Search Results (2,151)

Background/Objectives: The optimal timing for orthodontic treatment in pediatric patients with malocclusion, particularly Class II discrepancies, remains a topic of ongoing clinical debate. Early treatment during the mixed dentition stage harnesses craniofacial growth potential, whereas later intervention may capitalize on pubertal growth for greater skeletal correction, especially for skeletal and airway improvements. This systematic review aimed to compare the outcomes of early versus late orthodontic treatment to assess their relative effectiveness. Methods: A systematic review was conducted in accordance with PRISMA guidelines, including randomized controlled trials and observational studies published between 2015 and 2025. Eleven studies comparing early and late treatment were analyzed, and the risk of bias was evaluated using standardized assessment tools. Results: Of the eleven studies, eight reported statistically significant improvements favoring early orthodontic intervention. Early treatment was associated with greater enhancement of maxillary and mandibular arch development, improved jaw relationships, and expanded airway dimensions. Studies utilizing headgear or other growth-modifying appliances also showed more favorable eruption patterns and alignment, underscoring the clinical relevance of early-phase management. Conclusions: Early orthodontic treatment can provide meaningful benefits in guiding skeletal growth, improving dental arch form, and enhancing treatment efficiency. These benefits were most consistently supported in skeletal and airway outcome domains. While late treatment may be suitable for some cases, personalized planning remains essential. Further large-scale, standardized longitudinal studies are needed to refine treatment-timing protocols in pediatric orthodontics. Full article

Objectives: Transcatheter aortic valve implantation (TAVI) has become the standard of care for severe aortic stenosis across all surgical risk categories. Continuous innovation in prosthesis technology necessitates a comprehensive and clinically oriented analysis of contemporary TAVI systems to guide device selection and understand evolving trends. This review aims to provide a practical, device-specific decision-making framework for TAVI prosthesis selection, synthesizing the latest evidence (2023–2025) to address the challenge of individualized choice in an era of device proliferation. We conducted a detailed review of current TAVI models from leading manufacturers (Medtronic, Abbott, Boston Scientific, Biotronik, etc.), examining their technical specifications, design innovations, and data from recent international clinical trials and registries. A comparative analysis was performed based on key parameters: delivery profile, resheathability/repositionability, sealing mechanisms, hemodynamic performance, and complication rates. Modern TAVI prostheses demonstrate significant advancements. Self-expanding nitinol frames offer superior adaptability and lower profiles (as low as 14 Fr). Innovations in sealing technology have drastically reduced the incidence of moderate-to-severe paravalvular leak (PVL) to below 2–3%. Supra-annular leaflet designs provide superior hemodynamics. Clinical outcomes show excellent 30-day mortality rates (1.1–2.0%) and durability estimates of 10–15 years. Variation exists between devices in rates of permanent pacemaker implantation and coronary access. The current generation of TAVI prostheses represents a mature technology offering high safety and efficacy. The key development vectors are focused on further device miniaturization, enhancing long-term durability, and expanding indications. This analysis provides a novel, clinically oriented comparison that moves beyond technical specifications to guide optimal device selection based on specific patient anatomy and clinical characteristics. Full article

Background/Objectives: The present study investigated the effects on the mechanical and physical properties of PMMA when organoselenium was incorporated into it as antifungal at different concentrations. Methods: 141 PMMA rectangle samples were fabricated using a heat compression packing technique and assigned to 3 experimental groups (47/group): 0% organoselenium (control), 0.5% organoselenium (0.5% SE), and 1% organoselenium (1% SE). Each sample was post-processed and stored in water. A three-point bend test was performed to assess elastic modulus and flexural stress. Scanning electron microscopy (SEM) was used to examine the exterior and interior surface topography. Data were analyzed using one-way ANOVA with Tukey’s multiple comparisons test. Results: The mean flexure stress for the 0% samples was statistically significantly higher than those of the 0.5% samples and the 1% samples (p < 0.001). The mean elastic modulus for the 0% group was statistically significantly higher than those of the 0.5% group and the 1% group (p < 0.001). Under SEM, the 0.5% samples were smoother with fewer voids and irregularities. Conclusions: The incorporation of organoselenium into PMMA denture base negatively affected its physical and mechanical properties. Full article

Purpose: This study investigates the static mechanical behavior of a non-modular metallic hip prosthesis through Finite Element Method (FEM) simulations, assessing compliance with ASTM F2996-13 standards. The analysis specifically evaluates how key geometric parameters, such as trunnion extension and orientation angles (adduction and flexion), affect stress distributions within the prosthesis. Methodology: A three-dimensional finite element model of a Ti6Al4V alloy hip stem was developed. Boundary and loading conditions were defined according to the standard: the distal portion of the stem was fully constrained 90 mm below the head center, and a static load of 2300 N was applied at the head center along the directions defined by the adduction and flexion angles. A mesh sensitivity analysis was conducted to ensure convergence, and stresses were evaluated. Parametric analyses varying trunnion extension and orientation angles were performed to quantify their impact on local stress concentration. Results: The findings revealed that even minor deviations in the adduction and flexion angles significantly impact the stress distribution, with the potting-level region being particularly sensitive. Additionally, the extension of the trunnion led to notably increased stress concentrations, especially at the prosthesis neck, highlighting its critical influence in implant design. Conclusions: Comparison with existing literature and standard reference data exposed discrepancies primarily attributed to variations in FEM model setups and parameter selections. This emphasizes the necessity of clearly specifying trunnion extension and orientation angles in numerical analyses to ensure consistent stress predictions, supporting the development of safer and longer-lasting hip implants. Future research should extend these analyses to different prosthesis geometries, aiming to develop generalized predictive frameworks applicable to diverse biomechanical scenarios. Full article

Background/Objectives: This retrospective study aimed at evaluating the clinical performance of non-engaging abutments in multi-unit implant-supported prostheses and assessing the influence of abutment combinations and clinical variables on biological and technical outcomes. Methods: Forty patients with 90 implants and 40 fixed dental prostheses were involved. The study population was divided into three groups: 17 patients (8 males, 9 females) in the first group, 16 patients (7 males, 9 females) in the second, and 7 patients (2 males, 5 females) in the third. All patients received multi-unit implant restorations in a private practice between January 2021 and December 2023, and each prosthesis was in function for one year after delivery, with a mean follow-up of 2.17 ± 0.32 years. Restorations involved non-engaging abutments alone or in combination with engaging abutments or multi-unit abutments. Clinical parameters included implant and prosthesis survival rates, probing pocket depth, bleeding on probing, marginal bone loss, and the prevalence of biological and technical complications. For the comparison between the three groups, the analysis of variance was used to compare group means. When appropriate, Tukey’s post hoc test was applied for multiple comparisons. The significance level was set at p < 0.05. Results: The implant and prosthesis survival rates were both 100%. Mean marginal bone loss was 0.53 ± 0.33 mm, and mean probing pocket depth was 4.2 ± 0.75 mm. No cases of peri-implantitis were observed. Mucositis prevalence was 11.11% at the implant level. No significant differences were found among different abutment combinations for biological outcomes or complications. The technical complication rate was 5%. Conclusions: Non-engaging abutments demonstrated favorable short-term clinical outcomes with minimal biological and technical complications. They may represent a reliable option for the restoration of multi-unit prostheses, although long-term studies are needed. Full article

Background/Objectives: Edentulism is a prevalent chronic condition among older adults, and conventional complete dentures remain the standard of care. However, their fabrication often involves multiple clinical sessions and operator-dependent steps that may compromise fit and comfort. Digital workflows using CAD/CAM technologies have emerged as viable alternatives, offering improved efficiency, precision, and patient-centered outcomes. This case report aims to present a fully digital workflow for maxillary complete dentures and describe clinical efficiency and patient-reported outcomes. Case Presentation: A 73-year-old edentulous male patient underwent maxillary rehabilitation using a fully digital workflow. The protocol included intraoral scanning; the design and 3D printing of a custom tray with occlusal rims; border-molded functional impressions; virtual articulation; and CAD/CAM fabrication. A digitally designed Try-In denture was 3D printed for clinical evaluation, followed by adjustments. The definitive prosthesis was milled from high-performance PMMA discs using a five-axis milling machine. The workflow reduced the number of appointments and laboratory steps. At six-month follow-up, the patient reported high satisfaction with esthetics, retention, phonetics, and masticatory performance. No significant post-delivery adjustments were required. Conclusions: This case demonstrates that fully digital workflows for maxillary complete dentures are clinically viable, providing excellent precision, patient satisfaction, and time efficiency compared to conventional methods. The reproducible protocol described may support the broader integration of CAD/CAM technologies in edentulous rehabilitation. Full article

Background/Objectives: To report our single-centre experience with the first 100 patients who underwent transcatheter aortic valve replacement (TAVR) with the new balloon-expandable Myval system. We report 3-year outcomes in low- to high-risk TAVR patient populations. Methods: From November 2019 to July 2021, 100 consecutive patients underwent TAVR, and their outcomes were classified according to the Valve Academic Research Consortium 3 definitions. Device performance was assessed using transthoracic echocardiography. Data collection was approved by the local ethical committee. Results: Among the 100 patients, most were male (n = 63), the mean age was 74.7 years, the mean EuroSCORE II score was 4.8 ± 4.9, and the mean Society of Thoracic Surgeons score was 5.6 ± 3.9. All patients were followed up for three years or until death. The rates of all-cause mortality, cardiac mortality and stroke were 28%, 7% and 5%, respectively. After three years, residual moderate aortic regurgitation was detected in eight patients without severe grade, and bioprosthetic valve dysfunction was observed in 17: structural valve deterioration in 10 (only stage 2), non-structural valve deterioration in three (paravalvular leak in one, patient–prosthesis mismatch in two), and endocarditis in four. Definite transcatheter heart valve thrombosis (hypoattenuated leaflet thickening) was not observed. Bioprosthetic valve failure was detected in four patients (stage 1: 1, stage 2: 0, stage 3: 3). After three years of follow-up, survival analysis revealed no significant differences in all-cause mortality, cardiac mortality, or the composite endpoint (including cardiac mortality, stroke and valve-related dysfunction) between patients with bicuspid (BAV) and tricuspid (TAV) aortic valve morphology and across annulus sizes (small, intermediate and large). Conclusions: TAVR resulted in significant and sustained improvements in valve haemodynamics with low rates of valve dysfunction and adverse clinical outcomes over a three-year follow-up period. Valve morphology (BAV vs. TAV) and annulus size did not significantly impact survival, haemodynamic performance, or valve durability. These results support the expanded use of TAVR in diverse patient populations, although extended follow-up is essential to fully establish long-term durability. Full article

Modern myoelectric prostheses remain difficult to control, particularly during rehabilitation, leading to high abandonment rates in favor of static devices. This highlights the need for advanced controllers that can automate some motions. This study presents an end-to-end framework coupling deep reinforcement learning with augmented reality (AR) for prosthetic actuation. A 14-degree-of-freedom hand was modeled in Blender and deployed in Unity. Two reinforcement learning agents were trained with distinct reward functions for a grasping task: (i) a discrete, Booleann reward with contact penalties and (ii) a continuous distance-based reward between joints and the target object. Each agent trained for 3 × 10⁷ timesteps at 50 Hz. The Booleann reward function performed poorly by entropy and convergence metrics, while the continuous reward function achieved success. The trained agent using the continuous reward was integrated into a dynamic AR scene, where a user controlled the prosthesis via a myoelectric armband while the grasping motion was actuated automatically. This framework demonstrates potential for assisting patients by automating certain movements to reduce initial control difficulty and improve rehabilitation outcomes. Full article

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

Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft–prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 ± 3.8 (74.3% ± 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 ± 5.2 vs. 26.6 ± 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results. Full article

Introduction: Odontogenic keratocyst (OKC) is a locally aggressive cystic lesion derived from remnants of the dental lamina. It is most commonly located in the posterior mandible, while maxillary involvement is rare and poses diagnostic and surgical challenges due to its proximity to critical anatomical structures. This case report describes the surgical management of a maxillary OKC with an uncommon localisation. Methods: A 50-year-old male presented with an asymptomatic swelling in the posterior maxilla. Cone beam computed tomography (CBCT) revealed a well-defined unilocular radiolucency extending toward the maxillary sinus floor. Surgical management included complete enucleation and peripheral curettage, followed by histopathological confirmation. The defect was left to heal naturally through bone regeneration without the need for grafting. Results: Intraoperatively, a thin pearly white cystic capsule and buccal cortical thinning were observed, consistent with OKC. The lesion was enucleated intact, without rupture or sinus perforation. Histology confirmed the diagnosis. Postoperative healing was uneventful, with radiographic follow-up at one month showing favourable healing changes. Conclusions: Careful surgical planning combined with advanced imaging facilitates safe and effective management of OKCs in uncommon maxillary sites. Enucleation with peripheral curettage provided satisfactory short-term outcomes. Long-term follow-up remains essential due to the risk of recurrence. Full article

Introduction: Oral health in children is essential for their overall well-being, influencing nutrition, language development, and self-esteem. Dental caries represent one of the most prevalent chronic diseases in childhood. Objective: The objective of this study is to evaluate the association between parents’ self-perceived knowledge of oral health and the presence of dental caries in their children. Materials and Methods: A cross-sectional observational study was conducted with 1052 children aged 4 to 14 years and their parents in Quito, Ecuador. Parents completed validated questionnaires (OHIP-14, OIDP, CPQ, and OHQoL-UK) to assess their self-perceived oral health knowledge. Clinical examinations were performed to detect cavitated carious lesions. Statistical analysis included Chi-square tests and odds ratio (OR) calculations. Results: A significant association was found between lower parental knowledge and higher prevalence of dental caries in children (Chi-square = 16.245, p = 0.0062; OR = 18.18, 95% CI [1.80–183.75]). Most caries cases were found in children whose parents rated their knowledge as “good” or “very good,” suggesting a gap between perceived and actual knowledge. Conclusions: The findings highlight the need for targeted educational strategies that address both knowledge and behavioral practices in oral health, especially among parents with low self-perceived knowledge. Full article

Objectives: This study aimed to compare the 5-year cumulative survival rates and clinical outcomes of zirconia and lithium disilicate restorations in both tooth- and implant-supported prostheses, focusing on survival, technical and biological complications, as well as patient-reported satisfaction. Materials and Methods: A retrospective cohort of 200 patients treated with either zirconia (n = 100) or lithium disilicate (n = 100) fixed restorations between 2020 and 2024 was analyzed. Only cases with a minimum follow-up of 5 years were included. Clinical parameters (fracture, chipping, retention loss, secondary caries, peri-implant complications), radiographic outcomes (marginal bone loss, periapical stability), and patient satisfaction (VAS scores for esthetics and function) were evaluated. Kaplan–Meier survival analysis and subgroup analyses (anterior/posterior, tooth-/implant-supported) were performed. Results: At 5 years, the cumulative survival rate was 94.0% for zirconia and 89.0% for lithium disilicate (p = 0.210). Technical complications were lower with zirconia (14.0% vs. 21.0%, p = 0.182), including fewer fractures (6.0% vs. 12.0%, p = 0.126). Chipping (5.0% vs. 7.0%) and debonding (3.0% vs. 2.0%) showed no significant differences. Biological outcomes were comparable: secondary caries (7.0% vs. 11.0%, p = 0.332), endodontic issues (4.0% vs. 6.0%, p = 0.516), peri-implant mucositis (9.0% vs. 12.0%, p = 0.495) and peri-implantitis (3.0% vs. 5.0%, p = 0.470). Radiographically, periapical stability was preserved in most cases (93.0% vs. 89.0%, p = 0.317), and the mean marginal bone loss was slightly lower with zirconia (0.46 ± 0.25 mm vs. 0.53 ± 0.30 mm, p = 0.148). Patient-reported outcomes were favorable in both groups, with esthetic VAS scores of 8.6 vs. 8.2 (p = 0.072) and functional scores of 8.4 vs. 8.0 (p = 0.085). Zirconia was rated higher in posterior/implant-supported cases, while lithium disilicate was preferred in anterior restorations. Conclusions: Both zirconia and lithium disilicate restorations demonstrated favorable long-term outcomes, with zirconia trending toward superior mechanical reliability in posterior and implant-supported restorations, and lithium disilicate excelling in esthetic performance, particularly in anterior regions. Material selection should be guided by clinical indication, occlusal load distribution, and esthetic requirements. Full article

The number of endoprosthetic implants is constantly increasing. Successful osseointegration of the inserted material into the bone is essential for a prosthesis to remain in the bone as long as possible. In the clinical setting, a roughened titanium surface of implants is used as standard to enable the best possible osseointegration. Vitamin K2 and vitamin D3 play a decisive role in dynamic bone metabolism and therefore also influence osseointegration. For the first time, we carried out in vitro investigations with clinically relevant cells, primary healthy human osteoblasts (hOBs). We qualitatively compared the adhesion behaviour of hOBs on a plastic surface, a smooth, regular titanium surface structure and a roughened, irregular titanium surface structure by scanning electron microscopy and fluorescence microscopy. The osteogenic behaviour and the osteogenic differentiation capacity were quantitatively investigated by analysing the activity of alkaline phosphatase and the alizarin red S assay under the influence of vitamin K2, vitamin D3 and the combination of both vitamins. It was shown that more adhesion points formed between the cells and the titanium on the rough surface structure. In addition, a solid cell network developed more quickly on this side, with cell runners forming in three-dimensional space, which means the interactions between the cells across different cell layers. On the other hand, a structured cell network also appeared on the regular smooth surface structure, which means that the network seems to be formed and built up along a defined structure. The addition of vitamins further increased the osteogenic differentiation capacity on the rough titanium surface structure. In particular, the isolated addition of vitamin K2 showed an improved osteogenic differentiation in the long-term observation, whereas the combined addition of both vitamins promoted the initial osteogenic differentiation. Vitamin K2, therefore, plays a greater role in osseointegration than previously assumed. This opens up new possibilities for the use of vitamin K2 during and after the surgical insertion of an implant. The use of vitamin K2 should be reconsidered for clinical applications in implant care and further investigated clinically. Full article

Acrylic resin is widely used in removable dental prostheses due to its biocompatibility, low cost, and ease of handling; however, it presents mechanical limitations and a high susceptibility to microbial colonization, particularly by Candida albicans. The incorporation of nanoparticles into polymethyl methacrylate (PMMA) has been investigated as a strategy to mitigate these drawbacks. This scoping review evaluated the impacts of incorporating chitosan (CTS) nanoparticles into PMMA on antimicrobial activity and mechanical properties. A comprehensive search of the PubMed, Scopus, Web of Science, and BVS databases resulted in the retrieval of 1912 records. After removing 557 duplicates and applying the eligibility criteria, 9 in vitro studies were included. Despite methodological heterogeneity, most studies reported enhanced antifungal activity against C. albicans and improvements in mechanical properties, such as microhardness and overall strength, when CTS was incorporated. Thus, CTS appears to be a promising additive for denture base resins, with the potential to reduce denture-associated infections and increase the longevity of prostheses. Nevertheless, standardized methodologies and well-designed in vivo and clinical investigations remain essential to determine optimal concentrations, incorporation techniques, and long-term clinical performance before implementation. A scoping review design was selected due to the exploratory nature of the study and the heterogeneity of available evidence, which precludes direct comparisons and quantitative synthesis. Full article