Clinical Oral Investigations最新文献

Objectives: Oral toxicities affect a high proportion of head and neck cancer (HNC) patients receiving radiotherapy, lacking reliable predictive biomarkers for incidence and severity. We investigated salivary metabolites and metabolic pathways as non-invasive predictors of radiotherapy-induced oral mucositis (OM) and candidiasis.

Material and methods: HNC patients undergoing radiotherapy were prospectively studied. Saliva samples of 45 HNC patients and 30 controls were analysed using NMR spectroscopy, and patients were assessed for oral complications during treatment.

Results: Significant metabolite differences were identified between patients with and without complications. An increased concentration of lactate (p < 0.000), and a reduced concentration of formate (p = 0.018) and pyruvate (p = 0.045), was found in HNC patients at risk for OM during RT. Comparison of salivary metabolites between patients at risk or not risk for candidiasis presented increases in acetate (p = 0.005), alanine (p = 0.009), proline (p = 0.002), tyrosine (p < 0.000), trimethylamine (p = 0.007) and fucose (p < 0.000), whereas the level of citrate (p = 0.008) was decreased. Of the metabolic pathways, glucose-alanine cycle and thyroid hormone synthesis, were significantly different in patients at risk for candidiasis.

Conclusions: Salivary metabolomics is a promising predictive tool for radiotherapy-induced oral complications, potentially enabling early intervention and personalized supportive care.

Clinical relevance: Elevated level of salivary lactate seems to predict the development of OM, while fucosis was a sign of candidiasis. Multicentre validation studies are needed for its clinical implementation.

Objective: An increase in the incidence of oral cancer in women has been reported in some countries. This study investigated demographic, clinicopathological, risk factors, treatment outcomes and predictors for survival in female patients with oral cancer treated in a reference head and neck cancer center for the past 32 years.

Methods: This retrospective cohort study reviewed the clinical records of women patients with oral squamous cell carcinoma (OSCC). The proportion of OSCC cases in women relative to men over the last three decades was investigated. Clinicopathological data were correlated with treatment outcomes using logistic regression analysis. The 2 and 5-year overall survival (OS) and disease-specific survival (DSS) were assessed through the Kaplan-Meier and Cox regression analyses.

Results: In total, 133 women patients with OSCC were investigated. The ratio of oral cancer cases in women to men has almost doubled in the last decade. Most female patients were non-smokers (51.9%) and non-alcoholics (69.2%) and had early-stage disease at the time of diagnosis (51.9%). The most frequent tumor sites were tongue (46.6%) and alveolar ridge (18%). Advanced clinical stage was the independent predictor for worse 5-year OS (p < 0.001) and DSS (p < 0.001), while non-surgical treatment was associated with poor OS only at the 2-year cutoff (p = 0.003).

Conclusion: This study demonstrates an increase in the proportion of oral cancer cases in women in the last decade. Advanced-stage tumors remain the main predictor for women with oral cancer, denoting the need to strengthen policies to increase the rate of early diagnosis for this population.

Clinical relevance: The number of female patients with oral cancer without the classic risk factors for the disease has been increasing over the years. Clinicians should be alerted to ulcerated lesions in the oral mucosa of non-smoking and non-alcoholic women, favoring early diagnosis.

Objectives: The aim of this study was to compare volumetric and linear hard tissue changes, as well as the efficacy of augmentation using periosteal secured suture (PSS) and fixation devices (FD) for resorbable membrane stabilization in horizontal guided bone regeneration (GBR).

Materials and methods: A retrospective matched cohort study was conducted on 14 patients undergoing horizontal GBR, with 7 in each of the PSS and FD (screws/tacks) groups. Inclusion criteria included the availability of high-quality pre- and post-GBR cone beam computed tomography (CBCT) scans and complete documentation of patient- and GBR-related characteristics. Patient-related variables (medical history and demographics) and GBR-related variables (location, type of bone substitute and membrane, and complications) were extracted from dental records. Postoperative CBCT scans were obtained at least 5 months after GBR procedure. CBCT subtraction analysis was performed using spatial registration and semi-automatic segmentation. Outcome variables included volumetric hard tissue gain (primary outcome), volumetric hard tissue loss, efficacy of augmentation (i.e. volumetric gain relative to defect extent), and changes in linear vertical and horizontal hard tissue dimensions between pre- and post-operative scans, measured at the mesial, middle, and distal planes.

Results: Both PSS and FD groups demonstrated significant increases in the linear horizontal dimension from preoperative to postoperative (p < 0.05). The mean horizontal hard tissue gains at 3 mm from the crestal bone in the middle plane were 2.8 ± 1.6 mm for the PSS group and 3.8 ± 1.2 mm for the FD group. The mean volumetric gain and efficacy of augmentation were 0.8 ± 0.9 cm³ and 0.025 ± 0.018 cm³/mm for the PSS group, and 0.6 ± 0.3 cm³ and 0.024 ± 0.010 cm³/mm for the FD group, respectively. No significant differences were observed between groups in linear dimensions, volumetric changes, or efficacy (p > 0.05).

Conclusions: Stabilizing resorbable membranes using periosteal secured sutures or fixation devices in horizontal guided bone regeneration procedures results in comparable linear and volumetric hard tissue gains, demonstrating similar efficacy in hard tissue augmentation.

Clinical relevance: Periosteal secured sutures and fixation devices are both reliable methods for stabilizing resorbable membranes in horizontal guided bone regeneration, yielding comparable efficacy in hard tissue augmentation.

Objectives: To quantitatively evaluate the progression of non-carious cervical lesions (NCCLs), gingival recession (GR), and occlusal tooth wear (OTW) over 25 years.

Methods: This observational, retrospective study involved 33 dental students who completed a questionnaire regarding their oral habits, diet, and health information. Impressions from the baseline and the 25-year follow-up were used to create digital casts, which were analyzed with 3D software (Geomagic Control; 3D Systems) to measure the progression of NCCLs, GR, and OTW. Occlusal analysis from Phase I, using the T-Scan system (Tekscan), was also included to evaluate occlusal interferences.

Results: NCCL dimensions (area, height, and width) showed moderate associations with GR and only weak correlations with OTW. Multivariate regression analyses identified significant factors associated with NCCL progression. For NCCLs, visible plaque, vigorous toothbrushing, occlusal interferences, dentin hypersensitivity, alcohol consumption, smoking, and frequent exposure to acidic or cariogenic diets were associated with increased NCCL progression. For GR, was significantly associated with occlusal contact, dentin hypersensitivity, alcohol consumption, and smoking. For OTW, unilateral mastication, long-term orthodontic treatment, and smoking were positively correlated with wear progression.

Conclusions: Mechanical and behavioral factors-particularly vigorous toothbrushing, occlusal interferences, and lifestyle habits such as smoking and alcohol consumption-significantly influenced the long-term progression of NCCLs, GR, and OTW. Mandibular molars and premolars were the most frequently affected teeth.

Clinical significance: The use of digital three-dimensional analysis allows accurate monitoring of NCCLs, GR, and OTW. Preventive measures should prioritize controllable risk factors, including brushing habits, smoking, alcohol consumption, and occlusal imbalances.

Objectives: To evaluate angular and linear tooth movements following orthodontic treatment for correction of moderate to severe crowding using clear aligner therapy (CAT).

Materials and methods: This retrospective study included 46 patients treated with clear aligners in permanent dentition for correction of moderate to severe crowding. Twenty-three patients (6 males, 17 females; mean age 20.0 years) were treated with premolar extractions and 23 patients (8 males, 15 females; mean age 17.3 years) were treated without premolar extractions. Three-dimensional tooth linear and angular displacements were quantified in the pre- and post-treatment digital dental models superimposed using the Slicer Automated Dental Tools module of 3D Slicer software ( www.slicer.org ). Generalized estimation equations were used for group comparisons (p < 0.05).

Results: CAT correction of moderate to severe crowding with premolar extraction led to significant retroclination of upper and lower incisors (upper: -6.71° ±7.79, P < 0.001 and lower: -5.11° ±8.49, P < 0.001). Anchorage control in extraction cases was limited, with approximately equal molar mesialization and incisor lingualization. In non-extraction cases, crowding was corrected through arch expansion with flaring of incisors. Vertical changes were similar between groups.

Conclusions: CAT of moderate to severe crowding without extraction led to arch expansion and proclination of incisors. In contrast, premolar extraction cases often presented incisor retroclination and molar mesial tipping, requiring careful biomechanical management.

Clinical relevance: These findings help clinicians plan treatments, manage patient expectations, and anticipate side effects, enabling the use of proper strategies and resources to optimize outcomes in both extraction and non-extraction cases.

Objectives: To evaluate the efficacy of ozone therapy on pain reduction, trisma and number of analgesic tablets taken following surgical removal of impacted mandibular third molar.

Methods: A split-mouth randomized clinical trial was conducted in 54 patients in need of bilateral impacted mandibular third molars (Pell-Gregory class II-B) extraction. Test sites were treated with adjunctive ozone therapy to the surgical extraction, while controls underwent surgical intervention only (time between surgeries: 3 weeks). Study primary outcome measure was the difference in perceived pain recorded using a Numerical Rating Scale (NRS) at 7 days after surgery. In addition, functional limitation in mouth opening (mm), number of analgesic tablets taken within one week after surgery as well as the patient's perceived quality of life (Oral Health Impact Profile (OHIP-14) were evaluated.

Results: Fifty patients (20 males and 30 females; median age: 21 years; all non-smokers) completed the study. Mean reported perceived pain decrease from 5.06 to 0.58 (test group) and from 5.62 to 1.08 (control group) between day 1 and 7. No statistically significant differences were detected between the two groups at any time points (p > 0.05). At day 7, mean mouth opening value was 40.8 vs. 36.6 mm in test and control group respectively (mean difference: 4.24 mm; p < 0.001; 95% CI: 6.55-1.93). The same trend was detected for the of number of analgesic tablets taken (median: 4 vs. 7; p = 0.01). Finally, OHIP-14 values did not differ between groups (p > 0.05).

Conclusion: Ozone therapy had a beneficial clinical effect in terms of mouth opening and in the number of analgesic tablets intake at 7 days after surgical removal of impacted mandibular third molar, despite the lack of adjunctive benefit on patients perceived pain reduction.

Clinical relevance: The clinical use of ozone therapy as adjunct to surgical removal of impacted mandibular third molar might be considered in light of the promising positive reported results in terms of mouth opening reduction and analgesic intake.

Clinical trial registration number: NCT05949476.

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.