Search Results (1,489)

Background: Trigeminal neuralgia (TN) is clinically defined, but patients presenting to tertiary practice with trigeminal-region pain are often diagnostically heterogeneous and may follow prolonged medication, dental, imaging, and procedural pathways before a stable phenotype is established. We aimed to characterize diagnostic phenotypes, secondary causes, and treatment-escalation patterns in a large retrospective tertiary-center trigeminal pain cohort derived from routine free-text clinical documentation. Methods: We conducted a retrospective single-center cohort study based on a clinical dataset containing 18,007 note fragments linked to 672 unique patient records between 12 October 2010 and 21 April 2026. A rule-based natural-language-processing-assisted chart review framework was used to identify patients with trigeminal pain and to extract documentation-derived demographic features, pain distribution, secondary causes, dental pathway variables, imaging signals, medication exposure, procedures, and outcome language. Patients were grouped into primary/classical TN, secondary TN/trigeminal pain, and dental-first or mimic pathways using predefined operational criteria. Results: A total of 455 patients met criteria for the analytic trigeminal pain cohort; 311 (68.4%) carried explicit TN terminology. Mean age was 58.7 years, median age 60 years, and 267 of 428 patients with recoverable sex data (62.4%) were women. Trigeminal branch involvement could be extracted in 351 patients (77.1%), with V2 involvement documented in 256 (56.3%), V3 involvement in 218 (47.9%), and V1 involvement in 138 (30.3%). The final NLP-derived phenotypic distribution comprised 201 primary/classical TN cases (44.2%), 146 secondary TN/trigeminal pain cases (32.1%), and 108 dental-first or mimic presentations (23.7%). MRI was documented in 384 patients (84.4%), neurovascular conflict or vascular loop in 253 (55.6%), multiple-sclerosis-related disease in 69 (15.2%), and tumor-related trigeminal involvement in 84 (18.5%). Prior dental evaluation was identified in 169 patients (37.1%), and prior dental procedures in 114 (25.1%). Carbamazepine exposure was documented in 367 patients (80.7%), pregabalin in 221 (48.6%), gabapentin in 150 (33.0%), oxcarbazepine in 116 (25.5%), and phenytoin in 73 (16.0%). At least one invasive or image-guided procedure was documented in 390 patients (85.7%), including nerve blocks/injections in 355 (78.0%), radiofrequency procedures in 126 (27.7%), balloon compression in 90 (19.8%), microvascular decompression in 113 (24.8%), and stereotactic radiosurgery in 55 (12.1%). Dental-first patients were significantly more likely to have undergone prior dental procedures (65.7% vs. 3.5% in primary/classical TN and 24.7% in secondary TN; p < 0.001), whereas secondary TN/trigeminal pain was associated with higher use of radiofrequency procedures (36.3%; p = 0.017), higher use of stereotactic radiosurgery (19.9%; p = 0.002), higher recurrence documentation (70.5%; p = 0.001), and a higher rate of complete pain relief documented at last follow-up (46.6%; p = 0.004). Conclusions: In tertiary practice, trigeminal pain is substantially broader than a formal TN label. Secondary disease and dental-first pathways account for a large fraction of referrals, and management is characterized by heavy medication burden, frequent escalation, and recurrent retreatment. A structured phenotyping approach may help convert routine clinical documentation into a clinically meaningful framework for diagnostic triage and treatment selection, although imaging and outcome variables require cautious interpretation when derived from retrospective free text. Full article

Background: Haptic simulation technologies are increasingly integrated into preclinical dental education to support procedural skill development. However, the extent to which haptic simulators improve performance compared to traditional phantom-head-based training remains unclear. Our goal is to systematically evaluate the effectiveness of haptic simulators in operative dentistry training, compared with conventional approaches. Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane (2015–2025), complemented by manual searching, to identify studies evaluating virtual reality haptic simulators in preclinical operative dentistry education. The search strategy, structured according to the PICO framework, included preclinical undergraduate dental students, interventions with virtual reality haptic simulators, comparisons with conventional methods, and objective assessment of technical performance. Relevant data were extracted in a standardized manner, and the methodological quality of randomized controlled trials was assessed using RoB 2.0, while non-randomized studies were evaluated using ROBINS-I v2. Results: Of the 66 identified articles, 5 studies were included. The use of virtual reality simulators with haptic feedback in preclinical dental students was associated with increased efficiency in cavity preparation, reflected by reduced execution time and improved learning curves, as well as specific technical gains such as depth control. Overall cavity preparation quality was comparable to that achieved with conventional methods, with virtual reality being well accepted as an effective complementary tool in preclinical operative dentistry education. Conclusions: Haptic simulators appear effective for early preclinical skill development in operative dentistry and may complement traditional instruction. Evidence remains insufficient to confirm superiority over conventional methods or long-term clinical benefit. Higher-quality multicenter randomized trials with standardized performance measures are needed to strengthen the evidence base. Full article

Background/Aim: While improvements in oral health can sometimes lead to improvements in systemic diseases, certain systemic diseases such as heart disease require consideration during dental treatment. In clinical pediatric dentistry, dental professionals may encounter the pediatric patient with systemic diseases, and should consult with physicians regarding the overall health status of their patients with systemic diseases before dental procedures. Materials and Methods: We reviewed the responses to letters of inquiry made to external medical institutions regarding the overall physical condition of patients during a 5-year period (2021–2025). The survey items were the gender, age, aim of letter, systemic disease, and physician responses and instructions. Result: A total of 48 letters of inquiry were found, of which 34 were initial confirmations and 14 were reconfirmations. In children aged ≤5 years, the common aim was oral management or caries treatment, and the proportion of surgical procedures increased with age. Among the systemic diseases involved, the diseases of the circulatory system such as congenital heart disease were the most common, with 70% of initial confirmations leading to premedication with antibiotics prior to invasive dental procedures. Although many responses remained unchanged upon reconfirmation, the responses for some patients changed. Conclusions: This study shows the importance of dental professionals consulting with physicians regarding the health condition of patients with systemic diseases before oral management. Furthermore, a single confirmation is insufficient, and the information must be regularly updated. Full article

Purpose: This study provides a comparative evaluation of surface changes in BioHPP materials under routine professional hygiene procedures, which is recommended by dentists, twice a year. BioHPP is a polyetheretherketone polymer used in prosthetic dentistry as a frame material. The aim was to investigate whether routine dental cleaning procedures such as ultrasonic scaling and brushing affect the surface proprieties of prosthetic BioHPP restorations. This study was conducted to evaluate the surface properties of different restorations based on BioHPP (veneered with composite resin and polished) after brushing and ultrasonic scaling exposure. Materials and Methods: The BioHPP specimens were divided into three groups. The first group (marked BioHPP) served as a baseline reference for assessing the effect of different surface processing approaches, and no further treatment was applied. The specimens in the second group (BioHPP-P) were polished, while the specimens in the third group (BioHPP-C) were veneered with composite resin. Group BioHPP-P and BioHPP-C of samples was divided into three subgroups: 0—no treatment, 1—exposed to tooth brushing, 2—exposed to ultrasonic scaling. Untreated samples (subgroup 0) served as controls for evaluating treatment-related changes within groups 2 and 3. The surface morphology was investigated by atomic force microscopy (AFM). The structure of samples was analyzed using the XRD technique, and the surface wettability was evaluated. Results: The surface roughness of the samples was evaluated via root mean square (RMS) parameter. Baseline BioHPP specimens exhibited higher roughness values compared to the other analyzed groups. The roughness of the non-treated specimens (0) decreased in the line 59.18→28.84→14.51 nm. Treatment of the samples by brushing and ultrasonic scaling was associated with an increase in surface roughness. Variations in water contact angle values were observed. However, no consistent treatment-related trend could be established. Conclusions: Composite veneered BioHPP showed a tendency toward higher surface resistance to brushing and ultrasonic scaling. These findings should be interpreted within the limitations of an in vitro descriptive study. Full article

Background: Full pulpotomy has gained increasing attention as a conservative treatment option for managing complicated crown fractures and pulp exposures in mature permanent teeth. However, little is known about how undergraduate dental students perceive this treatment approach and which factors influence their willingness to adopt it in clinical practice. Objective: This study aimed to evaluate undergraduate dental students’ knowledge, attitudes, and preferences regarding full pulpotomy and to identify factors associated with willingness to use full pulpotomy as a definitive treatment option. Materials and Methods: A cross-sectional questionnaire-based study was conducted among fourth- and fifth-year dental students. The questionnaire evaluated participants’ treatment preferences, perceived procedural difficulties, preferred pulp capping materials, attitudes toward rubber dam use, perceived barriers to full pulpotomy adoption, and willingness to use full pulpotomy as a definitive treatment. Associations between variables were assessed using chi-square tests and multivariable binary logistic regression analysis. Results: In total, 255 undergraduate dental students participated in the study. Spontaneous pain (69.4%), prolonged pain to heat (50.6%), percussion sensitivity (46.7%), and radiographic findings (43.9%) were the most frequently reported diagnostic criteria for symptomatic irreversible pulpitis. In the standardized clinical scenario, a pulpotomy-based approach was the most preferred treatment strategy (45.1%), followed by single-visit pulpectomy with obturation (28.6%) and pulpectomy with calcium hydroxide dressing (24.7%). MTA was the most preferred pulp capping material (57.3%), followed by Biodentin (12.9%) and calcium hydroxide (8.2%). Overall, 55.7% of participants reported willingness to use full pulpotomy as a definitive treatment option. Clinical year, previous exposure to pulpotomy cases, and confidence in bleeding control were independently associated with willingness to use full pulpotomy. Previous performance of pulpotomy procedures and attitude toward mandatory rubber dam use were independently associated with greater willingness to use full pulpotomy, whereas perceived barriers and uncertainty regarding implementation were negatively associated. Conclusions: In this single-center, questionnaire-based study, undergraduate dental students generally showed a positive attitude toward full pulpotomy; however, acceptance was strongly influenced by practical experience, confidence in procedural protocols, and perceived implementation barriers. These findings may help inform future educational strategies aimed at improving confidence and supporting evidence-based adoption of conservative pulp-preserving approaches. Full article

Background: Investigation of craniofacial growth and maturation, particularly of structures such as the spheno-occipital synchondrosis (SOS) and mandibular condyle cortication (MCC), provides valuable insight into late adolescent development. These markers may serve as valuable tools in age assessment, especially in legal and forensic contexts, where accurate determination of the 18-year threshold is critical. In addition, understanding their maturation can support more accurate assessment of skeletal development and improve clinical decision-making in growth-related dental treatments. Methods: This retrospective observational cross-sectional study was conducted to evaluate the stage of SOS and MCC maturation on a group of 230 individuals aged 14–22 years. Data was acquired from the mid-sagittal and sagittal sections of CBCT images representing, respectively, the SOS and the condyles. MCC was assessed bilaterally using a three-type system (Types I–III), and SOS fusion was evaluated using a four-stage system (Stages 0–3). Statistical analysis was performed to evaluate the association and correlation between the variables. Results: The Kruskal–Wallis test showed statistically significant differences in the age distribution of right and left MCC types, as well as SOS fusion stages (p < 0.001). Statistically significant differences were found in age distributions between all four SOS fusion stages in the MCC Type II groups of both condyles in both sexes, as well as Type III groups of the right condyle in both sexes and the left condyle in females (p < 0.001). Statistically significant differences were not observed in the MCC Type I group of the right and left condyle in both sexes and in the Type III group of the left condyle in males (p > 0.05). Spearman’s correlation analysis showed that the correlation between SOS fusion stages and MCC types was positive and statistically significant both between the parameters and with chronological age between sexes (r_s = 0.461–0.534, p < 0.001). Conclusions: This study revealed a statistically significant association and correlation between the maturation of the SOS, the MCC and chronological age. Simultaneous MCC Type III and SOS Stage 3 maturation was predominantly observed in individuals aged 18 years or older, although a small number of cases were identified below this threshold. SOS fusion and MCC may serve as skeletal parameters for age assessment; thus, they could be used as an adjunct method in a multifactorial age assessment procedure. Full article

Background/Objectives: Aim: Dental practice involves continuous exposure to saliva and blood, creating persistent opportunities for cross-infection if contaminated instruments are not processed correctly. This study aimed to evaluate dental students’ knowledge regarding blood-borne infections and infection prevention measures, and to compare knowledge levels according to academic year and sex. Materials and Methods: A structured questionnaire consisting of 21 single-best-answer questions was administered to 93 undergraduate dental students (Years I–VI) from the Faculty of Dental Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, Iași, Romania. The questionnaire evaluated knowledge related to instrument classification, cleaning and disinfection procedures, sterilization parameters, autoclave monitoring tests, and storage conditions. Demographic data were also collected. Statistical analysis was performed using IBM SPSS Statistics version 31, and associations between responses and demographic variables were assessed using chi-square tests. Associations between responses and demographic variables (academic year and sex) were evaluated using chi-square tests (p < 0.05). Results: Most participants correctly identified several key steps in the instrument processing circuit, including the use of high-level disinfectant–detergent solutions (88.2%) and the need for disinfection followed by sterilization (76.3%). However, important knowledge gaps were identified regarding autoclave pre-use checks, correct sterilization temperatures and exposure times, recommended sterile storage periods, and the interpretation of sterilization monitoring tools such as type 5 chemical integrators, Bowie–Dick tests, and Helix tests. Knowledge levels differed significantly according to academic year (p < 0.05). Conclusions: Although overall awareness of instrument processing procedures among dental students was generally satisfactory, several inconsistencies were observed in critical technical aspects of sterilization and monitoring. These findings highlight the need for strengthened infection control education and repeated practical training to reduce the risk of cross-infection in dental practice. Full article

Background/Objectives: Delivering consistent preclinical instruction for implant attachment procedures can be challenging in large dental cohorts. This report describes the development and implementation of institutionally produced training tools designed to support Locator housing pick-up exercises for second-year predoctoral dental students. Methods: Modified typodont-based simulation tools were integrated into the preclinical curriculum. Clear dentures and gypsum models were fabricated to allow visualization of seating relationships and identification of common interferences. Complete seating of the denture was verified using inspection windows, flange evaluation, and polyvinylsiloxane disclosing materials before housings were incorporated with autopolymerizing acrylic resin. After each session, components were collected, inspected, and prepared for reuse in subsequent cycles. Learner perceptions were obtained through an anonymous voluntary survey. Results: The configuration enabled visualization of seating conditions and identification of misalignment during the exercise. Removal of anterior teeth reduced material use and emphasized posterior stabilization during the pick-up procedure. Of 83 learners, 28 completed the survey (34% response rate), with responses tending toward agreement across items (mean range: 4.5–4.9/5), indicating favorable learner perceptions of the exercise and its organization within the scheduled laboratory period. Across three academic cycles, six dentures required replacement, whereas all gypsum models remained serviceable and no additional fabrication was necessary. Conclusions: This structured simulation approach provided an alternative method for delivering Locator housing pick-up training in a high-volume preclinical environment. The model allowed repeated implementation of the exercise across academic cycles. Full article

Background: The trigeminocardiac reflex (TCR) is a potent brainstem response often underrecognized during pediatric dental procedures. We aimed to quantify TCR dynamics, identifying procedural and temporal predictors of occurrence and resolution. Methods: We conducted a prospective observational study (NCT07240688) in pediatric patients undergoing dental procedures under standardized sevoflurane anesthesia. TCR was defined as a ≥10% (mild) or ≥20% (severe) abrupt decrease in heart rate (HR) and/or mean arterial blood pressure (MABP). Data were analyzed using Generalized Estimating Equations (GEE) and hierarchical logistic regression to identify procedural risk factors and recovery dynamics. Results: The study included 85 pediatric patients (aged 2–9 years) undergoing 1115 monitored dental procedures. The overall TCR incidence was 82.3% (n = 70). Operative duration was the strongest predictor of occurrence; each 1 min increase raised TCR odds by 6.7% (aOR: 1.067, p < 0.001). A landmark “60-min Autonomic Cliff” was identified: the probability of rapid spontaneous recovery dropped from 97.1% before 60 min to 0.0% thereafter (p < 0.001). Pulpal involvement was associated with a 3.37-fold increase in odds of severe TCR (Cramer’s V = 0.747). While lingual manipulation was strongly associated with rapid resolution (OR: 650.04), deep pulpal maneuvers led to a state of “Vagal Lock-in”—a sustained bradycardic response with reduced spontaneous recovery—effectively neutralized by atropine (97.0% success). Conclusions: Pediatric TCR is a time-dependent autonomic phenomenon in which operative duration influences reflex susceptibility and recovery dynamics, without affecting reflex severity. Beyond the “60-min Autonomic Cliff,” spontaneous recovery becomes unlikely, marking a transition to a refractory physiological state rather than an increase in reflex severity. This threshold provides a clinically actionable signal for anesthesiologists to intensify monitoring and consider early vagolytic intervention, supporting anticipatory, time-guided intraoperative management. Full article

Background: Oral dysbiosis during pregnancy has been associated with adverse outcomes, including preterm birth, premature rupture of membranes (PROM), and low birth weight, yet oral health remains an underappreciated component of routine prenatal care. Dental caries and gingival bleeding are frequently reported during pregnancy and may remain clinically relevant in the immediate postpartum period, but their relationship with specific oral pathogens in postpartum women has been insufficiently characterised, particularly in Eastern European populations. Methods: This exploratory cross-sectional, single-centre study included 60 postpartum women recruited consecutively at “Cuza-Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania, between December 2025 and February 2026. All participants completed a structured questionnaire covering obstetric history, demographic characteristics, and oral hygiene behaviours and underwent a standardised clinical oral examination by two calibrated examiners. Before study initiation, the two examiners underwent a joint calibration session based on the predefined visual oral assessment criteria used in this study and agreed on uniform recording procedures for visible dental caries, self-reported gingival bleeding during brushing, tooth mobility, and overall oral status. Saliva samples were collected after delivery. Genomic DNA was extracted using a magnetic-bead protocol and analysed by Real-Time PCR using TaqMan-based assays to detect four oral pathogens: Porphyromonas gingivalis, Streptococcus mutans, Mycoplasma salivarium, and Fusobacterium nucleatum. Results: Most participants were primiparous (55.0%) and delivered at term (≥37 weeks of gestation; 78.3%). The prevalence of pathogen detection was: P. gingivalis 38.3% (23/60), S. mutans 70.0% (42/60), M. salivarium 71.7% (43/60), and F. nucleatum 100% (60/60). Poly-microbial carriage was common: 15.0% of participants carried all three variable pathogens simultaneously (S. mutans, M. salivarium, and P. gingivalis), and the most frequent two-pathogen combination was S. mutans + M. salivarium (30.0%). No statistically significant associations were identified between pathogen detection and clinical or obstetric variables, consistent with limited statistical power in this small convenience sample. Conclusions: This exploratory study provides the first salivary prevalence estimates for these four oral pathogens in postpartum women in Northeast Romania. The high prevalence of poly-microbial carriage, including the novel quantitative estimate for M. salivarium, provides an empirical foundation for power calculations and future confirmatory research integrating standardised periodontal assessment with pregnancy outcome data. Full article

Background/Objectives: Fear of pain is common in both dental and health care settings and a factor that clinicians have to consider when examining and treating patients. Fear of dental pain has been described as associated with dental anxiety. The aims were to translate the Fear of Dental Pain Questionnaire—short form (s-FDPQ) into Swedish, to add three items, and to analyze the associations between fear of dental pain, dental anxiety and painful experiences of dental treatment. Methods: This cross-sectional study with a translation and validation component of the s-FDPQ, in a dental setting, included 178 adult individuals. Dental anxiety was measured with the Dental Anxiety Scale (DAS), and single questions captured experiences of dental care regarding pain. The analyses included exploratory factor analysis, internal consistency, intraclass correlation (ICC), and regression analysis (GLM). Results: Psychometric analyses revealed a two-factor solution, treatment and examination dimension, and the modified s-FDPQ (ms-FDPQ) had acceptable internal consistency = 0.87 and ICC = 0.93. Validation analyses using fearfulness of painful dental care and dental anxiety showed r = 0.75 and 0.68, respectively. In the GLM model, there were three significant predictors of fear of dental pain: women, dental anxiety and “fear of dental pain makes it more difficult to undergo dental treatment”. Conclusions: The ms-FDPQ shows acceptable validity and reliability as an instrument to measure fear of dental pain concerning several common procedures or treatments in routine dental care. However, the ms-FDPQ needs to be tested in other populations and settings. The results indicate that fear of dental pain is prevalent among adults. Full article

Background: Nocebo effects are described as adverse symptoms arising from negative expectations rather than direct physiological harm, and are increasingly recognised across healthcare. While traditionally examined within pharmacological trials, emerging literature suggests that nocebo effects are shaped by broader interactional, situational, and communicative processes. In dentistry and paediatric care, where behaviour support and reassurance are central to practice, these mechanisms remain under-synthesised. Objectives: This scoping review aimed to map how nocebo effects are conceptualised across healthcare literature, with particular attention to the role of communication, reassurance, and behaviour support, and to explore how these mechanisms are discussed in paediatric, procedural, and dental contexts. Methods: An interpretive scoping review was conducted in line with JBI guidance and PRISMA-ScR reporting standards. Multidisciplinary literature spanning experimental, clinical, ethical, and applied domains was systematically identified and charted. Studies were grouped using a conceptual framework encompassing expectancy, learning, communication-mediated, ethical, and contextual mechanisms, allowing overlap between categories. Results: A large and heterogeneous body of literature was identified, with most studies conceptualising nocebo effects through overlapping mechanisms rather than discrete pathways. Expectancy and learning processes formed a foundational substrate across contexts, while communication, including framing, tone, reassurance, and checking-in, emerged as an active mechanism shaping symptom perception and vigilance. Ethical discussions highlighted tensions between transparency and potential harm, particularly in consent and risk communication. Paediatric and procedural settings, including dental sedation, were comparatively underrepresented despite features likely to amplify nocebo effects, such as reduced agency and heightened attentional focus. Conclusions: Nocebo effects are best understood as interactional phenomena that emerge within everyday clinical encounters. This review highlights the need to critically examine behaviour support practices, including reassurance, that are typically assumed to be benign. Greater conceptual clarity and reflexivity in communication may support future research and training aimed at minimising unintended distress within dental and paediatric care. These findings suggest that routine communication practices, including reassurance and expectation-setting, should be understood as active components of care that can influence patient experience, rather than as neutral or purely supportive interactions. Full article

Background/Objectives: The loss of orthodontic microimplants is a common clinical complication that significantly disrupts the continuity of malocclusion treatment. Despite increasing clinical use of microimplant reinsertion, the factors influencing its success remain unclear. The aim of this exploratory systematic review was to examine the available literature regarding clinical outcomes related to the retention of orthodontic microimplants following their reinsertion. Methods: Studies that assessed the success of orthodontic microimplant reinserted were included in the review. Searches were conducted on 27 September 2025, in the following databases: BASE (Bielefeld Academic Search Engine), PubMed, Scopus, and EMBASE. The ROBINS-I (Risk of Bias in Non-randomized Studies—of Interventions) tool was used to assess the risk of bias. Due to heterogeneity of included studies, a narrative synthesis was performed. Results: Four of the 577 studies were included in the review. A total of 305 microimplants were reinserted in 276 patients. The overall success rate ranged from 44.16% to 66%. Analysis indicated a significantly higher success rate in the maxilla (up to 68.60%) compared to the mandible (lowest 36.84%). Furthermore, a narrative synthesis suggests better clinical outcomes for 8 mm long microimplants compared to 6 mm ones, as well as reduced reinsertion success in areas with high cancellous bone density. Regarding the modification of the insertion site, the current data are contradictory; while some studies indicate significant benefits from changing the site (e.g., to the midpalatal suture), others show no statistical difference compared to reinsertion at the same site. Overall, the evidence remains limited and heterogeneous. Conclusions: The current review of the literature on the success of reinsertion of orthodontic microimplants is subject to a high risk of misinterpretation, due to the limited amount of data and the risk of unidentified confounding factors. Further standardized clinical trials are needed to develop unified protocols for these procedures. Other: The review was prospectively registered with the Open Science Framework (OSF); osf.io/tbj2s. Full article

The increasing prevalence of peri-implantitis has led to a growing clinical use of implantoplasty, a procedure involving intraoral machining of the dental implant surface to remove biofilm. The absence of standardized clinical protocols may contribute to premature fatigue failure of dental implants. The present study aimed to evaluate the influence of machining depth on the cyclic mechanical behavior of dental implants. A total of 250 commercially pure grade 4 titanium dental implants were distributed into four groups according to machining depth: untreated (original), 0.2 mm, 0.4 mm, and 0.6 mm wall reduction. The implant system featured an internal connection with a thread height of 0.4 mm. Finite element analysis was performed for each machining depth to evaluate von Mises stress distribution and simulate fatigue behavior. The numerical models were validated through experimental fatigue testing using a servo-hydraulic MTS Bionix testing machine under ISO 14801:2016 conditions, showing a high correlation between simulated and experimental results (correlation coefficients > 0.9). The results indicated that maximum von Mises stresses were concentrated at the junction between the implant thread and the implant body. The fatigue limit of the untreated implants was approximately 351 N. Implants subjected to 0.4 mm machining exhibited a fatigue limit of 301 N, whereas lower fatigue limits were observed for 0.2 mm (255 N) and 0.6 mm (185 N) reductions. These findings suggest a significant mechanical effect of thread removal: 0.4 mm implantoplasty may provide improved fatigue performance compared to 0.2 mm, potentially due to reduced stress concentration at the thread–body junction. At high applied loads, fracture occurred in the coronal region of the implant, whereas at lower loads failure shifted to the implant–abutment connection. Although a good agreement between numerical and experimental results was observed, these findings should be interpreted with caution due to the in vitro testing conditions and the assumptions inherent to the finite element simulations. Therefore, while the results suggest that implantoplasty depth should not exceed the original thread height, further validation under clinically relevant conditions is required to confirm its impact on long-term mechanical reliability. Full article

Background: Maxillary sinus lift is among the most common preprosthetic procedures in the posterior maxilla due to alveolar ridge resorption and the maxillary sinus pneumatization. It often extends treatment duration, significantly increases costs, and is not without complications. Objective: To explore the prevalence and morphology of the palatal bone reservoir as a viable site for dental implant insertion, offering a conservative alternative to avoid maxillary sinus lift. Methods: DICOM data sets from helical CT of maxillofacial trauma patients aged 50 years and older were used to perform virtual dental implant positioning in the edentulous second premolar, first molar, or second molar areas using ImplaStation software (version 5.3.2; ProDigiDent, Inc., Scottsdale, AZ, USA). A 3D Slicer software (version 5.3.2; ProDigiDent, Inc., Scottsdale, AZ, USA) was used to calculate the volume of the palatal bone reservoir and identify its mean density. The density of the residual alveolar process was also identified and compared with that of the previous one. Results: A total of 1822 maxillofacial trauma cases with helical CT between 2015 and 2025 were retrieved. After exclusion, 305 cases were analyzed. A total of 65 implants were virtually positioned in 50 patients. The mean volume of the palatal bone reservoir was 229 ± 139.2 mm³ with a mean radiodensity of 546.7 ± 159.6 HU. The mean radiodensity of the residual alveolar process was 286.3 ± 118.0 HU. The palatal bone reservoir was significantly denser than the residual alveolar process (95% CI [184.2, 336.6]; p < 0.01). Conclusions: The presence of a palatal bone reservoir is not uncommon and can offer a more conservative alternative for implant placement, potentially increasing primary stability and facilitating immediate loading. Full article