Search Results (6,219)

Background/Objectives: Metal artifacts from dental implants degrade CBCT image quality and may impair detection of peri-implant bone defects. Zirconia implants produce stronger artifacts than titanium due to its higher atomic number. This study evaluated the impact of a native MAR algorithm (SMARF) on CBCT detection of buccal fenestration and dehiscence of varying sizes adjacent to zirconia versus titanium implants. Methods: In this ex vivo pilot study, two 4 mm × 12 mm implants (one titanium and one zirconia) were implanted in a dry human mandible. Artificial fenestration and dehiscence defects were created at the buccal surface of right and left premolar regions, in three sizes (small 2 mm × 2 mm× 1 mm; medium 2 mm × 4 mm× 1 mm; large 2 mm × 6 mm× 1 mm). Scans were acquired with a Papaya 3D (Genoray) CBCT using a single-tooth FOV (4 cm× 4 cm × 5 cm), 83 kVp, 10 mA, 0.1 mm voxel; each condition was imaged with MAR on and off (six repeats each). Two trained observers scored defect presence on a five-point Likert scale. Sensitivity, specificity, inter- and intraobserver agreement (Cohen’s kappa), and comparisons across conditions were calculated. Results: Interobserver κ = 0.65 (substantial); intraobserver κ = 0.87–1.00 (excellent). For titanium implants, sensitivity and specificity were 100% across all defect types, sizes, and MAR settings. For zirconia implants, fenestration sensitivity with MAR off increased with size (small 50%, medium 75%, large 100%); MAR on raised sensitivity to 100% for all sizes, with a significant improvement for small fenestrations (p = 0.005). Dehiscence sensitivity for zirconia was 100% across sizes and MAR conditions. Specificity for zirconia defects was 83.3% with MAR off and decreased to 66.6% with MAR on (p = 0.07). Conclusions: With the Papaya 3D system used in this pilot study, MAR was unnecessary for defect detection adjacent to titanium implants but affected performance for zirconia implants: MAR increased sensitivity for small fenestrations while reducing specificity (although not statistically significant). Clinicians should weigh the sensitivity–specificity trade off when applying MAR around zirconia implants. Full article

Background/Objectives: Contemporary patient-specific subperiosteal implants have re-emerged as graftless solutions for oral and maxillofacial rehabilitation, driven by advances in digital planning, CAD/CAM workflows, additive manufacturing, and biomaterial engineering. Their indications have progressively expanded from severely atrophic edentulous jaws to segmental defects, single-tooth replacement, congenital craniofacial anomalies, salvage situations, and oncologic reconstruction. This scoping review aimed to map the current evidence on modern patient-specific subperiosteal implants, focusing on indications, workflow, design principles, materials, outcomes, complications, and maintenance. Methods: A scoping review was conducted according to PRISMA-ScR principles to identify clinical studies, case series, case reports, systematic and scoping reviews, technical notes, finite element analyses, in vitro studies, and relevant translational investigations dealing with contemporary custom-made or CAD/CAM subperiosteal implants. The evidence was narratively synthesized according to clinical indication and thematic domains, including full-arch rehabilitation, sectional and single-tooth applications, congenital and post-oncologic defects, rescue indications, biomechanics, material selection, surface response, prosthetic protocols, and complication management. No quantitative meta-analysis was performed because of the scoping design and the substantial heterogeneity of study types, indications, implant systems, outcome definitions, and follow-up durations. Results: The final evidence map included 116 records, of which 56 were unique human clinical records with extractable denominators and 60 were biomechanical, in vitro, surface-biology, review, consensus, historical, or conceptual records. Of the 56 unique clinical records, 49 were mapped within the six indication-level clinical sections, while seven were retained as cross-cutting clinical evidence addressing patient-reported outcomes, design-related complications, bone apposition, anchorage strategy, comparative graftless rehabilitation, or reconstructive/prosthetic principles. The six indication-level sections included 52 clinical-record assignments: 15 for full-arch rehabilitation, 13 for segmental or sectional rehabilitation, one for single-tooth rehabilitation, four for congenital or craniofacial indications, 13 for post-oncologic or post-ablative reconstruction, and six for rescue or salvage indications. Because three records addressed more than one indication, these counts represent indication-level assignments rather than mutually exclusive clinical records. Reported survival in most short- to mid-term clinical series was generally high, commonly ranging from 90% to 100%, although lower values of 70–80% were reported in selected longer-term cohorts and survival clearly overestimated clinical success in some studies. Expanding applications include posterior mandibular and maxillary defects, lateral incisor agenesis, cleft-related or syndromic deformities, maxillectomy reconstruction, obturator support, and hybrid rehabilitation with endosseous implants; however, evidence for the indications at the extremes of this spectrum—single-tooth replacement and primary oncologic reconstruction—remains limited to small, largely single-group case series and reports. Soft-tissue events, including dehiscence, mucositis, recession, and framework exposure, were the dominant complications and showed wide variability, with reported recession/exposure rates ranging from approximately 10% in some sectional and full-arch series to as high as 65% in bilateral maxillary cohorts; their clinical significance varied from asymptomatic stable findings to progressive inflammatory complications requiring revision. Conclusions: Patient-specific subperiosteal implants represent a promising and increasingly versatile reconstructive option; however, the present findings should be interpreted as evidence mapping rather than as definitive comparative evidence. Their clinical use should remain highly selective, prosthetically driven, and supported by meticulous planning, rigid fixation, soft-tissue management, and structured maintenance. Standardized success criteria, longer follow-up, and comparative prospective studies are required. Full article

Background and Clinical Significance: Odontogenic myxoma (OM) is a rare benign neoplasm of the jawbones characterized by spindle-shaped cells embedded in a myxoid stroma. Despite its benign histological nature, it demonstrates locally aggressive behavior, significant invasiveness, and a high risk of recurrence. OM ranks as the third most common odontogenic tumor after odontoma and ameloblastoma. It affects both sexes and occurs more frequently in the mandible than in the maxilla, typically during the second to fourth decades of life. Macroscopically, OM is non-encapsulated, whitish-gray, and gelatinous. Radiographically, it usually presents as a radiolucent lesion with fine bony trabeculae, producing a characteristic “tennis racket” appearance. Case Presentation: We report a case of a 27-year-old male diagnosed with maxillary odontogenic myxoma measuring 2.3 × 1.7 cm. Clinical, radiographic, and histopathological findings were evaluated, and the lesion was treated conservatively by surgical enucleation and curettage. Results: The surgical procedure was completed without complications. Histopathological analysis confirmed the diagnosis of odontogenic myxoma. The patient showed satisfactory postoperative healing, and no evidence of recurrence was observed during a 10-month follow-up period. Conclusions: Although odontogenic myxoma is benign, its locally aggressive nature and recurrence potential require accurate diagnosis and appropriate management. Conservative treatment by enucleation and curettage may be effective for small, well-defined lesions, provided that careful long-term follow-up is maintained to monitor for recurrence. Full article

Background/Objectives: Intra-articular injections are used for temporomandibular disorders (TMDs) resistant to conservative treatment. However, many reviews assess injectable agents combined with arthrocentesis or other co-interventions, limiting interpretation of their standalone effects. This overview aimed to summarize meta-analytic evidence on standalone intra-articular injections for temporomandibular joint disorders. Methods: MEDLINE, BASE, and Europe PMC were searched on 29 March 2026. Systematic reviews with quantitative meta-analyses evaluating standalone intra-articular TMJ injections were included. Data regarding injectable substances, clinical indications, and outcome domains were extracted and synthesized descriptively. Results: Three systematic reviews with meta-analyses were included. The evidence addressed platelet-rich plasma, corticosteroids, sodium hyaluronate, and physiological saline. Reported indications included degenerative joint disease, osteoarthritis, internal derangement, and arthritis. All included agents were reported to be associated with pain reduction. Conclusions: Meta-analytic evidence on standalone intra-articular injections for TMDs remains limited and heterogeneous. Available data suggest potential benefits, mainly for pain reduction, but do not establish clear superiority of any agent. The potential therapeutic activity of physiological saline should be considered when designing future injection trials. Full article

Accurate dental working posture is essential for clinical performance and patient safety, yet objective and consistent posture training remains challenging. We present a motion-recognition-based posture assessment approach for dental clinical training that computes posture features from skeletal motion data and applies a rule-based (heuristic) posture assessment module based on predefined clinical criteria to generate posture scores, penalty counts, and warning counts. We conducted a comparative feasibility study with five dental residents (40 sessions total; eight procedure states per participant, 5 min/session). Heuristic-based assessment outputs were compared with specialist video-based ratings using paired nonparametric tests and Bland–Altman analysis. Across pooled sessions (n = 40), the heuristic method yielded lower posture scores than the video-based assessment (89.38 ± 5.21 vs. 97.38 ± 2.99) and higher penalty and warning counts (2.13 ± 1.04 vs. 0.53 ± 0.60; 7.23 ± 3.10 vs. 2.48 ± 1.54). Between-method differences were significant (p < 0.001), and Bland–Altman analysis showed a mean bias of 8.00 points (95% limits of agreement: −1.36 to 17.36), indicating limited session-level interchangeability. The proposed approach shows practical feasibility for quantitative posture recording and training support, but larger validation studies and calibration strategies are needed to improve agreement with reference assessments. Full article

Background: Orofacial myofascial pain (MFP) is one of the leading causes of chronic orofacial pain, often resulting in functional limitations and a compromised quality of life. Intramuscular injection therapies appear to be a promising alternative for patients resistant to conservative treatment. Objective: The objective of this rapid review was to synthesize evidence from randomized controlled trials evaluating intramuscular injectable therapies for orofacial myofascial pain. Specifically, the review aimed to compare the clinical effects of different injectable agents on pain intensity, mandibular function, and patient-reported outcomes, and to identify methodological limitations and research gaps within the current evidence base. Methods: A comprehensive search across five databases (ACM, BASE, Cochrane, PubMed, and Scopus) was conducted on March 15, 2026. Randomized controlled trials (RCTs) published between 2022 and 2026 that investigated the use of active injectable agents into the masticatory muscles for clinically diagnosed myofascial pain syndrome were included. Data regarding post-interventional pain intensity, masticatory function, mandibular range of motion, and safety were extracted to compare therapeutic efficacy across interventions. Results: A total of five RCTs met the inclusion criteria. Eligible studies evaluated intramuscular injections of botulinum toxin A, platelet-rich plasma (PRP), magnesium sulfate, and lidocaine, with sample sizes ranging from 30 to 180 participants. Across all interventions, consistent reductions in pain intensity and enhancements in masticatory function were observed. Furthermore, no major adverse events were reported. Conclusions: Intramuscular injectable therapies represent an emerging approach for reducing orofacial myofascial pain, particularly as a treatment for patients with persistent symptoms. Full article

Oral squamous-cell carcinoma (OSCC) is a prevalent malignancy of the head and neck region. A delay in the diagnosis of OSCC often results in a high metastatic tendency, which is the main reason for the high patient mortality. Dynamic monitoring and management of the onset and progression of OSCC are critical for improving patient survival rates. Liquid biopsy technology—characterized by its non-invasive nature, procedural convenience, and capacity for longitudinal monitoring—is a promising adjunct to histopathological examination for the early diagnosis of OSCC. Epigenetic alterations, characterized by reversibility and long-term stability in physiological fluids, are critical enablers of liquid biopsy and its clinical utility. Advances in detection technologies, including quantitative polymerase chain reaction (qPCR), digital droplet PCR (ddPCR), next-generation sequencing (NGS), and electrochemical biosensors, have significantly facilitated the research and clinical translation of epigenetic biomarkers in oral liquid biopsies. However, translating epigenetic biomarkers from research discovery to clinical practice for OSCC remains hindered by several critical challenges: the scarcity of large-scale, rigorously designed cohort studies, limited multicenter validation, inconsistent preprocessing protocols, and a lack of harmonized analytical platforms. Finally, we propose a conceptual framework to outline potential clinical application models for these biomarkers. Full article

Radiation-induced periodontitis represents an underrecognized and mechanistically complex toxicity of head and neck radiotherapy, arising from the interplay of oxidative stress, inflammatory dysregulation, impaired bone remodeling, and epithelial barrier disruption. Despite its clinical relevance, the molecular determinants underlying inter-individual susceptibility remain poorly defined. Heat shock protein 27 (HSP27), a stress-inducible molecular chaperone, has emerged as a candidate mediator potentially linking biological pathways relevant to radiation-induced tissue injury, including redox regulation, cytoskeletal stability, DNA repair, and apoptosis control. However, no clinical or experimental study has directly evaluated HSP27 in radiation-induced periodontitis. Therefore, the proposed involvement of HSP27 in this setting should be interpreted as a biologically plausible, hypothesis-generating framework rather than evidence of a proven causal mechanism. Convergent but indirect evidence from periodontal biology, radiation-response models, inflammatory disease, and cellular stress systems suggests that HSP27 may plausibly influence periodontal tissue resilience and injury responses after radiotherapy. Therapeutic modulation of HSP27 may represent a potential investigational strategy to mitigate radiation-induced periodontitis, but this concept requires direct validation in periodontal cell-based, animal, organoid, and prospective clinical studies. This review synthesizes current mechanistic and translational evidence to evaluate HSP27 as a candidate mediator, biomarker, and investigational therapeutic target in radiation-induced periodontitis. Full article

Background/Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent among nursing home residents and represent a major clinical and care-related challenge. These symptoms are frequently associated with increased psychotropic drug use despite limited efficacy and important safety concerns. This study aimed to evaluate longitudinal changes in BPSD and psychotropic drug use following implementation of the “Los Filabres” protocol, a structured person-centered non-pharmacological intervention, in nursing home residents with dementia. Methods: A single-arm longitudinal pre–post observational study was conducted in five nursing homes in Andalusia, Spain, including 204 residents with dementia or cognitive impairment. After staff training, the intervention was implemented over 12 months. Outcomes were assessed at baseline (T0), 6 months (T1) and 12 months (T2) using the Neuropsychiatric Inventory (NPI), including symptom frequency, severity, clinical relevance, and caregiver-related distress. Psychotropic drug use was analyzed according to the Anatomical Therapeutic Chemical classification system. Statistical analyses included Friedman and Cochran’s Q tests, with effect sizes estimated using Cohen’s d and h. The observational nature of the study implies that observed changes may be subject to limitations such as Hawthorne effects. Results: Significant reductions were observed across all global NPI dimensions over time (p < 0.001), including symptom frequency, severity, clinical relevance, and caregiver-related distress. The proportion of participants with at least one clinically relevant symptom decreased from 93.1% at baseline to 35.8% at 12 months (p < 0.001). Significant longitudinal reductions were also observed in psychotropic drug use, with the mean number of psychotropic drugs per participant decreasing from 2.38 to 1.57 (p < 0.001). Reductions were observed in anxiolytic and antipsychotic use, as well as in as-needed prescriptions. Conclusions: The “Los Filabres” protocol was associated with significant longitudinal reductions in BPSD and psychotropic drug use in nursing home residents with dementia. These findings suggest that structured person-centered non-pharmacological interventions based on the identification of unmet needs may help support dementia care and more individualized pharmacological management in long-term care settings. These findings should be interpreted cautiously due to the observational pre–post design and absence of a control group. Full article

Background/Objectives: Odontogenic infections range from localized abscesses to life-threatening deep neck infections and are a frequent cause of emergency admission. We aimed to identify prognostic factors for postoperative complications after their surgical treatment. Methods: We retrospectively analyzed 194 adults (59.3% male) treated at the Department of Cranio-Maxillofacial Surgery in Cracow between 2020 and 2025. The primary outcome was any postoperative complication, graded by the Clavien–Dindo classification and dichotomized into minor (grade I–II) and major (grade ≥ III). Prolonged hospitalization and prolonged irrigation (>7 days) were secondary outcomes. Pre-specified main factors (advanced age, diffuse phlegmonous spread, diabetes mellitus) and covariates (sex, maxillary location, systemic disease) were tested by uni- and multivariable logistic regression. Results: Comorbidities were present in 69.1%. Complications occurred in 49 patients (25.3%): 19 (9.8%) minor and 30 (15.5%) major, including 12 grade IV intensive-care events and two deaths (grade V). In multivariable analysis, diffuse phlegmonous spread independently predicted any complication (adjusted OR 11.7), major complication (OR 23.4), prolonged hospitalization (OR 5.02) and prolonged irrigation (OR 4.39; all p ≤ 0.004). Advancing age independently predicted major complications (OR 1.03 per year, p = 0.037). Both fatal cases shared phlegmon, maxillary location and diabetes. Conclusions: Diffuse phlegmonous spread was the principal prognostic factor across all adverse outcomes, with advancing age additionally predicting major complications. Because intensive-care admission occurred almost exclusively in phlegmon patients, this association is partly definitional. Early identification of diffuse spread and advanced age may support effective triage. Full article

Aim: This study aimed to evaluate the impact of cone beam computed tomography (CBCT) on preoperative surgical decision-making and risk assessment for mandibular third molar (MM3) extractions in cases identified as high-risk by orthopantomography (OPG). Materials and Methods: This prospective observational diagnostic study utilized the purposive sampling method, recruiting 50 MM3s from 33 patients (21 females, 12 males; mean age 24.24 ± 6.77 years, range 16–42). Samples were categorized into five distinct radiographic groups based on the proximity of roots to the inferior alveolar nerve (IAN) on OPG. The methodology involved a comparative 3D analysis to determine neurovascular contact, spatial orientation, and the presence of a cortical border. Surgical strategies, specifically the necessity for coronectomy or the lingual split technique, were reassessed following 3D evaluation. Postoperative neurosensory outcomes were recorded. Statistical analysis was performed using the Fisher–Freeman–Halton and Kruskal–Wallis tests. Results: CBCT identified direct IAC contact in 74% of the cases. In 18% of the cases initially deemed high-risk by OPG, CBCT revealed a safe distance, thereby altering the surgical approach. Tooth angulation (p = 0.012) and Pell and Gregory classification (p = 0.024) were significant predictors of contact. Temporary neurosensory disturbances occurred in 4% (n = 2) of the sample, specifically in cases where CBCT had confirmed the loss of nerve canal cortication. Conclusions: In accordance with the study aim, CBCT provides essential 3D data that refines surgical planning in nearly one-fifth of high-risk cases. The findings justify selective CBCT use, guided by the ALADA principle, to minimize iatrogenic injury. Full article

Xerostomia is a common and debilitating condition caused by salivary gland dysfunction, frequently associated with primary Sjögren’s syndrome and head and neck radiotherapy. Current management is largely symptomatic and does not address underlying glandular injury. Extracellular vesicles (EVs), including exosomes, have emerged as candidate mediators of intercellular communication that have been proposed for diagnostic and therapeutic applications; however, their translational relevance to xerostomia remains uncertain and is currently supported only by exploratory evidence. This scoping review aimed to map and interpret current evidence on EV-based approaches in xerostomia and salivary gland dysfunction. A scoping review was conducted in accordance with “Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)” checklist. Twenty-five articles were included, comprising 14 primary studies and 11 review articles. Studies were analysed based on application focus, methodological characteristics, reported outcomes, and translational readiness. Most primary studies focused on EVs as diagnostic biomarkers or their roles in immune–epithelial signalling. Therapeutic research was limited and largely confined to human-relevant translational models, namely human peripheral blood mononuclear cell (PBMC) assays and freshly resected human salivary gland tissue-maintained ex vivo. Outcomes were predominantly molecular and cellular, with minimal assessment of salivary flow or patient-reported symptoms. The current evidence base, although biologically plausible, remains exploratory: most included studies are mechanistic, and no clinical efficacy studies in xerostomia were identified. A substantial gap therefore persists between molecular findings and clinically meaningful outcomes, and further translational research is required before any conclusions can be drawn regarding the clinical utility of EV-based approaches. Full article

Periodontitis is a chronic inflammatory disease driven largely by dysregulated host responses that lead to destruction of periodontal tissues. Integrins are heterodimeric transmembrane receptors that regulate cell adhesion and bidirectional signaling in epithelial cells, immune cells, periodontal ligament fibroblasts, and osteoclasts. During disease progression, integrin-related responses may shift across overlapping molecular phases. Epithelial integrins such as α3β1 and α6β4 support barrier integrity, whereas α5β1 may facilitate microbial interaction and inflammatory signaling. β2 integrins and α4β1 contribute to leukocyte recruitment and inflammatory amplification, whereas increased α9β1-associated signaling and reduced αvβ6-mediated regulation of transforming growth factor β (TGF-β) may promote inflammatory persistence. Matrix-associated integrins, including α2β1 and α11β1, support extracellular matrix (ECM) organization and mechanotransduction, whereas αvβ3 cooperates with Receptor activator of nuclear factor kappa B ligand (RANKL) to promote osteoclast activity and alveolar bone resorption. Impaired β1 integrin-dependent signaling and potentially reduced αvβ5-associated efferocytosis may contribute to defective resolution and regeneration. Importantly, integrin expression, activation, and downstream signaling are distinct, and the strength of evidence varies among integrin subtypes. This review proposes a conceptual framework in which periodontitis reflects a dynamic imbalance in integrin-mediated processes that link inflammation, bone resorption, and regenerative failure, rather than being a direct equivalent of clinical periodontal stages or grades. Full article

Background: The rehabilitation of patients who have undergone extensive maxillectomy for neoplastic lesions is a significant clinical challenge. The resulting anatomical and functional defects severely impact quality of life, and traditional removable prostheses often lack stability. Zygomatic implants offer a viable solution by providing stable anchorage in the zygomatic bone, bypassing the need for bone reconstruction. Methods: This case report details the rehabilitation of a 62-year-old female patient with a history of recurrent oral squamous cell carcinoma. A fully digital workflow, including CBCT and CAD/CAM technology, was used for meticulous surgical and prosthetic planning. The surgical procedure involved a guided maxillectomy, a free forearm flap reconstruction, and the simultaneous placement of two zygomatic implants and one conventional implant. The procedure was done with EZGOMA guided surgery, which, starting from the EZPLAN software design of zygomatic and traditional implants, allowed us to determine the implant’s position in the three-dimensional axes and also the position of the internal hexagon. This allowed us to design the implant beneath the diagnostic wax-up in the three axes, and also to calculate the degrees of inclination of the multi-unit abutment. Results: All implants achieved primary stability with a torque exceeding 45 Ncm. The patient received an immediate provisional prosthesis, which allowed for the rapid restoration of phonetic and esthetic function. The post-operative course was uneventful, with no complications. Follow-up imaging confirmed the successful integration of the implants and the absence of any prosthetic or surgical issues at 24-month successful follow-up. Conclusions: This case suggests that implant-supported rehabilitation with zygomatic implants can be a highly effective treatment for patients with severe maxillary defects following cancer surgery. By using an integrated surgical and prosthetic strategy, along with advanced digital technology, we can achieve fast, safe, and predictable results. This approach successfully restores both function and esthetics, even in challenging anatomical situations. The auxilium of guided plates is a helpful aid for both implant placement and managing bone resection during cancer surgery. Full article