Dentistry Journal最新文献

Background: This observational ambispective longitudinal international study explored dentists' practices and patient records concerning dental caries risk management across four European countries (Bulgaria, Greece, Poland and Portugal). Methods: Dentist volunteers recruited patients needing caries risk management, either through preventive or curative measures, from their regular practice. Analyses focused on assessing dentists' practices in caries risk assessment and management, along with gathering information on patient and dentist characteristics, oral health assessments, and caries risk evaluation. Results: A total of 51 dentists recruited 1008 patients. Across the countries studied, caries risk assessment and management methods varied, with fewer than 15% of dentists using standardized tools. Primary assessment methods included oral examinations and medical interviews, while nutritional and fluoride intake assessments were less common, and salivary or microbiological tests were rare. There was an inverse association between the risk of dental caries and patients' socioeconomic status. Specific university training on caries risk showed a positive correlation with adherence to recommendations. Conclusions: Our findings emphasize the importance of clinicians adapting their approaches to individual patient needs in caries risk assessment and management. However, the wide array of available risk assessment tools presents a challenge, underscoring the necessity of integrating biopsychosocial models into dental practice to effectively deliver personalized care.

Background/Objectives: Digital technologies and generative artificial intelligence (AI) are increasingly used in undergraduate dental education, yet international variations in adoption and governance remain insufficiently described. This study aimed to characterise cross-national patterns of educational software use, perceived importance for curriculum delivery, and institutional readiness for AI governance. Methods: A cross-sectional online survey of educators and academic administrators involved in undergraduate dental education captured institutional software use across teaching delivery, learning management, assessment, clinical record systems, imaging, simulation, digital workflows, and generative AI. Results: A total of 97 respondents from 38 countries completed the survey, with most institutions delivering both undergraduate and postgraduate dental education (66.0%). Videoconferencing platforms were widely adopted. LMS provision varied, with Google Classroom, Moodle, and Blackboard most frequently reported. Paper-based clinical records remained in use in 32% of institutions. Among digital PMS/EDR platforms, axiUm, Salud/Titanium, and Carestream Dental were the most prevalent. Adoption of simulation software, CAD/CAM systems, and 3D printing was inconsistent. LMS and videoconferencing were most often rated as essential, whereas simulation, scanners, CAD/CAM, and 3D printing were generally considered useful but not essential. Generative AI use was commonly reported, while formal institutional guidance and policies were frequently absent. Conclusions: Although digital integration in undergraduate dental education is widespread, its distribution is uneven across different regions and technology domains. The combination of rapid generative AI uptake and limited governance highlights an urgent need for institution-level guidance, staff development, and strategic investment to support responsible and equitable integration.

Background/Objectives: Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT), is a rare and extremely aggressive subtype of non-Hodgkin lymphoma that most frequently involves the nasal cavity and upper aerodigestive tract. Primary isolated oral manifestation is exceptionally uncommon and may mimic odontogenic or infectious diseases, delaying diagnosis. We report a case of ENKTCL-NT presenting initially as a destructive oral lesion without sinonasal involvement at diagnosis. Methods: A 32-year-old man with progressive palatal ulceration underwent clinical and imaging assessment (panoramic radiography and staging ^18F-FDG PET-CT) and repeated biopsies. Diagnosis was established using histopathology (H&E), immunohistochemistry (T-cell markers and cytotoxic profile), EBV detection by EBER in situ hybridization, and T-cell receptor gamma (TCRG) gene rearrangement analysis. Results: The lesion presented as a hemorrhagic, ulcerative palatal destruction covered by pseudomembranous exudate and was complicated by fungal infection, periostitis, and severe dental inflammatory foci, contributing to diagnostic delay. Histopathological examination revealed extensive necrosis with a dense atypical lymphoid infiltrate; angiocentric and angiodestructive growth was identified in one biopsy specimen. Tumor cells expressed T-cell markers (CD2, CD3, CD5, CD7; heterogeneous) and cytotoxic markers (TIA-1) and showed CD30 and CD56 positivity, with EBV positivity confirmed by EBER in situ hybridization. Molecular analysis demonstrated monoclonal TCRG rearrangement, and Ki-67 indicated high proliferative activity. Initial PET-CT demonstrated an intensely FDG-avid, locally invasive lesion without distant organ involvement. The patient was treated with L-asparaginase-based SMILE chemotherapy followed by radiotherapy (50 Gy), achieving marked initial clinical improvement and partial metabolic response; however, systemic relapse subsequently occurred with refractory disease despite salvage therapy and immunotherapy. Conclusions: This case highlights the substantial diagnostic challenge posed by isolated oral extranodal NK/T-cell lymphoma, nasal type, which may closely mimic benign inflammatory or infectious conditions and lead to significant diagnostic delay. Persistent, progressive, or therapy-resistant oral ulcerations should prompt early consideration of hematologic malignancy. Timely biopsy with comprehensive immunophenotyping, EBV testing, and close multidisciplinary collaboration are essential for accurate diagnosis and may contribute to earlier diagnosis and improved patient outcomes in these rare and atypical presentations.

Background/Objectives: The prominent role the internet plays in being a source of dental information prompts qualitative evaluation of relevant online content. This study aimed to explore patients' experience regarding periodontal graft surgery communicated through the social media platform YouTube. Methods: An initial YouTube search using the term "gum surgery experience" retrieved 40 videos. Graft surgery was the most frequently discussed procedure, and 19 relevant videos were included in the qualitative analysis. Video content was analysed using a combined human-centered and artificial intelligence (AI)-assisted approach. AI-supported analysis of viewer comments was conducted using ChatGPT-4 and Gemini-1.5 Pro. Themes generated by human and AI analyses were compared. Results: Nine key themes were identified from the 19 videos that satisfied selection criteria. Most themes were similar between human and AI analyses, with six overlapping and three unique. The most frequently coded theme was post-operative recovery (n = 177), with pain, work absence, eating difficulties, and disrupted oral hygiene commonly reported. Patient-clinician relationships were frequently highlighted, with mixed experiences regarding communication and trust. Positive experiences were reported more frequently than negative. Comment analysis revealed varied audience engagement and sentiments, emphasizing concerns about pain, recovery, and procedural anxiety. Conclusions: Key themes related to patient experiences were identified, notably concerns regarding post-operative recovery and patient-clinician relationships. Challenges in finding information prior to having surgeries motivated patients to provide support and advice on YouTube, emphasizing the need for patient-centered resources and effective patient-clinician communication. Integrating human and AI methods in qualitative analysis was efficient and insightful, with AI supplementing but not substituting human research.

Objectives: Combining mechanical plaque control, the physical removal of oral biofilm, with chemical plaque control, the use of agents to inhibit biofilm formation, is effective in preventing periodontal disease. Chlorogenic acid (CGA) found in coffee beans has medicinal effects, such as anti-inflammatory and antibacterial properties. Periodontal pathogens are difficult to reach in certain areas with traditional self-care tools, such as toothbrushes. Additionally, the viscous biofilm is difficult to remove using mechanical plaque control alone. Therefore, this study aimed to evaluate the efficacy of CGA in chemical plaque control. Methods: The mRNA and protein expression of inflammatory cytokines in lipopolysaccharide (LPS)-stimulated human gingival fibroblasts (HGFs) and human periodontal ligament fibroblasts (HPDLs) in the presence of CGA were analyzed using reverse transcription-qPCR and enzyme-linked immunosorbent assay. Additionally, the proliferation levels of oral bacteria in the presence of CGA were evaluated. Results: CGA suppressed mRNA and protein expression levels of the inflammatory cytokines, interleukin (IL)-1β and IL-8, in HGFs and HPDLs stimulated with Porphyromonas gingivalis LPS. Furthermore, CGA inhibited bacterial proliferation of Streptococcus mutans, Aggregatibacter actinomycetemcomitans, P. gingivalis, and Fusobacterium nucleatum. Conclusions: This study demonstrated that CGA exhibits anti-inflammatory effects on gingiva and periodontal ligaments, and antibacterial effects against oral bacteria. These results indicate the potential application of CGA in chemical plaque control and suggest its use in preventing periodontal disease progression.

Background/Objectives: This study evaluated the effects of at-home bleaching on color stability (ΔE) and surface roughness (Ra) of a single-shade nanohybrid composite, an ORMOCER-based composite, and a conventional nanohybrid resin composite, acknowledging that bleaching represents only one of several clinical ageing challenges. Methods: One hundred and five extracted, non-carious human molars received standardized Class I restorations and were randomly allocated to five groups (n = 21): an ORMOCER-based composite (Admira Fusion), a single-shade composite (Omnichroma), Omnichroma bonded with an alternative universal adhesive, and two conventional nanohybrid composites (Filtek Supreme Ultra and Harmonize). Baseline and experimental color (CIELAB, ΔE) were measured with a spectrophotometer, and surface roughness (Ra) was measured using a 3D optical profilometer. Specimens underwent five bleaching cycles using 22% carbamide peroxide, with each cycle consisting of 8 h of bleaching followed by 16 h of storage in artificial saliva at 37 °C. Measurements were taken at baseline and after each cycle. The data were analyzed using a repeated-measures ANOVA, with bleaching cycle as the within-subject factor, the effect sizes reported as partial eta-squared (ηp²), and the statistical significance set at α = 0.05. Results: All restorative materials exhibited progressive color change with repeated bleaching, and ΔE values exceeded established clinical acceptability thresholds across materials. The extent of color change varied among materials. None of the evaluated materials maintained clinically acceptable color stability following repeated bleaching cycles. The single-shade composite (Omnichroma) demonstrated the greatest magnitude of color change, particularly when bonded with Scotchbond Universal Bond. Admira Fusion and Filtek Supreme Ultra had lower ΔE values but still exceeded acceptability thresholds. Surface roughness generally decreased following bleaching, with statistically significant reductions in Ra observed for multiple materials. Admira Fusion and Omnichroma bonded with Tokuyama Universal Bond showed minimal surface alteration. Conclusions: All restorative materials demonstrated clinically unacceptable color changes following bleaching, indicating limited esthetic stability under bleaching conditions. ORMOCER-based composites showed comparatively greater resistance to surface roughness alterations.

Background/Objectives: Bisphosphonates, a class of drugs that are widely used in the treatment of neoplastic diseases, can lead to the development of medication-related osteonecrosis of the jaw (MRONJ). This condition is challenging to manage due to the high incidence of postoperative complications: superinfections, local wound dehiscence, or fractures in pathological bone. The aim of this study is to evaluate the therapeutic role of bovine-derived xenografts in the management of MRONJ. Methods: This retrospective observational study evaluates the clinical outcomes of patients with confirmed stage II or III MRONJ, after surgical treatment with Bio-Oss application. All patients had received zoledronic acid therapy, which was discontinued for a minimum of four months prior to surgical intervention. The surgical protocol included local debridement, sequestrectomy, and grafting of the residual defect with a bone substitute, followed by periodic clinical evaluations and monitoring of local healing with a follow-up period of up to one year. Results: Of the total number of patients treated according to this surgical protocol, 85.71% achieved favorable healing without complications at 8 weeks. Cases with poor local healing results were more likely to have prolonged zoledronic acid administration. Conclusions: Within the limits of this retrospective observational study, the use of bovine-derived xenografts following sequestrectomy in stage II-III MRONJ was associated with satisfactory local healing in several cases. However, considering the limited sample size and lack of a comparator group, these findings should be interpreted cautiously. To better understand the connection between the length of antiresorptive therapy, surgical management techniques, and postoperative outcomes, more prospective, multicenter trials with bigger patient cohorts are needed.

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising incidence of peri-implantitis has renewed interest in classical conservative treatment alternatives, such as hemisection, root resection and bicuspidization. The aim of this study is to present clinical cases in which hemisection and bicuspidization were performed to maintain compromised molars in function and achieve long-term outcomes. Methods: This retrospective case series study was conducted in a private dental practice and included three patients treated between 2009 and 2017. The presented cases involved molar teeth exhibiting a vertical fracture or extensive subgingival carries in one root while the remaining root(s) demonstrated favourable periodontal, endodontic and restorative prognosis. An interdisciplinary approach was followed in each case, involving comprehensive clinical and radiographic evaluation including cone beam computed tomography when indicated. The clinical treatment included an endodontic approach (primary treatment or retreatment if required) followed by hemisection or bicuspidization and placement of a permanent prosthetic rehabilitation with full-coverage restoration designed to optimize proper load distribution. Clinical and radiographic follow-up examination was done up to six years in case one, after six months in case two and up to six years in case three. Results: The teeth remained in function through their respective follow-up periods. Clinical and radiographic assessments, according to predefined success criteria, demonstrated periodontal stability (probing depth ≤ 4 mm), no evidence of secondary caries or root fracture, absence of clinical symptoms, normal tooth mobility and masticatory function, absence or reduction in periradicular radiolucency, and stable bone levels. Conclusions: Resective techniques require an interdisciplinary approach, namely, careful case selection, lege artis endodontic treatment, precise surgical technique, and appropriate prosthetic rehabilitation, in order to provide predictable and long-term outcomes. Within the limitations of this case series, resective techniques appeared to be a reliable and predictable alternative to extraction and implant placement in carefully selected clinical cases.

Background: Buccal bone dehiscence is a frequent finding during implant placement and often requires horizontal bone augmentation. When combined with immediate loading protocols, concerns remain regarding early implant stability and failure risk. This retrospective case series aimed to describe the early clinical outcomes of immediately loaded implants placed in sites with buccal dehiscence treated by horizontal bone augmentation and restored with full-arch screw-retained prostheses. Methods: Fifty-nine consecutive edentulous patients were rehabilitated with immediately loaded cross-arch implant-supported prostheses. A total of 253 implants were placed, including 148 implants presenting buccal dehiscence and treated with horizontal bone augmentation using particulate grafting materials with or without autogenous bone and a resorbable collagen membrane. Clinical outcomes were assessed over a 1-year follow-up period. Implant survival and biological complications were recorded. Descriptive statistics were applied. An exploratory event-based comparison between augmented and non-augmented implants was performed using Fisher's exact test, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: At 1 year, no patients were lost to follow-up. Two implant failures occurred, both in augmented sites (2/148; 1.35%), while no failures were observed among non-augmented implants (0/105). The exploratory comparison did not show a statistically significant difference in failure rates between groups (p = 0.51). The estimated RR for implant failure associated with horizontal augmentation was 3.56 (95% CI: 0.17-73.34). Two biological complications (one peri-implantitis and one peri-implant mucositis) were recorded, both involving augmented implants. Conclusions: Within the limitations of this retrospective case series, immediately loaded implants placed in sites with buccal dehiscence and treated with horizontal bone augmentation demonstrated high early survival rates and a low incidence of biological complications. These findings are descriptive and exploratory and should be interpreted as hypothesis-generating. Further prospective controlled studies with longer follow-up are needed to confirm these observations.

Background/Objectives: The classification of adhesive systems has historically relied on the type of etching agent and the sequence of application steps, distinguishing etch-and-rinse and self-etch categories. However, these models do not encompass the versatility introduced by universal adhesives or other emerging polymeric materials. This review aimed to integrate etching technique as a defining parameter within adhesive classification, linking material composition, bonding strategy, and clinical execution into a coherent functional framework. Methods: A structured narrative review of experimental, translational, and clinical studies published between 2010 and 2025 was conducted using PubMed and Scopus. Literature addressing adhesive categories, etching strategies, etching techniques, and smear layer characteristics was critically synthesized to identify functional relationships relevant to bonding performance and clinical decision-making. Results: The proposed taxonomy classifies materials as conventional, universal, touch-cure primers, self-adhesive/universal, and glass ionomer cements. Bonding strategies are organized as etch-and-rinse, self-etch, pre-etched, and unassisted, while etching techniques are defined as selective or nonselective families encompassing five clinically defined techniques. Incorporating etching technique clarifies the role of smear layer density, the acidity of adhesive materials, and functional monomer reactivity in demineralization and bonding. This structure enhances the understanding and teaching of adhesive concepts and supports evidence-based clinical selection of materials and techniques. Conclusions: Integrating etching technique into adhesive classification provides a functional and dynamic framework that unifies material, strategy, and technique. This taxonomy facilitates clinical decision-making and can evolve with future adhesive formulations. Further independent, long-term studies are warranted to validate the proposed combinations of materials and etching procedures.