Search Results (940)

Background/Objective: Bitewing radiographs are widely used for evaluating dental caries, restorations, and periodontal status due to their low radiation dose and high image quality. While artificial intelligence–based studies are common for other dental imaging modalities, multi-class diagnostic charting on bitewing radiographs remains limited. This study aimed to simultaneously detect eight periodontal and restorative parameters using a YOLOv8x-seg–based deep learning model and to assess its diagnostic performance. Materials and Methods: A total of 1197 digital bitewing radiographs were retrospectively analyzed and annotated by experts, resulting in 7860 labels across eight conditions. Periodontal conditions included alveolar bone loss, dental calculus, and furcation defects, while restorative and dental conditions comprised caries, cervical marginal gaps, open contacts, overhanging fillings, and secondary caries. The dataset was divided on a patient basis into training (80%), validation (10%), and test (10%) sets. The YOLOv8x-seg model was trained for 800 epochs with extensive data augmentation, and performance was evaluated using precision, recall, and F1-score, along with confusion matrices. Results: The model showed the highest accuracy in the alveolar bone loss class (precision: 0.84, recall: 0.93, F1: 0.88). While moderate performance was achieved for dental calculus (F1: 0.58) and caries (F1: 0.57) detection, lower scores were recorded in low-frequency classes such as cervical marginal gap (F1: 0.23), secondary caries (F1: 0.29), overhanging filling (F1: 0.35), furcation defect (F1: 0.40), and open contact (F1: 0.41). The overall segmentation performance achieved an mAP@0.5 of 0.30 and an mAP@0.5:0.95 of 0.10, indicating an acceptable performance level for segmentation-based multi-class models. Conclusions: The obtained findings demonstrate that the YOLOv8x-seg architecture can detect and segment periodontal conditions with high success and restorative parameters with moderate success in automation processes in bitewing radiographs. Accordingly, the model presents a methodologically feasible framework for the multiple and simultaneous radiographic evaluation of periodontal and restorative findings on bitewing radiographs, with performance varying across classes and lower sensitivity observed in low-frequency conditions. Full article

Background: Patients with a thin gingival phenotype and a narrow buccal alveolar plate are highly susceptible to periodontal complications during orthodontic expansion. Traditional biomechanics often fail to maintain root control in thin alveolar housing. This report presents two clinical cases illustrating soft- and hard-tissue responses to a novel biomechanical approach, the Bone Protection System (BPS), designed to reduce buccal cortical overload during expansion. Case Presentation: Two adult patients with a thin gingival phenotype assessed by a standardized periodontal probe transparency test and narrow alveolar ridges underwent orthodontic expansion. Patient 1 was treated with the full BPS protocol in both arches. Patient 2 received BPS only in the maxilla, while the mandible was treated conventionally, creating an intra-individual control model under identical systemic conditions. Soft-tissue phenotype and cortical plate response were evaluated clinically and radiographically when applicable. Results: In Patient 1 clinically, the vestibular phenotype showed clear thickening and stabilization. In Patient 2, the maxillary arch treated with BPS exhibited progressive thickening of the vestibular phenotype, whereas the mandible treated conventionally presented thinning and increased translucency—features consistent with buccal compression in thin alveolar bone. No soft- or hard-tissue augmentation procedures were performed in either case. Conclusions: The Bone Protection System may contribute to improved periodontal safety during orthodontic expansion in thin-biotype patients by reducing buccal cortical loading and supporting adaptive soft-tissue and bone responses. Preliminary observations suggests that BPS has potential value for possibly expanding the biological limits of safe tooth movement. Further studies on larger cohorts are warranted. Full article

Background: Mechanical loading is a fundamental regulator of bone remodelling; however, the mechanotransduction mechanisms governing alveolar bone adaptation under tensile-dominant orthodontic loading remain insufficiently defined. In particular, the molecular pathways associated with tension-driven cortical modelling in the periodontal ligament (PDL)–bone complex have not been systematically interpreted in the context of advanced biomechanical simulations. Methods: A nonlinear finite element model of the alveolar bone–PDL–tooth complex was developed using patient-specific CBCT data. Three loading configurations were analysed: (i) conventional orthodontic loading, (ii) loading combined with corticotomy alone, and (iii) a translation-dominant configuration generated by the Bone Protection System (BPS). Pressure distribution, displacement vectors, and stress polarity within the PDL and cortical plate were quantified across different bone density conditions. The mechanical outputs were subsequently interpreted in relation to established mechanotransductive molecular pathways involved in osteogenesis and angiogenesis. Results: Conventional loading generated compression-dominant stress fields within the marginal PDL, frequently exceeding physiological thresholds and producing moment-driven root displacement. Corticotomy alone reduced local stiffness but did not substantially alter stress polarity. The BPS configuration redirected loads toward a tensile-favourable mechanical environment characterised by reduced peak compressive pressures and parallel (translation-dominant) displacement vectors. The predicted tensile stress distribution is compatible with activation profiles of key mechanosensitive pathways, including integrin–FAK signalling, Wnt/β-catenin–mediated osteogenic differentiation and HIF-1α/VEGF-driven angiogenic coupling, suggesting a microenvironment that may be more conducive to cortical apposition than to resorption. Conclusions: This study presents a computational–molecular framework linking finite element–derived tensile stress patterns with osteogenic and angiogenic signalling pathways relevant to alveolar bone remodelling. The findings suggestthat controlled redirection of orthodontic loading toward tensile domains may shift the mechanical environment of the PDL–bone complex toward conditions associated with osteogenic than resorptive responses providing a mechanistic basis for tension-induced cortical modelling. This mechanobiological paradigm advances the understanding of load-guided alveolar bone adaptation at both the tissue and molecular levels. Full article

Background & Objectives: Periodontal disease (PD) is a common oral disease that affects the supporting structures of the teeth and is a leading cause of tooth loss worldwide. This study aimed to estimate the prevalence of PD among 9th-grade teachers in the northern West Bank and examine its association with key behavioral and socioeconomic factors. Methods: A cross-sectional study was conducted among 920 teachers selected through proportional stratified random sampling from governmental and private schools. Periodontal health was assessed using the WHO Community Periodontal Index for Treatment Needs (CPITN), and oral hygiene status was measured with the Simplified Oral Hygiene Index (S-OHI). A structured questionnaire was administered to collect data on socioeconomic status, oral hygiene practices, dietary habits, and smoking behaviours. Data was analysed using descriptive statistics, bivariate and multivariate logistic regression. Results: Only 11.8% of participants exhibited completely healthy gingiva, with the mean condition ranging between calculus and shallow pockets. Oral hygiene practices were the strongest predictors of periodontal outcomes: frequent tooth brushing (Adjusted Odds Ratio: AOR = 0.015), morning brushing (AOR = 0.015), and regular toothbrush replacement (AOR = 2.514) were protective. Higher red meat intake was negatively associated with periodontal health (AOR = 0.032), while frequent nut consumption was protective (AOR = 0.227). The number of cigarettes smoked per week was positively associated with PD (AOR = 1.085). Conclusions: PD is highly prevalent among Palestinian adults, with significant behavioural and lifestyle-related determinants. Targeted oral health interventions are urgently needed to improve adults’ oral health. Full article

Background: Hyperbaric oxygen therapy (HBOT) is considered a potential adjunctive modality to enhance tissue regeneration in oral and maxillofacial surgery. By increasing tissue oxygen availability, HBOT may support bone and soft-tissue repair under hypoxic and chronically inflamed conditions. Aim: This narrative review evaluates current experimental and clinical evidence regarding HBOT in high-risk dental indications, including osteoradionecrosis (ORN), medication-related osteonecrosis of the jaw (MRONJ), chronic osteomyelitis, poorly healing postoperative wounds, and procedures in patients with systemic comorbidities. Methods: A structured search of PubMed, Web of Science, and the Cochrane Library identified 123 relevant English-language publications (from 1 January 2000–September 2025) addressing HBOT mechanisms and clinical applications in oral and maxillofacial surgery, including clinical trials, observational studies, preclinical models, and systematic reviews. Results: Available evidence suggests that HBOT may improve healing outcomes and reduce complication rates in early-stage ORN and MRONJ when used as an adjunct to surgery and systemic therapy. However, findings in implantology—particularly in irradiated or diabetic patients—and in periodontal therapy remain limited, heterogeneous, and methodologically inconsistent. Conclusions: HBOT may be considered in selected clinical scenarios, particularly where healing is impaired by hypoxia or systemic disease. Nevertheless, current evidence remains insufficient to support routine use. Standardized, high-quality studies with clearly defined endpoints and uniform therapeutic protocols are needed to determine its clinical effectiveness and optimal indications. Full article

Background/Objectives: Periodontal disease is a prevalent chronic inflammatory condition that often progresses to irreversible tissue destruction. This study aimed to evaluate the clinical efficacy of a combined minimally invasive periodontal therapeutic protocol scaling and root planing (SRP) with injectable platelet-rich fibrin (i-PRF) and microneedling (MN) compared to conventional SRP with i-PRF alone in patients with stage II–III periodontitis. Methods: A prospective split-mouth clinical study was conducted on 54 patients diagnosed according to the 2018 EFP/AAP classification. Each participant received SRP + i-PRF in the upper arch (control) and SRP + i-PRF + MN in the lower arch (test). Periodontal parameters clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI) were measured at baseline, 1, 3, and 6 months. Data were analyzed using Friedman and Wilcoxon tests with Bonferroni correction. Results: Both treatment protocols produced significant longitudinal improvements in CAL, BOP, and PI (p < 0.001). The most pronounced BOP reduction occurred within the first month, while CAL improvement was progressive and stabilized after six months. The Combined protocol achieved slightly greater CAL gain at 6 months (mean difference ≈ 0.46 mm; p = 0.0013), indicating a modest yet statistically significant advantage in attachment recovery. Correlation analyses confirmed a coherent healing trajectory characterized by early inflammation resolution, plaque control, and later tissue stabilization. Conclusions: Both i-PRF-based regenerative approaches significantly improved periodontal parameters. The addition of MN enhanced CAL recovery and may favor early vascularization and collagen remodeling. Although the clinical difference was limited, the biological plausibility and sustained improvement suggest that MN could represent a valuable adjunct to non-surgical regenerative periodontal therapy. Longer-term studies are warranted to assess the durability of these effects. Full article

Background/Objectives: Periodontal disease is a condition marked by the destruction of tooth-supporting tissues, driven by an exaggerated immune response to an unbalanced dental biofilm. Conventional treatments struggle due to antimicrobial resistance and the biofilm’s protective extracellular matrix. This study evaluates the potential of bacteriophages as an innovative strategy for managing periodontal disease. Methods: This research employed a qualitative approach using Discursive Textual Analysis, with IRAMUTEQ version 0.8 alpha 7 (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) software. The search was conducted in the Orbit Intelligence and PubMed databases, for patents and scholarly articles, respectively. The textual data underwent Descending Hierarchical Classification, Correspondence Factor Analysis, and Similarity Analysis to identify core themes and relationships between words. Results: The analysis revealed an increase in research and patent filings concerning phage therapy for periodontal disease since 2017, emphasizing its market potential. The primary centers for intellectual property activity were identified as China and the United States. The study identified five focus areas: Genomic/Structural Characterization, Patent Formulations, Etiology, Therapeutic Efficacy, and Ecology/Phage Interactions. Lytic phages were shown to be effective against prominent pathogens such as Fusobacterium nucleatum and Enterococcus faecalis. Conversely, the lysogenic phages poses a potential risk, as they may transfer resistance and virulence factors, enhancing pathogenicity. Conclusions: Phage therapy is a promising approach to address antimicrobial resistance and biofilm challenges in periodontitis management. Key challenges include the need for the clinical validation of formulations and stable delivery systems for the subgingival area. Future strategies, such as phage genetic engineering and data-driven cocktail design, are crucial for enhancing efficacy and overcoming regulatory hurdles. Full article

Background: Cognitive aging is a physiological process that involves gradual and mild changes in mental functions. When these changes significantly affect cognitive performance, it is considered cognitive decline. Objective: This analytical cross-sectional pilot study examined the association between periodontal status, systemic conditions, and cognitive performance in middle-aged and older adults. Methods: Forty adults aged 35–59 years (n = 20) and ≥60 years (n = 20) from northeastern Mexico were evaluated. Oral assessments included the Modified Gingival Index and detection of Porphyromonas gingivalis and Fusobacterium nucleatum using qPCR. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE), and frailty with the Clinical Frailty Scale (CFS) and Oral Frailty Checklist (OF-5). Systemic medical history and oral hygiene habits were determined using a questionnaire. Results: MMSE scores were lower in older adults compared with middle-aged adults, and the magnitude of the difference was small. The presence of P. gingivalis or F. nucleatum was similar between groups. Frailty indicators were more prevalent in older adults. Logistic regression identified age and frailty-related variables as the strongest predictors of lower cognitive performance, whereas microbiological findings were not significant predictors. Conclusions: Age and frailty indicators, rather than bacterial presence alone, were associated with reduced cognitive performance in this pilot sample. Although no microbiological differences were observed, the findings highlight the need for larger analytical studies incorporating quantitative bacterial load and additional confounders to better understand the oral–systemic–cognitive interactions. Full article

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues—including depression, anxiety, cognitive decline, and the use of psychotropic medications—reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth–mind connection promotes holistic health rather than functional decline. Full article

Objectives: The purpose of this study is to compare the differences between lemon-derived exosome-like nanovesicles (LELNs) stored at −80 °C, −20 °C, and 4 °C for one month and freshly isolated LELNs, in terms of characterization and anti-inflammatory effects on periodontal ligament cells, aiming to identify suitable storage conditions for LELNs. Methods: Nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and micro bicinchoninic acid assay (BCA) were conducted to access the characterization differences. LPS-induced human periodontal ligament cells were used as an in vitro inflammatory model, and the changes in biological functions were examined by qRT-PCR and ELISA. Results: LELNs stored at −80 °C retained the highest particle and protein concentration and showed the least aggregation and heterogeneity in size on TEM images, while the average particle sizes shown by NTA were similar. And LELNs exhibited similar anti-inflammatory effects on periodontal ligament cells after one month of storage at −80 °C, −20 °C, and 4 °C. Conclusions: We found that LELNs can maintain in vitro anti-inflammatory ability when stored at either −80 °C, −20 °C, or 4 °C for one month, while storing at −80 °C maintains the concentration and uniform particle size best. Full article

Orthodontic treatment, offering significant benefits for oral function and facial aesthetics, is in high demand among both adolescent and adult populations. Orthodontic appliances pose challenges for maintaining oral hygiene and increase the risk of dental and periodontal diseases. With advances in dental materials and the use of nanoparticles, a significant amount of research has focused on modifying orthodontic appliances with nanoparticles to reduce bacterial adhesion and biofilm formation. Silver nanoparticles are one of the most popular antibacterial materials in medical research. This article presents current evidence on silver nanoparticle-incorporated orthodontic appliances, including brackets, molar bands, archwires, elastomeric ligatures, mini-implants, and acrylic retainers. Silver nanoparticles and modified silver nanoparticles exhibit robust antibacterial activity when applied to the surfaces of orthodontic appliances. However, there are exceptions in which, on a few orthodontic appliances, the silver nanoparticle incorporation actually increased biofilm formation. Moreover, a silver nanoparticle incorporation may introduce adverse effects, such as cytotoxicity, and increase surface roughness. It is also worth noting that most of the studies were conducted in vitro. Long-term clinical studies are necessary to evaluate the stability, safety, and clinical efficacy of silver nanoparticle-incorporated orthodontic appliances under real-world conditions. Full article

Background/Objectives: End-stage chronic kidney disease (ESKD) represents a complex condition that also impacts oral health. This pilot study evaluates and compares some approaches to oral health assessment and aims to define the specific oral features common in adolescents with ESKD. Methods: A total of 50 children aged 12 to 17 years were examined, including 30 adolescents with ESKD (Group 1) and 20 adolescents without urinary pathology (Group 2). The decayed, missing, filled teeth (DMFT) index, oral hygiene index-simplified, papillary marginal attached index, and periodontal index were used for dental and periodontal assessment. The Milwaukee PH56 device was used to determine salivary pH. Oral microbiota was analyzed by chromatography–mass spectrometry and polymerase chain reaction detection of periodontopathogenic bacteria. Salivary and gingival crevicular fluid (GCF) biomarkers (IL-1β, TNF-α, IL-8, VEGF, sIgA) and total antioxidant capacity (TAC) were determined using an enzyme-linked immunosorbent assay. Results: DMFT did not differ between the groups. Periodontal indices in Group 1 were increased compared to Group 2 (p < 0.0001). Salivary pH in Group 1 was slightly alkaline; in Group 2, it was slightly acidic (p < 0.0001). Oral dysbiosis and periodontopathogenic bacteria were found in ESKD adolescents. Salivary IL-1β, TNF-α, VEGF, and IL-1β in GCF were elevated in Group 1 compared to Group 2 (p < 0.05). TNF-α, IL-8, and VEGF in GCF and TAC in both fluids were lower in Group 1 compared to Group 2 (p < 0.0001). Salivary IL-8 and sIgA in both saliva and GCF did not differ between the groups. Conclusions: ESKD adolescents had poor oral hygiene and significant oral dysbiosis including periodontopathogenic bacteria. Evaluation of biomarkers in saliva and GCF allowed us to vindicate inflammation, dysbiosis severity, and periodontal diseases. Full article

With the accelerating trend of global population aging, oral and gut diseases are imposing a rising socioeconomic burden, both of which have well-known connections to microbial dysbiosis. As the gateway to the human body, the oral cavity exhibits close interactions with the gastrointestinal tract, which includes translocation of bacteria and bacterial extracellular vesicles (BEVs), as well as intermucosal immunity and neural signaling. These oral–gut crosstalk pathways play vital roles in the pathogenesis and progression of oral diseases, such as periodontitis, and gut diseases, such as inflammatory bowel disease (IBD). Focusing on periodontitis and IBD as representative conditions, this review summarizes current understanding of the oral–gut crosstalk and underlying mechanisms. Among diverse interactions, we emphasize BEVs as effective trans-barrier mediators and their therapeutic potentials during oral–gut crosstalk. Beneficial BEVs, notably those from Akkermansia muciniphila (Akk), exert various probiotic roles, including modulating microbial homeostasis, promoting tissue repair and alleviating inflammation, thereby shedding light on the prevention and treatment of oral and gut diseases, even systemic disorders. Full article

Background: Smoking has a detrimental effect on the periodontal condition. Smoking intensity has recently been considered as a criterion for grading periodontitis cases. However, the influence of smoking intensity on the subgingival microbial community has not been evaluated in depth. This cross-sectional analytical study aims to assess the differences in the subgingival microbiome in adult patients with chronic periodontitis and different smoking habits (heavy smokers versus moderate smokers versus non-smokers). Methods: Sixty patients diagnosed with chronic periodontitis were grouped according to their daily smoking intensity as follows: group I (smoke ≥ 10 cigarettes/day), group II (smoke < 10 cigarettes/day), and non-smokers (group III). For each patient, samples from subgingival plaque were harvested from the deepest three periodontal pockets, and their 16S rRNA was sequenced using the S5 Ion Torrent platform. Sequences were clustered in taxonomic units, and the microbial diversity was expressed using the Shannon index or Simpson index, while the abundance of the microbial species was expressed using the Chao index. Results: Bacterial diversity was lowest in the heavy smoker group (group I) and highest in non-smokers (group III). Veillonella, Streptococcus, Prevotella, Fusobacterium, and Dialister were found to have different prevalences in the three study groups. Campylobacter decreased and Fusobacterium increased as a function of the number of cigarettes smoked per day. The moderate smoker group showed a higher abundance of Spirochaetes. At the species level, the heavy smoker group (group I) showed a higher abundance of Fusobacterium compared to the other two groups. Conclusions: Greater smoking intensity has been associated with higher Fusobacterium abundance, together with decreased diversity of the subgingival microbiome, establishing a more stable putative subgingival bacterial environment. Full article

Background: Chronic inflammation is a hallmark of many oral and systemic diseases and has long been recognised as a risk factor for cancer development. Central to inflammatory responses are inflammasomes—multiprotein complexes that, upon activation, trigger caspase-1–mediated release of the pro-inflammatory cytokines interleukin-1β (IL-1β) and interleukin-18 (IL-18). Their emerging contribution to chronic oral inflammatory conditions has generated interest in understanding whether persistent inflammasome activity may also influence pathways involved in oral carcinogenesis. This review summarises current evidence on the role of inflammasomes in oral inflammatory diseases and explores their potential involvement in the transition from chronic inflammation to malignant transformation. Methods: A narrative review of the literature was conducted by searching major scientific databases for studies investigating inflammasome activation in oral tissues, inflammatory oral diseases, and mechanisms linking chronic inflammation to oral cancer. Eligible articles included experimental studies, animal models, observational clinical research, and review papers that provided mechanistic or associative insights. Due to heterogeneity in study designs, a qualitative synthesis was performed. Results: Available evidence indicates that inflammasomes, particularly NLRP3 and AIM2, contribute to the pathophysiology of pulpitis, periodontitis, and several systemic conditions that affect oral health. Preclinical and observational findings also suggest potential involvement of inflammasome-related pathways in early tumorigenic processes, although these associations require further clarification. Preliminary biomarker-based studies demonstrate that inflammasome components measurable in saliva, pulpal blood, or gingival crevicular fluid may offer minimally invasive indicators of inflammatory burden and oral health status. Conclusions: Inflammasomes appear to play a meaningful role in oral inflammatory diseases, and growing evidence links their persistent activation to mechanisms relevant to oral carcinogenesis. However, current findings are largely associative and derived primarily from experimental and early clinical research. Additional work is needed to define precisely how inflammasomes contribute to the progression from chronic oral inflammation toward malignant change and to evaluate whether targeting inflammasome pathways offers viable therapeutic or diagnostic potential. Full article