Search Results (57)

This scoping review mapped the clinical readiness of directly additively manufactured (AM) dental ceramics for single-unit definitive restorations (crowns, veneers, and partial-coverage restorations) using a predefined review-specific five-tier readiness framework (R1–R5) designed to organize evidence maturity from restoration-relevant foundational studies to comparative clinical evidence. MEDLINE (PubMed), Scopus, Web of Science Core Collection, EBSCO (Dentistry and Oral Sciences Sources), and ClinicalTrials.gov were searched from inception to February 2026, with citation tracking. Thirty-five sources were included: 31 in vitro studies and 4 clinical studies. Evidence clustered in preclinical tiers, with most studies classified as restoration-level in vitro investigations (R2, 22/35) or foundational specimen-level studies explicitly linked to restorative performance (R1, 9/35); only one feasibility study reached R3 (1/35), three studies provided comparative clinical evidence (R4, 3/35), and no R5-level evidence was identified. The additively manufactured definitive restorations evaluated were zirconia-based. Most restoration-level studies addressed zirconia crowns (18/35), with fewer studies focusing on veneers/laminates (5/35) and occlusal veneers/tabletops (2/35). Across AM routes (most commonly vat photopolymerization ceramic workflows and nanoparticle jetting) outcomes focused on fit/adaptation, manufacturing accuracy, mechanical performance, and aging simulations; clinical studies reported short- to mid-term performance using standardized evaluation criteria. Overall, the evidence suggests technical feasibility and increasing restoration-level evaluation under controlled conditions, but clinical applicability remains preliminary because higher-readiness clinical evidence is still limited. Future work should prioritize standardized reporting, clinically relevant aging/fatigue paradigms, and longer-term comparative clinical studies. Full article

Objective: This retrospective comparative cohort study investigated the craniofacial growth effects of the RAMPA (Right Angle Maxillary Protraction Appliance) system. The system aims to protract the maxilla in an anterosuperior direction to address maxillary hypoplasia and skeletal Class III malocclusion, potentially mitigating the posteroinferior displacement often associated with conventional orthopedic approaches. Materials and Methods: Craniofacial measurements were analyzed before (T1) and after (T2) RAMPA treatment in 30 growing patients (17 males, mean age 7.32 years; 13 females, mean age 8.34 years). Coben analysis was utilized to quantitatively evaluate coordinate relationships and proportional changes based on the Frankfurt Horizontal plane. Statistical significance was determined using paired t-tests or Wilcoxon signed-rank tests (two-sided, α = 0.05) without adjustment for multiple comparisons due to the exploratory nature of the study. Results: RAMPA treatment was associated with significant increases in facial depth (Ba-N) and anterior facial height (N-Me) in both sexes. Specifically, facial depth increased by an average of 2.65 mm in males (p = 0.001) and 2.18 mm in females (p = 0.007). Female patients showed a significant increase in the maxillary depth ratio (Ptm-A/Ba-N), while males exhibited a significant decrease in the Gonial Angle (avg. 1.47° decrease), suggesting anterior mandibular rotation. Conclusions: RAMPA treatment effectively promoted anterosuperior craniofacial growth and induced favorable mandibular rotation in this cohort. These findings suggest the system has potential clinical value for improving craniofacial balance in skeletal Class III malocclusion. While improved cervical posture is a theoretical benefit of such remodeling, systemic outcomes were not directly measured in this study. Full article

Objectives: To compare artificial intelligence (AI) crown design with expert or non-AI computer-aided (CAD) design for single-unit tooth and implant-supported crowns across efficiency, marginal and internal fit, morphology and occlusion, and mechanical performance. Materials and Methods: This systematic review was conducted and reported in accordance with PRISMA 2020. PubMed MEDLINE, Scopus, Web of Science, IEEE Xplore, and Dentistry and Oral Sciences Source were searched from 2016 to 2025 with citation chasing. Eligible studies directly contrasted artificial intelligence-generated or artificial intelligence-assisted crown designs with human design in clinical, ex vivo, or in silico settings. Primary outcomes were design time, marginal and internal fit, morphology and occlusion, and mechanical performance. Risk of bias was assessed with ROBINS-I for non-randomized clinical studies, QUIN for bench studies, and PROBAST + AI for computational investigations, with TRIPOD + AI items mapped descriptively. Given heterogeneity in settings and endpoints, a narrative synthesis was used. Results: A total of 14 studies met inclusion criteria, including a clinical patient study, multiple ex vivo experiments, and in silico evaluations. Artificial intelligence design reduced design time by between 40% and 90% relative to expert computer-aided design or manual workflows. Marginal and internal fit for artificial intelligence and human designs were statistically equivalent in multiple comparisons. Mechanical performance matched technician designs in load-to-fracture testing, and modeling indicated stress distributions similar to natural teeth. Overall risk of bias was judged as some concerns across tiers. Conclusions: Artificial intelligence crown design delivers efficiency gains while showing short-term technical comparability across fit, morphology, occlusion, and strength for single-unit crowns in predominantly bench and in silico evidence, with limited patient-level feasibility data. Prospective clinical trials with standardized, preregistered endpoints are needed to confirm durability, generalizability, and patient-relevant outcomes, and to establish whether short-term technical advantages translate into clinical benefit. Full article

Background: Pain after giving birth is commonly observed in horses, yet there has not been a specific tool developed for assessing this pain in postpartum mares. The goal was to adapt existing equine pain scales and to preliminarily validate a practical pain scale for use by veterinarians and caregivers after foaling. Methods: The pain scale was developed by adapting items from other pain scales, including established orthopedic and colic equine pain scales, and incorporating caregiver feedback. The final scale includes eight areas for assessing pain: behavior, facial expressions, vital signs, udder examination, gastrointestinal function, hoof temperature, response to food, and movement. Observations were conducted on ten heavy draft mares that experienced dystocia, with pain scores recorded twice daily for 1 to 4 days postpartum. Simultaneous saliva samples were collected to measure cortisol levels. Results: The pain scale proved feasible for use at the stall and allowed for partial scoring when certain assessments were deemed risky. Pain scores were highest on the first day after foaling and decreased as the mares recovered. In a case of clinical deterioration, a substantial increase in pain score was noted. Increased pain scores were associated with elevated cortisol levels, supporting the biological relevance of the scale. In clinical practice, if a pain score exceeded 40% of the maximum score, the mare was identified as a patient requiring analgesic treatment. Conclusions: This postpartum-specific pain scale provides a standardized method for assessing pain in mares after foaling and may assist in guiding appropriate pain management. Although the proposed pain scale shows promise as a clinical tool, the present results are preliminary and require confirmation in larger studies. Full article

Background: Whether nanoengineered titanium surfaces confer superior implant stability beyond modern microrough controls remains uncertain. Methods: This systematic review followed PRISMA 2020 guidance: comprehensive multi-database searching with de-duplication; dual independent screening, full-text assessment, and standardized data extraction for predefined outcomes (implant stability quotient [ISQ], mechanical anchorage by removal/push-out/pull-out torque, and histologic bone-to-implant contact). Risk of bias was appraised with RoB 2 for randomized trials, ROBINS-I for non-randomized clinical studies, and CAMARADES (animal experimentation). The certainty of clinical evidence was summarized using GRADE. Results: Across animal models, nanoengineered surfaces consistently improved early osseointegration indices (higher removal torque and bone-to-implant contact at initial healing). In clinical comparative studies, nanoengineered implants showed modest, time-limited gains in early stability (ISQ) versus microrough titanium. By 3–6 months, between-group differences typically diminished, and no consistent advantages were demonstrated for survival or marginal bone outcomes at later follow-up. Methodologic heterogeneity (surface chemistries, timepoints, outcome definitions) and small clinical samples limited quantitative synthesis. Overall, risk-of-bias concerns ranged from some concerns to high in non-randomized studies; the certainty of clinical evidence was low. Conclusions: Nanofeatured titanium surfaces improve early osseointegration but do not demonstrate a consistent long-term advantage over modern microrough implants. Current evidence supports an early osseointegration benefit without clear long-term clinical advantage over contemporary microrough implants. Adequately powered, head-to-head trials with standardized stability endpoints and ≥12-month follow-up are needed to determine whether early gains translate into patient-important outcomes. Full article

Objectives: The aim of this study was to determine the epidemiological characteristics of bicycling-related maxillofacial fractures in a defined population and to identify factors contributing to these injuries. Methods: An 8-year cohort study was carried out, including all patients presenting with bicycling-related maxillofacial fractures at a tertiary care center from 2017 through 2024. Data recorded for each patient included age, gender, date and cause of injury, contributing factors, type of facial fractures, other injuries, hospital stay, and helmet use. Statistical analysis was performed. Continuous variables were assessed for normality (Shapiro–Wilk test) and compared using the Mann–Whitney test. Categorical variables were analyzed with chi-square tests. A p-value ≤ 0.05 was considered statistically significant. Results: Out of 899 cycling accident patients seeking medical treatment, 122 (13%) sustained facial fractures, accounting for 4% of all facial fracture cases in our department during the study period. In our cohort, the male–female ratio was 2.6:1, and the mean age was 29.5 years (SD 12.8, range 13–77). Collision with another object/vehicle was the most common cause (64%), followed by isolated falls (36%). A total of 135 facial fractures were recorded (some patients had multiple fractures). Mandibular fractures were most frequent (49% of patients), followed by zygomatic (32%), orbital (13%), nasal (7%), maxillary (2%) and frontal (2%) fractures. Among mandibular injuries, condylar fractures were the most common subtype (63%). Dental injuries were found in 27% of patients. The most common dental trauma was tooth fracture (43% of those with dental injuries), followed by tooth luxation (32%) and tooth avulsion (25%). In 80% of cases involving dental injuries, the upper anterior teeth were involved. Concomitant injuries were present in 20% of patients, most often orthopedic limb injuries. Only 27% of patients reported always wearing a helmet, whereas 43% reported never having worn one. Conclusions: Bicycling-related facial injuries are a noteworthy subset of facial trauma. Missed or delayed diagnosis can lead to lasting deformities and functional issues. Preventive strategies—especially promoting helmet use and improving helmet design—along with broader safety measures are important to reduce the incidence and severity of these injuries. Full article

Objective: This systematic review and meta-analysis aimed to evaluate the effects of moisture control strategies (including wet-bonding techniques, universal adhesives, and etching type) on dentin bonding performance in restorative dentistry. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, following PRISMA guidelines. Only in vitro and ex vivo studies comparing wet- and dry-bonding protocols, using human dentin substrates, and reporting microtensile bond strength (μTBS) were included. The data were synthesized using a random-effects meta-analysis and the methodological quality was assessed using the MINORS tool. Certainty of evidence was evaluated using the GRADE framework. Results: Nine studies met the inclusion criteria, eight of which were included in this meta-analysis. The moisture control strategies significantly influenced the bonding outcomes, with ethanol and acetone wet bonding yielding higher μTBS and enhanced hybrid layer morphology. The universal adhesives performed effectively under both moist and dry conditions, although their performance varied by the adhesive composition and solvent system. The meta-analysis revealed a statistically significant advantage for hydrated dentin (SMD = +1.20; 95% CI: 0.52 to 1.86; p < 0.001), with the moist and ethanol-treated substrates outperforming the dry and over-wet surfaces. The long-term durability was better preserved with ethanol and acetone pretreatments and the adjunctive use of chlorhexidine. Conclusions: Moisture conditions influence dentin bond strength, but modern universal adhesives show consistent bonding performance across different moisture conditions. Solvent-wet-bonding protocols, particularly with ethanol or acetone, enhance the immediate and long-term performance. While the current evidence is limited by the in vitro designs and heterogeneity, the findings demonstrate protocol flexibility and highlight strategies to optimize adhesion in clinical practice. Future clinical trials are necessary to validate these approaches under real-world conditions. Full article

Background/Objectives: Craniofacial microsomia (CFM), previously known as hemifacial microsomia, is a congenital condition involving structures derived from the first and second pharyngeal arches. CFM is characterized by asymmetrical craniofacial growth, affecting the mandible, ear, orbit, soft tissues, and facial nerve. Functional therapy is among the treatment options for mild to moderate cases. This study aimed to assess the effect of functional therapy on mandibular growth in patients with CFM by comparing mandibular and condylar height on the affected and unaffected sides, using pre- and post-treatment panoramic radiographs. Methods: A retrospective longitudinal study was conducted on 14 patients treated with functional therapy with the Asymmetrical Functional Activator (AFA) appliance. Mandibular ramus height (Co-Go) and condylar height (Co-Is) were measured bilaterally on pre- (T0) and post-treatment (T1) panoramic radiographs. Growth differences and rates were analyzed using descriptive and inferential statistics. Results: A significant increase in the mandibular ramus height (Co-Go) and in condylar height (Co-Is) was observed on the affected side from T0 to T1. The increase in mandibular ramus height was significantly greater on the affected side compared to the unaffected side (p = 0.0016). Although condylar height increased significantly on both sides over time, the difference in growth rate between sides was not statistically significant (p = 0.7148). Conclusions: Functional therapy may contribute to reducing mandibular asymmetry in CFM patients by enhancing the growth of the affected mandibular ramus, but the asymmetry may still be present at the end of treatment. These findings support its use in the early management of mild to moderate CFM. Full article

Background/Objectives: In maxillo-facial high-velocity complex war injuries, a rigid internal fixation is inappropriate, and external fixation is suitable with described benefits. This systematic review aimed to summarize the literature regarding the benefits, side effects and complications of external fixators in the management of mandibular war-related injuries. Methods: An electronic search was performed in the databases of PubMed and Google Scholar in December 2024. The title and abstracts from retrieved items were read by two reviewers to identify studies within the selection criteria. Included articles had to be published in English up to December 2024 and related to external fixators used in mandibular fracture war injuries. Results: The search strategy initially identified 445 studies through PubMed and 987 studies through Google Scholar. Following the application of inclusion criteria, 12 articles were selected for this review, describing the use of an external fixator for a mandibular fracture in a war injury. Conclusions: The external fixator offers effective treatment for severe mandibular fractures in war-related injuries with low rates of complications and high success rates. Where a manufacturer external fixator is not available, orthopedic external fixators and self-crafted external fixators are used. Full article

Background: Facial features are the first basic sign of medical knowledge of children and adults with congenital malformations. Children born with multiple contractures almost always receive the misdiagnosis of arthrogryposis multiplex. Larsen syndrome can easily be diagnosed at birth via the proper interpretations of its characteristic facial features and multiple dislocations. Comprehensive clinical diagnosis can facilitate an orthopedic strategy for early treatment and can enhance the recognition of unreported craniocervical malformation complexes. Material and Methods: Six children (four boys and two girls, with ages ranging from a few months to 7 years old) were referred to our department for diagnosis and treatment. All children received their first misdiagnosis by the pediatricians as manifesting arthrogryposis multiplex congenita. The clinical phenotype was our first decisive tool for diagnosis. All children exhibited the classical phenotype of dish-like facies associated with multiple joint dislocations. Radiological phenotypic characteristics confirmed our clinical diagnosis of Larsen syndrome. Three children out of six showed unpleasant cervical spine deformities. The first child, a 2-year-old, became tetraplegic after minor trauma. One child presented with progressive rigid cervical kyphosis. The third child was a product of a first-relative marriage and was born with congenital tetraplegia. A genotype was carried out for confirmation. Results: Three children underwent open reduction for congenital hip and knee dislocations. One child underwent spinal fusion CO-C7 because of tetraplegia. A 3D-reformatted and reconstruction CT scan of the craniocervical junction showed two forms of unusual dys-segmentation, firstly along C2-3 effectively causing the development of acute-angle cervical kyphosis. Secondly, an infant with congenital tetraplegia showed a serious previously undescribed atlanto–axial malformation complex. Namely, atlanto–axial maldevelopment (dys-segmentation) of (C1/C2) was associated with hypoplasia of the anterior and the posterior rings of the atlas. Genetic tests of these children were compatible with the autosomal dominant type of Larsen syndrome and manifested a heterozygous mutation in FLNB mapped 3p14.3, encoding an actin-binding protein, filamin B. The child with congenital tetraplegia showed no mutations in FLNB, though his clinical and radiological phenotype and his family history of first-relative marriage were totally compatible with the diagnosis of the autosomal recessive type of Larsen syndrome. Conclusions: Our strategy was and still is based on a coherent clinical and radiological diagnosis, which is based on comprehensive clinical and radiological phenotypic characterizations. We implemented a 3D-reformatted CT scan to further understand the craniocervical junction pathology in three children. Strikingly, prenatal onset of lethal maldevelopment (dys-segmentation) of the atlanto–axial spine segments has been diagnosed in an infant with congenital tetraplagia. A less serious cervical spine malformation was detected in two children who presented with progressive acute-angle cervico and cervico-thoracic kyphosis. Our clinical strategy can form the basis for a thorough clinical assessment for infants and children born with multiple malformation complexes and can lead to recognition of novel understandings. Full article

Background: Condylar hyperplasia (CH) leads to mandibular overgrowth with anatomical, aesthetic, and functional consequences, particularly affecting facial harmony. It is characterized by severe mandibular prognathism (MP) in bilateral cases. This study aims to propose a therapeutic algorithm for diagnosing and treating bilateral condylar hyperplasia (BCH) based on demographic, clinical, craniofacial growth, and clivus ratio uptake conditions. Methods: Ten patients with severe skeletal Class III by MP, whose alteration was clinically associated with BCH, were consecutively evaluated in a specialized dentofacial deformity center between the period of 2019 and 2024. A detailed protocol was followed to gather clinical history, assess anatomical features, evaluate malocclusion, and identify potential BCH. When suspicion arose, a nuclear medicine test measured condylar scintigraphy uptake. If the result was positive, patients underwent bilateral condylectomy, following one of three treatment protocols. Results: Severe PM, pronounced Class III with excessive negative overjet, elongated condyles of normal anatomy, absence of family history, and accelerated growth since preadolescence and adolescence were common characteristics in these patients. Regarding the treatment protocol chosen according to the characteristics of the patients, five cases followed treatment protocol A: condylectomy and surgical correction of the alteration in two surgical stages. Two cases followed protocol B: bilateral condylectomy and orthognathic surgery in the same surgical time, and three cases followed protocol C: condylectomy and later post-surgical orthopedics and/or orthodontics without a second surgical intervention. Histopathological results confirmed bilateral hyperplastic growth and stability in mandibular size, and occlusion was observed during follow-up. Conclusions: Specialists need to recognize the clinical signs of BCH and use scintigraphy tests to measure condylar metabolic activity when suspected. Early detection of BCH is crucial, as it influences treatment decisions and helps prevent relapses in orthodontic or surgical interventions aimed solely at correcting or compensating for Class III malocclusion caused by MP. Full article

Background/Objectives: The relationship between chronological age, dental age, and cervical vertebral maturation is critical for assessing the reliability of dental age as an indicator of skeletal age and for identifying the patient’s growth peak. This assessment facilitates the planning of appropriate orthodontic-orthopedic treatment. Methods: This retrospective observational study analyzed data from the Clinical Department of Orthodontics and Dento-Facial Orthopedics in Cluj-Napoca, Romania. The sample included 73 patients with Class II malocclusion (31 males and 42 females), with data obtained from orthopantomography and lateral cephalometric radiographs. Dental age was evaluated using both the Demirjian method and the Chronology of Eruption method. Skeletal age was determined based on Baccetti’s cervical vertebral maturation (CVM) staging method. Results: A strong and statistically significant correlation was found between cervical vertebral maturation and chronological age (r = 0.81, p < 0.001), as well as between cervical vertebral maturation and dental age assessed using the Demirjian method (rs = 0.72, p < 0.001). Additionally, a significant correlation was observed between cervical vertebral maturation and dental age assessed using the Chronology of Eruption method (rs = 0.78, p < 0.001). Conclusions: The correlation found between dental age and skeletal maturity suggests that dental age (DA) assessment might serve as a supplementary tool for estimating a patient’s growth peak in Class II malocclusion cases. Future research exploring the use of artificial intelligence (AI) in panoramic radiograph analysis could improve the accuracy and consistency of DA assessment, contributing to more reliable skeletal maturity evaluations. Full article

Background/Objectives: The study evaluated the effectiveness of Nuvola^® OP aligners, combined with an interceptive myofunctional device, in achieving dental arch expansions over an 18–26-month treatment period. Methods: 54 patients (31 women and 23 men, aged between 18 and 48 years old) participated in the study. The inclusion criteria for the present research were optimal oral hygiene, no prior orthodontic treatments, and no systemic conditions affecting outcomes of the treatment. Linear measurements (D1, D2, D3, D4) were obtained from STL files of the dental arches before and after treatment using Carestream CSMODEL™ software 3.10.47. Statistical analysis included MANOVA, Pearson’s correlation, and paired t-tests, following the Shapiro–Wilk test for data normality. Results: The treatment duration averaged 22.4 months. D1–D4 measurements means increased by 2.1 mm for D1, 2.37 mm for D2, 1.0 mm for D3, and 3.67 mm for D4. MANOVA results (p = 0.063) confirmed similar effects on all parameters, while Pearson’s correlation showed a weak positive association among distance changes. Conclusions: Nuvola^® OP aligners, used with an interceptive myofunctional device, effectively improved arch parameters. The significant increases in D1–D4 mean values suggest that this approach might be beneficial for controlled dental arch expansion in adult patients. Full article

Background/Objectives: Regenerative periodontal therapy is a treatment method that focuses on restoring the periodontium affected by chronic inflammatory disease or injury. It involves using different biomaterials and techniques to completely restore the periodontal structures. The main objective was to identify and critically evaluate relevant studies comparing the clinical efficacy of allograft and alloplastic materials in regenerative periodontal therapy. Methods: For evaluation, a systematic review based on PRISMA guidelines was conducted. Data were extracted using only specific types of study designs, which included randomized controlled trials, cohort studies, and case-control studies. Target patients with periodontal disease or periodontal lesions undergoing periodontal therapy using allograft or alloplastic materials were selected. Periodontal parameters such as clinical attachment level, probing pocket depth, radiographic bone fill, or patient-reported outcomes were analyzed. Results: The results showed that allograft and alloplastic materials offered reduced pocket depth, a gain in clinical attachment, and bone repairment. The variation observed indicated that allografts showed a slightly more significant clinical attachment gain and a superior bone fill than alloplastic ones, suggesting that allografts enhance osteogenesis and provide a greater capacity for repair in periodontal defects. Conclusions: The results of the present study suggest that allograft and alloplastic materials offered reduced pocket depth, a gain in clinical attachment, and bone repairment, with both methods having similar clinical efficacy. Full article

Background/Objectives: The literature suggests that the cranial base angle is considered one of the contributing factors to sagittal jaw malpositions when its relationship with the viscerocranium is examined. Our study aims to compare and evaluate the outcomes of fixed functional orthopedic treatment in patients with mandibular retrognathia across different cranial base groups. Methods: Participants were treated at Erciyes University with fixed functional appliances and categorized by CBA into low (<130°), medium (130°–134°), and high (>134°) groups. A total of 39 patients were included: 13 in the low CBA group (7 males, 6 females; mean age 14.62 ± 1.12 years), 13 in the medium CBA group (3 males, 9 females; mean age 14.38 ± 0.96 years), and 13 in the high CBA group (4 males, 9 females; mean age 14.08 ± 1.04 years). Results: In the low CBA group, Ar-Go-N (p = 0.005) and SNA (p = 0.023) angles significantly decreased, while the ANB angle and Wits appraisal significantly decreased across all groups (p < 0.05). The high CBA group showed increases in ANS-Me, N-Me, N-ANS, and N-Gn lengths (p < 0.05). The medium and high CBA groups had significant increases in S-Go and ANS-Gn lengths, while Co-Gn length increased significantly in the low and high CBA groups (p < 0.05). Incisor measurements (IMPA, L1-APog, L1/NB, L1-NB) increased in all groups, with overjet and overbite reduced (p < 0.05). U1/PP (p = 0.039), U1/SN (p = 0.043), U1-NA (p = 0.030), and U1/NA (p = 0.025) parameters increased in the low CBA group, with the Upper Lip–E distance decreasing significantly in the low and high CBA groups (p < 0.05). A comparison between groups showed significant differences in U1/PP, U1-NA, and U1/NA parameters, which increased in the low and medium CBA groups but decreased in the high CBA group. Conclusions: CBA influences treatment outcomes. The low CBA group experienced decreases in Ar-Go-N and SNA angles, while the high CBA group showed increases in certain vertical facial dimensions. Incisor parameters rose in the low and medium CBA groups but decreased in the high CBA group, suggesting limited CBA effects on treatment results. Full article