Search Results (165)

Background/Objectives: The diagnosis of pediatric dental conditions from panoramic radiographs is uniquely challenging due to the dynamic nature of the mixed dentition phase, which can lead to subjective and inconsistent interpretations. This study aims to develop and rigorously validate an advanced deep learning model to enhance diagnostic accuracy and efficiency in pediatric dentistry, providing an objective tool to support clinical decision-making. Methods: An initial comparative study of four state-of-the-art YOLO variants (YOLOv8, v9, v10, and v11) was conducted to identify the optimal architecture for detecting four common findings: Dental Caries, Deciduous Tooth, Root Canal Treatment, and Pulpotomy. A stringent two-tiered validation strategy was employed: a primary public dataset (n = 644 images) was used for training and model selection, while a completely independent external dataset (n = 150 images) was used for final testing. All annotations were validated by a dual-expert team comprising a board-certified pediatric dentist and an experienced oral and maxillofacial radiologist. Results: Based on its leading performance on the internal validation set, YOLOv11x was selected as the optimal model, achieving a mean Average Precision (mAP50) of 0.91. When evaluated on the independent external test set, the model demonstrated robust generalization, achieving an overall F1-Score of 0.81 and a mAP50 of 0.82. It yielded clinically valuable recall rates for therapeutic interventions (Root Canal Treatment: 88%; Pulpotomy: 86%) and other conditions (Deciduous Tooth: 84%; Dental Caries: 79%). Conclusions: Validated through a rigorous dual-dataset and dual-expert process, the YOLOv11x model demonstrates its potential as an accurate and reliable tool for automated detection in pediatric panoramic radiographs. This work suggests that such AI-driven systems can serve as valuable assistive tools for clinicians by supporting diagnostic workflows and contributing to the consistent detection of common dental findings in pediatric patients. Full article

Background/Objectives: Oral cancer resection often leads to maxillofacial defects and dentition loss, compromising patients’ quality of life. Implant-supported prosthetic rehabilitation offers a reliable solution to restore function, though factors such as bone reconstruction, radiotherapy, and timing of implant placement (immediate vs. delayed) may influence outcomes. This study aimed to evaluate long-term implant survival and rehabilitation timelines in oncologic patients, comparing two cohorts (2005–2014 and 2015–2024) to assess the impact of evolving clinical practices. Methods: A retrospective cohort study was conducted at Hospital General Universitario Gregorio Marañón (Madrid, Spain), including 304 patients who underwent ablative oral cancer surgery and subsequent implant-based rehabilitation between 2005 and 2024. Data on demographics, oncologic treatment, reconstruction, implant timing, and prosthetic rehabilitation were collected. Outcomes were compared using Kaplan–Meier analysis and appropriate statistical tests between the 2005–2014 (n = 122) and 2015–2024 (n = 182) cohorts. Results: A total of 2341 Ticare Implants^® were placed, supporting 281 prostheses. Implant placement during primary surgery increased from 41% to 71% (p < 0.001). The median time from surgery to prosthesis significantly decreased from 24 to 15 months (p < 0.001). Five-year implant survival was 95% in the early cohort versus 97% in the later cohort. Implant survival was comparable between irradiated and non-irradiated patients (~94–96%). Fixed prostheses became more frequent (92% vs. 79%, p = 0.002). Conclusions: Implant-supported rehabilitation in oncologic patients is highly feasible and durable, with improved timelines and functional outcomes associated with early implant placement and modern digital planning strategies. Full article

Background: Early caries management is essential to enable reversal of white spot lesions without the further need for operative interventions, especially in primary dentition. Silver-based compounds can be quite effective in arresting caries lesions; however, a major drawback is teeth staining. This study aimed to evaluate the remineralization potential and aesthetic effects of novel, green-synthesized nano-silver fluoride (NSF) on artificial white spot lesions in primary teeth in comparison to 38% silver diamine fluoride (SDF) and silver diamine fluoride/potassium iodide (SDF/KI). Materials and Methods: NSF was synthesized using green tea extract. Sixty primary teeth specimens with artificial enamel lesions were randomly divided into five groups depending on the applied material: 38% SDF, 38% SDF/KI, single and double application of NSF, and control group. Treatments were followed by pH cycling. Surface microhardness and photographic analysis were conducted to assess remineralization and staining. Statistical analysis was conducted using non-parametric tests including Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction. Results: The greatest increase in microhardness was observed in the group receiving double NSF application. Its remineralizing potential was comparable to that of 38% SDF/KI, with no statistically significant difference (p = 1.000). Importantly, NSF-treated samples exhibited no teeth discoloration, unlike the black staining observed in SDF and SDF/KI groups. Conclusions: Green-synthesized NSF is a promising alternative to conventional SDF and SDF/KI, offering remineralization benefits without compromising aesthetics. The eco-friendly formulation and non-staining properties support its potential for clinical use in pediatric dentistry. Full article

Background and Objectives: This is the first systematic review to focus exclusively on in vivo randomized controlled trials that compare bulk-fill and conventional incremental composite restorations in primary teeth. Our aim was to synthesize current evidence on their clinical performance, including retention, two-year survival rates, marginal integrity, and procedural efficiency. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Elicit AI platform up to March 2025. Eligible studies were in vivo randomized controlled trials involving children aged 3–12 years with carious primary teeth, directly comparing bulk-fill and incremental composite restorations. Primary outcomes included retention rates, two-year survival, and marginal integrity, while secondary outcomes were postoperative sensitivity, secondary caries, and aesthetic outcomes. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessments using the Cochrane RoB 2.0 tool. A narrative synthesis was undertaken due to substantial heterogeneity in study design and outcome reporting. The review protocol was registered in PROSPERO (CRD420251021433). Results: Thirteen randomized controlled trials met the inclusion criteria. Both restoration techniques demonstrated high short-term retention rates (>90%) and comparable two-year survival (85–90%). Marginal integrity was generally equivalent, though incremental techniques showed modest advantages in complex cavities. Secondary outcomes were inconsistently reported, with no significant group differences. Bulk-fill restorations consistently reduced the procedural time by 2–4 min per restoration, representing a meaningful advantage in pediatric clinical settings. Conclusions: Bulk-fill composites offer a clinically effective and time-efficient alternative to incremental layering in the restoration of primary teeth. This focused synthesis addresses a gap in existing reviews by concentrating solely on primary dentition and in vivo evidence. Despite similar clinical outcomes, the time savings associated with bulk-fill techniques may enhance their utility in pediatric dentistry. Further standardized and long-term trials are warranted to confirm these findings and inform clinical guidelines. Full article

Introduction: Unilateral cleft lip and palate (CLP) is a severe orofacial birth defect characterized by improper fusion of facial parts and disturbed orofacial functions. The defect manifests as a gap in the orofacial tissues that is accompanied by defective healing patterns and chronic inflammation. The immune system’s defense factors modulate immunity, inflammation, and healing. Angiogenesis factors control blood-vessel formation. Therefore, these factors are vital in the immunological assessment and understanding of CLP morphopathogenesis. The aim of the study is to assess the distribution of vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF- β1), the total macrophage population and the M2 subtype, heat-shock proteins (HSP) 60 and 70, and nuclear factor kappa B (NF-κB) p50 and p65 subtypes in the affected tissue of children with CLP before and during primary dentition. Materials and Methods: Tissue samples were obtained from 15 patients aged from 3 to 8 months during veloplastic surgery. Five controls were used for comparison of data. Immunohistochemistry, light microscopy, semi-quantitative evaluation (from 0 to ++++), and statistics (Mann–Whitney U test and Spearman’s rank correlation) were used to evaluate the data for statistically significant differences and correlations between the groups. Results: Epithelial tissues affected by CLP presented with statistically significant increases in levels of VEGF (p = 0.007), total macrophages (p = 0.007), HSP60 (p = 0.001), NF-κB p65 (p = 0.000), and p50 (p = 0.045), but with a decrease in M2 macrophages (p = 0.025). Blood vessels in CLP-affected tissues showed a statistically significant increase in levels of NF-κB p65 (p = 0.003) and a statistically significant decrease in M2 numbers (p = 0.014). Connective tissue presented with no statistically significant differences. Spearman’s rank correlation revealed multiple statistically significant correlations—26 positive and 5 negative. Conclusions: Statistically significant changes in levels of VEGF and both NF-κB subtypes and numbers of total macrophages and M2 macrophages suggest a possible alteration of variable immune and inflammatory reactions and macrophage functions associated with the initiation and maintenance of the chronic process and the resulting damage. Full article

This study aimed to evaluate and compare the performance of four advanced artificial intelligence-powered chatbots—ChatGPT-4 Omni (ChatGPT-4o), DeepSeek, Gemini Advanced, and Claude 3.7 Sonnet—in responding to questions related to traumatic dental injuries (TDIs) in the primary dentition. The assessment focused on accuracy, completeness, readability, and response time, aligning with the 2020 International Association of Dental Traumatology guidelines. Twenty-five open-ended TDI questions were submitted to each model in two separate sessions. Responses were anonymized and evaluated by four pediatric dentists. Accuracy and completeness were rated using Likert scales; readability was assessed using five standard indices; and response times were recorded in seconds. ChatGPT-4o demonstrated significantly higher accuracy than Gemini Advanced (p = 0.005), while DeepSeek outperformed Gemini Advanced in completeness (p = 0.010). Response times differed significantly (p < 0.001), with DeepSeek being the slowest and ChatGPT-4o and Gemini Advanced being the fastest. DeepSeek produced the most readable outputs relatively, though none met public readability standards. Claude 3.7 generated the most complex texts (p < 0.001). A strong correlation existed between accuracy and completeness (ρ = 0.701, p < 0.001). These findings emphasize the cautious integration of artificial intelligence chatbots into pediatric dental care due to varied performance. Clinical accuracy, completeness, and readability are critical when offering information aligned with guidelines to support decisions in dental trauma management. Full article

Deciduous teeth accumulate toxic metals until fully mineralized, making them a stable biological matrix for assessing chronic exposure during fetal and early postnatal life. Their metal content is influenced by environmental factors (e.g., industrial areas, mining sites) and individual factors (e.g., maternal diet, early nutrition, passive smoking). The aim of this study was to evaluate the toxic metal content in deciduous teeth and to identify factors contributing to its accumulation, as well as possible health implications. A systematic review was conducted in accordance with the PRISMA guidelines and following the PICO framework. Quality assessment was assessed using the Joanna Briggs Institute (JBI) checklist for quasi-experimental studies. The literature search was carried out in the PubMed, Scopus, and Web of Science databases using the following keywords: deciduous, milk, primary, decidua, teeth, dentition, heavy metal, toxic metals. A total of 134 articles were initially identified, with 95 remaining after duplicate removal. After screening, 75 articles were excluded: 71 did not meet the inclusion criteria, 3 were not available in English, and 1 lacked full-text access. Ultimately, 20 studies were included in the review. Toxic metal concentrations were determined using various analytical techniques, mainly inductively coupled plasma mass spectrometry (ICP-MS) and atomic absorption spectrometry (AAS). Higher levels of metals, especially lead, were observed in the teeth of children residing in industrial areas, near mines, or in regions affected by armed conflict. Although two out of five studies indicated a possible link between fathers’ smoking habits and elevated lead concentrations, no definitive relationship was established between secondhand smoke exposure and the levels of lead and cadmium found in dental tissue. Similarly, no definitive relationship was identified between mercury and lead content and the prevalence of autism. However, lower manganese levels were associated with the presence of autistic traits, weaker verbal performance, and reduced memory capacity. In conclusion, deciduous teeth represent a valuable biological material for assessing chronic prenatal and early postnatal exposure to toxic metals, which may serve as a starting point for further research into diseases of unknown etiology, such as autism, and in the future may have clinical significance in their prevention and treatment. And it is also important for monitoring environmental pollution levels. Full article

Background: Dental radiographs play a crucial role in diagnosis and treatment planning. With the rise in digital imaging, there is growing interest in leveraging artificial intelligence (AI) to support clinical decision-making. AI technologies can enhance diagnostic accuracy by automating tasks like identifying and locating dental structures. The aim of the current study was to assess and validate the accuracy of an AI-powered application in the detection and numbering of primary teeth on panoramic radiographs. Methods: This study examined 598 archived panoramic radiographs of subjects aged 4–14 years old. Images with poor diagnostic quality were excluded. Three experienced clinicians independently assessed each image to establish the ground truth for primary teeth identification. The same radiographs were then evaluated using EM2AI, an AI-based diagnostic software for the automatic detection and numbering of primary teeth. The AI’s performance was assessed by comparing its output to the ground truth using sensitivity, specificity, predictive values, accuracy, and the Kappa coefficient. Results: EM2AI demonstrated high overall performance in detecting and numbering primary teeth in mixed dentition, with an accuracy of 0.98, a sensitivity of 0.97, a specificity of 0.99, and a Kappa coefficient of 0.96. Detection accuracy for individual teeth ranged from 0.96 to 0.99. The highest sensitivity (0.99) was observed in detecting upper right canines and primary molars, while the lowest sensitivity (0.79–0.85) occurred in detecting lower incisors and the upper left first molar. Conclusions: The AI module demonstrated high accuracy in the automatic detection of primary teeth presence and numbering in panoramic images, with performance metrics exceeding 90%. With further validation, such systems could support automated dental charting, improve electronic dental records, and aid clinical decision-making. Full article

This study aimed to assess the formation of internal and external voids in class II restorations of primary molars using bulk-fill composites with different viscosities through micro-CT analysis. Standardized class II cavities were prepared on 50 extracted intact primary molars. The teeth were restored with bulk-fill materials of varying viscosity: SDR, Tetric EvoCeram bulk-fill, Viscalor bulk, Cention forte, and a control group (Dyract XP). They were then scanned using a computed microtomograph. The volumes of the internal and external voids were quantified and expressed as percentages (%) of the total restoration volume. The data were analyzed using one-way ANOVA, followed by Tukey’s test (α = 0.05). The detected external and internal voids ranged from 0.19% to 0.62%. The data indicated no significant difference in the formation of external voids among the various bulk-fill materials or the control group (p > 0.05). Significantly fewer internal voids were observed with more flowable materials and when heat was applied (p < 0.05). The highest percentage of internal and external voids was observed when the layering restorative technique was used. It was concluded that in class II bulk-fill composite restorations in primary dentition, the percentages of both external and internal voids were relatively small compared with the entire volume of the restoration and decreased when more flowable materials were used. Full article

Background: Traumatic injuries to the alveolar process and primary teeth in early childhood can have long-term consequences on the development of permanent dentition and eruption pathways. Objective: This case report aims to illustrate the impact of early orofacial trauma on the eruption and development of permanent maxillary incisors and to emphasize the importance of timely interdisciplinary management. Case Presentation: An 8-year-old female patient presented to a pediatric dentistry clinic with delayed eruption of the maxillary anterior permanent teeth. In contrast, her monozygotic twin sister exhibited complete eruption of all permanent anterior teeth, raising parental concern regarding a possible pathological delay. Her medical history revealed orofacial trauma at the age of two, resulting in an alveolar process fracture, avulsion of the primary maxillary left central incisor (tooth 61), and luxation of the primary maxillary right central incisor (tooth 51). A clinical examination demonstrated sufficient arch space without signs of eruption and enamel defects on tooth 52. Radiographic evaluations, including panoramic imaging and cone beam computed tomography (CBCT), confirmed the presence of impacted permanent teeth with structural anomalies suggestive of trauma-related developmental disturbances. Results: The patient underwent a multidisciplinary treatment over a three-year period involving pediatric dentistry, oral surgery, and orthodontics. Management included surgical exposure of the impacted teeth followed by orthodontic traction to guide the eruption and treatment of enamel hypoplasia. Conclusions: This case highlights the long-term consequences of early traumatic dental injuries on permanent dentition development. It underscores the necessity of early diagnosis and a coordinated interdisciplinary approach to optimize outcomes and enhance the long-term oral health and quality of life of affected individuals. Full article

Background/Objectives: Parental attitudes play a crucial role in shaping children’s oral health habits and preventing dental diseases. This study aimed to explore the theoretical pathways through which parental behavior and attitudes toward child oral health can influence the dental caries experience as measured by the dmf-t index in preschool children in Lithuania. Methods: A cross-sectional study was conducted involving 302 children aged 4–7 years and their parents (262 mothers). Parental attitudes were assessed using the Parental Attitudes Towards Child Oral Health (PACOH) scale. For the children, the following variables were considered: sex, age, dental caries experience (dmf-t index in the primary dentition), oral hygiene index (Silness–Löe Plaque Index), toothbrushing frequency, and parental assistance with toothbrushing. Structural Equation Modeling (SEM) was applied for the data analysis. Results: The main path through which parental attitudes towards child oral health influenced the dmf-t index was via toothbrushing frequency (β = −0.17) or parental assistance with toothbrushing (β = 0.24). These factors were then linked to the oral hygiene index (β = 0.20 and β = −0.47, respectively), which ultimately influenced dmf-t (β = 0.52). The parents’ attitudes and toothbrushing frequency per se had no significant effect on children’s dmf-t (β = −0.06 and β = −0.04, respectively). The final model met all goodness-of-fit criteria: Chi-square test p = 0.211, Incremental Fit Index IFI = 0.994, Tucker–Lewis Index TLI = 0.982, Comparative Fit Index CFI = 0.994, and Root Mean Square Error of Approximation RMSEA = 0.038. Conclusions: Findings from this study demonstrate that parents play a significant role in determining children’s oral health. Regular toothbrushing, parental assistance with toothbrushing, and good oral hygiene are critical factors linking parents’ oral health-related attitudes to a child’s experience of early caries. Identifying the associations between dental caries risk factors helps plan interventions. Full article

The occurrence of triplication in the deciduous teeth is rare. However, it can cause several problems in primary dentition, alteration of development, and eruption of permanent successors. Case Presentation: A three-year-old boy presented with an exuberant acute periapical abscess in the left front teeth region of the upper jaw. Examination revealed a presence of a triple tooth involving the central and lateral left primary incisors and a supernumerary tooth. Radiographs showed that the fused teeth had separate roots, pulp chambers and root canals. The implemented treatment was extraction under local anesthesia. After 2 years of observation, surgical exposure of the crowns of the permanent maxillary central incisor was performed. After seven years, the permanent dentition was completed without any sequelae. Discussion: Triple tooth, as observed in this case report, results from the union of three tooth germs, potentially influenced by physical, hereditary, or environmental factors, leading to esthetic and functional issues and increased susceptibility to caries. Treatment is challenging, requiring preventive care, complex endodontic procedures, and, in some cases, extraction with space maintenance to avoid future orthodontic complications. Conclusion: Early diagnosis, an adequate treatment plan and clinical monitoring should be performed, aiming at preventing the possible disturbances. Full article

Background: Cemento-ossifying fibroma (COF) is a benign, non-aggressive fibro-osseous tumor in which normal bone is replaced by fibrous tissue containing collagen fibers, bone, or cementum-like material. Although COF is rare in children, its occurrence requires careful management due to its potential impact on tooth development and occlusion. Surgical excision is the widely used treatment; however, post-operative occlusal guidance is crucial, particularly in pediatric patients. Case report: This case report presents the early intervention using a preformed eruption guidance appliance (EGA) following the excision of COF in a 5-year-old boy. The patient exhibited premature loss of the primary canine and displacement of the devel-oping permanent tooth bud. After surgical excision, an EGA was applied to facilitate proper eruption of the successor teeth and optimize oral muscle function. Over a four-year follow-up period, the permanent teeth in the affected area erupted favorably, and intercuspal relationships improved during the transition from primary to mixed dentition. Conclusions: Given the limited research on the long-term effects of COF on developing dentition, long-term follow-up and additional studies are necessary to further evaluate its impact and the effectiveness of eruption guidance appliances in pediatric patients. Full article

Background/Objectives: Frailty and sarcopenia are geriatric syndromes associated with increased vulnerability to adverse health outcomes, including functional decline, disability, and mortality. Emerging evidence suggests that oral health interventions may play a role in mitigating these conditions. This systematic review aims to evaluate the impact of oral health interventions on frailty and sarcopenia in older adults. Methods: A systematic search was conducted in PubMed, Scopus, and SciELO databases for studies published up to December 2023. Inclusion criteria comprised experimental and quasi-experimental studies assessing dental interventions and their effects on frailty and sarcopenia in individuals aged 60 years and older. The primary outcomes included frailty index, grip strength, walking speed, and functional dentition. Study quality was assessed using GRADEpro. Results: Eight studies were included. Preventive oral hygiene interventions improved oral health but did not significantly impact frailty scores. Oral exercises significantly improved muscle strength and weight, leading to frailty score reductions (−1.1 points, 95% CI: −1.5 to −0.7, p < 0.01). Swallowing therapies were linked to increased grip strength (+1.8 kg, p = 0.03) and walking speed (+0.2 m/s, p = 0.04), with corresponding frailty index reductions (−0.8 points, 95% CI: −1.2 to −0.4, p = 0.01). The certainty of evidence ranged from very low to moderate. Conclusions: Oral health interventions, particularly oral exercises and swallowing therapies, show potential in reducing frailty and sarcopenia-related outcomes in older adults. However, methodological heterogeneity and low-certainty evidence highlight the need for high-quality, large-scale trials with standardized assessment measures to establish definitive clinical recommendations. Full article

This study presents an evaluation of the microtensile bond strength (µTBS) and microleakage (ML) of a bulk-fill (BF) composite, Ormocer, and Alkasite in comparison to the conventional composite bonded to caries-affected dentin (CAD) in deciduous dentition. Eighty-four human primary molars displaying carious lesions involving the middle third of dentin were included. CAD was exposed, and the teeth were randomly assigned to four groups based on the type of restorative material used: Group 1 (conventional composite), Group 2 (BF composite), Group 3 (Alkasite), and Group 4 (Ormocer). Sample storage and artificial aging were performed. Dye penetration, a universal testing machine, and a stereomicroscope were used for microleakage, µTBS, and failure mode assessment. The interface was evaluated by scanning electron microscopy (SEM). µTBS and ML results were analyzed using a one-way analysis of variance (ANOVA) and Tukey’s post hoc tests (p < 0.05). Group 1 (conventional composite) exhibited the highest microleakage and lowest bond strength. The minimum ML and maximum μTBS values were demonstrated by Group 4 (Ormocer). Ormocer and Alkasite proved to be better alternatives to conventional composites in terms of ML and bond strength in deciduous dentition. Full article