irradiation of tumors to activate the photosensitizers, and overcoming tumor hypoxia will enhance the efficacy of photodynamic therapy of tumors accessible to light sources. Full article

Background: Temporomandibular joint (TMJ) arthroscopy has become popular due to its satisfactory long-term results and few surgical complications. However, patients’ postoperative recovery is poorly studied. This study evaluates the postoperative evolution of the masticatory function and the daily activities of patients who have undergone TMJ arthroscopy. Methods: A prospective study was conducted in a Portuguese orofacial pain center with patients fulfilling the criteria for TMJ arthroscopy. For the first 30 days (D) after surgery, every 3 days, patients scored: (1) discomfort in the mastication of different food textures (soft, medium, hard); (2) time for a return to normal lifestyle (work, physical activities); and (3) TMJ pain during essential functions (mastication, speech, deglutition, deep breaths). The data were compared with preoperative results using descriptive statistics, one-way ANOVA, and the Friedman test. The level of significance was set at p < 0.05. Results: Forty-two patients were assessed for eligibility; fifteen did not meet the inclusion criteria, and five declined participation. Twenty-two patients initially started the study, but two canceled on days 6–18, and eleven patients tested positive for SARS-CoV-2. Nine female patients with sixteen operated joints completed the study. A progressive tolerance for scaling food textures was observed. Soft and medium textures were tolerated after D15 and D21, respectively. The hard texture was not well tolerated in the 30 days after surgery. Discomfort returning to work and practicing physical exercise was significantly reduced on D15 and D21, respectively. In addition, significant improvements in TMJ pain during mastication and speech were observed over time. Conclusions: Despite the study’s limitations, namely the small sample size, the non-validated questionnaire, and the non-biomechanical analysis of food texture, it was possible to observe after TMJ arthroscopy an early return to masticatory capacity with the progressive introduction of different food textures. The authors expect these results will help in future postoperative guidelines regarding postoperative recovery from TMJ arthroscopy. Full article

The current study aimed to implement and validate an automation system to detect carious lesions from smartphone images using different one-stage deep learning techniques. 233 images of carious lesions were captured using a smartphone camera system at 1432 × 1375 pixels, then classified and screened according to a visual caries classification index. Following data augmentation, the YOLO v5 model for object detection was used. After training the model with 1452 images at 640 × 588 pixel resolution, which included the ones that were created via image augmentation, a discrimination experiment was performed. Diagnostic indicators such as true positive, true negative, false positive, false negative, and mean average precision were used to analyze object detection performance and segmentation of systems. YOLO v5X and YOLO v5M models achieved superior performance over the other models on the same dataset. YOLO v5X’s mAP was 0.727, precision was 0.731, and recall was 0.729, which was higher than other models of YOLO v5, which generated 64% accuracy, with YOLO v5M producing slightly inferior results. Overall mAPs of 0.70, precision of 0.712, and recall of 0.708 were achieved. Object detection through the current YOLO models was able to successfully extract and classify regions of carious lesions from smartphone photographs of in vitro tooth specimens with reasonable accuracy. YOLO v5M was better fit to detect carious microcavitations while YOLO v5X was able to detect carious changes without cavitation. No single model was capable of adequately diagnosing all classifications of carious lesions. Full article

The use of digital health technologies, including telemedicine and teledentistry, has become a necessity in healthcare due to the SARS-CoV-19 pandemic. These technologies allow for the reduction of the workload of healthcare providers and the improvement of patient outcomes in cases of remote monitoring, diagnosis, and communication. While there are no doubtful benefits, there are some counterparts, such as concerns about clinical risks, data security, and privacy protection. This paper aims to review the regulations regarding the use of digital health apps and software in healthcare. This scoping review followed the PRISMA-ScR guidelines and the five-step framework of Arksey and O’Malley. Study selection was based on eligibility criteria that were defined using the population-exposure framework. The review of the articles selected (n = 24) found that the majority focused on data security policies in the healthcare industry, highlighting the need for comprehensive regulations and app control systems to protect patient data. The articles also emphasized the requirement for more appropriate research and policy initiatives to improve data security practices and better address privacy and safety challenges related to health-related apps. The review recognized that papers did not report consistent standards in professional obligation and informed consent in online medical consultations, with potential risks for data privacy, medical liabilities, and ethical issues. Digital health has already revolutionized medical service delivery through technology but faces some challenges, including the lack of standardized protocols for handling sensitive patient data and the absence of common legislative provisions, raising concerns about confidentiality and security. To address these issues and deficiencies, regulatory compliance is crucial to clarify and harmonize regulations and provide guidelines for doctors and the health system. In conclusion, regulating patient data, clarifying provisions, and addressing informed patients are critical and urgent steps in maximizing usage and successful implementation of telemedicine. Full article

The oral problems of 24 cancer patients on immunotherapy between 2017–2022 and referred by their oncologists, were reported. The age range was 49–80 years, and the median was 64 years. Lung cancer was the most common disease. Three patients a had history of autoimmune disease prior to cancer diagnosis. Patients received immunotherapy for two to 48 months. Prior to immunotherapy, 17 patients received cytotoxic chemotherapy, five angiogenesis inhibitors and one1 radiotherapy to head/neck. During immunotherapy, four patients received chemotherapy, one received bevacizumab, and eight received bone targeting agents, either alone or in combination. Presenting symptoms were oral pain (18 patients, 75%), dental pain (five patients), xerostomia (five patients), burning/itching (seven patients), bleeding (three patients), swelling (three patients), and taste problems (dysgeusia) (three patients). One patient was asymptomatic. Immune-related lesions were observed in 15 patients (62.50%), of which three were exacerbations of prior autoimmune disease. Three patients reported severe deterioration and itching after using a mouthwash. We also observed six (25%) infections (four candidiasis and two herpes simplex), and six (25.00%) cases of medication-related osteonecrosis of the jaw (MRONJ). Five of those MRONJ cases developed among the eight patients with the administration of bone targeting agents and one in a patient with bevacizumab. Two patients presented with more than one lesion. In conclusion, immune-related lesions were most common; oral infections and MRONJ were also observed. Various oral complications might be related to the interplay between immunotherapy and other therapies prior or concurrent to immunotherapy. Full article

The aim of this study is to study the effect of aging in different media (deionized water and artificial saliva) on the force/torque generation by thermoplastic orthodontic aligners. Ten thermoformed aligners, made of Essix ACE^® thermoplastic sheets, were aged in deionized water and in artificial saliva over two weeks at 37 °C, five in each medium. The force/torque generated on upper second premolar (Tooth 25) of a resin model was measured at day 0 (before aging), 2, 4, 6, 10, and 14, using a biomechanical test set-up. The results showed that aging of aligners by storage in aging agent has no significant impact on their force/torque decay. No significant differences were also found in force/torque between the aligners stored in deionized water nor artificial saliva. The vertical extrusion-intrusion forces were measured in the range of 1.4 to 4.6 N, the horizontal oro-vestibular forces were 1.3 to 2.5 N, while the torques on mesio-distal rotation were 5.4 to 41.7 Nmm. It could be concluded that the influence of saliva only on the mechanical properties can be classified as insignificant, and no significant difference between artificial aging in deionized water or artificial saliva was observed. Full article

(1) Background: Psoriasis is a chronic and inflammatory systemic disease that has been associated with periodontal pathologies, specifically periodontitis. The aim of this research is to answer the following question: Could periodontitis aggravate psoriasis? (2) Methods: We carried out a systematic review following the PRISMA guide using PubMed, Embase, Scopus, and WOS; (3) Results: A total of 111 studies were identified in the databases and 11 were obtained after screening. The selection included nine case–control studies, one cross-sectional study, and one cohort study. Most of the publications report an increase in bleeding on probing and the presence of periodontal pockets in patients with psoriasis, confirming that inflammation caused by periodontitis can contribute to systemic inflammation worsening psoriasis. To summarize, the scientific literature indicates that local periodontal inflammation could aggravate psoriasis. Full article

The aim of this study is to capture the dental anxiety of patients in a dental clinic. A special focus was placed on the measurement of the course of possible anxiety occurring during a single dental visit with different surgical procedures. Therefore, 129 patients were interviewed in an oral surgical clinic. The course of possible anxiety was measured with a short questionnaire about the current stress (“Kurzfragebogen zur aktuellen Beanspruchung”, KAB), which was completed by the patients at three different times in the waiting room, as well as before and after the treatment in the consulting room. In the waiting room, the patient answered a questionnaire, including the following instruments: questions about age and sex, KAB (stress), and the Dental Anxiety Scale (DAS, anxiety). According to the DAS, 64.1% belonged to the low-anxiety group, 29.7% belonged to the medium-anxiety group and 6.2% belonged to the high-anxiety group. For all groups, the stress just before the treatment was the highest and it was the lowest after treatment. The KAB values of the female patients were significantly higher than those of the male patients. About one third of the patients suffered from dental anxiety. Full article

The aim of the article is to discuss the development of calcium channel blocker (CCB) influenced gingival enlargement. Data and Sources: MEDLINE/PubMed, Scopus, ScienceDirect, and Google Search databases. The article reviews contemporary and classic literature with a focus on pathophysiology, clinical presentation, and risk factors associated with this condition. The application of various treatment options is also discussed. Study selection: Clinical studies, systematic reviews, in vitro studies, and case reports. Conclusion: Dental plaque, genetic predisposition, and type of drug used are critical in the development of drug-influenced gingival enlargement (DIGE). The surgical technique employed to treat the pathosis plays an important role in long term success of therapy. There has been an upward trend in occurrence of CCB-influenced gingival enlargement due to the unbridled use of CCBs. Due to the cosmetic and functional ramifications; the review underscores the importance of clinical research on prevention, treatment, and causes of recurrence of CCB-influenced gingival enlargement. Full article

“Epulis” is a widely used term to describe a localized gingival enlargement. However, a wide range of neoformations might present as localized, slow-growing, asymptomatic gingival masses. A systematic review was conducted to outline the pathological entities that were provisionally dignosed as “epulis” and whose final diagnosis was made after microscopic examination. An electronic search of PubMed, Google Scholar and Scopus databases from January 2000 to February 2021 was performed. An initial search of the databases identified a total of 864 documents, and after a careful process of screening and selection, 14 studies were included in this systematic review and processed for data extraction. The results show that histological examination, sometimes combined with immunohistochemistry, might reveal a wide spectrum of lesions, including hamartomatous lesions, non-neoplastic lesions, benign and malign neoplasms and metastases from distant cancers. Full article

(1) Background: Gingival cancer has a significant incidence and is often diagnosed at advanced stages. The aim of this paper is to highlight its clinical aspects on the basis of a case series analysis in order to promote awareness and improve the diagnosis process. (2) Methods: Oral cancers diagnosed and treated at three Italian University Hospitals over ten years were retrospectively investigated. Cancer location on the gingiva, edentulous ridge, and retromolar pad was addressed. Data regarding clinical features, stage at the diagnosis, and time from presenting symptoms to first medical consultation were retrieved. (3) Results: Thirty-three cancers located on the gingiva, edentulous ridge, and retromolar pad were retrieved from 276 total oral cancer cases (11.9%). A median of 50 days (range 2–300) passed for the patient to seek for a medical evaluation. At the time of diagnosis, 63.3% were advanced stage cancers, mainly located at the mandible (91%), especially in the retromolar pad (48.5%) and the edentulous alveolar ridge (24.2%). Lesions were red (45.5%), red and white (45.4%), or white (9.1%), appearing as an ulcer (69.7%), exophytic mass (12.1%) or flat lesion (12.1%). Sixty-six percent of cancers were completely asymptomatic, regardless their clinical appearance. A statistically significant association between the time from the presentation of symptoms to the first medical consultation and the cancers stage was found. (4) Conclusions: The clinical appearance of gingival cancer is very polymorphous; its understanding may be significant to improve patient education and early medical consultation. Full article

A human papillomavirus (HPV) infection is globally one of the most common causes of sexually transmitted infections of the mucous membranes (genital, anal and oral). Over the last decade, an increasing number of young patients have been infected due to the changes in sexual habits in the general population. The majority of the lesions are benign; however, substantial scientific evidence has suggested a role for the HPV family in the carcinogenesis of squamous cell carcinoma (SCC). It is proposed that dentists, in addition to ENT specialists, should apply standardized management protocols in order to construct a well-defined pathway in terms of diagnosis, which is based on a PCR diagnostic technique and the management of those lesions. Full article

COVID-19 became a pandemic with a worldwide impact leading to stay-at-home orders, death, economic difficulties, and a significant influence on daily lives. Dental services became limited at this time, causing increased concerns for patients requiring urgent dental care. We report the case of a 5-year-old previously healthy male who presented to our hospital’s emergency department (ED) with facial swelling secondary to infected maxillary left molars. Extractions were performed in the ED with moderate sedation. He was later found to be COVID-19 positive before admission for intravenous antibiotics. The use of universal precautions during the pandemic in treating patients with possible COVID-19 symptoms and in aerosol-generating procedures is recommended. Evaluating and providing treatment to our patients with urgent dental care should not be delayed to prevent further complications and decrease the burden placed on the ED, which may be limited in its ability to provide definitive care. Full article

The purpose of this in silico study was to investigate the effect of abutment screw torque and implant-abutment contact surfaces on the stress generation, microgap formation and simulated fatigue life of an external hexagon connection under oblique loading. Three-dimensional numerical models of the external hexagon implant were modeled containing two different implant-abutment contact surfaces (with and without contacting the hexagon axial walls) as well as using screw torques of 20 Ncm or 30 Ncm. Following the ISO 14801, an oblique load of 100 N was applied to the prosthesis. The von Mises stress, microgap formation, safety factor and fatigue life were obtained. The stresses in the abutment screw and implant were minimally influenced by the screw torque. However, this minimal stress in the screw with a 30 Ncm torque reduced the calculated fatigue life in comparison with 20 Ncm when the external hexagon axial walls were not in contact at the implant-abutment interface. The safety factor for the implant was higher when using minimal surfaces at the abutment-interfaces; however, it compromised the screw safety factor increasing its failure probability. The higher the screw torque, the lower was the microgap formation at the implant-abutment interface. However, the calculated residual stress is proportional to the applied torque, reducing the fatigue life in the screw. This effect can be attenuated using an implant-abutment system with more contacting surfaces. Full article

Bulk-fill restorative material has gained popularity in clinical practice, due to their perceived timesaving aspect. Objective was to compare the properties of bulk-fill direct restorative materials. Filtek Z350 (CR), Filtek One Bulk Fill Restorative (BF), Fuji IX and EQUIA Forte (EF) were compared. Thirty specimens from each material were prepared according to ISO 4049 for three-point flexural strength. Elastic moduli and hardness (n = 20) were evaluated using nanoindentation. Depth of cure (DC) (n = 20) was measured for BF at three different depths (2, 3, 4 mm) and at two irradiation times (20 and 40 s). Wear testing was carried out for three different periods (3, 6, 12 month(s)). All specimens were stored in 37 °C water for 24 h prior to testing. Results were evaluated using one-way ANOVA followed by a post hoc Bonferroni test (p < 0.05). BF and CR showed a significantly higher flexural strength than other groups (p < 0.05), and the highest Weibull modulus was found in CR. BF showed sufficient DC with at least 85%, at all thicknesses. CR and BF also had a high level of translucency than EF and Fuji IX. Significant differences in flexural strength were found among all materials except between Fuji IX and EF. While all material tested are suitable for use clinically, BF and CR have superior properties than GIC based bulk-fill. Full article

The importance of the oral microbiota is strictly linked to global human health. When imbalance of the oral microbiota occurs, and it is characterized by shifts in bacterial composition and diversity; a state called dysbiosis is settled. There is an increasing amount of scientific evidence that this condition is associated with oral diseases caries, gingivitis and periodontitis. Diet seems to be a key factor for oral and dental health, impacting upon the oral microbiota. In an attempt to clarify the role of diet, as well as other implicating risk factors predisposing to oral disease, in the present study we enrolled an urban area of north-eastern Greece. Socio-demographical as well as hygienic and nutritional habits of a target group consisting of adult and children were entered in our study through a survey. People of the studied area are less interested in preventive and other dental therapies. Children and adults are less interested in healthy eating, yet they often consume sugary foods and often outside of their main meal. The partial shifting to the standard of the Mediterranean diet and less to the standard of the western type foods is notable. It is important to raise the awareness of both children and adults through strategical campaigns and education on oral health, oral hygiene and the benefits of a balanced diet. Full article

Cone beam computed tomography (CBCT) is an emerging radiographic imaging modality. The diagnostic benefit must exceed the individual detriment that its generally higher radiation exposure may cause. Since limited studies exist on the use and impact of CBCT in paediatric dentistry, a service evaluation was carried out to explore the reasons for CBCT referral and to identify its impact on the treatment plan and/or management in a paediatric dentistry department. Clinical records for all paediatric patients who underwent a CBCT were reviewed, to identify the reason for referral and its influence on diagnosis or management, by comparing the provisional treatment plan with the definitive treatment plan, post-CBCT. A total of 130 paediatric patients underwent CBCT in a 12-month period, of which 52 satisfied the inclusion criteria. CBCTs were most commonly requested for the localisation of unerupted/impacted teeth 14/52 (27%), assessment of supernumerary teeth 12/52 (23%), and to investigate root resorption 9/52 (17%). All CBCTs provided additional information that assisted treatment planning, diagnosis, or management and, most significantly, 16/52 (31%) of treatment plans were changed based on CBCT findings. All CBCTs requested in this study were justified and confirmed or influenced the management of paediatric patients, ultimately reducing the risk of complications and further treatment. Full article

The aim of this study was a comparative statistical analysis of three categories of maxillary odontogenic cysts, evaluating frequency in relation to localization (mandibular or maxillary region), age and gender of patients. The study was a retrospective cohort study conducted at the University Hospital of Messina. Three hundred and fifty-six maxillary odontogenic cysts were classified into 283 inflammatory, 43 developmental and 30 neoplastic cysts. Female patients are more affected by developmental odontogenic cysts, while male patients are more affected by inflammatory odontogenic cysts. Both the mandibular and maxillary regions were affected mainly by inflammatory odontogenic cysts; no significantly statistic relationship was found between lesions and age. A significant association between odontogenic cyst lesions and patient gender was found. No significant association between histological features of lesion and age of patient was observed, nor subtype of odontogenic disease and localization (mandibular or maxillary). Full article