Dental and Medical Problems最新文献

This review aims to comprehensively examine the historical development, molecular mechanisms and clinical applications of checkpoint inhibitors in squamous cell carcinoma of the head and neck (SCCHN). Squamous cell carcinoma of the head and neck represents a significant global health challenge as the 7th most common malignancy worldwide. Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 and CTLA-4 pathways have emerged as promising therapeutic approaches. Current evidence supports the use of ICIs in the recurrent/metastatic (R/M) setting, while data for neoadjuvant and adjuvant applications is evolving. Pembrolizumab monotherapy or in combination with chemotherapy has demonstrated survival benefits in PD-L1-positive R/M SCCHN, while nivolumab has shown efficacy in the second-line setting. Results from trials combining ICIs with radiotherapy have been mixed, with several phase III studies failing to meet primary endpoints.The integration of ICIs has transformed the treatment landscape for R/M SCCHN, while the ongoing research continues to define their optimal use in earlier disease settings and in novel therapeutic combinations. Future directions include exploring combination strategies with targeted therapies, identifying predictive biomarkers beyond PD-L1 expression, and developing immunotherapy approaches tailored to HPV-positive vs. HPV-negative disease.

Background: The oral and maxillofacial region comprises a wide spectrum of pathological conditions, among which odontogenic lesions (OLs) are particularly prevalent. Ongoing academic research in this field focuses on advancing diagnostic modalities, improving therapeutic strategies and elucidating disease pathogenesis, thereby promoting interdisciplinary collaboration across medicine, pathology and dentistry.

Objectives: Within this context, the present bibliometric analysis aimed to evaluate the current landscape of OL research, retrospectively map the field, and identify the emerging trends and future research directions.

Material and methods: Guided by the principles of the Leiden Manifesto, this comprehensive bibliometric study analyzed 4,298 publications published between 1980 and 2023, and retrieved from the Web of Science Core Collection. The analysis examined international collaboration patterns, keyword evolution, institutional affiliations, co-citation networks, and thematic clustering. CiteSpace, RStudio Bibliometrics and VOSviewer were employed to explore bibliometric relationships and generate visualizations.

Results: The 40-year bibliometric mapping analysis of OL research revealed a diverse and evolving scientific landscape. A total of 4,298 publications encompassing 40,209 references demonstrated extensive international collaboration, represented by 111 nodes and 385 collaborative links. India emerged as the most prolific contributor (670 publications), while the USA led in citation impact (12,169 citations). Co-citation analysis identified highly influential works, notably updates to the World Health Organization (WHO) classifications. Thematic clustering highlighted major research domains, including odontogenic keratocysts, ameloblastomas and calcifying odontogenic lesions. Trend analysis further indicated a shift from traditional pathological concepts toward advanced diagnostic approaches, with growing emphasis on gene expression profiling and imaging technologies, such as cone-beam computed tomography (CBCT).

Conclusions: In the present study, the historical development of OL literature was evaluated using bibliometric analysis, identifying the most influential publications, major thematic domains and research hotspots. The emerging trends in OL research continue to shape the field and drive advances in both scientific understanding and clinical practice.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is an undesirable consequence of the action of drugs, involving the exposure of bones in a patient not exposed to ionizing radiation in the head and neck area. The occurrence of MRONJ is associated with therapy with anti-resorptive drugs (bisphosphonates), receptor activator of nuclear factor-kappa B ligand (RANKL) drugs, e.g., denosumab, and anti-angiogenic drugs that are vascular endothelial growth factor (VEGF) inhibitors.

Objectives: The aim of the present study was to identify risk factors for the development of MRONJ.

Material and methods: The medical records of patients hospitalized in the years 2015-2022 in the Department of Maxillofacial Surgery of the Ludwik Rydygier Specialist Hospital in Krakow and the Clinical Department of Maxillofacial Surgery of University Hospital in Krakow, Poland, were retrospectively analyzed. The study included patients treated for MRONJ in the maxilla and/or the mandible with a history of past bisphosphonate therapy. Patients with symptoms of osteonecrosis after radiotherapy of the head and neck region were excluded from the study. The patients' demographic data, comorbidities, the initial disease treated with bisphosphonates, the route of drug administration, the type of causative dental surgery, the area of necrosis, and the MRONJ class according to the American Association of Oral and Maxillofacial Surgeons (AAOMS) criteria were analyzed.

Results: The investigated group consisted of 29 females and 14 males. Common comorbidities were anemia, diabetes mellitus (DM) and hypertension. Bisphosphonates were used in 30 patients (69.8%) treated for cancer, in 10 patients (23.3%) treated for osteoporosis and in 2 patients (4.7%) treated for osteopenia. In the majority of cases (n = 19; 44.2%), bisphosphonates were administrated intravenously. Medication-related osteonecrosis of the jaw was diagnosed in the mandible in 25 cases (58.1%) and in 18 (41.9%) - in the maxilla. In 14 patients (32.6%), necrosis was initiated by a dental procedure, most often tooth extraction.

Conclusions: Risk factors for the development of MRONJ in patients treated with bisphosphonates include the intravenous route of drug administration, past intraoral surgery, female gender, and senior age.

The hyoid bone exhibits potential sex-based variations and is implicated in the severity of obstructive sleep apnea (OSA). Sex-specific comparisons are lacking. The present meta-analysis aimed to address this gap.The Embase, MEDLINE and Web of Science databases were searched. The inclusion criteria were as follows: studies that reported the measurements of the hyoid bone-mandibular plane distance (HMP), demonstrated in cephalometric imaging (CEPH) in patients with OSA of both sexes, involving a polysomnography (PSG) examination with the apnea-hypopnea index (AHI), as well as information on the body mass index (BMI) and age. The exclusion criteria comprised reviews, meta-analyses and case reports. The risk of bias was assessed with the use of the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Statistical analysis was conducted using Comprehensive Meta-Analysis software (CMA) and IBM SPSS Statistics for Windows.Seven observational studies with 718 adult patients (515 males and 203 females) met the inclusion criteria. The mean HMP value was 20.5 ±3.8 mm, with a significant difference observed between males (21.6 ±3.3 mm) and females (17.8 ±3.7 mm) (p < 0.00001). The correlation between HMP and AHI was significantly stronger in females - 2.5 times higher than in males (r = 0.423 vs. r = 0.167, respectively).Although a standard range of the hyoid bone position for healthy adults and elderly individuals is currently lacking, sex significantly affects the anatomical variation of the hyoid mandibular position in patients with OSA. It is crucial to identify distinct OSA endotypes by sex to ensure accurate diagnosis and treatment planning, which could lead to sex-specific therapeutic strategies.

Temporomandibular disorders (TMD) are often linked with a variety of comorbidities, which can complicate their diagnosis and management. A systematic literature review (SLR) was conducted to investigate the association between the occurrence of TMD signs and symptoms in patients with infectious diseases.The present SLR was carried out in PubMed®. The eligibility criteria were established to include patients presenting with TMD signs and symptoms associated with an infection. The search identified 258 records, of which 27, involving 20,489 patients, were included in the qualitative analysis. Three types of associations were identified between the onset of TMD signs and symptoms and the type of infection. The first association is TMD arising from hematogenous spread of the pathogen to the temporomandibular joint (TMJ), the predominant symptoms of which are related to impaired TMJ function. The infection varies in severity and is occasionally asymptomatic, making it challenging to establish a clear connection between pathogen spread and symptoms in the temporomandibular region. Second, TMD resulting from the local spread of pathogens to adjacent tissues within the temporomandibular area were examined. This category included odontogenic infections, upper respiratory tract infections and otogenic infections. Thirdly, TMD associated with chronic systemic infection without arthritis were analyzed, which develop as a consequence of systemic changes due to prolonged illness and/or psychological disorders arising from limited treatment options.The relationship between the onset of TMD and infectious diseases is complex and multifaceted. A careful differential diagnosis is essential, as TMD can mask an underlying infection, leading to delays in accurate diagnosis and timely anti-infective treatment.

Headache associated with comorbid insomnia and sleep apnea (COMISA) may represent a distinct clinical phenotype. Its severity, refractoriness and unique characteristics necessitate a comprehensive, integrative therapeutic approach.

Background: Obesity and periodontal diseases are associated with oxidative stress activation. Periodontitis and gingivitis are inflammatory diseases that cause systemic and local production of reactive oxygen species, leading to tissue damage. Obesity exacerbates systemic free radical oxidation.

Objectives: The aim of the study was to evaluate the influence of cerium oxide nanoparticles (CNPs) as potential pharmaceutical agents for targeting oxidative stress activation in patients with obesity and periodontal disease.

Material and methods: Young patients with obesity and generalized gingivitis were randomly allocated into 2 groups. In the first group (n = 28), a professional oral hygiene procedure was performed, followed by the local application of the Nanosept solution (a formulation comprising CNPs and chlorhexidine digluconate (CHG)). Over the next 5 days, the subjects were instructed to administer the Nanosept solution twice a day on the gums using a cotton sponge for 5 min. The second group (n = 30) was additionally prescribed the antioxidant Cerera (CNPs) for 10 days.

Results: Following treatment in both groups, a complete resolution of gingivitis was registered. In both groups, a significant decrease in salivary mucopolysaccharides and total nitric oxide synthase (NOS) activity was observed. However, a significant decrease in oxidative and nitrosative stress markers, as well as an increase in catalase activity were registered only after systemic administration of CNPs. Similarly, the normalization of colonization resistance (CR) was observed only in the second group.

Conclusions: Systemic administration of CNPs in the treatment of obese patients with generalized gingivitis resulted in a decrease in oxidative and nitrosative stress activation in the oral cavity, enhanced antioxidant capacity of the saliva, and normalized the level of CR of the oral cavity.

Background: The accuracy of cone-beam computer tomography (CBCT) in measuring the labial alveolar bone thickness requires further evaluation.

Objectives: The aim of the present study was to evaluate the impact of dental implants on the accuracy of CBCT in measuring the postoperative labial alveolar bone thickness in the maxillary anterior region.

Material and methods: The distance from the labial alveolar bone surface at the bone crest level to the implant neck was measured using 2 methods. One method involved using periodontal probes during an immediate implant surgery, while the other employed the CBCT scans obtained immediately postoperation.

Results: Twenty patients were recruited from the Department of General Dentistry at the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China, from February 2023 to October 2023. In total, 20 implants with a diameter of 3.3 mm were placed surgically. The average distance from the labial alveolar bone surface at the bone crest level to the implant neck in the group of 20 patients, obtained through the intraoperative measurement, was 3.7 ±0.8 mm. The corresponding average value based on the CBCT data of the 20 patients was 3.1 ±0.6 mm. A significant difference was observed between the 2 methods (p < 0.001). The average diameter of the 20 implants measured using the CBCT scans was 4.1 ±0.4 mm, which was significantly greater than the actual implant diameter of 3.3 mm.

Conclusions: The distance from the labial alveolar bone surface at the bone crest level to the implant neck, which comprises the thickness of the labial alveolar bone and the jumping gap, was smaller according to the CBCT data than the actual values obtained from intraoperative measurements. However, the average diameter of the 20 implants measured using the CBCT scans exceeded the actual implant diameter of 3.3 mm. When assessing the thickness of the labial alveolar bone around implants in the maxillary anterior region using CBCT during follow-up, a moderate underestimation of the labial bone thickness may occur.

Background: Self-assessment is key to improving the quality of work performed by dental professionals. The ability to accurately self-assess has been found to correlate with better clinical performance, making it an important skill for students to master during their dental education. Furthermore, studies conducted in dental schools across the world have shown that lower-performing students tend to overestimate their abilities compared to their peers.

Objectives: This study aimed to evaluate the self-assessment skills of dental students in pre-clinical operative dentistry and to investigate the impact of gender on these skills.

Material and methods: Third-year undergraduate dental students (N = 335) took 2 pre-clinical practical exams: class II composite preparation and restoration. Students self-assessed each assignment using a standardized rubric, and 6 calibrated faculty members graded all procedures blindly and independently. The difference between students' self-assessment scores (S) and mean faculty grades (F) reflected the students' self-assessment skills and was referred to as the Student-Faculty (S-F) gap. A positive S-F gap indicates that students overestimate their work, while a negative S-F gap indicates that students underestimate their work. Data was stratified by gender and by faculty-determined student performance, and then statistically analyzed.

Results: The study demonstrated a statistically significant difference between faculty grades and students' self-assessment scores. Positive S-F gaps were observed across all procedures, indicating overestimation, with a mean S-F gap of 11.4 ±9.9%. A negative correlation was found between faculty grades and S-F gaps. Higher-performing students showed smaller S-F gaps (4.8 ±5.3%) compared to lower-performing students (21.2 ±9.68%). Furthermore, male students showed significantly higher S-F gaps (14.0 ±10.3%) compared to females (9.7 ±9.4%).

Conclusions: Overestimation was more prevalent among lower-performing and male students compared to higher-performing and female students. Future investigations should consider exploring effective interventions and educational strategies aimed at improving students' self-awareness and their ability to accurately assess their performance.

Background: According to the World Health Organization (WHO), malocclusion is the most common oral disease in children after dental caries. Disorders pertaining to smile aesthetics and appearance can cause psychosocial problems and feelings of marginalization in children.

Objectives: The aim of the study was to assess the prevalence of malocclusion and to compare the need for orthodontic treatment in children treated with removable appliances and those who are not treated orthodontically.

Material and methods: The study sample consisted of 653 children aged 9-12 years (349 boys and 304 girls) from a selected urban population in Poland. The clinical study was based on the evaluation of Angle's classification and analysis of other occlusal characteristics (overjet, overbite, crossbite, scissor bite, crowding, diastema, and midline shift). The assessment of orthodontic treatment needs was carried out according to the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC).

Results: In the sample group, 533 children (81.62%) were diagnosed with malocclusion. The most frequent diagnoses were class I malocclusions (43.80%) and class II malocclusions (35.99%), as well as crowding (37.98%). Among the children studied, 28.95% were receiving orthodontic treatment and using removable appliances. As many as half (50.26%) of the children treated with removable appliances exhibited no or minimal need for orthodontic treatment. The study revealed no significant association between the severity of patient's need for treatment and the probability of receiving orthodontic treatment with removable appliances.

Conclusions: The prevalence of malocclusion in the studied population is high. However, not all children with a diagnosed malocclusion require orthodontic treatment. For an effective plan of orthodontic care and rational budgeting, it is recommended that appropriate indicators be used to identify individuals with the most severe malocclusions who are eligible for treatment.