Clinical Oral Investigations最新文献

Aim: The purpose of this study was to compare postoperative nasal morphological changes between two intraoral alar cinch suture techniques in patients undergoing Le Fort I osteotomy.

Methods: A retrospective longitudinal study was conducted with patients undergoing Le Fort I osteotomy, and two types of alar cinch were evaluated. Patients with a history of nasal procedures or cleft lip surgery were excluded. Group 1 received a cinch that passes through the anterior nasal spine, and Group 2 involves only soft tissues. A descriptive analysis was performed, and the normality of variables was assessed using the Shapiro-Wilk test. The repeated measures ANOVA test was then used to evaluate changes over time between the two groups. When the assumption of sphericity was violated, the Mauchly's test, Greenhouse-Geisser, Huynh-Feldt, and Lower-Bound tests were used to correct for it. Between- and within-subjects effects were analyzed using Type III sums of squares. A significance level of 0.05 was considered.

Results: (N = 60) were randomly assigned to two groups (n = 30). No significant differences were found in demographic or clinical variables at baseline (p > 0.05). A considerable increase in interalar width was seen before and after surgery (p < 0.001), with more significant differences in group 1 (p = 0.004). Nasal projection and nasolabial angle changed between pre- and postoperative periods (p < 0.001 and p = 0.003, respectively); however, there was no difference in the type of suture technique used (p = 0.474 and p = 0.647).

Conclusions: Orthognathic surgery produces significant changes in nasal morphology. However, only the interalar width showed differences between sling techniques, with a greater increase in the group using the sling that passes through the anterior nasal spine. These findings indicate that the choice of sling affects control of the nasal base, while projection and the nasolabial angle depend on maxillary movement.

Objective: This letter responds to the recent study article by Shaaban et al. published in Clinical Oral Investigations in 2025 ( https://doi.org/10.1007/s00784-024-06051-0 ), which reported the efficiency of intraoral botulinum-A toxin (BTX-A) injection guided by ultrasound for trigger points (TrPs) in the masseter muscles.

Materials and methods: We discuss the diagnostic protocol adopted in the study, the absence of specific criteria to confirm the presence of TrPs either during palpation or ultrasound evaluation, the paucity of information regarding the identified TrPs and the BTX-A doses associated with them, and the terminological confusion surrounding TrP injections.

Result: The diagnostic approach employed in the study revealed certain inconsistencies. The dearth of data concerning the reported cumulative BTX-A dose impedes the comparability of the findings of this study. Both intra- and extra-oral injections described in the article do not conform to the definition of TrP injections.

Conclusion: The ambiguities in the methodology and terminological inconsistency can lead to significant bias when evaluating the efficacy of TrP injections, and may cause conceptual confusion in the literature.

Clinical relevance: Our critique emphasizes the necessity of transparent studies and standardized terminology to adequately assess the potential role of TrPs in masticatory muscle disorders and the effectiveness of injections targeting these structures. In the absence of such clarity, the reproducibility of therapeutic outcomes remains limited, potentially compromising clinical decision-making and patient care.

Objectives: Endodontic irrigants, including chlorhexidine digluconate (CHX) and sodium hypochlorite (NaOCl), are commonly used and may interact chemically with root canal sealers, affecting their physicochemical properties and surface structure. This study evaluated the effects of clinically relevant irrigation solutions on the physicochemical and microstructural properties of the epoxy resin-based AH Plus Jet (AHP) and calcium silicate-based AH Plus Bioceramic (AHPB) sealers.

Materials and methods: Sealers were placed in Teflon molds, and irrigants (2% CHX, 2.5% NaOCl, or 0.9% saline) were applied to the top surface of each specimen before incubation at 37 °C and 95% relative humidity for 72 h. Physicochemical properties (setting time, microhardness, solubility, dimensional change), chemical properties (ion release, pH changes), and surface characteristics (scanning electron microscopy (SEM)-energy-dispersive X-ray spectroscopy, contact angle) were assessed following the ISO 6876:2012 standard. Additional analyses were conducted after immersion in Hank's balanced salt solution (HBSS) for 28 days. Statistical analysis included one-way ANOVA, paired t-tests, and repeated measures ANOVA.

Results: Exposure to irrigants significantly prolonged the setting times of both AHP and AHPB. AHP exhibited significantly increased solubility beyond ISO standards and showed reduced microhardness after NaOCl exposure. AHPB demonstrated high solubility exceeding ISO standards under all tested conditions, particularly after CHX exposure. Both sealers maintained dimensional changes in accordance with ISO requirements. AHPB demonstrated significantly reduced calcium ion release following CHX and NaOCl exposure yet maintained high alkalinity (pH > 10). After 28 days of immersion, SEM analysis revealed uniform spherical precipitates on AHPB surfaces in the saline and control groups, whereas CHX- and NaOCl-exposed groups showed irregular deposits. In addition, CHX exposure significantly reduced contact angles on AHP surfaces after aging.

Conclusions: CHX and NaOCl affected the physicochemical properties of both sealers. AHP was most affected by NaOCl, exhibiting delayed setting, reduced hardness, and increased solubility. AHPB was primarily influenced by CHX and NaOCl, showing increased solubility, reduced calcium ion release, and retention of irrigants on its surface, while element concentration and alkalinity were not affected by sealer-irrigant interactions.

Clinical relevace: The choice of final irrigant can substantially influence the performance of root canal filling materials. Understanding sealer-irrigant interactions can help clinicians choose combinations that optimize sealing efficacy and long-term treatment success.

Objective: To develop a fully automatic artificial intelligence (AI) system for diagnosing alveolar bone defects (ABDs) in anterior teeth on cone-beam computed tomography (CBCT) images.

Materials and methods: This fully automatic AI system consists of two stages: (1) 2D image construction (sagittal and coronal slices) of anterior teeth root/bone morphology using a recognition algorithm, and (2) multi-perspective alveolar bone defect classification (normal, mild dehiscence, moderate dehiscence, severe dehiscence, and fenestration) based on the Hierarchical Multi-Scale Feature Fusion Network (HiFuse). In total, 300 CBCT images with 3600 anterior teeth from two clinical centers were used to train the model.

Results: The system achieved automatic and accurate construction of sagittal and coronal slices for 12 anterior teeth, with a high structural similarity index measure (SSIM) index of 0.803. The HiFuse model significantly outperformed ConvNeXt and Swin Transformer counterparts (P < 0.05), achieving an accuracy of 0.936 (95% CI: 0.906-0.959), F1-score of 0.932 (95% CI: 0.895-0.955), recall of 0.936 (95% CI: 0.906-0.959), and precision of 0.928 (95% CI: 0.896-0.952). HiFuse also effectively distinguished between ABD types and accurately located alveolar bone defects.

Conclusions: Our proposed AI system demonstrated great performance in ABDs diagnosis of anterior teeth using original 3D CBCT images and has potential for assisting with orthodontic diagnosis and decision-making.

Clinical relevance: Accurate diagnosis of ABDs in anterior teeth is essential when selecting appropriate orthodontic treatment strategies and performing bone augmentation surgery. This AI system could preliminarily achieve diagnosis of ABDs in anterior teeth, reducing manual intervention and improving the overall diagnostic workflow.

Objectives: To evaluate the clinical outcomes of zirconia dental implants over five years, considering the growing demand for metal-free alternatives to titanium due to aesthetic concerns and potential hypersensitivity reactions to metals.

Materials and methods: This retrospective study analyzed 80 zirconia implants from an initial cohort of 95, with 15 excluded due to loss to follow-up or not meeting inclusion criteria. Both one-piece and two-piece designs were included, and some cases involved Guided Bone Regeneration (GBR). The primary outcome was implant survival.

Results: The overall survival rate was 83.8% (67/80) after a mean follow-up of 29.0 ± 16.6 months (maximum 62 months). Kaplan-Meier analysis estimated mean survival at 52.6 ± 2.38 months, with the median not reached due to censoring. Survival was significantly lower with immediate placement (p = 0.016). GBR was linked to higher survival, with all GBR implants surviving and failures only in non-GBR cases (p < 0.001). No significant differences appeared in implant design, loading protocol, diameter, jaw location, prosthesis, surface, zirconia brand, or patient sex.

Conclusions: Zirconia implants showed 83.8% survival at five years, supporting their clinical applicability as metal-free implant systems. Immediate placement had significantly lower survival, favoring late placement. No significant differences were found between one-piece and two-piece implants, or between implants placed with and without GBR. Larger prospective studies with standardized clinical and radiographic assessments are needed to confirm these findings and refine zirconia implant protocols.

Clinical relevance: Zirconia implants show good mid-term survival and can be an alternative to titanium. However, immediate placement should be approached cautiously due to potential impacts on success.

Objectives: Smile aesthetics are crucial in orthodontic and orthognathic planning, particularly for patients with dentofacial deformities seeking enhanced facial harmony. This study evaluated changes in smile parameters of patients with class III deformities before and after orthognathic surgery using 3D stereophotogrammetry.

Materials and methods: Conducted at Başkent University Oral and Maxillofacial Surgery Department, this retrospective investigation comprised 21 patients with class III skeletal deformities who underwent bimaxillary orthognathic surgery. Standardized social-smile photographs and 3D facial scans were obtained preoperatively and at an average 8-month follow-up. Smile parameters, including buccal-corridor ratio, upper-lip length, inter-commissural width, lip thickness, lip asymmetry and volumetric measures were reported. Preoperative and postoperative differences were analyzed with paired T-tests or Wilcoxon signed-rank tests (p < 0.05), 95% confidence intervals, and Cohen's d for paired samples.

Results: Mean follow-up was approximately 8 months. False-discovery-rate correction identified one significant change: buccal-corridor ratio decreased by 4.4%, producing a visibly fuller transverse smile (d = 0.66). Upper-lip length and inter-commissural width increased by about 1.0 mm and 1.6 mm, respectively (both d ≈ 0.5). Vertical smile dimensions, incisor display, and global facial height and width remained stable (|d|≤0.18). Measurement reliability ranged from good to excellent (ICC = 0.60-0.93(Intraclass Correlation Coefficient).

Conclusion: Orthognathic surgery improved transverse smile fullness in patients with class III skeletal deformities while preserving vertical dental display, affirming the value of 3D assessment.

Clinical relevance: Three-dimensional stereophotogrammetry offers objective, reproducible documentation of soft-tissue changes and should be integrated into routine orthognathic evaluations. Unlike previous studies relying on cephalometry and photographs, this is the first study to utilize 3D stereophotogrammetry for assessing smile parameters.