Clinical Oral Investigations最新文献

Objectives: Vitamin D has been extensively studied in dentistry in the modern past. However, its impact on caries progression and arrest remains unclear. This narrative review aims to provide a critical overview of the relationship between vitamin D and caries, with a focus on the historical development of the topic, current scientific understanding, and potential future perspectives.

Materials and methods: A literature review and screening of historical periodicals was performed to outline the role of vitamin D in caries prevention in the past and in the future. Articles focusing on the historic use of vitamin D in cariology and vitamin D in cariology were included and evaluated.

Results: Literature showed that vitamin D was described as one of the central caries preventive agents in the 1930s and 1940s until systemic and topical fluoridation became more prominent. Possible mechanisms described by current science include effects on tooth development and immune modulation via saliva.

Conclusions: The emergence of fluoride as the leading preventive measure in cariology shifted the focus away from vitamin D research. However, recent studies have renewed interest in the potential causal role of vitamin D in caries prevention.

Clinical relevance: Further research is needed to examine the role of vitamin D in the proteome of saliva, pellicle and initial caries lesions, as well as to visualize its presumed arresting effect at the ultrastructural level. Additionally, prospective studies on the influence of vitamin D on caries progression in permanent teeth are necessary.

Objectives: This study aimed to evaluate the effects of different irrigation protocols on the removal of mono- and multispecies biofilms, as well as on chemical alterations induced in superficial dentin.

Materials and methods: Specimens were divided into two groups according to the irrigating solution used: sodium hypochlorite (NaOCl 2.5%) or saline solution (SS 0.9%), and were subjected to agitation using either passive ultrasonic irrigation or EasyClean. The chemical composition of dentin discs was assessed by attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR), based on the Amide III/Phosphate and Carbonate/Phosphate ratios at three time points: baseline, after conventional irrigation, and after agitation. In parallel, E. faecalis, E. faecalis + S. oralis, and E. faecalis + C. albicans biofilms were grown on bovine dentin blocks and subjected to the same irrigation protocols. Cell viability was quantified by confocal laser scanning microscopy following Live/Dead staining. Data were analyzed using Kruskal-Wallis, Dunn, and Wilcoxon tests (α < 0.05).

Results: The Amide III/Phosphate ratio was significantly reduced in the NaOCl groups after agitation (p < 0.05), while changes in the Carbonate/Phosphate ratio were observed only in the SS groups when compared to NaOCl (p < 0.05). From a microbiological perspective, both activation methods with NaOCl significantly reduced cell viability, particularly ultrasonic activation in monospecies biofilms and EasyClean in multispecies biofilms (p < 0.05).

Conclusion: Based on the results and the methodology applied, it can be concluded that NaOCl activation with either ultrasonic irrigation or EasyClean is effective for disinfection, although it promotes chemical changes in dentin.

Clinical relevance: This study analyzes the impact of irrigation protocols on biofilm removal and dentin composition. NaOCl activation was effective in reducing microbial viability but promoted chemical changes in dentin, highlighting the need to balance disinfection and structural preservation in endodontic practice.

Aim: The Nuclear Receptor Coactivator 4 (NCOA4)-mediated ferritinophagy and the Acyl-CoA synthetase long-chain family member 4 (ACSL4)-mediated lipid peroxidation promote ferroptosis. Nuclear factor erythroid-2 related factor-2 (Nrf2), a transcription factor, controls antioxidants, detoxifying enzymes, and ferroptosis. The concerted activity of NCOA4, ACSL4, and Nrf2 in periodontitis associated with or without T2DM needs exploration.

Materials and methods: Forty-two patients were recruited and categorized into 3 groups: Group I: systemically and periodontally healthy (PH, n = 14); Group II: Stage III/IV Periodontitis (PD, n = 14); Group III: Stage III/IV Periodontitis with uncontrolled Type 2 Diabetes mellitus (T2DM + DM, n = 14). The site-specific periodontal clinical parameters were recorded. Gingival tissue biopsies were evaluated for gene expression of NCOA4, Nrf2, and ACSL4 by real time -PCR.

Results: In groups II and III, NCOA4 expression increased by 10.07 ± 9.15 and 9.40 ± 6.29-fold, respectively, whereas ACSL4 expression increased by 3.23 ± 2.53 and 2.03 ± 2.22-fold, respectively, compared to group I (P < 0.05). Nrf2 expression decreased in groups II (0.36 ± 0.39) and III (0.83 ± 0.89) compared to group I, with the least expression in group II. In the total sample analysis, NCOA4 FC and Nrf2 CT showed a significant positive correlation with all clinical parameters and with each other (P < 0.05). There was a significant positive correlation (P < 0.05) between NCOA4 FC and ACSL4 CT (P < 0.05). In group II, NCOA4 CT had significant positive and negative correlations with Nrf2 FC and ACSL4 FC values, respectively (P < 0.05). The diagnostic accuracy of NCOA4 and Nrf2 in differentiating between periodontal health and periodontitis was 89% (AUC = 0.96) and 71% (AUC = 0.60), respectively. Likewise, NCOA4 and Nrf2 demonstrated diagnostic accuracy of 67.8% (AUC = 0.73) and 78.5% (AUC = 0.85) in differentiating between diabetic periodontitis and periodontal health, respectively.

Conclusions: Ferroptosis in the progression of periodontitis and diabetes-associated periodontitis may be linked to dysregulated expressions of the NCOA4, ACSL4, and Nrf2 genes. However, additional investigation is required to fully comprehend the findings.

Objectives: This prospective controlled clinical trial aimed to evaluate the periodontal status of posterior indirect resin composite (IRC) restorations followed by proximal box elevation (PBE), based on clinical and radiographic parameters. Additionally, the study investigated the influence of restoration depth and supracrestal tissue attachment (STA) violation on periodontal outcomes.

Materials and methods: A total of 80 molars with deep cervical margins were restored using IRC (SR Nexco) with PBE (Tetric-N Flow and Tetric-N Ceram). Of these, 42 restorations with PBE on one proximal surface (mesial or distal) in 39 patients were included. The test group consisted of the proximal surfaces restored with PBE due to subgingival margin placement, whereas the control group comprised the opposite proximal surfaces of the same teeth without restoration. Periodontal parameters including plaque index (PI), gingival index (GI), probing pocket depth (PPD), and bleeding on probing (BoP) were assessed at baseline (15 days after cementation), and at 6, 12, 24, and 36 months. Standardized periapical radiographs were used to monitor alveolar bone levels at designated follow-ups. Test and control sides were compared using the Robust Mixed ANOVA test (PI, GI, PPD) and McNemar's test (BoP).

Results: Data were available from 42, 39, 33, and 30 teeth at baseline, 6, 12, 24, and 36 months. No significant differences were found at any time point (p > 0.05) for none of the periodontal parameters. PPD values showed a significant change over time (p = 0.001), with pairwise differences observed between baseline and 12-, 24-, and 36-month measurements, as well as between 6- and 36-month, 12- and 36-month, and 24- and 36-month time points. Within the test group, no significant differences in BoP were found among STA grades (p > 0.05).

Conclusions: PBE appears to be biologically safe and clinically acceptable, even when the restorative margin is located close to or slightly within the STA, without leading to severe periodontal response resulting in alveolar bone resorption.

Clinical relevance: PBE facilitates the adhesive restoration of deep proximal cavities without surgical intervention. The findings support the clinical use of PBE in anatomically challenging cases where subgingival margin elevation is required.

Trial registration: ClinicalTrials.gov identifier: NCT03832829.

Objectives: To evaluate the presence of SARS-CoV-2 RNA in the subgingival biofilm of COVID-19 individuals and its association with generalized gingivitis.

Materials and methods: A pool of subgingival biofilm samples was collected from 80 individuals, 59 with and 21 without COVID-19, after periodontal diagnosis (classified as periodontally healthy or generalized gingivitis). Samples were tested for SARS-CoV-2 RNA by qRT-PCR. Binary logistic regression and Mann-Whitney test were applied to evaluate associations between the presence and amount of SARS-CoV-2 RNA in the biofilm and the presence of gingivitis (p < 0.05).

Results: SARS-CoV-2 RNA was detected in the subgingival biofilm of 35.6% (n = 21) of individuals with COVID-19 but not in individuals without COVID-19. In the COVID-19 group, SARS-CoV-2 RNA was detected in periodontally healthy individuals (47.6%) and those with gingivitis (52.4%). After adjusting for covariates, SARS-CoV-2 in dental biofilm was associated with 7.25-fold higher odds of generalized gingivitis (OR = 7.25; 95% CI: 1.41-37.33; p = 0.02).

Conclusion: SARS-CoV-2 was detected in subgingival biofilms of COVID-19-positive individuals and was associated with an increased chance of gingivitis, providing preliminary evidence of a potential role of the virus in gingival inflammation. However, a bidirectional relationship may be present, as gingival inflammation could also create a more favorable environment for viral colonization of the subgingival biofilm.

Clinical relevance: Maintaining periodontal health during and after COVID-19 infection may be important not only for oral well-being but also for mitigating viral persistence and its inflammatory effects.

Objective: To evaluate the effects of concentrated growth factors (CGFs) combined with Bio-Oss bone substitute on the periodontal healing of adjacent teeth following impacted tooth extraction.

Methods: This single-centre prospective controlled study enrolled 60 patients requiring bilateral impacted mandibular third molar extraction. Patients were randomly allocated to a test group (n = 30; extraction socket filled with CGFs + Bio-Oss and covered with a CGF membrane) or control group (n = 30; natural healing). Primary outcomes included periodontal probing depth (PD) and distal bone height measured by cone beam computed tomography at baseline and 3 and 6 months. Secondary outcomes comprised the visual analogue scale (VAS) pain scores, swelling assessment and dry socket incidence. Statistical analysis was performed using SPSS 26.0, with significance set at P < 0.05.

Results: A total of 60 patients were enrolled in this randomised single-blind clinical trial. The test group showed significantly greater PD reduction (2.41 ± 0.89 vs. 1.52 ± 0.73 mm, P < 0.001) and bone height gain (2.87 ± 1.12 vs. 1.63 ± 0.91 mm, P < 0.001) at 6 months than the control group. The VAS pain scores were significantly lower in the test group at days 3 and 7 (P < 0.001). No cases of dry socket occurred in the test group, compared with three cases (11.1%) in the control group. Multivariate analysis revealed that CGFs + Bio-Oss application was the strongest predictor of bone gain ≥ 2 mm (β = 0.412, P < 0.001).

Conclusion: Concentrated growth factors combined with Bio-Oss significantly enhance periodontal healing and bone regeneration at adjacent teeth following impacted tooth extraction while reducing postoperative complications. This combined approach represents a promising strategy for clinical practice.

Objective: This study aimed to evaluate and compare the concentrations of Platelet-Derived Growth Factor (PDGF), Vascular Endothelial Growth Factor (VEGF), and Transforming Growth Factor (TGF) in platelet-rich fibrin (PRF) biomaterials obtained from individuals with various systemic diseases.

Materials and methods: A total of 65 individuals were included and divided into five groups: healthy controls (n = 13), patients diagnosed with diabetes (n = 13), patients receiving bisphosphonate therapy (n = 13), patients using immunomodulatory drugs (n = 13), and patients diagnosed with hepatitis (n = 13). PRF samples were collected from each participant and analyzed in a biochemistry laboratory using ELISA kits specific to PDGF, VEGF, and TGF. The growth factor concentrations were statistically compared across the groups.

Results: The highest mean concentration of PDGF was observed in the hepatitis group. The highest mean concentrations of VEGF and TGF were found in patients using immunomodulatory drugs. However, the differences in growth factor concentrations among the groups were not statistically significant.

Conclusion: PRF is an effective biomaterial widely used in dentistry due to its rich content of growth factors. While no statistically significant differences were found in growth factor concentrations among individuals with different systemic conditions, a notable increase in these levels was observed in certain disease groups. These findings suggest that systemic diseases may influence the biological composition of PRF, warranting further investigation.

Objectives: This study aimed to evaluate the efficacy of a Wnt pathway activator, lithium chloride (LiCl), and LiCl-stimulated human primary periodontal ligament cells (hPDLCs) cell sheets integrated with medical-grade melt-electrowritten polycaprolactone (mPCL) scaffolds for in vivo periodontal regeneration.

Methods: This study followed a three-stage experimental design. The first stage consisted of local administration of various concentrations of LiCl (10, 100, and 1000 mM) in rat periodontal defects for 3 weeks to evaluate its dosage effects on in vivo periodontal regeneration. Next, the impact of LiCl on cementogenic and osteogenic differentiation of human primary periodontal ligament cells (hPDLCs) was examined in vitro. Finally, LiCl-pretreated hPDLCs cell sheets, combined with mPCL scaffolds, were transplanted into rat periodontal defects for 4 weeks. Micro-CT, histology, and immunohistochemistry analyses were conducted to assess in vivo periodontal tissue formation.

Results: Local administration of LiCl (10 mM and 100 mM) promoted the regeneration of alveolar bone, cementum, and obliquely oriented PDL Sharpey fibres in the rat defect model. In vitro, 10 mM LiCl enhanced cementogenic and osteogenic differentiation in hPDLCs. Moreover, when implanting a 10 mM LiCl-treated hPDLCs cell sheet combined with a PCL scaffold into experimentally induced rat periodontal defects, significant regeneration occurred, including the formation of alveolar bone and cementum, along with Sharpey's fibres inserted into the new cementum and alveolar bone.

Significance: This study demonstrates the potential of combining LiCl-stimulated hPDLCs cell sheets with mPCL scaffolds to enhance periodontal regeneration, highlighting the significance of LiCl as a promising therapeutic agent for periodontal regenerative treatment and tissue engineering strategies.

Objectives: This randomized clinical trial evaluated the effects of three different antiseptic mouth rinses, chlorhexidine (CHX), CHX with anti-discoloration system (CHX ADS), and povidone-iodine (PVP-Iodine), on early wound healing, plaque formation, microbial load, inflammation biomarkers, and patient satisfaction after dental implant placement.

Materials and methods: Sixty patients received one dental implant and were assigned by a computer-generated simple random allocation (random.org) to rinse with either CHX 0.2%, CHX ADS 0.2%, or PVP-Iodine 10% preoperatively and for 10 days postoperatively. No blinding was implemented. Primary outcome of the study was the assessment of the Early Wound Healing Index (EHI). Secondary outcomes included bacterial load of five periopathogens, levels of activated matrix metalloproteinase-8 (aMMP-8), plaque index (PI), and patient satisfaction. Statistical analysis employed Kruskal-Wallis and chi-square tests with significance set at p < 0.05.

Results: No statistically significant differences were observed among the three groups in EHI scores, microbiological profiles, aMMP-8 levels, or PI at any time point. However, CHX ADS was rated significantly more favorably by patients regarding taste, dysgeusia, mucosal burning, and tooth discoloration (all p < 0.05). Interrater agreement on EHI was substantial (κ = 0.72).

Conclusions: All tested mouth rinses demonstrated comparable efficacy in promoting early wound healing and infection control after implant surgery. CHX ADS showed superior patient acceptance, suggesting its potential as a preferred option based on subjective tolerability. Standardization of healing assessment indices is recommended for future studies to enhance comparability.

Clinical relevance: While CHX, CHX ADS, and PVP-Iodine were equally effective for early peri-implant wound healing, CHX ADS showed better patient acceptance with fewer side effects (taste alteration, tooth discoloration), which is likely to improve compliance, reflecting enhanced tolerability rather than superior healing efficacy. This finding may guide clinicians in selecting antiseptic protocols that optimize both clinical outcomes and patient comfort and patient compliance.

Objectives: The study described a protocol for static-guided endodontic surgery, involving 3D in-house printed guides and trephine burs, to perform osteotomy and root apex resection simultaneously.

Materials and methods: Clinical and radiographic data from 6 patients (9 roots) were evaluated. Cone-Beam Computed Tomography and intraoral scans were imported into the guided surgery software to virtually plan the osteotomy and a 3 mm root-end resection. Based on the virtual plan, surgical guides were designed, and Computer-Aided Design files exported in Standard Tessellation Language format were imported into the slicing software of the 3D printer for manufacturing. Surgeries were carried out under local anaesthesia and involved a mucoperiosteal flap incision and elevation, guided osteotomy and root-end resection using trephine burs, removal of the bone trapdoor, root apex, and periapical lesion with curettes, ultrasonic retropreparation and filling with Mineral Trioxide Aggregate, followed by suturing.

Results: For osteotomy, the size ranged from 20.00 to 93.00 mm² (59.17 ± 32.28 mm²), and the surgical time from 40 to 102 min (73.67 ± 23.00 min). These parameters were influenced by the size of the periapical lesion and the limited accessibility and visibility of the area. No complications occurred, and postoperative pain intensity was mild to moderate. Four patients achieved complete healing at the 6-month follow-up, and two by 12 months.

Conclusions: The current findings supported the use of 3D in-house printed guides and trephine burs in endodontic surgery.

Clinical relevance: 3D in-house printed guides in static-guided endodontic surgery offer a more cost-effective alternative to centralised facilities.