Search Results (394)

Background/Objectives: Diode lasers are used as adjuncts for endodontic disinfection, but their depth-resolved effects on root dentin are insufficiently described. This ex vivo study used optical coherence tomography (OCT) to qualitatively document laser-related morphological signatures on canal walls. Methods: Palatal roots from extracted maxillary first molars were standardized and hemisectioned to create specimens allocated to a conventional diode-laser protocol, a higher-power protocol, or control. A 940-nm diode laser with endodontic tips was applied per group. Swept-source OCT acquired serial B-scans along the root length. Two endodontists reviewed images for thermally induced morphological alterations (TIMAs). Reporting is descriptive. Results: OCT revealed laser-related hyper-reflective linear/radial signatures extending from the canal lumen toward the external root surface in laser-treated specimens. Qualitatively, signatures appeared more conspicuous and extended deeper with the higher-power protocol than with the conventional protocol. Findings were most evident in the coronal/middle thirds. Control specimens served to contextualize background appearances from preparation and sectioning. Representative B-scans illustrate typical patterns. The novelty of the present study results from the identification of areas of morphological alteration through the OCT examination of the walls of the root canals. Conclusions: Depth-resolved OCT can visualize dentinal alterations associated with diode-laser irradiation in an ex vivo model. These observations support careful parameter selection and motivate in situ studies with concurrent temperature monitoring and histologic correlation. Full article

Tissue responses to zirconia-coated implants treated with molecular precursor method were evaluated. The zirconia film was characterized using scanning electron microscopy (SEM), atomic force microscopy (AFM), energy dispersive X-ray spectroscopy (EDX), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD). Cylindrical titanium (ZrO₂/Ti) specimens were sandblasted, acid-etched, and coated with zirconia using the molecular precursor method. Control specimens were sandblasted and acid-etched only (SLA/Ti). After maxillary first molar extraction, four ZrO₂/Ti and four SLA/Ti implants were placed in the alveolar bone of the rats, and tissue responses were observed after 3 weeks. Surface analysis using SEM and AFM showed zirconia was present on ZrO₂/Ti surface, with coating not affecting surface morphology compared to SLA/Ti. EDX, XPS, and XRD measurements confirmed the ZrO₂ coating on the roughened Ti. The amount of new bone was greater in ZrO₂/Ti (77.0 ± 7.2%) than in SLA/Ti (59.7 ± 5.8%) (p = 0.807). Collagen fibers oriented perpendicular to implant surface were observed more frequently in ZrO₂/Ti (67.3 ± 9.5%) than in SLA/Ti (18.8 ± 10.01%) (p < 0.001). The area of perpendicular collagen fibers was significantly larger in ZrO₂/Ti (53.1 ± 13.4%) than in SLA/Ti (16.8 ± 2.6%) (p = 0.002). Zirconia-coated implants maintained surface morphology and improved bone formation and fiber orientation in the gingiva compared to conventional titanium implants in short-term animal experiments. Full article

Diabetes is a significant risk factor for bisphosphonate-related osteonecrosis of the jaw (BRONJ), a severe oral complication with limited treatment options. Salivary testing offers a noninvasive approach for monitoring BRONJ risk; however, few studies have investigated salivary biomarkers in BRONJ. This study screened salivary biomarkers that reflect the progression of BRONJ under diabetic conditions. A diabetic BRONJ rat model was established to screen for diabetes-related biochemical biomarkers in saliva. Streptozotocin (STZ) administration elevated blood glucose and glycated albumin levels and altered lipid and renal function markers, confirming diabetes induction. Subsequent zoledronic acid (ZA) administration and extraction of the maxillary first molar delayed epithelialization, inflammatory cell infiltration, bone exposure, and necrosis in extraction sockets, indicating successful establishment of a diabetic BRONJ model. This model showed reductions in submandibular and sublingual gland size, as well as in acinar cell number. Although salivary secretion volume was reduced, saliva samples were successfully collected from all groups. Screening identified elevated urea nitrogen (UN) and total ketone bodies (T-KB) in the STZ + ZA group. These findings suggest that salivary UN and T-KB may reflect disease progression and serve as potential biomarkers for predicting BRONJ risk under diabetic conditions. Full article

Background: Molar–incisor hypomineralization (MIH) represents a challenging dental condition, often requiring complex and invasive interventions. In severe cases, extraction of the first permanent molars (FPM) is frequently indicated. However, methods to assess the effectiveness of this approach in promoting spontaneous mesialization of the second permanent molars (SPM) through Orthopantomography (OPT), as well as the factors influencing this process, remain unexplored. Aim: This perspective study aimed to assess the effectiveness of novel radiograph-based methods for assessing spontaneous SPM mesialization after FPM extraction and to identify clinical and developmental factors associated with complete space closure. Methods: OPTs of 19 patients (12 males, 7 females; age range 6.2–13.8 years) who underwent extraction of 36 FPM due to severe MIH were analyzed by 2 operators. Pre- and post-extraction OPTs were evaluated using specifically developed geometric measurements of distances and angles to quantify SPM movement. Variables considered included patient age at extraction, dental developmental stage (Demirjian index), observation period, and presence or absence of the third permanent molar (TPM). The reliability of the proposed measurements evaluated through ICC (Intraclass Correlation Coefficient) resulted in values above 0.9, confirming excellent intra- and inter-operator reliability. Results: Complete or quite-complete mesialization (target scores 0–1 and ≤33% residual space) occurred in 78.6% of maxillary and 73.7% of mandibular sites. Maxillary SPMs showed more favorable spontaneous movement, exhibiting substantial uprighting (e.g., from −32° to 2°) and a higher frequency of complete or near-complete space closure (78.6% vs. 73.7% in the mandible). Developmental stages D–E of SPM were associated with successful outcomes. Conclusions: Early extraction of severely compromised first permanent molars (FPMs) can represent an effective treatment option to promote spontaneous mesialization of SPMs, particularly in the maxilla. The proposed radiograph-based measurement method demonstrated high consistency and reproducibility. Overall, this novel measurement approach may serve as a reliable and valuable tool for future clinical and research applications. Full article

Background/Objectives: Population-specific data on permanent-tooth eruption are essential for accurate diagnosis, treatment planning, and public health strategies. In Hungary, current clinical practice relies on outdated international eruption standards. The aim of this study was to determine the timing and sequence of permanent tooth emergence in Hungarian children and provide sex-specific eruption standards. Methods: A cross-sectional study was conducted based on dental screening records of 2948 children aged 4–15 years in Debrecen, Hungary, during the 2015–2016 school year. Probit regression was used to estimate median eruption times and percentiles, and eruption sequences were assessed by sex and jaw. Results: Girls exhibited earlier eruption than boys for all teeth except mandibular central incisors (difference: 1.9–8.9 months; p < 0.05). Mandibular teeth generally preceded maxillary teeth, though premolars in boys showed the opposite trend. Eruption sequences varied by sex, particularly in the canine-premolar region. The 5th-95th percentile eruption range was widest for second molars (4.8 years) and narrowest for maxillary central incisors (2.3 years). Conclusions: This study provides the first modern eruption standards for Hungarian children. These sex-specific reference values are clinically useful for assessing delayed eruption, guiding radiographic decisions, and optimizing the timing of preventive and orthodontic interventions. Full article

This study aimed to evaluate the biomechanics of maxillary first molar teeth following palatal, disto-buccal, and mesio-buccal root amputation. An intact maxillary molar underwent root canal treatment using Reciproc R25 files (VDW, Munich, Germany). The canals were obturated with gutta-percha (DiaDent, Seoul, Republic of Korea) and 2Seal sealer (VDW, Munich, Germany), and the access cavity was restored with composite resin. A high-resolution CBCT scan of an intact maxillary first molar was obtained using a Planmeca Promax 3D Max system (Planmeca Oy, Helsinki, Finland) at 75 kVp and 10 mA. The acquired data were processed in 3D Slicer software (v5.8.0, BSD license, Boston, MA, USA) to segment enamel, dentin, and pulp based on pixel density variations using the three-point cloud method. A baseline intact model and three root-resected models (palatal, disto-buccal, mesio-buccal) were reconstructed in SolidWorks 2021, with resected roots simulated as being sealed with MTA. Finite element analysis was conducted in CosmosWorks to evaluate von Mises stress distribution under a 300 N static occlusal load. Maximum von Mises stresses were detected at occlusal force application sites. Among root dentin tissues, stress values ranked highest after palatal root resection, followed by the mesio-buccal, disto-buccal, and non-resected models. Conclusions: Palatal root amputation of maxillary first molars generated the highest von Mises stresses in root dentin, suggesting a higher biomechanical risk than disto-buccal or mesio-buccal resections. Full article

Background: This case report aimed to quantify dental, alveolar, and skeletal changes, periodontal health, and sleep quality after treatment with a tooth-borne rapid palatal expander (RPE) in a young adult with bilateral posterior crossbite due to transverse maxillary deficiency. Tooth-borne RPE is typically indicated during the prepubertal or pubertal growth phases; however, some post-pubertal or young adult patients may still present with incomplete maturation of the midpalatal suture—the so-called “gray zone.” In clinical practice, treatment decisions should ideally consider multiple skeletal resistance areas (the zygomaticomaxillary buttress, the pterygomaxillary junction, the nasal aperture pillars), although midpalatal suture assessment often remains central to case selection. Methods: A 19-year-old male patient presented with a skeletal Class III tendency, dental crowding, and anterior and bilateral posterior crossbites, accompanied by snoring and breathing difficulties. The patient declined surgical- and miniscrew-assisted RPE. Cone-beam computed tomography (CBCT) scan revealed incomplete midpalatal suture maturation. Based on periodontal evaluation, a conventional tooth-borne RPE was chosen. Pre- and post-expansion CBCT scans were used to evaluate dental, skeletal, and periodontal outcomes. Results: After one year of treatment, bilateral posterior crossbite was successfully corrected. Buccal bone thickness showed a slight reduction only on the upper left first molar (from 1.2 mm to 0.9 mm), without evidence of dehiscence or fenestration. A 2° increase in the dental tipping angle (DTA) was observed on both molars, and the palatal alveolar angle (PAA) increased by 3°. Sutural separation expanded from 0.32 mm to 7.82 mm. The Midpalatal Opening Related to Expander Opening (MORE) factor was 0.54, indicating a predominantly skeletal response. Periodontal health remained stable, and CBCT analysis confirmed increases in intermolar width (from 36.08 mm to 50.02 mm) and palatal maxillary width (from 28.04 mm to 34.5 mm). A reduction in the Pittsburgh Sleep Quality Index (PSQI) from 7 to 3 was observed, though this finding should be interpreted cautiously due to its subjective nature and the absence of objective airway measurements. Conclusions: The present case report suggests that tooth-borne RPE may represent a viable and minimally invasive option for correcting posterior crossbite in carefully selected young adults with incomplete midpalatal suture maturation. However, the findings are limited to a single case with short follow-up and should be regarded as hypothesis-generating rather than conclusive. Full article

Odontogenic cutaneous fistulas (OCFs) are relatively uncommon in veterinary patients. They are typically caused by chronic periapical infections of the maxillary teeth. Mandibular OCFs that extend through the cortical bone into submandibular soft tissues are extremely rare. This report describes the case of a 14-year-old male mixed-breed dog that presented with a submandibular cutaneous lesion initially misdiagnosed as a salivary mucocele. OCFs are frequently misdiagnosed because atypical presentations may lack obvious intraoral abnormalities and mimic salivary gland disease, lymphadenopathy, or cutaneous neoplasia. Computed tomography (CT) revealed a periapical lesion associated with the right mandibular first molar, cortical bone lysis, and extension into the adjacent submandibular tissues, which formed an external fistulous tract. Surgical management included extraction of the affected tooth, resection of the fistulous tract, and excision of the associated lymph nodes, which resulted in a complete and uneventful resolution of the fistula. At the 3-month follow-up, the patient remained clinically stable without evidence of recurrence. This case underscores the clinical pearl that odontogenic origins should always be considered in the differential diagnosis of submandibular or cervical cutaneous lesions and that cross-sectional imaging modalities, such as CT, are indispensable for confirming anatomical continuity and guiding surgical planning. Full article

Background and Clinical Significance: Maxillary sinus augmentation is a well-established surgical procedure for dental implant placement in the posterior maxilla when the residual alveolar bone height is insufficient. Traditionally, the lateral approach has been preferred in cases with less than 4 mm of bone; however, the crestal approach has emerged as a less invasive alternative, particularly with the advent of advanced techniques and tools such as hydraulic pressure systems and dedicated osteotomy kits. Case Presentation: This case report presents the clinical management of a 68-year-old female patient requiring rehabilitation of the right maxillary molars, where the residual bone height measured only 3.6 mm (in position 1.6) and 2.5 mm (in position 1.7). Using the CAS kit system with rounded drills and hydraulic pressure, a controlled crestal sinus elevation was performed, followed by simultaneous implant placement. Despite the extremely limited bone height, a final insertion torque of 30 Ncm was achieved for both implants, likely due to favorable sinus floor anatomy, under-preparation of the implant sites, and the use of tapered, macro-textured implants. Postoperative follow-up over three years showed stable bone levels and successful prosthetic rehabilitation with single crowns. Conclusions: This case report highlights the potential of the crestal approach in anatomically challenging scenarios. Proper planning, technique, and implant selection are mandatory to achieve predictable and long-lasting outcomes, even in cases previously considered contraindicated for this method. Further randomized controlled trials are needed to confirm this preliminary result. Full article

Objectives: Maxillary nerve block via the greater palatine canal (GPC) offers the potential for profound regional anesthesia of the maxilla but remains underutilized due to anatomical variability and technical complexity. The aim of this study was to explore the clinical feasibility, accuracy, and anesthetic effectiveness of a computer-guided approach by using CBCT-based surgical guides to access the pterygopalatine fossa via the GPC. Methods: Thirty-one patients underwent the procedure with patient-specific guides designed from cone-beam computerized tomography (CBCT) and intraoral scans. A 27G needle was directed through the guide to deliver 1.8 mL of 2% lidocaine with epinephrine 1:80.000. Pulpal anesthesia was assessed via electric pulp testing (EPT), and soft tissue anesthesia via pressure algometry at predefined oral and facial sites. Success was defined as absence of EPT response at maximum output and pressure pain threshold ≥ 700 g. To assess variations in anesthetic efficacy among multiple related groups, Cochran’s Q test and McNemar’s test were employed. Results: Successful needle placement was achieved in 30 out of 31 patients (96.7%) using the computer-guided approach, with a mean of 1.45 insertion attempts per case. Complete palatal soft tissue anesthesia was achieved in all subjects across the tested sites (100%). Pulpal anesthesia was most effective in posterior teeth, with success rates of 96.7% for first molars and 93.3% for first premolars, while the central incisor showed a reduced success rate of 50%. Transient visual disturbances occurred in three patients (10%), with no other adverse effects reported. Conclusions: These findings support the use of computer-guided GPC block as a method for achieving maxillary nerve anesthesia. Although anesthetic spread to anterior and buccal regions was limited, the technique demonstrated consistent effectiveness in the posterior maxilla, highlighting its potential utility in complex dental and surgical interventions requiring deep and long-lasting regional anesthesia. Full article

Background and Objectives: This study aimed to evaluate the biomechanical behavior of three-unit implant-supported prostheses with different bridge configurations (mesial cantilever, distal cantilever, and pontic) and two types of retention in the atrophic posterior maxilla, through three-dimensional finite element analysis (3D FEA). The focus was on stress distribution in short implants used in pontic and mesial cantilever designs. Materials and Methods: Six 3D finite element models were developed to represent various prosthetic designs and retention mechanisms in a maxillary segment including the first premolar, second premolar, and first molar regions. Type III bone with 8 mm vertical height simulated an atrophic maxilla. Standard implants were placed in premolar areas and short implants in molar regions. A 100 N oblique load at 45° was applied to each unit to simulate masticatory function. Stress distribution was assessed using von Mises and principal stress criteria. Results: The highest implant and crown stress occurred in the cement-retained distal cantilever (100.14 MPa and 329.95 MPa, respectively), while the lowest values were found in the screw-retained pontic model (44.74 MPa and 81.23 MPa). Mesial cantilevers showed intermediate stress levels. Screw-retained designs generally generated lower stresses within implants than cement-retained ones. In cortical bone, stress ranged from 10.25 MPa in the cement-retained distal cantilever to 4.22 MPa in the screw-retained pontic, while trabecular bone showed maximum stress of 1.69 MPa and 0.82 MPa, respectively. Conclusions: Prosthetic design and retention type significantly influenced biomechanical performance. Screw-retained pontic prostheses with short implants in the molar region provided the most favorable stress distribution. When cantilevers are required, mesial extensions are biomechanically more advantageous than distal ones. Short implants can thus be safely used in the posterior maxilla when accompanied by proper prosthetic design and retention type. Full article

Background/Objectives: Sclerostin is a glycoprotein produced by osteocytes that regulates osseous remodeling, particularly in the context of orthodontic tooth movement. The purpose of the current systematic review is to assess the effect of orthodontic tooth movement (OTM) on sclerostin expression (SE) in the alveolar bone matrix (ABM). Methods: Indexed databases including PubMed, Embase and Web of Science were searched without time and language restrictions up to and including March 2025. Results: Seven studies performed on 8- to 12-week-old male rodents were included. The magnitude of orthodontic forces ranged from 10–120 g. Distalization and mesialization of the maxillary first molar were performed in one and six studies, respectively. In two studies, SE was increased on the compression and tension sides during OTM. In one study, SE is increased and decreased on the compression and tension sides, respectively; and another reported no difference in SE on the compression and tension sites during OTM. Two studies did not report data on SE on the control-sites (sites unexposed to OTM). Sample-size estimation was not performed in any of the included studies. All studies had a high risk of bias (RoB) and low certainty of evidence (CoE). Conclusions: Sclerostin may play a regulatory role in ABM during OTM. However, current evidence is limited by methodological inconsistencies, high RoB, and low CoE. Well-designed, power-adjusted studies using standardized protocols are required to establish reproducible findings and assess the translational potential of SE in orthodontics. Full article

Objectives: This study aimed to evaluate maxillary arch width increase in juvenile patients requiring space gain, but without skeletal transverse discrepancies necessitating orthopedic expansion. The comparison focused on the effects of Rapid Maxillary Expansion (RME) using Hyrax expanders and dentoalveolar expansion via Invisalign First. Methods: This retrospective longitudinal study analyzed digital dental models of 38 patients (19 males and 19 females, aged 8 ± 2 years) undergoing maxillary expansion at the Department of Biomedical, Surgical, and Dental Science, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico (Milan, Italy). Patients were divided into two groups: one treated with Hyrax expanders (n = 19) and the other with Invisalign First (n = 19). Intraoral scans were taken before (T0) and after treatment (T1), and measurements were performed using Mimics Materialize 21.0 software. Statistical analysis included t-tests, ANOVA, and regression models to assess differences in maxillary expansion between groups. Results: Both groups showed statistically significant transverse arch increases (p < 0.01). Hyrax achieved greater expansion at the deciduous canine level, while Invisalign showed more at the deciduous molar level. First permanent molar expansion was similar. ICC for reliability was excellent (>0.97). No significant differences in sex or Angle class distribution were observed. Conclusions: Hyrax and Invisalign First both produce measurable maxillary expansion, but they serve distinct roles. While Hyrax expanders provide rapid skeletal expansion, Invisalign First offers a less invasive alternative for dentoalveolar widening with controlled force application. They should not be used interchangeably. Appliance selection must be tailored to the severity and nature of the transverse deficiency. Full article

Background/Objectives: The nasomaxillary complex is a compound anatomical structure in which the correlation between changes in palatal width and height has been poorly investigated. Methods: A three-year prospective study with 28 patients treated with printed expanders was conducted. Measurements on CBCT images were performed before and after treatment; the width and height parameters were measured on a coronal slice of a CBCT image at the level of the first molars and upper first molar inclination relative to the palatal plane. Results: A significant difference was found between the values measured before and after treatment, including an increase in the measured width parameters and a statistically significant decrease in palatal height (0.75 ± 0.97). The mean change in the upper molar inclination was not significant (tooth 16: 0.60 ± 6.42; tooth 26: 2.19 ± 4.51). The regression analysis did not establish a significant correlation between the expansion of the maxillary occlusal width and palatal height change or a significant correlation between the increase in the upper molar inclination and palatal height change. Conclusions: The use of a printed tooth-borne expander causes predictable and reproducible skeletal changes. It is a feasible treatment option, allowing for precise screw positioning to achieve bodily movement of the teeth and decrease the change in molar inclination. Full article

Guided bone regeneration membranes are essential for bone formation. While non-resorbable membranes require removal surgery, resorbable membranes such as poly (lactic-co-glycolic acid) PLGA are widely used; however, issues with animal-derived components and degradation control have been identified. A novel bilayer membrane composed of synthetic poly (L-lactic acid-co-ε-caprolactone) (PBM) was developed, offering prolonged degradability and elasticity. This study compared the wound-healing effects of PBM and PLGA membranes in vivo and in vitro experiments. In vivo, maxillary molars were extracted from rats, and membranes were placed over the sockets. Healing was evaluated histologically at 1, 2, 3, 4 and 8 weeks. In vitro, oral epithelial cells and fibroblasts were seeded on both sides of PBM. Adhesion and permeability of the membranes were assessed. In vivo, both groups displayed similar mucosal healing. However, PBM preserved a clear bone-soft tissue boundary. In vitro, the surface of PBM supported significantly greater oral epithelial cell adhesion than the reverse side, with no differences for fibroblasts. Both sides of PBM exhibited better protein permeability compared to PLGA. PBM maintained distinct bone-soft tissue separation in rat extraction sockets, suggesting its potential as an effective space maintainer in guided bone regeneration. Further studies are warranted to investigate the mechanisms underlying these favorable properties. Full article