Clinical Oral Investigations最新文献

Objective: To examine the transdentinal response of odontoblast-like cells (MDPC-23), dental pulp stem cells (DPSC), and macrophages to flavonoid-based primers applied to caries-affected dentin.

Materials and methods: Primers were prepared from 20 mM of Naringin, Kaempferol, or Baicalein in 20% ethanol. Caries-affected dentin discs (N = 56) were produced using a microcosm biofilm model and mounted in artificial pulp chambers with MDPC-23 cells seeded on the pulp side. Occlusal surfaces (n = 8) were etched with 35% phosphoric acid, rinsed, and blot-dried, followed by application of ultrapure water (negative control, NC), 20% ethanol (solvent control, SC), flavonoid primers, or 29% hydrogen peroxide (positive control, PC). After 24 h, cell viability and morphology (scanning electron microscopy, SEM) were evaluated. Extracts obtained by transdentinal diffusion were applied to DPSC and MDPC-23 cells for up to 7 days to assess cell viability and mineralization, and to macrophages (RAW 264.7) for reactive oxygen species (ROS) production. Data were analyzed using ANOVA and Sidak's test (α = 5%).

Results: None of the flavonoid primers reduced MDPC-23 viability, while PC and phosphoric acid showed significant differences from NC. SEM images revealed altered cell morphology in acid-etched groups. After 7 days, primers slightly increased DPSC viability, maintained MDPC-23 viability, promoted mineralization, and reduced ROS.

Conclusions: Flavonoid-based primers applied to caries-affected dentin were non-cytotoxic, stimulated mineralization in pulp cells, and lowered oxidative stress in macrophages.

Clinical relevance: Flavonoid primers could support pulp health during dentin pretreatment, providing a conservative strategy for managing caries-affected dentin and reducing the risk of pulp irritation.

Objectives: To develop a cycling protocol for the evaluation of enamel erosion and to evaluate the effect of fluoride mouthrinses containing micrometric (TMPm) or nano-sized (TMPn) trimetaphosphate on enamel erosion using an artificial mouth apparatus.

Materials and methods: Fifty-three volunteers with high frequency of acid drink consumption were evaluated for duration and interval between sips, as well as the total drinking time. After standardizing the protocol, bovine enamel blocks (n = 120) were subjected to erosive cycles three times a day and treated with mouthrinses twice a day (1 min): placebo, 100 ppm F, 225 ppm F, 100 ppm F + 0.2% micrometric TMP (100F+TMPm) and 100 ppm F + 0.2% nano-sized TMP (100F+TMPn). The blocks were analyzed by profilometry (µm), surface hardness (KHN) and cross-sectional hardness (ΔKHN) after 1 or 3 days. Data were submitted to two-way ANOVA, followed by Student-Newman-Keuls' test, and Pearson correlation (p < 0.05).

Results: Most volunteers were women (74.4%) with a mean age of 21 years. Among all volunteers, 35.9% preferred to consume juices. Median sip time was 3.4 s, with a pause of 6.4 s and a total drinking time of 1 min and 10 s. Mouthrinses containing TMP maintained significantly higher SH (p < 0.001), with 100F+TMPn showing the lowest ΔKHN among all groups (p < 0.05). After 3 days, placebo produced the greatest enamel wear, SH loss, and ΔKHN, whereas 100F+TMPn achieved the lowest values (p < 0.05).

Conclusions: The protocol developed using an artificial mouth is informative and suitable for studying erosive tooth wear under in vitro conditions. Treatment with mouthrinses containing TMP significantly reduced enamel erosive wear and mineral loss.

Clinical relevance: TMP supplementation in mouthrinses significantly enhances their protective effect against erosive enamel wear.

Objectives: "The objective of this randomized control trial is to compare the marginal bone loss (MBL) in single implant-retained mandibular overdentures (SIRMO) retained by two different types of attachments using two healing protocols after a 2-year follow-up.

Materials & methods: SIRMOs were constructed for eighty completely edentulous patients. The latters were randomized based on the healing protocol and the used attachments into 4 equal groups: Submerged healing with ball attachment (BS), submerged with CM-LOC attachment (CS), non-submerged with ball attachment (BN), and non-submerged with CM-LOC (CN). Standardized peri-apical radiographs at baseline, 12 and 24 months were recorded to measure MBL. Comparisons for numerical data were performed using either Mann Whitney-U or Kruskal Wallis tests. Binary and categorical data were compared using chi square test. Significance level was set at p < .05.

Results: During the healing period, 6 implants failed, and 4 drop-outs were recorded. At the second year, 27/34 ball groups and 28/36 CM-LOC groups were recalled, no significant difference between B (0.28 ± 0.44) and C (0.38 ± 0.46) favoring B group (p = .3), and N (0.27 ± 0.39) and S (0.43 ± 0.51) favoring N group (P = .6). MBL revealed no significant difference neither between B and C groups nor between N and S groups.

Conclusion: Both attachments showed physiologically accepted limits of MBL, favoring the non-submerged healing protocol after a 2-year follow-up period.

Clinical relevance: Submerged (S) and Non-submerged (N) protocols could be used for a SIMOR, favoring the N protocol after a 2-year follow-up.

Trial registration number: PACTR20183003085193.

Aim: This in vitro study aimed to compare the direct (visual exam) versus indirect (3D-colored digital images exam) assessments of ICDAS (dental caries), BEWE (erosive tooth wear), and TF (enamel fluorosis lesions) indices performed on the occlusal surfaces of extracted human teeth for the detection and severity differentiation of dental caries, erosive tooth wear, and enamel fluorosis lesions.

Materials and methods: A total of 453 occlusal surfaces from extracted human teeth were mounted on 28 typodont models. Surfaces were examined directly (visual) and indirectly using 3D-coloured intraoral scans (TRIOS 4, 3Shape). Three indices were assessed: International Caries Detection and Assessment System (ICDAS; caries), Basic Erosive Wear Examination (BEWE; erosive tooth wear), and Thylstrup-Fejerskov (TF; fluorosis). Agreement between methods was analysed using weighted kappa statistics and percentage agreement.

Results: Substantial agreement was observed between direct and indirect methods: ICDAS (κ = 0.72, 64%), BEWE (κ = 0.70, 73%), and TF (κ = 0.75, 86%). Early lesions (ICDAS 1-2, BEWE 1) were more frequently misclassified.

Conclusions: 3D-coloured intraoral scanner imaging shows substantial agreement with visual examination for detecting and grading caries, erosive tooth wear, and fluorosis.

Clinical significance: This study supports the use of intraoral scanners as a practical adjunct to visual examination for documentation, education, and potentially remote consultations. Further clinical validation is warranted.

Objectives: This study aims to propose an iterative finite element method to simulate and analyze the long-term biomechanical responses during space closure in clear aligner therapy (CAT) extraction treatment.

Materials and methods: A patient-specific FE model was reconstructed from cone beam computed tomography and intraoral scanning. An innovative algorithm has been developed to automate the generation of CA model sequences for subsequent force loading and to enable dynamic simulation through real-time updates of teeth and periodontal ligament (PDL) positions. Each aligner was simulated in 10 iterations ("micro-cycle"), and the full treatment consisted of 30 aligners with 0.25 mm/step ("macro-cycle").

Results: The algorithm achieved complete space closure. In the macro-cycle, torque control gradually escalated as the extraction gap narrowed, leading to a reversal in the direction of root movement of anterior teeth in the 16th aligner. In the micro-cycle, the initial displacement of the anterior teeth accounts for 36% to 65% of the cumulative displacement, with the contact stress initially distributed evenly across the labial surface of the dental crown, gradually concentrating on the labial cervix and lingual incisal sites.

Conclusions: Changes in contact stress led to altered tooth movement, initially tipping and later torque movements during space closure. Cumulative displacements, rather than initial responses, should represent tooth movement tendency.

Clinical relevance: The proposed methods can be integrated into existing clinical software platforms and advance precision treatment planning through biomechanical simulation. Based on the biomechanical results, personalized staging strategies and overcorrection can be made to alleviate side effects.

Objectives: The objective of this study is to assess how different annotation methods used during AI model training affect the accuracy of early caries lesion detection, and how the choice of the evaluation reference standard leads to significant differences in assessing AI models' outcomes.

Clinical relevance: AI-based tools for caries detection are becoming common in dentistry. This study shows that how these models are evaluated can significantly impact perceived performance. Clinicians and developers should ensure that evaluation standards are independent and clinically relevant to avoid overestimating AI's diagnostic abilities and to build trust for real-world use and regulatory approval.

Methods: Multiple AI caries lesion segmentation models were trained on the ACTA-DIRECT dataset using annotations from (1) single dentists, (2) aggregated strategies (majority vote, consensus meetings, STAPLE), and (3) micro-CT-based methods. Model accuracy was evaluated using two approaches: (1) comparison against micro-CT-based annotations and (2) comparison against the training-matched annotations. Statistical significance of differences in model diagnostic accuracy across annotation strategies was assessed using the McNemar test.

Results: There was no statistically significant difference in diagnostic accuracy among AI models when compared to micro-CT-based annotations. However, the diagnostic accuracy was considered statistically significantly higher when the results of the AI models were evaluated with the training-matched annotations.

Conclusion: Our findings indicate a strong influence of reference standards on AI model evaluation. While annotation strategies during training did not significantly affect AI accuracy in caries lesion segmentation, evaluation was subject to bias when models were tested against different reference standards. CLINICAL RELEVANCE : AI-based tools for caries detection are becoming common in dentistry. This study shows that how these models are evaluated can significantly impact perceived performance. Clinicians and developers should ensure that evaluation standards are independent and clinically relevant to avoid overestimating AI's diagnostic abilities and to build trust for real-world use and regulatory approval.

Objectives: Although superficial fungal infections of the oral and maxillofacial region are common, deep fungal infections remain unfamiliar. We investigated the prevalence of fungal infections in this location in Thailand from specimens examined in the Department of Oral and Maxillofacial Pathology over a 50-year period.

Materials and methods: Cases diagnosed as fungal infections in our archive were selected. Demographic data, risk factors, clinical and radiographic features, clinical differential diagnoses and treatments were analyzed.

Results: Of 22,070 biopsied specimens, 41 cases (0.19%) were fungal infections in this location. The prevalence increased in the last decade. Approximately 71% were candidiasis, while 29% constituted deep infections including mucormycosis, aspergillosis and histoplasmosis. Fungal infections predominantly affected elderly individuals (mean age: 62.1 years). Both superficial and deep types exhibited a female predominance with a ratio of 1:3.8 and 1:3, respectively. About 60% of patients were associated with risk factors, namely, betel quid chewing, diabetes mellitus and human immunodeficiency virus infection. Clinically misdiagnosed chronic hyperplastic candidiasis as erythroleukoplakia/lichen planus, and deep fungal infections as osteomyelitis/oral squamous cell carcinoma were frequently observed. All candidiasis were treated with topical antifungal drugs, while mucormycosis and histoplasmosis required systemic antifungal therapy.

Conclusions: Fungal infections constituted less than 1% among biopsied specimens. The majority of fungal infections were clinically misdiagnosed. Currently, histopathologic examinations using proper special stains play a vital role to achieve a definite diagnosis.

Clinical relevance: Unfamiliarity with deep fungal infections in the oral and maxillofacial region among oral healthcare personnel may lead to misdiagnosis and inappropriate treatment. Awareness of fungal infections in this area must be encouraged.