Search Results (515)

Background/Objectives: This study evaluated autologous platelet concentrates (APCs), including advanced platelet-rich fibrin (A-PRF+) and concentrated growth factors (CGFs), as biologically active matrices, and photobiomodulation (PBM) as a biophysical stimulus affecting soft and hard tissue regeneration following mandibular third molar extraction. Methods: A six-arm parallel randomised controlled trial was conducted including 135 patients. A total of 122 participants completed follow-up and were analysed: control (n = 22), photobiomodulation (n = 20), A-PRF+ (n = 19), CGF (n = 20), A-PRF+ plus photobiomodulation (n = 22), and CGF plus photobiomodulation (n = 19). The primary endpoint was postoperative pain intensity assessed on postoperative day 3 using an 11-point visual analogue scale (VAS). Secondary outcomes included swelling, trismus, wound healing assessed by the early healing index, and bone regeneration assessed by CBCT-based fractal dimension analysis at 4 months. Results: On postoperative day 3, mean VAS pain was 2.95 ± 2.65 in the control group and 1.00 ± 1.65 in the photobiomodulation group, corresponding to a mean difference of 1.95 VAS points. The overall between-group difference for day 3 pain was statistically significant. In swelling outcomes, no statistically significant between-group differences were observed at days 1, 3, or 7 across facial measurement lines. In CBCT fractal analysis, a significant group effect was detected for the mid socket region, with higher fractal dimension at 4 months in the CGF plus photobiomodulation group compared with the control. Conclusions: Both APCs and PBM positively influenced postoperative healing. Their combined application, particularly CGF with PBM, showed the most consistent regenerative effects, although not all outcomes differed significantly between groups. These minimally invasive strategies may support soft and hard tissue regeneration. Full article

This study evaluated the effect of saliva contamination at different stages of application of an acetone-based universal adhesive on dentin bond strength. Seventy-two caries-free third molars were assigned to six groups (n = 12) according to contamination step. Specimens underwent shear bond strength testing. To determine the SBS, each bonded specimen was subjected to an SBS test in a universal testing machine (Shimadzu Autograph AGS-X; Shimadzu Corp., Kyoto, Japan) equipped for operating at a crosshead speed of 1 mm/min. Data were analyzed using one-way analysis of variance (ANOVA) followed by Tamhane’s T2 test for post hoc multiple comparisons with p ˂ 0.05 as the significance level. Saliva contamination significantly affected dentin bond strength (p < 0.001). The highest bond strength was observed in the post-polymerization contamination group with adhesive reapplication (12.32 MPa), whereas the lowest values were recorded when contamination occurred after the initial adhesive application (6.37 MPa). Overall, contamination prior to polymerization resulted in reduced bond strength, while reapplication of adhesive after polymerization improved bonding performance. Within the limitations of this in vitro study, salivary contamination adversely influences the dentin bonding effectiveness of acetone-based universal adhesives, particularly when it occurs before curing. However, adhesive reapplication following post-polymerization contamination may partially compensate for this effect. Full article

The introduction of calcium-silicate-based sealers has renewed interest in simplified obturation protocols such as the single-cone technique, although warm techniques, including carrier-based obturation, are still considered the gold standard. The aim of this in vitro study was to compare the quality of root canal obturation achieved with single-cone and carrier-based techniques when used with the same calcium-silicate-based sealer. Thirty extracted mandibular molars were prepared using a standardized rotary instrumentation protocol and randomly assigned to two groups (n = 15 each): Group A was obturated using a carrier-based technique (Soft-Core obturators), while Group B was obturated with the single-cone technique. All canals were filled with the same calcium-silicate-based sealer (NeoSEALER Flo). Micro–computed tomography was used to evaluate the number and volume of voids of the obturation. Quantitative analysis showed that Group A exhibited a significantly lower number of voids (9.0 ± 5.0) and reduced total void volume (2.58 ± 0.8 mm³) compared with Group B (22.0 ± 10.1 voids; 4.71 ± 1.1 mm³; p = 0.00002 and p = 0.0026, respectively). Qualitative analysis confirmed that carrier-based obturation achieved a denser and more homogeneous filling, while the single-cone technique showed larger voids mainly in the coronal and middle thirds. Both techniques provided a reliable apical seal. Within the limitations of this in vitro study, carrier-based obturation demonstrated superior overall filling quality compared with the single-cone technique when used with a calcium-silicate-based sealer, particularly in the middle and coronal regions of the root canal. Full article

The objective of this in vitro study was to investigate the effects of dentin pretreatment protocols and thermocycling on the shear bond strength (SBS) of a self-adhesive resin cement (Maxcem elite chroma) on dentin. A total of 168 extracted human third molars were randomly divided into four main groups according to dentin pretreatment: no treatment, 10% polyacrylic acid, Optibond universal, and Scotchbond universal plus. Half of these were subjected to thermocycling (5000 cycles; 5–55 °C). Composite resin rods were bonded using the self-adhesive resin cement, and SBS was measured with a universal testing machine. Two-way ANOVA showed that dentin pretreatment and thermocycling significantly affected SBS, with significant interaction between factors (p < 0.001). The highest SBS was observed in the Optibond universal group (18.71 ± 0.43 MPa), while the lowest SBS occurred in the 10% polyacrylic acid-treated group after thermocycling (2.69 ± 0.39 MPa). Thermocycling significantly reduced SBS in all groups. These results indicate that pretreatment with a compatible universal adhesive improves bond durability, whereas 10% polyacrylic acid pretreatment adversely affects bonding performance. Full article

This study evaluated the effects of different provisional luting cement removal methods on the shear bond strength (SBS) of resin cement to dentin following immediate dentin sealing (IDS) performed with two adhesive systems. A total of 168 extracted, caries-free human third molars were used, of which 144 were allocated for SBS testing and 24 for scanning electron microscopy (SEM) analysis. Specimens were assigned according to the IDS protocol (no IDS, IDS with OptiBond FL, or IDS with G2-Bond), followed by provisional cementation using an eugenol-free temporary cement. Contaminated surfaces were subsequently cleaned with a hand scaler, aluminum oxide (Al₂O₃) air abrasion, or Katana Cleaner prior to final bonding with a dual-cure resin cement. SBS was measured after 24 h of water storage, and surface morphology was evaluated by SEM at 2500× magnification. IDS significantly increased SBS under uncontaminated conditions, with G2-Bond-based IDS exhibiting higher bond strength values than specimens without IDS. However, provisional cement contamination significantly reduced SBS regardless of the cleaning method applied, and none of the tested protocols fully restored the bond strength observed in uncontaminated IDS-treated dentin. SEM analysis revealed residual cement remnants and surface alterations after cleaning, even in specimens that appeared macroscopically clean. Within the limitations of this in vitro study, IDS enhances resin–dentin bonding when contamination is avoided; however, current mechanical and chemical cleaning methods are insufficient to completely recover bond strength compromised by provisional cement contamination, highlighting the importance of preventing contamination and preserving IDS layer integrity during indirect restorative procedures. Full article

Background: Idiopathic osteosclerosis is a non-expansile bone lesion of unknown etiology, mostly detected incidentally on dental radiographs. It is typically asymptomatic and does not require intervention. Methods: This case report presents a rare clinical presentation in a 30-year-old female patient in whom enlargement of idiopathic osteosclerosis was associated with the progressive migration of an impacted mandibular third molar into close proximity with the inferior alveolar canal. Consequently, this caused paresthesia of the lower lip and chin and required surgical intervention. Results: The diagnosis was confirmed through histopathological examination following surgical removal of the tooth and bone biopsy, which verified the presence of idiopathic osteosclerosis and excluded other possible differential diagnoses. Conclusions: The postsurgical period was uneventful, and the patient reported no neurosensory disturbances after surgical treatment. Full article

Background/Objective: Preoperative prediction of third molar eruption with artificial intelligence (AI) has been a challenge in dentistry and oral surgery. Methods: In this investigation, we used machine learning (ML) algorithms to characterize M3 panoramic radiological images for the preoperative differential diagnosis of third nolar eruption/retention and compared them with clibical explorations to validate their performance. Results: We retrospectively collected data of patients with mandibular thid molar retention, where all eruption diagnoses were confirmed via clinical exploration. A total of 383 panoramic radiographies were selected to train the PDApp software for eruption diagnosis for the software validation. Conclusions: The PDApp software achieved the highest performance metrics for the prediction of mandibular third molar eruption Full article

Ex vivo human tooth culture models preserve the native dentine–pulp complex and offer a translational platform to study pulp-capping biomaterials. This systematic review aimed to synthesize the evidence on histological pulp tissue responses to calcium silicate-based cement (CSCs) used for direct pulp capping in human tooth culture models. The review followed PRISMA 2020 guidance. Eligible studies were ex vivo whole human tooth culture models with direct pulp exposure treated with commercial or experimental CSCs and reporting histological outcomes. Risk of bias was assessed using the QUIN tool. Thirteen studies were included. Most used immature human third molars (from 15- to 19-year-old patients) and culture periods up to 28 days, with a minority extending observation to 45–90 days. Across hydraulic CSCs, Biodentine was the most frequently evaluated material, followed by ProRoot MTA and several experimental hydraulic and resin-modified formulations. Overall, hydraulic CSCs were consistently associated with biocompatible pulp responses and a pro-mineralization pattern characterized by periexposure mineralized foci/osteodentin-like tissue; where assessed, immunohistochemistry supported odontoblast-like differentiation. In contrast, the resin-modified CSC TheraCal LC and other experimental resin-modified CSCs showed more heterogeneous findings, with reports of absent, delayed, or less prominent mineralization compared with reference hydraulic CSCs. In intact human tooth culture models, hydraulic CSCs show reproducible biocompatibility and early mineralization features consistent with reparative dentinogenesis, whereas resin-modified CSCs demonstrate more variable histological performance. Full article

Background/Objectives: Impacted third molars are frequent and may increase surgical complexity, particularly when the mandibular third molar is in close proximity to the inferior alveolar canal (IAC). This study aimed to estimate the prevalence and impaction patterns of third molars in a Portuguese population and to characterize, using a nested CBCT subsample, the three-dimensional relationship between mandibular third molars and the IAC, including cortical integrity and lingual plate thickness. Methods: A retrospective observational analysis of 1062 orthopantomograms (OPGs) was performed to determine the prevalence and panoramic patterns using Winter, Pell and Gregory classifications and Rood–Shehab signs. A consecutive CBCT subsample (n = 205) was assessed for IAC position, contact status (no contact; contact with cortical bone; contact without cortical bone), cortical integrity, and lingual plate thickness. Descriptive statistics were complemented by effect sizes to support clinical interpretability. Results: The prevalence of impacted third molars was 34.9%, occurring predominantly in the mandible. Vertical angulation was the most prevalent pattern in both jaws. In the CBCT subsample, IAC position and contact patterns varied widely, and loss of cortical integrity was more often observed when panoramic high-risk signs were present. No clinically meaningful left–right asymmetry was identified across key anatomical risk indicators. Conclusions: In this Portuguese cohort, impacted third molars showed consistent panoramic patterns, while CBCT provided clinically relevant three-dimensional risk descriptors—particularly IAC contact type and cortical integrity—supporting selective CBCT use based on anatomical risk indicators rather than routine imaging. Full article

Background: Rotary instrument fracture during third molar extraction is rare but clinically relevant, presenting diagnostic and therapeutic challenges. Aim: This scoping review summarizes available evidence on bur breakage and displacement during third molar surgery, focusing on causes, clinical manifestations, and management strategies. Materials and Methods: A systematic search of PubMed, Virtual Health Library, and Google Scholar was conducted for studies published from January 2008 to March 2025 reporting rotary instrument fracture during third molar extraction. Extracted data were qualitatively analyzed. Results: Eight studies reporting eleven clinical cases were included. All fractures occurred during mandibular third molar extractions. Pain was the most frequent symptom (45%), followed by swelling (27%) and trismus (18%). Management varied from immediate surgical retrieval to conservative observation. Conclusions: Although uncommon, rotary bur fracture during third molar extraction requires preventive attention and accurate reporting. Adherence to manufacturer recommendations, single-use bur policies, and adequate irrigation should be considered. Prospective multicenter and mechanical studies are needed to establish standardized management protocols. Full article

Background: This in vitro study aimed to evaluate the effect of microabrasion as a surface pretreatment and to compare an experimental resin infiltrant with a commercially available system (ICON) in terms of enamel surface microhardness recovery and resin penetration depth in artificially demineralized enamel lesions. Methods: Forty-eight caries-free human third molars were prepared to obtain standardized enamel specimens, and artificial enamel lesions were created using a pH-cycling model. Specimens were randomly allocated into four groups (n = 12): experimental resin with microabrasion, experimental resin without microabrasion, ICON resin with microabrasion, and ICON resin without microabrasion. When indicated, microabrasion was performed using a 6.6% hydrochloric acid paste for a total application time of 30 s, followed by standard hydrochloric acid etching as part of the infiltration protocol. Enamel surface microhardness was measured at baseline, after demineralization, and after resin infiltration. Resin penetration depth was assessed using confocal laser scanning microscopy, with six specimens per group (n = 6). Data were analyzed using repeated-measures mixed-effects models and one-way ANOVA (p < 0.05). Results: Resin infiltration resulted in a partial recovery of enamel surface microhardness following demineralization; however, baseline hardness values were not fully restored, and no statistically significant differences were observed among the study groups (p > 0.05). These findings indicate surface stabilization rather than complete mechanical or mineral restoration. The ICON resin demonstrated significantly greater penetration depth than the experimental resin. In both resin systems, microabrasion significantly increased penetration depth. Conclusions: Within the limitations of this in vitro study, resin infiltration primarily contributed to the stabilization of demineralized enamel surfaces rather than true remineralization or full mechanical recovery. Although microabrasion enhanced resin penetration depth, this effect should be interpreted with caution due to the potential for cumulative enamel loss. From a clinical perspective, these findings support the selective use of microabrasion to enhance resin infiltration in early enamel lesions with pronounced surface barriers, while emphasizing the need to balance penetration benefits against enamel preservation. Full article

Objective: Inferior alveolar (IAN) and lingual nerve (LN) injuries are known complications of impacted mandibular third molar surgery and may result in persistent neurosensory deficits. This exploratory, non-randomized clinical study evaluated the clinical and electrophysiological effects of low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) on neurosensory recovery following trigeminal nerve injury. Methods: Twenty-seven patients with postoperative IAN or LN injury received LLLT, TENS, or placebo therapy according to institutional clinical protocols. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores, and electrophysiological evaluation was performed using electromyography by measuring cutaneous silent period (CSP) duration. Non-parametric statistical analyses were conducted using the Wilcoxon signed-rank and Mann–Whitney U tests. Results: LLLT was associated with statistically significant improvements in several neurosensory symptoms, including pain, burning sensation, speech difficulty, biting, and taste disturbance. In contrast, TENS and placebo treatment did not demonstrate a consistent or generalized improvement across neurosensory outcomes. CSP durations differed significantly between healthy and pathological sides both before and after treatment. Although CSP duration showed a tendency to increase following LLLT, these changes did not reach statistical significance. Subgroup analysis revealed greater clinical improvement in LN injuries compared with IAN injuries within the LLLT group. Conclusions: Within the limitations of this exploratory study, LLLT was associated with more pronounced clinical improvement than TENS or placebo in patients with third molar-related trigeminal nerve injury. CSP measurements provided supportive objective information, although electrophysiological recovery remained limited. Full article

Background/Objectives: Dynamic computer-assisted surgery (dCAS) has emerged as a promising tool, particularly in implantology, enabling real-time procedural adjustments through 3D image-based tracking. However, their application in other areas of oral surgery remains limited. This systematic review aims to evaluate the advantages, limitations, clinical implications, and complications associated with the use of dCAS in oral surgery (excluding implants or miniscrew insertion) beyond implant placement, in comparison to conventional freehand (FH) techniques. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. A focused PICO question was developed, and a comprehensive literature search was performed in PubMed, Scopus, and the Cochrane Library between February and March 2025, and supplemented by manual screening. The risk of bias of the included studies was evaluated using the Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized controlled trials (NRCTs). Data were summarized in tables and analyzed through qualitative synthesis. Results: Ten studies evaluating dCAS in several oral surgical procedures, including complex tooth extractions and endodontic surgery, were included. A substantial improvement was observed in accuracy of endodontic procedures. Operator experience was a key factor in surgical outcomes. Regarding postoperative complications, no significant differences were observed, although the trend indicated an equal or lower risk in comparison with conventional FH techniques. Conclusions: dCAS may significantly improve accuracy and efficiency in endodontic surgery and reduce operative time in complex mandibular third molar (M3M) extractions. The complication rate is comparable to that of conventional FH techniques. However, current evidence remains limited, heterogeneous, and mainly experimental. Further studies are recommended to validate the benefits of dCAS in clinical settings. Full article

The present study aimed to evaluate the effect of air-abrasion as a dentin pre-treatment on the bond strength of contemporary adhesive systems. The bonding approaches included etch-and-rinse (ER), self-etch (SE) and universal (UN) adhesive systems, with the latter applied in both ER and SE modes. Twenty-eight third molars were used, each sectioned in four parts. All specimens were embedded in acrylic resin, ground with silicon carbide papers, and divided into eight experimental groups (n = 14) based on the combination of surface pre-treatment (air-abrasion or none) and adhesive approach. Subsequently, a resin cylinder was bonded to each surface following the respective treatment. Shear bond strength (SBS) was evaluated at a cross-head speed of 0.7 mm/min using a shear-testing machine (OM100 Odeme, Luzerna, Brazil). The data were analyzed with one-way ANOVA and Tukey’s post hoc test. No statistically significant increase in SBS after air-abrasion of dentin was found for any of the experimental groups (p > 0.05). Among the adhesive strategies, the ER system presented higher SBS values (32.81 ± 9.04 MPa) than the UN adhesive applied in SE mode (21.68 ± 5.85 MPa) (p < 0.05). Mixed failures were the most common failure type across all groups. In particular, 20.5% of the specimens exhibited adhesive failure, 14.3% cohesive failure within resin composite, 12.5% cohesive failure within dentin and 52.7% specimens demonstrated mixed failure types. Dentin pre-treatment with air-abrasion using 29 μm Al₂O₃ did not significantly increase the SBS of the three tested contemporary adhesive systems; however, the choice of adhesive strategies influenced the SBS outcomes. Full article

In the present study, ten type-V natural deep eutectic solvents (NADESs) were synthesized and comprehensively characterized, based on urea as a hydrogen-bond acceptor and three different groups of donors—glycerol, organic carboxylic acids, and carbohydrates. Their physicochemical parameters, spectral characteristics (FTIR), surface tension, and solvatochromic properties were determined using Nile Red, betaine 30, and Kamlet–Taft parameters. The densities of the systems (1.243–1.361 g/cm³) and the high values of molar refraction and polarizability indicate the formation of highly organized hydrogen-bonded networks, with the incorporated carboxyl and hydroxyl groups enhancing the structural compactness of the NADES. Surface tension varied significantly (46.9–80.3 mN/m), defining systems with low, medium, and high polarity. Solvatochromic analysis revealed high E_NR, E_T(30), and E_T^N values, positioning all NADES as highly polar media, comparable or close to water, but with distinguishable H-bond donating/accepting ability depending on the third component. The normalized Kamlet–Taft parameters show that the NADES cover a broad solvent spectrum—from highly H-bond accepting to strongly H-bond donating or dipolar systems—highlighting the potential for fine-tuning the solvent according to target applications. The obtained results highlight the applicability of these NADESs as green, tunable media for the extraction and solvation of bioactive compounds. Full article