Search Results (1,897)

Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied. Full article

Background/objective: To evaluate the effectiveness of resin infiltration in managing anterior molar incisor hypomineralization (MIH) defects, focusing on color improvement, lesion size reduction, sensitivity outcomes and patient aesthetic perception. Enamel defects in MIH result from a combination of environmental, systemic, and genetic factors, indicating a multifactorial etiology. These defects, particularly in anterior teeth, pose significant aesthetic and emotional challenges due to their high visibility. This study provides one of the few prospective clinical evaluations of resin infiltration for anterior MIH lesions, assessing not only objective clinical outcomes but also patients’ aesthetic perception. It further introduces a patient-centered approach by comparing aesthetic evaluations made by children and dental professionals over time. Methods: A total of 109 MIH-affected anterior teeth were treated using Icon^® resin infiltration (DMG, Hamburg, Germany) in this registered prospective clinical study (ClinicalTrials.gov: NCT05597956). Participants were classified as children (6–12 years) and adolescents (13–17 years) according to standard pediatric age definitions. Of these, 101 teeth were available for evaluation at the 6-month follow-up due to patient loss to follow-up. The evaluation included photographic follow-up, measurement of lesion size and color, and assessment of sensitivity. During follow-up visits, patients rated the appearance of their lesions using the FDI scale. Results: Before treatment, spectrophotometric analysis showed that lesions exhibited a reddish hue (mean a* = 2.12), were distinctly yellowish (mean b* = 23.20), and clearly differed from surrounding enamel (ΔE = 8.62). The brightness level (L* = 69.81) indicated medium-high luminosity. Lesion size was reduced by an average of 4.5 percentage points. Significant increases in L values and reductions in a* and b* components were observed, with clinically perceptible ΔE changes. Sensitivity improved in 36.6% of patients, who reported a 1–2 point decrease on the SCASS. Moreover, patients’ aesthetic perception significantly improved after Icon^® infiltration resin. Conclusions: Resin infiltration produced noticeable improvements in color, reduced lesion size and sensitivity, and enhanced aesthetic perception, making it a valuable treatment option for managing MIH-affected anterior teeth in children. Full article

Aim: Traumatic dental injuries (TDI) in children are a common but often underestimated emergency. Parental knowledge and timely response are crucial for successful treatment. This study aimed to evaluate parental knowledge, experiences, and awareness regarding dental trauma management and the use of protective mouthguards. Methods: A cross-sectional study was conducted using a self-administered questionnaire among 333 parents in dental clinics in Split and Zagreb, Croatia. The questionnaire assessed sociodemographic data, parental knowledge of TDIs, and prior experience with dental trauma. Statistical analysis included chi-square test (p < 0.05). Results: The overall level of parental knowledge regarding traumatic dental injuries was generally low (7.6 out of 15 points). Almost all parents correctly identified the age when children have primary or permanent teeth. However, less than half knew that an avulsed primary tooth should not be replanted, while about three-quarters recognized that professional help should be sought within 30 min after trauma. Overall, 43.5% of parents reported that their child had experienced dental trauma, most often affecting primary teeth (60.7%), particularly the maxillary central incisor (76.6%). Mothers demonstrated significantly higher knowledge than fathers (p = 0.025), and prior experience or information about dental trauma significantly improved awareness (p < 0.001). Although 54.3% of respondents were unaware of the purpose of dental shields, 82.3% considered them necessary during contact sports, yet only 12.9% reported that their child actually uses them. Conclusions: Within the limitations of this clinic-based study, the findings indicate gaps in parental knowledge regarding the appropriate management of dental trauma. Strengthening parents’ understanding of emergency response and preventive measures may support timelier and appropriate care and contribute to improved outcomes for children experiencing traumatic dental injuries. Full article

Background/Objectives: The rotation of maxillary canines represents one of the least predictable movements with clear aligners, particularly in cases requiring rotations greater than 10°, due to the rounded crown morphology and limited aligner grip. The aim of this retrospective study was to compare three different crescent-shaped attachment designs (vertical, horizontal, and oblique) for maxillary canine rotations greater than 10° with clear aligners. Methods: Seventy-eight maxillary canines were retrospectively selected and allocated into three equal groups (n = 26) according to the orientation of the applied attachment: vertical, horizontal, or oblique crescent-shaped attachments. Digital STL models (initial, predicted, and final) were imported into Dolphin 3D software 12.0.63 to assess the accuracy of maxillary canine’s rotation through the comparison between planned and achieved values. Results: Mean rotational accuracy was 55.10% ± 15.60 for the vertical group, 62.40% ± 16.10 for the horizontal group, and 64.60% ± 19.40 for the oblique group. One-way ANOVA showed no statistically significant differences among groups (p = 0.09). Pairwise analysis revealed a statistically significant difference between the oblique and vertical designs (p = 0.05). Conclusions: Attachment orientation may influence the accuracy of maxillary canine rotation with clear aligners, with oblique crescent-shaped attachments showing a trend toward improved rotational control. Full article

Survival rates for children treated for malignant diseases continue to improve, yet many survivors face persistent late oral complications that affect function, aesthetics, and quality of life. Oncological therapy, especially at a young age and following head and neck radiotherapy or intensive chemotherapy, can disrupt dental and craniofacial development, resulting in dental developmental disorders, enamel defects, salivary gland dysfunction, caries susceptibility, periodontal problems, trismus, and osteoradionecrosis of the jaw. Although these effects are partially known, they are frequently underrecognized in routine practice, and many children do not receive adequate long-term dental follow-up. A key challenge highlighted in the recent literature is the absence of structured, evidence-based guidelines for monitoring and managing late oral effects. The article emphasizes the need for clearer recommendations, better communication of oncological treatment histories, and stronger integration of dental professionals within survivorship care. Developing standardized follow-up protocols will be essential to ensure timely detection, consistent management, and improved oral health outcomes for childhood cancer survivors. This article is intended as a narrative review, synthesizing available evidence from key publications to highlight clinically relevant late oral complications and gaps in current survivorship care. Full article

Background: Patients with dental phobia frequently require intravenous sedation (IVS) to undergo dental treatment; however, some can gradually discontinue IVS through repeated clinical experiences. The physiological and psychological factors influencing successful IVS withdrawal remain unclear. This study aimed to compare physiological (sAA, HR) and subjective (VAS) measures between patients who discontinued IVS and those who remained dependent on IVS. Methods: This prospective cohort study included 51 patients with dental phobia treated under IVS. Participants were classified into a Non-Sedation Group (NSG; n = 25) and a Sedation-Dependent Group (SDG; n = 26) based on their ability to discontinue IVS during the course of treatment. Salivary alpha-amylase (sAA), heart rate (HR), and visual analog scale (VAS) scores for fear, tension, and anxiety were assessed at predefined time points from the waiting room to venous cannulation. Treatment satisfaction and expectations for future treatment were also evaluated. Results: sAA activity was significantly higher in the SDG than in the NSG at T0 and T1 (p < 0.05), indicating higher levels of selected physiological measures during anticipatory phases; however, the difference at T2 was not significant. HR differed significantly only in the waiting room, whereas no between-group differences were observed in self-reported VAS scores for fear, tension, or anxiety at any time point, indicating a dissociation between physiological and subjective stress measures. Treatment satisfaction and expectations for future treatment were significantly higher in the SDG. Conclusions: Patients who remained dependent on IVS showed higher levels in selected physiological measures at the group level during anticipatory stages, whereas no corresponding differences were observed in self-reported subjective measures. These findings are exploratory and descriptive in nature and do not imply predictive or causal relationships. Full article

Background and Objectives: The aim of this study is to evaluate the effect of positive and negative visual aids used during verbal–active oral hygiene education on oral hygiene-related behaviors in children aged 7 to 14 years. Materials and Methods: In this single-blind design, sixty children were randomly assigned to three groups: G1:Positive visual aid, G2:Negative visual aid, and G3:Verbal–active education. Oral hygiene was evaluated using the Silness–Löe Index (plaque) and Rosenberg Organoleptic Scale (halitosis) at baseline, one week, and one month. Measurements were taken at baseline, at the end of the first week, and at the end of the first month. Data were analyzed using split-plot ANOVA. Results: The test groups did not show any statistically significant differences in terms of age (F = 0.530, p = 0.449) or gender (χ² = 1.600, p = 0.449). Additionally, the groups were similar in terms of clinical variables, including dentition stage (permanent or mixed) (χ² = 5.566, p = 0.062), presence of malocclusion (χ² = 3.801, p = 0.150), and presence of anterior dental caries (χ² = 1.250, p = 0.535). Significant reductions in both plaque and halitosis scores were observed over time in all groups (p < 0.001), and there were no statistically significant differences between the types of intervention (p > 0.05). Conclusions: This study demonstrated that both verbal education aided by positive and negative visuals and structured-only verbal education improved children’s oral hygiene and halitosis scores in the short term. Full article

The occurrence of cysts and tumors in pediatric patients varies across different age groups. Follicular and dentigerous cysts are among the most common lesions. However, typical odontogenic tumors in juvenile patients are not frequently observed. Early stages of cyst and odontogenic tumor development might exhibit some similar characteristics due to the presence of unerupted teeth or their relationship with various stages of tooth formation and eruption. Many small lesions are discovered accidentally on routine orthopantomography (OPG), while the bigger ones manifest themselves as bone swelling, cortical perforation, or displacement and mobility of teeth. Each odontogenic tumor has characteristic clinical and radiological features. Biopsy of larger lesions, or incisional biopsy of smaller lesions, allows detailed histopathological evaluation to determine tumor type and growth behavior and guide appropriate treatment planning. In some cases, atypical signs on OPGs, like asymmetry in dental follicles, occurrence of round or oval bone lesions near impacted or retained teeth, and visibility of irregular radiolucent, radiopaque, or mixed jawbone lesions, might suggest the occurrence of some possible odontogenic tumor in juvenile patients. Each case should be handled individually. In this case, we demonstrate how atypical appearances of dental follicles on panoramic radiographs may not correspond with cone-beam computed tomography findings and may indicate the early stages of odontogenic myxoma in a juvenile patient. Full article

Background/Objectives: This study examined the metabolic, oxidative, immunological, and histomorphological effects of the multicomponent fermented biological product derived from camel milk, Inullact-Fito, in comparison to metformin in a rat model of alloxan-induced diabetes resulting from insulin insufficiency. The model was chosen as an experimental system that replicates pancreatic β-cell damage induced by oxidative stress rather than insulin resistance. Methods: Alloxan-induced diabetes was used to evaluate metabolic, oxidative, immunological, and histomorphological alterations. Metformin was utilized as a pharmacological comparator. Blood glucose levels, circulating insulin concentrations, markers of oxidative stress and lipid peroxidation, immunoglobulin levels, CD4⁺/CD8⁺ T cell balance, and pancreatic histostructure were assessed. Results: Alloxan administration led to substantial hyperglycemia, oxidative stress, immunological imbalance, and structural damage to pancreatic tissue. Following therapy with Inullact-Fito, blood glucose levels reduced dramatically (from 21.9 ± 0.22 to 9.85 ± 0.10 mmol/L, p < 0.05), circulating insulin concentrations were largely corrected, oxidative stress and lipid peroxidation markers decreased. Immunological evaluation revealed decreased serum immunoglobulin M and IgG levels (p < 0.05) and partial normalization of the CD4⁺/CD8⁺ T cell balance. Metformin showed comparative effects; however, its activity in this model is limited by its primary mechanism related to insulin resistance. Conclusions: Overall, the data reveal that Inullact-Fito combines metabolic, antioxidant, and immunomodulatory actions under experimental oxidative and metabolic stress conditions. Further research using models of insulin resistance and type 2 diabetes, as well as long-term clinical trials, is needed to fully evaluate the therapeutic potential, safety profile, and translational importance of this fermented dairy product as a functional nutritional intervention. Full article

Parents’ awareness, attitudes, and perceptions of barriers to orthodontic care for children significantly influence decisions regarding early orthodontic interventions. This mixed-methods study explored parents’ perceptions of their child’s orthodontic needs and examined their experiences and perceived barriers to accessing early orthodontic treatment (EOT) among children aged 6–12 years. Methods: Quantitative data were collected using a 12-item validated questionnaire, while qualitative insights were obtained through structured interviews and analyzed thematically. Results: Parents’ perception of their child’s orthodontic needs was significantly associated with their attitude toward seeking consultation or treatment (p < 0.001). Among parents who sought consultation, only 38.7% had initiated the required orthodontic treatment. The most frequently reported barriers were high cost (32.1%), long appointment wait times (30.6%), and lack of insurance coverage (22.5%). Thematic analysis revealed four major barriers: financial, structural, cognitive, and psychological. Conclusions: These findings highlight critical challenges to accessing EOT for children, including affordability, long waiting times, limited parental awareness, and inadequate, timely referrals. Addressing these challenges through combined efforts at both the individual and community levels could significantly enhance the uptake of early orthodontic services in children. Full article

During the COVID-19 pandemic, the prevalence of death in men was higher than in women. Using transgenic mice expressing the human angiotensin-converting enzyme 2 (hACE2), we demonstrated that SARS-CoV-2 infects Leydig cells and uses its steroidogenic machinery for replication. This study investigates the impact of SARS-CoV-2 in the seminiferous epithelium of K18-hACE2 mice, focusing on the immune response, junctional proteins, and spermatogenesis. The seminiferous tubules (STs) and epithelial (EA) areas were measured. The number of Sertoli cells (SCs), spermatocytes, and damaged ST was quantified. Ultrastructural analysis was performed under transmission electron microscopy. Angiotensin II levels and immunolocalization of hACE2, spike, and nucleocapsid were evaluated. TUNEL and immunoreactions for Ki-67, TNF-α, INF-γ, iNOS, NF-κB, and Conexin-43 were performed and correlated with Jam-α, Stat1, Stat3, and iNOS expressions. hACE2, spike, and nucleocapsid immunolabeling were detected in the epithelium along with high angiotensin II levels in the infected mice. The infection caused a significant reduction in ST, EA, spermatocytes, SCs, Ki-67+ cells, Cx43 immunoexpression, and Jam-a expression. In the epithelium, TNF-α, IFN-γ, iNOS, and nuclear NF-κB immunolabeling increased along with Stat1 upregulation. These findings, combined with the increased epithelial hACE2 and high angiotensin II levels, confirm epithelial responsiveness to the infection and explain the spermatogenic failure and impaired junctional proteins. The presence of viral particles, increased TNF-α immunolabeling, and apoptotic features in Sertoli cells suggests that these sustentacular cells are targets for viral infection in the epithelium, and, due to their extensive projections and ability to phagocytize dying infected germ cells, they may disseminate the viruses throughout the epithelium. Full article

Background/Objectives: Three-dimensional virtual surgical planning (VSP) is increasingly central to contemporary orthognathic surgery, enhancing diagnostic precision and enabling more reliable forecasts of postoperative outcomes. NemoFAB (Nemotec, Madrid, Spain) is a recently developed digital platform that integrates CBCT data, digital dental models, and facial photographs into a single workflow. Despite its growing clinical use, independent validation of its predictive accuracy remains limited. This study evaluated how closely NemoFAB virtual predictions corresponded to actual postoperative results using standardized cephalometric parameters. Methods: Forty adult patients with dento-maxillofacial deformities requiring combined orthodontic–surgical treatment were included. Eleven cephalometric variables—common to both WebCeph (2D) and NemoFAB (3D)—were measured preoperatively, virtually in NemoFAB, and postoperatively. AI-assisted landmark placement was manually verified by two orthodontists. Statistical analyses included repeated-measures ANOVA, paired t-tests, Bland–Altman plots, and intraclass correlation coefficients (ICC) to evaluate agreement and predictive accuracy. Results: Overjet, overbite, maxillary incisor inclination, maxillary incisor exposure, mandibular incisor projection to the True Vertical Line, and occlusal plane angulation all showed statistically significant changes after surgery (p < 0.05). Bland–Altman analysis demonstrated the narrowest limits of agreement in Nemo–Post comparisons, indicating strong predictive alignment. ICC values showed excellent agreement for incisor angulation (ICC = 0.921–0.984) and Pogonion projection (ICC = 0.943). Consistently poor pre-Nemo agreement reflected expected discrepancies between initial anatomy and planned surgical correction. Conclusions: When predicting skeletal and dentoalveolar changes brought about by orthognathic surgery, NemoFAB showed a high degree of agreement, especially for parameters that are directly impacted by jaw repositioning. Its strong concordance with postoperative outcomes supports its reliability for virtual planning, interdisciplinary coordination, and surgical execution. Advances in soft-tissue modeling and AI-driven automation may further enhance predictive accuracy. Full article

The use of miniscrews as Temporary Skeletal Anchorage Devices (TSAD) in orthodontics has allowed clinicians to perform challenging tooth movements by dissipating undesired forces into the bone structure; thus, avoiding unwanted movement of the adjacent teeth. It is essential for miniscrews to be highly resistant to fracture during clinical use. While many studies have analysed torsional loads, none have measured the changes in flexural and bending strength of miniscrews before and after an ageing process. This study aims to analyse the resistance to orthogonal forces of miniscrews with different diameters, focusing on both new and aged materials, the latter subjected to thermocycling and autoclaving laboratory processes to simulate a 3- and a 6-month exposure to the oral environment. A total of 105 pristine miniscrews have been tested; specimens were divided into seven groups based on the different endosseous body diameters. Each group was further subdivided into three subgroups, according to the simulated ageing of the miniscrews (intact, 3 months of ageing and 6 months of ageing, respectively). An Instron Universal Testing Machine has been used to measure deflection at 0.1 mm and 0.2 mm, as well as maximum load at fracture. The results evidenced that miniscrews respond differently to cutting forces; in particular, the resistance to orthogonal loads increases as the diameter of the miniscrews increases. Linear regression analysis revealed a significant influence between all the dependent variables—maximum load, 0.1 mm deflection load, and 0.2 mm deflection load—and the independent variables, such as diameter and thermocycling (p < 0.05). Both new and aged miniscrews are suitable for orthodontic and orthopaedic loads; moreover, ageing up to 6 months does not seem to significantly decrease the resistance to shear forces for the same diameter. Linear regression analysis of the miniscrews subjected to experimental ageing showed a slight but significant decrease in resistance to orthogonal loading. Full article

Background/Objectives: The resin infiltration protocol was introduced as a minimally invasive approach for the treatment of incipient carious lesions using low-viscosity resins with high penetration coefficient. This study aimed to determine the effectiveness of resin infiltration in hypomineralized anterior teeth of paediatric patients, based on aesthetic improvement, colour change (ΔE), and visual perception. The risk of bias was assessed using the Newcastle–Ottawa and physiotherapy evidence database scales. The level of evidence was assessed using the grading of recommendations, assessment, development and evaluation tool. Methods: The following five databases were searched: Web of Science, Scopus, Embase, Cochrane, and PubMed. The review protocol was registered in PROSPERO (registration number: CRD42023405299). Results: The search identified 130 preliminary references related to the population, intervention, control, and outcome question, identified from the PubMed, Scopus, Embase, Web of Science, and Cochrane databases, respectively. In addition, two items were added from the grey literature. Ten articles met the eligibility criteria and were included in the qualitative analyses, and only three studies were included in the quantitative analyses. Positive results regarding stain-size reduction and colour improvement with resin infiltration (Icon^®; DMG, Hamburg, Germany), were reported in moderately severe lesions. Luminosity increased immediately after treatment, and the mean difference in total color change (ΔE), T0–T1 was significant (ΔE, 5.45; confidence interval, 1.94 to 8.96; p < 0.01). The most favourable clinical outcomes were observed following the initial resin infiltration. Moreover, the results were maintained at the 6 month follow-up. Conclusions: Infiltration resin can successfully mask white or white/creamy opacities characteristic MIH affected enamel, similar to those in carious enamel for which it was designed. It yields acceptable aesthetic results in anterior teeth with mild to moderate MIH lesions. Lack of predictability is the main limitation of this therapeutic option. Full article

Background/Objectives: This systematic review and meta-analysis aimed to evaluate the clinical performance and survival of bulk-fill resin composite restorations in posterior primary teeth, compared with conventional resin composites and glass ionomer cements (GICs). Methods: The protocol was registered in PROSPERO (CRD42024539097) and conducted according to PRISMA guidelines. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, and Cochrane databases up to December 2025. Randomized clinical trials (RCTs) evaluating bulk-fill resin composite restorations in primary molars were included. Restoration survival was considered the primary clinical endpoint. Secondary outcomes included marginal integrity, marginal discoloration, color match, postoperative sensitivity, secondary caries, retention, and anatomical form, assessed using USPHS or FDI criteria. Meta-analyses were performed for color match, marginal discoloration, and marginal integrity using a random-effects model. Comparisons involving GICs were synthesized descriptively. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated using GRADE. Results: Six RCTs involving 1220 restorations in children aged 3 to 10 years were included, with follow-up periods ranging from 6 to 24 months. Survival rates were high across all materials. Meta-analyses up to 12 months showed no significant differences between bulk-fill and conventional resin composites for color match, marginal discoloration, or marginal integrity. Most RCTs were judged as having low risk of bias, with one study presenting some concerns. The certainty of evidence was rated as moderate, mainly due to imprecision related to sample size and limited reporting of confidence intervals. Conclusions: Bulk-fill resin composites demonstrate clinical performance and survival comparable to conventional resin composites in posterior restorations of primary teeth over follow-ups of up to 12 months. Based on RCTs with predominantly low risk of bias and moderate certainty of evidence, bulk-fill composites represent a reliable and efficient restorative option in pediatric dentistry. Full article