Editor’s Choice Articles

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