Search Results (4,979)

Background/Objectives: This retrospective study aimed to assess the sociodemographic and temporal factors associated with dental emergency presentations in adults from Arad county, Western Romania. Methods: We collected data on age, sex, origin area, presentation time, and diagnostic (macro)category in 510 adult patients. Diagnoses were grouped into four macrocategories: dental pathology (PD), endodontic and periapical pathology (EPP), odontogenic septic complications (OSC), and other emergencies (OE). Results: EPP was the predominant (macro)category, with most cases involving acute apical periodontitis and pulpitis. Age differed significantly across diagnostic categories (p < 0.001), with PD patients being significantly younger than other groups (p < 0.001). Increasing age was associated with higher odds of EPP (AOR = 1.06, p = 0.004) but lower odds of PD (AOR = 0.93, p < 0.001). Rural origin was associated with increased odds of EPP (AOR = 1.49, p = 0.031) but decreased odds of OE (AOR = 0.39, p = 0.003). No significant associations were identified for sex. Most patients presented in the evening (46.47%) and on weekends, particularly Sundays (21%; n = 107) and Saturdays (16%; n = 82). Patient age differed significantly across time intervals (p = 0.016), with individuals seeking dental emergency care during morning and afternoon hours being significantly older than those presenting in the evening (p = 0.009) or nighttime (p = 0.047). Conclusions: Our findings suggest that observed sociodemographic and temporal differences may be associated with variations in the stage and type of dental pathology at presentation. Understanding these presentation patterns may help inform service organization and resource allocation in emergency dental care. Full article

Background and Objectives: Conventional stainless-steel orthodontic molar bands may exhibit limited anatomical adaptation, favoring plaque retention and periodontal inflammation. This study aimed to compare the periodontal outcomes of standard bands and CAD/CAM-customized molar bands in adolescents. Materials and Methods: A prospective randomized controlled clinical study was conducted in 180 adolescents (mean age: 11.9 years) undergoing fixed orthodontic therapy. Participants were allocated to CAD/CAM-customized bands (n = 90) or standard stainless-steel bands (n = 90). Periodontal parameters—Plaque Control Record (PCR), Bleeding on Probing (BOP), and Periodontal Probing Depth (PPD)—were assessed at baseline, 1, 3, and 6 months. Data were analyzed using the Mann–Whitney U test (p < 0.05). Results: Baseline values were comparable between groups (p > 0.05). During follow-up, the CAD/CAM group showed significantly lower PCR, BOP, and PPD values. At 6 months, PCR was 21 ± 8% vs. 42 ± 12%, BOP was 17 ± 6% vs. 40 ± 10%, and PPD was 2.5 ± 0.5 mm vs. 3.1 ± 0.6 mm (all p < 0.001). Conclusions: CAD/CAM-customized molar bands demonstrated superior periodontal performance compared with conventional bands. Improved anatomical adaptation may reduce plaque accumulation and gingival inflammation during orthodontic treatment. Full article

Background/Objectives: Furcation defects pose a significant challenge in the diagnosis and treatment planning of periodontal diseases. Accurate clinical identification of furcation involvement is essential for improving treatment outcomes. This study aimed to evaluate the accuracy and effectiveness of various artificial intelligence (AI) algorithms in detecting furcation defects (FD) in mandibular molars. Methods: A total of 654 panoramic radiographs were randomly selected from patients who visited the Department of Oral and Maxillofacial Radiology at the Faculty of Dentistry, Ankara University. Each image was labeled as either “healthy” or “FD” and subsequently preprocessed. The performance of different deep learning algorithms in identifying FD was subsequently evaluated. Results: In the classification models employed, the highest scores were calculated as accuracy 97.9%, precision 97.10%, sensitivity 97.08%, and F1 score 97.09% in the Xception model. In the segmentation tests, the highest scores were calculated as accuracy 99.96%, precision 99.26%, sensitivity 97.57%, and F1 score 98.41% in the ENet model. Conclusions: Results of this study indicated that the use of artificial intelligence systems in detecting furcation involvement in mandibular molar teeth in panoramic radiography images is promising. Further studies covering larger data sets, including maxillary molar teeth, will increase the success rates in detecting furcation involvement. Full article

Abdominal aortic aneurysm (AAA) is a life-threatening disease for which no definitive medical therapy has been established, partly because its underlying mechanisms remain incompletely understood. Given accumulating evidence suggesting microbial involvement in vascular inflammation, we conducted a detection-based investigation to identify bacterial DNA in aneurysmal tissues. We performed 16S ribosomal RNA (rRNA) gene sequencing of the aneurysmal wall, intraluminal thrombus, feces, saliva, and dental plaque collected from 32 patients undergoing open surgical repair of non-infectious AAA. Based on the sequencing data, diversity analyses were performed for each sample to characterize bacterial composition, and exploratory statistical analyses were conducted to examine associations between patient characteristics and the relative abundance of bacterial taxa. Oral-associated genera were frequently detected in aneurysm-derived samples, including Prevotella in 78%, Leptotrichia in 81%, and Capnocytophaga in 38% of aneurysmal wall or thrombus samples, whereas their detection in fecal samples was limited. Beta diversity analysis demonstrated significant compositional differences between fecal and oral samples (permutational multivariate analysis of variance [PERMANOVA], p < 0.01). These findings demonstrate the presence of bacterial DNA in aneurysmal tissues and provide descriptive evidence of microbial signatures in AAA. Full article

Objectives: This study aimed to elucidate the multi-target therapeutic mechanisms of Camellia sinensis phytochemicals in periodontitis using an integrative multi-scale molecular modeling strategy. Methods: An integrated in silico strategy was employed, incorporating network-based pharmacological analysis, protein interaction network evaluation, molecular docking assessment, density functional theory (DFT) computations, molecular dynamics (MD) trajectory analysis, MM/PBSA-derived binding energy estimation, and residue-level energetic contribution profiling. Overlapping targets between C. sinensis and periodontitis-associated genes were identified, followed by topological screening to determine crucial hub proteins. The most promising target was subjected to detailed structural and energetic evaluation. Results: Intersection analysis identified 23 common targets, with AKT1, myeloperoxidase (MPO), MMP2, MMP3, MMP9, STAT1, IL2, BCL2, ESR1, and SERPINE1 emerging as central hubs. Functional enrichment highlighted AGE–RAGE and JAK–STAT signaling pathways and extracellular matrix remodeling processes. Docking revealed MPO as the most favorable core target. Gallate-containing catechins, particularly (−)-gallocatechin gallate (−9.63 kcal/mol) and gallocatechin 3-O-gallate (−9.52 kcal/mol), exhibited more favorable binding affinities than the standard inhibitor 4-ABAH (−6.02 kcal/mol). DFT analysis demonstrated moderate HOMO–LUMO gaps (4.31–4.78 eV) and favorable dipole moments supporting electronic stability and reactivity. MD simulations confirmed stable complex formation over 100 ns, with persistent hydrogen bonding and consistent ligand retention. MM/PBSA calculations further validated a favorable binding of (−)-gallocatechin gallate (−27.66 ± 7.53 kcal/mol) and gallocatechin 3-O-gallate (−26.09 ± 8.96 kcal/mol), comparable to or exceeding 4-ABAH (−25.88 ± 4.44 kcal/mol). Conclusions: C. sinensis phytochemicals, particularly gallate-containing catechins, exhibit stable, energetically favorable interactions with MPO, supporting their potential as competitive inhibitors that modulate oxidative stress and inflammatory pathways in periodontitis. Full article

Background/Objectives: Periodontal disease is a chronic inflammatory condition associated with systemic vascular dysfunction and elevated cardiovascular risk. This systematic review and meta-analysis aimed to quantitatively evaluate the association between periodontitis and endothelial dysfunction and to assess the effects of periodontal therapy on endothelial function and inflammatory biomarkers. Methods: Conducted per PRISMA 2020 and registered in PROSPERO (CRD420261309247). Electronic databases (PubMed, Scopus, Cochrane Library) were searched for observational and interventional studies assessing endothelial function in patients with periodontitis. Risk of bias was evaluated using RoB 2, ROBINS-I, and the Newcastle–Ottawa Scale; certainty of evidence was assessed with GRADE. Pooled effects on flow-mediated dilation (FMD) and inflammatory markers were estimated using random-effects meta-analysis (DerSimonian–Laird). Results: Fourteen studies were included in qualitative synthesis; six contributed quantitative FMD data. Observational studies consistently demonstrated impaired endothelial function and elevated inflammatory markers in patients with periodontitis versus controls. Meta-analysis showed that periodontal therapy significantly improved endothelial function (pooled FMD: +3.3 percentage points; 95% CI 1.7–4.9; I² = 77%; p < 0.001), though results should be interpreted cautiously given substantial heterogeneity and the limited number of studies (n = 6). Periodontal treatment reduced CRP levels (mean difference −0.38 mg/L; I² = 41%); IL-6 showed a favorable direction but with very low certainty of evidence. Publication bias could not be reliably assessed given the small number of included studies. Conclusions: Periodontitis is associated with impaired endothelial function and systemic inflammation. Periodontal therapy leads to measurable improvements in both, supporting its role as a potentially modifiable contributor to cardiovascular risk. Larger randomized trials with long-term cardiovascular endpoints are warranted. Full article

Oral mucosal and periodontal diseases are commonly associated with persistent inflammation, oxidative stress, impaired wound healing, and reduced oral health-related quality of life. Nano-Bio Fusion (NBF) gingival gel is a bioadhesive nano-formulated oral gel containing propolis, vitamin C, and vitamin E, developed for local application under oral soft tissue conditions. This critical narrative review aimed to evaluate the currently available evidence regarding the clinical applications, safety profile, and therapeutic potential of NBF gel in oral soft tissue therapy. A structured non-systematic literature search was performed using PubMed, Embase, Cochrane Library, and Google Scholar, and 16 relevant studies were included. The available evidence suggests that NBF gel may provide clinical benefits as an adjunct to non-surgical periodontal therapy, with reported improvements in plaque and gingival indices, periodontal probing depth, clinical attachment level, wound healing, and pain-related outcomes. In addition, potential beneficial effects have been reported in oral surgery-related wound healing, alveolar osteitis, desquamative gingivitis, erosive lichen planus, and xerostomia-associated mucositis. Several studies reported outcomes comparable to conventional therapies, including chlorhexidine-based regimens and locally delivered antimicrobials; however, the evidence remains heterogeneous and limited. Furthermore, the proposed biological mechanisms, including antioxidant, antimicrobial, and tissue-modulating effects, are not yet fully supported by mechanistic or pharmacokinetic evidence. The currently available literature is limited by heterogeneity in study design, small sample sizes, short follow-up periods, and limited independent validation. Therefore, further well-designed, adequately powered randomized controlled trials with standardized methodologies are required to better define the clinical role of NBF gel in evidence-based oral soft tissue therapy. Full article

Background: Gingival recession is a common periodontal condition. With the increasing use of artificial intelligence (AI)-based chatbots, patients frequently seek online health information. However, the reliability, accuracy, and readability of AI-generated patient-oriented information on gingival recession remain unclear. Objective: To evaluate the quality, accuracy, and readability of ChatGPT-generated responses to patient-oriented questions related to gingival recession. Methods: A total of 288 patient-oriented questions were developed by an expert panel and categorized into fourteen thematic domains. Responses generated by ChatGPT (version 3.5) were independently evaluated by five oral health professionals using a modified Brief DISCERN instrument, an accuracy scoring system, and the Global Quality Score (GQS). Readability was assessed using the Flesch Reading Ease and Flesch–Kincaid Grade Level indices. Results: Significant differences were observed among thematic categories for DISCERN, accuracy, GQS, and readability scores (all p < 0.01). The highest modified Brief DISCERN, accuracy, and GQS scores were recorded for the Information Sources/AI Reliability category (DISCERN: 19.60 ± 2.29; accuracy: 4.67 ± 0.49; GQS: 4.33 ± 0.49), whereas the lowest scores were observed for the What Happens If Left Untreated? category (DISCERN: 14.27 ± 1.75; accuracy: 3.23 ± 0.43). Strong positive correlations were identified between DISCERN and accuracy (r = 0.784, p < 0.001) and between accuracy and GQS (r = 0.868, p < 0.001). Readability indices were not significantly correlated with accuracy or quality measures. Conclusions: ChatGPT provided patient-oriented information on gingival recession with variable performance across thematic domains; however, readability remained a limitation. AI-generated content should therefore be considered a supplementary resource rather than a substitute for clinician-guided patient communication. Full article

Maxillary canine impaction is a common clinical condition often requiring a combined surgical–orthodontic approach; however, the effect of different surgical strategies on periodontal outcomes remains unclear. This systematic review aimed to evaluate periodontal outcomes following treatment of impacted maxillary canines, with particular focus on the influence of surgical technique (open vs. closed) and impaction site (palatal vs. buccal). A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to January 2026 in accordance with PRISMA guidelines, and the protocol was registered in PROSPERO. Randomized controlled trials, controlled clinical studies, observational studies, case series, and case reports reporting periodontal parameters were included. Primary outcomes comprised probing pocket depth, keratinized tissue width, gingival thickness, plaque and bleeding indices, and gingival recession. Twenty-seven studies were included. Overall, treated canines were associated with periodontal conditions comparable to normally erupted teeth, with probing depths generally within physiological limits and minimal gingival recession. Buccally impacted canines tended to show slightly reduced keratinized tissue compared with palatal impactions, although without clear clinical relevance. No consistent superiority of open or closed techniques was identified. Surgical–orthodontic treatment is generally associated with favorable periodontal outcomes, and treatment selection should be individualized according to anatomical and orthodontic factors. Full article

The oral cavity is home to a diverse community of microbiota comprising bacteria, viruses, protozoa, and fungi. These microorganisms inhabit several oral niches and play a significant role in supporting both oral and systemic health. The fine balance between the microbial communities can be influenced by genetics and environmental factors, potentially leading to dysbiosis. Alterations in the oral microbiota have been implicated in periodontitis, chronic inflammation, and systemic disease. Tobacco has been identified as a major player in altering the oral microenvironment and disturbing the balance between potentially pathogenic and beneficial commensals. The resulting dysbiosis promotes inflammation and assists in the passage of pathogenic microorganisms into the blood system. This narrative review examines current evidence linking the use of tobacco with the dominance of pathogenic oral bacteria and a dysfunctional immune response. We explore how the chemicals and toxins in cigarettes promote a reduction in oxygen and cause changes in the abundance of anaerobic bacteria. After discussing the mechanistic pathways leading to periodontitis and the entry of microorganisms into the circulation, the review will interrogate previous studies and identify opportunities and priorities for future research. Full article

Background: The primary goal of root canal treatment is the prevention and healing of apical periodontitis through the meticulous elimination of pathogenic bacteria and infected tissues. Within this framework, apical patency remains a fundamental yet debated clinical concept. Objectives: This review aims to evaluate the clinical significance of maintaining apical patency, its influence on postoperative discomfort, and the technical strategies required for predictable negotiation. Methods: We performed a comprehensive review of existing literature, including clinical studies and recent meta-analyses, focusing on the correlation between patency maneuvers and postoperative pain, the role of preoperative CBCT imaging, and the efficacy of specialized negotiation instruments and motor kinematics. While patency facilitates thorough debridement, evidence regarding its impact on postoperative pain is conflicting, with recent meta-analyses suggesting it may actually alleviate discomfort intensity. Preoperative CBCT was identified as essential for identifying complex anatomy, such as the MB2 canal. Furthermore, the use of specialized files and reciprocating motor modes enhances the predictability of glide path establishment. Conclusions: Although failure to achieve patency does not always dictate a negative outcome, it is associated with improved long-term healing. Clinicians should prioritize “Anatomical Patency”—respecting original morphology—over forceful “Operative Patency” to ensure procedural integrity and clinical success. Full article

The progressive decline in immune function during aging, termed immunosenescence, is increasingly recognized as a critical driver of skeletal fragility and impaired bone regeneration. This age-associated phenomenon—driven by thymic involution, inflammaging, and the accumulation of senescent immune cells—disrupts bone homeostasis primarily through the establishment of a pro-inflammatory milieu, wherein senescence-associated secretory phenotype (SASP) factors directly reprogram the function and fate of mesenchymal stem cells, osteoblasts, osteoclasts, and chondrocytes. Clinically, this immune-driven disruption of the bone microenvironment manifests across a spectrum of age-related skeletal disorders—including osteoporosis and osteoarthritis as prototypes of systemic and local bone loss, respectively, as well as delayed fracture healing, intervertebral disc degeneration, and periodontitis as paradigms of impaired regenerative and defensive responses. Despite advances in osteoimmunology revealing bidirectional immune-bone interactions, the mechanistic links between senescent immune cells and bone pathophysiology remain incompletely defined, presenting a significant barrier to therapeutic innovation. Herein, we synthesize current evidence to elucidate how immunosenescence, through the dysfunction of both innate and adaptive immunity, progressively dismantles bone homeostasis. We critically evaluate current challenges in dissecting the relative contributions of immunological memory accumulation versus fundamental aging processes to skeletal decline. We identify key knowledge gaps and propose strategic research directions, including longitudinal human immunophenotyping studies and innovative organoid-immune aging models. Such approaches hold the potential to transform the therapeutic landscape of age-related skeletal diseases by enabling precision interventions that target specific immunosenescence pathways to rejuvenate the aging skeleton. Full article

Periodontitis is a chronic inflammatory disease remaining elusive with its pathogenesis. Mitochondrial dysfunction and aberrant immune activation are implicated, but the underlying mechanisms remain incompletely understood. Given the essential role of Ca²⁺ homeostasis in maintaining normal mitochondrial function, we investigated the role of mitochondrial calcium (mtCa²⁺) dysregulation in periodontitis. Gingival tissues from periodontitis patients and healthy controls, as well as cultured gingival fibroblasts stimulated with Porphyromonas gingivalis lipopolysaccharide, were examined using transmission electron microscopy, confocal imaging, flow cytometry, qPCR, and western blotting. Notably, mtCa²⁺ was overloaded under inflammatory conditions, accompanied by disruption of whole-cell Ca²⁺ homeostasis. We also observed marked mitochondrial ultrastructural damage, mitochondrial DNA (mtDNA) leakage, and activation of the cyclic GMP-AMP synthase (cGAS)- stimulator of interferon genes (STING) pathway. The mitochondrial Ca²⁺ channel proteins, voltage dependent anion channel 1 (VDAC1) and mitochondrial calcium uniporter (MCU), were significantly upregulated in periodontitis gingiva, and their expression positively correlated with probing depth. Pharmacological inhibition of VDAC1 or MCU attenuated mtCa²⁺ overload, reduced mtDNA release and downregulated pro-inflammatory cytokines. These findings link mtCa²⁺ overload to mtDNA leakage and innate immune activation in periodontitis, and identify VDAC1 and MCU as promising therapeutic targets to restore mtCa²⁺ homeostasis and control host immune responses. Full article

Introduction: Odontogenic sinusitis (ODS) is an underrecognized cause of maxillary sinus inflammation and is frequently associated with dental, periodontal, endodontic, and iatrogenic factors. Accurate identification of the odontogenic source is essential for appropriate treatment planning. Cone-beam computed tomography (CBCT) allows detailed evaluation of the maxillary sinus, adjacent teeth, alveolar bone, and periodontal structures, and may improve the radiologic differentiation of ODS. Materials and Methods: This retrospective observational study analyzed radiologic data from patients evaluated and treated by the authors for suspected odontogenic sinusitis between 2019 and 2026. The final study group included 85 patients with CBCT-based evidence of odontogenic pathology affecting the maxillary sinus. CBCT scans were reviewed to identify tooth-related and treatment-related etiologic factors associated with ODS. Based on the radiologic findings, the authors developed a CBCT-based classification of odontogenic etiologies and proposed an imaging-guided management algorithm. Results: CBCT identified a broad spectrum of odontogenic factors associated with maxillary sinus disease. The most relevant radiologic patterns included endodontic and periapical pathology, periodontal or combined endo-periodontal disease, post-extraction inflammatory changes, odontogenic cysts, oro-antral communication or fistula, retained roots or teeth, displaced endodontic materials, and grafting or implant-related complications. These findings were organized into 16 radiologic categories reflecting the principal etiologic pathways of ODS. The proposed classification facilitated correlation between radiologic presentation and the recommended dental, surgical, and otolaryngologic treatment approach. Conclusions: CBCT is a valuable imaging modality for identifying odontogenic causes of maxillary sinus inflammation and provides more precise diagnostic information than conventional radiography alone. A structured CBCT-based evaluation may improve etiologic diagnosis, support multidisciplinary decision-making, and help guide individualized management of patients with ODS. Full article

Background/Objectives: Multiple impacted teeth are defined as the sequential impaction of more than two teeth in the alveolar bone, whether unilateral or multilateral. Multiple impactions are an uncommon and rare phenomenon demanding thorough treatment planning and careful execution, but data on the prevalence of multiple impactions is scarce in the literature. In cases of multiple impactions, clinicians generally perform a 3D assessment using CBCT to determine tooth positions, establish a sequence of surgical exposures, implement suitable traction, and utilise appropriate biomechanics. A multidisciplinary approach between orthodontists and oral surgeons is essential to achieve optimal results. Methods: This case report presents non-syndromic multiple impactions of three upper left permanent anterior teeth—21, 22, and 23—along with a retained supernumerary tooth preventing their eruption and a fused primary tooth. The primary teeth and the impacted supernumerary tooth were surgically removed. A digitally designed transpalatal arch was used to preserve the space and to act as anchorage for the orthodontic traction. After an 8-month observational period without spontaneous eruption, surgical exposure was carried out using the closed exposure technique. Subsequently, elastic traction was performed, guiding the impacted teeth into the dental arch. Results: The multiple impacted teeth were successfully aligned in the dental arch, achieving symmetry in the frontal segment while preserving periodontal health. In order to ensure stability during the retention period, thermoformed retainers were used. Conclusions: Each complex and rare clinical case poses a challenge to orthodontists and is important for the scientific literature as it provides valuable clinical experience. Full article