Dentistry Journal最新文献

Background: Systemic bone loss, particularly osteoporosis, and periodontal disease are highly prevalent chronic conditions that share common risk factors and biological pathways. Increasing evidence suggests a bidirectional relationship between these conditions; however, findings remain heterogeneous and evolving. Objective: This review aims to evaluate and update current evidence on the bidirectional association between systemic bone loss and periodontal disease, with emphasis on underlying mechanisms and clinical implications. Methods: A narrative review of the literature was conducted using major electronic databases, focusing on human studies evaluating the relationship between osteoporosis or systemic bone loss and periodontal disease. Relevant experimental, clinical, and epidemiological studies were included. Results: Most studies support an association between reduced bone mineral density and increased severity of periodontal disease, including greater alveolar bone loss and attachment loss. Conversely, periodontal inflammation may contribute to systemic bone remodeling through inflammatory mediators. However, variability in study design, diagnostic criteria, and confounding factors limits definitive conclusions. Conclusions: Current evidence supports a bidirectional association between systemic bone loss and periodontal disease. Greater interdisciplinary awareness is warranted, and future well-designed longitudinal studies are needed to clarify causality and inform preventive and therapeutic strategies.

Background and Objectives: Preheated composite resins have been proposed as an alternative to conventional luting agents due to their improved resistance, color stability, and adaptation. This review aims to critically evaluate the current literature on the use of preheated composites as luting agents exclusively on dentin and enamel, focusing on their mechanical behavior, optical properties, and biological effects, in order to determine whether they provide superior clinical outcomes compared with conventional resin cements. Materials and Methods: A comprehensive literature search from 2015 to 2025 was conducted in accordance with PRISMA-ScR guidelines. Eligible studies included in vitro investigations comparing the preheated composite with other luting agents performed on human, bovine, analog dentin or enamel substrates. Studies meeting these criteria were screened, evaluated, and synthesized. Results: Fifteen studies met the inclusion criteria: nine focused on the mechanical performance, and the remaining six studies examined additional properties such as color stability, pulpal temperature changes during preheating, film thickness characteristics, and the influence on marginal discrepancy. Conclusions: Preheated composite resins offer improved mechanical properties, marginal adaptation, and fracture resistance compared with conventional luting agents. However, their performance is highly technique-sensitive, and clinical outcomes depend on operator skill, restoration thickness, and material selection. Preheating generally does not compromise color stability, but it can elevate pulpal temperature, particularly when residual dentin is thin. Overall, preheated composites have potential clinical advantages, provided that careful handling and appropriate application are ensured.

Background: Altered passive eruption (APE) is one of the etiological factors associated with excessive gingival display and is commonly treated with esthetic crown lengthening (ECL). However, existing classification systems provide limited guidance for selecting appropriate treatment approaches. Objectives: The aim of this study was to evaluate (1) the expected outcome of ECL in eliminating unattractive excessive gingival display (4 mm) based on digital smile assessment and (2) the distribution of teeth and patients according to the modified APE classification. Methods: Forty-two Thai patients with APE underwent clinical examination, digital smile assessment, intraoral scanning, and CBCT. Predicted gingival display (PGD) was calculated to assess the expected outcomes of ECL. The modified APE classification, incorporating CEJ-BC distance and buccal bone thickness, was analyzed at both the tooth and patient levels. Results: A total of 252 maxillary anterior teeth were assessed. Most patients (78.57%) presented with APE and hyperactive upper lip. The mean gingival display (GD) was 6.04 ± 1.76 mm, with GD ≥ 4 mm observed in 92.86% of patients. The mean PGD was 3.56 ± 1.71 mm, and ECL was predicted to reduce GD to < 4 mm in 66.67% of patients. Teeth were classified as Class I (28.97%), II (15.48%), III (41.27%), and IV (14.28%); only Types II (11.9%) and III (88.1%) occurred at the patient level. Conclusions: ECL performed at the CEJ level is predicted to eliminate excessive gingival display in approximately two-thirds of APE patients. The modified APE classification offers guidance for selecting surgical approaches, highlighting the necessity of open-flap procedures and the limited applicability of flapless approaches.

Objectives: Investigating and comparing the micro-tensile bond strength (µTBS) of etch-and-rinse (ER) or self-etch (SE) adhesives on sound (s) and eroded (e) human (H) and bovine (B) dentin. Methods: Twenty-four human and bovine teeth were divided into eight groups (n = 6) and coronally ground down, exposing their dentin. Two groups of human (HeER + HeSE) and bovine teeth (BeER + BeSE) were subjected to erosive challenges (citric acid (pH 2.7), 10 × 2 min per day for five days, and stored in artificial saliva). Groups HsER + HeER and BsER + BeER were treated with an etch-and-rinse adhesive (OptiBond FL), and groups HsSE + HeSE and BsSE + BeSE were treated with a self-etch adhesive (OptiBond All-in-One), followed by buildups with a composite restorative material. After seven days of storage in tap water, µTBS was determined and failure type analysis was performed. Data were evaluated using two-way ANOVA and Tukey's post hoc tests at a level of significance of α = 0.05. Results: Using etch-and-rinse adhesive, sound human dentin (HsER) showed the significantly highest µTBS (p < 0.05) compared to eroded human (HeER) and sound and eroded bovine dentin (BsER + BeER). For sound human and bovine specimens (HsSE + BsSE), there was no significant difference (p ≥ 0.05) in µTBS when self-etch adhesive was applied, as well as in the eroded specimens (HeSE + BeSE). Conclusions: Within the limitations of this study, it can be concluded that for the etch-and-rinse approach, it is not recommended to substitute human dentin with bovine dentin. When using the specific self-etch adhesive used in the present study, bovine dentin can be used to substitute human dentin, as they showed comparable µTBS.

Background: Congenital Insensitivity to Pain and Anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by congenital analgesia, anhidrosis, and multisystem involvement affecting the musculoskeletal, cutaneous, oral, and para-oral structures. This case report describes the oral phenotype and multidisciplinary clinical management of a child with CIPA. Case Description: A 9-year-old boy presented with poor oral hygiene, multiple severely damaged teeth, masticatory difficulty, limited mouth opening, impaired bolus control, and para-oral traumatic injuries. Medical and orthopedic history indicated recurrent painless fractures, self-inflicted injuries, cutaneous scarring, and recurrent hyperpyrexia. Oral self-injury associated with CIPA was suspected and supported by the Nociception Assessment Test and Minor's Iodine-Starch Test. Although the clinical findings were suggestive of CIPA, the diagnosis remained presumptive due to the absence of confirmatory molecular or histopathological testing. Management: A wearable wireless continuous temperature-monitoring device was prescribed to assist in tracking hyperpyrexia associated with CIPA (RHA-CIPA). A conservative, staged, multidisciplinary treatment was planned rather than full-mouth extraction, emphasizing prevention of dental sepsis and mitigation of future self-injury. Dental procedures were performed under local anesthesia to manage discomfort related to tactile hyperesthesia. To reduce nocturnal biting and oral trauma, a hard acrylic occlusal protector was fabricated using an intraoral scanner and a 3D-printed cast. The patient was followed for 12 months. Outcomes: At the 12-month follow-up, clinical improvement was observed, with particularly notable gains in cheek elasticity and soft tissue resilience. Conclusions: This case highlights the considerable challenges involved in the interdisciplinary management of children with CIPA, including oral self-injury prevention, limited mouth opening, and the necessity of close coordination with medical specialties. These findings are descriptive observations of a single case and do not establish efficacy or generalizability of any intervention.

Background/Objectives: Limited residual bone height in the atrophic posterior maxilla complicates implant placement. Transcrestal sinus elevation can be used to correct bone shrinkage after sinus pneumatization or crestal bone loss. This study evaluated a minimally invasive, one-stage transcrestal sinus lift using a double-layer crosslinked collagen scaffold (MCCS) with autogenous bone from the implant osteotomy site in patients with RBH ≤ 6 mm. Methods: In this prospective series, 11 patients (48-64 years, mean RBH 4.75 mm, SD 0.95 mm) underwent one-stage transcrestal sinus floor elevation with simultaneous implants. After osteotomy, autogenous bone chips collected during drilling were compacted into the site, and two layers of MCCS were placed under the elevated Schneiderian membrane. Buccal and palatal bone heights were measured on CBCT before and after surgery to assess vertical bone gain (ΔRBH). Results: All implants achieved stable osseointegration. Mean ΔRBH was approximately 3.1 ± 0.9 mm (combined buccal-palatal). No postoperative complications occurred. Two small Schneiderian membrane perforations were sealed intraoperatively by MCCS placement, with uneventful healing. Follow-up imaging showed maintenance of the augmented bone around the implants. Conclusions: This double-layer MCCS plus autogenous bone approach is a safe, effective, and minimally invasive transcrestal sinus lift for atrophic maxillae. It yielded crestal bone gains even with minimal initial RBH, leveraging the palatal sinus wall's osteogenic potential and the implant's tent-pole effect. The MCCS scaffold maintained space for bone formation and enabled immediate sealing of any membrane perforations. This one-stage protocol is viable for implant placement in low-RBH sites.

Background: Previous reports suggest that patient age at the time of implant placement is not a factor in implant survival. However, analysis of data compiled for a previously published study on the effect of enamel matrix derivative (EMD), a frequently used biomaterial to aid bone regeneration, on peri-implantitis indicated that age and use of EMD may be a factor in implant survival. The current study further evaluated the existing database to determine the effect of age and EMD use on long term survival of implants. Methods: An existing database from a private periodontal specialty practice was evaluated for the effect of age at the time of implant placement on implant survival. In addition, all available clinical factors were evaluated, including the use of EMD at any point during site preparation or implant placement to determine any effect on implant survival. Results: Patient age at the time of implant placement had a negligible effect on implant survival for younger individuals. However, starting at 58 years of age, an increase in relative risk for implant loss was noted. When the patient age was divided into groups, it was determined that patients ≥ 58 and ≤68 years had a statistically significantly increased relative risk of implant loss (2.75), which was sharply reduced if EMD had been used (1.24). This trend was also noted to a lesser extent in patients older than 68 years. Conclusions: The risk of implant loss was elevated when implants were placed in older patients. This risk was reduced if EMD had been used at any point during implant site preparation or placement.

Background: Integrity, encompassing honesty, accountability, and ethical conduct, is a cornerstone of the dental profession, essential for patient trust and safety. Despite its importance, academic dishonesty remains a pervasive issue in dental education globally. This review examines the prevalence, causes, and long-term career implications of academic dishonesty in dental education and explores institutional strategies to cultivate a culture of integrity. Method: The study was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify studies published between 1970 and 2025 on academic dishonesty in dental education. Search terms included dental students, cheating, plagiarism, and clinical falsification. Eligible studies reported prevalence, drivers, or consequences of dishonest behaviors. Data were extracted and thematically synthesized to highlight common patterns and professional implications. Results: Self-reported data indicate alarmingly high rates of cheating among dental students, ranging from 43% to over 90%. Common forms include exam fraud, plagiarism, and the falsification of clinical records. Key drivers include intense academic pressure, competitive environments, and a perception of weak enforcement. Such behaviors are not merely academic violations-they have profound professional consequences. A history of academic dishonesty can damage a student's reputation, hinder licensure and credentialing processes, and limit postgraduate opportunities. Crucially, studies indicate that unethical behavior in school can normalize dishonesty, predicting a higher likelihood of future professional misconduct, such as insurance fraud or malpractice, thereby jeopardizing patient care and public trust. Conclusions: Academic integrity is a critical predictor of professional ethical conduct. Dental schools must move beyond punitive policies to implement proactive, multi-faceted approaches. This includes integrating comprehensive ethics curricula, fostering reflective practice, promoting faculty role modeling, and empowering student-led initiatives to uphold honor codes. Cultivating an unwavering culture of integrity is essential not only for academic success but for developing trustworthy practitioners committed to lifelong ethical patient care.

Background: Obstructive sleep apnea is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxemia, sleep fragmentation, and excessive daytime sleepiness. Affecting up to 11% of the adult Polish population and more commonly diagnosed in men, OSA poses a major public health concern due to its association with cardiovascular, metabolic, and neurocognitive complications. This review summarizes the current evidence on diagnostic methods, risk factors, and therapeutic approaches, with particular emphasis on oral appliance therapy using mandibular advancement devices (MADs). Methods: A systematic literature review was conducted using the PubMed and Scopus databases, covering publications from 2020 to 2025, including clinical trials, meta-analyses, and systematic reviews evaluating the efficacy and safety of MAD therapy. Results: Findings demonstrate that MAD effectively reduces apnea-hypopnea index (AHI) values, improves oxygen saturation, and alleviates snoring and daytime fatigue, offering a patient-tolerable alternative for those intolerant to continuous positive airway pressure (CPAP). However, long-term use may cause occlusal or dental changes. Novel techniques, such as Er:YAG laser therapy, show potential in treating mild OSA. Moreover, epidemiological data suggest a correlation between tooth loss and an increased risk of OSA, particularly among men over 65. Conclusions: Dentists play a pivotal role in early detection, screening, and interdisciplinary management of OSA, underscoring the importance of collaboration between dental professionals and sleep medicine specialists for comprehensive care.

Background/Objectives: Caries adjacent to restorations remain a leading cause of restoration failure and replacement. Conventional diagnostic methods are limited by subjectivity and restricted visualization. Fluorescence-enhanced three-dimensional (3D) imaging has been proposed to improve detection accuracy, but evidence on its clinical perception and usability remains scarce. The objective of this study was to evaluate the perceived diagnostic value of fluorescence-enhanced 3D imaging in detecting caries adjacent to direct restorations. Methods: A cross-sectional questionnaire-based survey was distributed to undergraduate dental students and licensed dentists (n = 94). Participants assessed images of extracted teeth with direct restorations presented in three formats: conventional photographs, monochromatic 3D models, and 3D models with fluorescence. Responses were analyzed using descriptive statistics, chi-square tests, and Cohen's kappa to measure inter-rater agreement. Results: Overall, 64.9% of respondents reported that fluorescence-enhanced images improved their diagnostic decision-making, while 29.8% reported partial benefit. Fluorescence was mainly perceived as helpful in defining cavity margins (53.3%) and assessing lesion volume (42.4%). Most participants preferred 3D models with fluorescence over conventional images for diagnostic value. However, inter-rater agreement was generally poor (κ range: -0.05 to 0.25; median κ = 0.02; only 4 images showed weak but statistically significant agreement), with only a few images demonstrating weak but statistically significant agreement. Notably, 39.3% of participants reported prior experience with 3D imaging, which was associated with greater confidence in interpreting fluorescence-enhanced images. Participants with prior 3D imaging experience reported greater confidence in fluorescence interpretation. Conclusions: While fluorescence-enhanced 3D imaging is perceived as a useful adjunct for visualizing lesion margins and depth, it does not currently yield consistent diagnostic agreement across clinicians. Training, calibration, and integration of artificial intelligence support may enhance the clinical reliability of this technology.