Dentistry Journal最新文献

Background: Primary intraosseous carcinoma (PIOC) is a rare and aggressive odontogenic malignancy that originates within the jaw bones without initial mucosal involvement. Its atypical and nonspecific symptoms frequently lead to diagnostic delays, especially in maxillary presentations. Methods: A 74-year-old male presented with persistent trigeminal-like neuralgic pain along the ophthalmic branch, initially misdiagnosed as secondary trigeminal neuralgia. MRI revealed a 45 × 46 × 34 mm mass occupying the right maxillary sinus with orbital wall destruction and dural invasion. Following histopathological confirmation of malignancy, a multidisciplinary team performed total maxillectomy with orbital exenteration and dural resection, followed by reconstruction using a temporoparietal flap. Adjuvant radiotherapy was administered. Results: Histopathology revealed invasive odontogenic carcinoma with atypical squamous features, dentinoid deposition, and perineural invasion. Postoperative recovery was uneventful, with complete pain resolution. MRI and PET surveillance over 2.5 years demonstrated no local recurrence. Conclusions: Maxillary PIOC may present exclusively with neuropathic pain, mimicking trigeminal neuralgia and leading to delayed diagnosis. In cases of unexplained facial pain with sinus or skull base involvement, odontogenic malignancies should be considered in the differential diagnosis. Early imaging and multidisciplinary management are key to achieving timely diagnosis, effective treatment, and improved quality of life.

Background/Objectives: Adolescents may experience psychosocial consequences from minor dentofacial variations. The relationship between objectively rated smile esthetics and self-reported psychosocial impact remains under-studied in Saudi adolescents. This study aimed to investigate the relationship between the objectively measured smile esthetics with the subjectively reported psychosocial impact of perceived smile esthetics. Methods: Cross-sectional, multistage cluster-stratified sample technique was used to study adolescents aged 15-20 years (n = 344) from Al-Ahsa schools. Standardized extra-/intraoral photography supported Dental Esthetic Screening Index (DESI) scoring and psychosocial impact using Arabic Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) were applied. Reliability was assessed through two-way mixed intraclass correlation coefficient (ICC), Bland-Altman analysis, standard error of measurement (SEM), and minimal detectable change at the 95% confidence level (MDC95). Associations were examined using correlations and regression models. Results: The distribution of DESI categories was excellent (6.4%), good (29.7%), satisfactory (42.2%), insufficient (18.9%), and poor (2.9%). The distribution of PIDAQ impact levels was minimal (37.8%), slight (41.6%), moderate (18.0%), and significant (2.6%) (age p = 0.052; sex p = 0.417). DESI and total PIDAQ were weakly correlated (Spearman ρ = 0.248, 95% CI 0.143-0.347; p < 0.001). In a multivariable linear regression model with continuous PIDAQ total score as the outcome (R² = 0.525; adjusted R² = 0.516; p < 0.001), self-perceived smile dissatisfaction (B = 7.789; β = 0.478; p < 0.001) and tooth-color dissatisfaction (B = 4.099; β = 0.306; p < 0.001) showed the strongest associations with higher PIDAQ scores, while DESI total score showed a smaller association (B = 0.310; β = 0.120; p = 0.002). Age and sex were not significant predictors after adjustment. Conclusions: Objective smile esthetics were modestly associated with psychosocial impact, whereas adolescents' self-perceived smile and tooth-color dissatisfaction were strongly associated with worse psychosocial outcomes. Although the smile esthetics may be clinically acceptable, adolescents can still experience reduced oral health-related quality of life due to the psychosocial impact of perceived dental esthetics. These findings support incorporating brief subjective questions on smile and tooth-color perception alongside objective assessment during routine adolescent dental care.

Background: Cervical restorations remain clinically challenging due to complex anatomy, limited enamel availability, and difficulties in achieving reliable adhesion at dentin or cementum margins. Polymerization shrinkage and marginal leakage are frequent causes of failure. Although the Closing Gap Technique has been proposed to improve marginal adaptation in cervical restorations, evidence supporting its medium- to long-term clinical performance is limited. The aim of this case report was to evaluate the clinical effectiveness of the Closing Gap Technique in the restoration of carious and non-carious cervical lesions. Materials and Methods: Two patients presenting with cervical lesions were treated using the Closing Gap Technique. One case involved carious cervical lesions, while the second included multiple non-carious cervical lesions. Restorations were performed following an enamel-anchored incremental layering protocol with resin composite. Clinical evaluations were conducted at 8 years (case #1) and 2 years (case #2) post-treatment, respectively. Results: Both cases demonstrated favorable clinical outcomes at follow-up. The restorations exhibited good marginal integrity, satisfactory esthetics, absence of marginal discoloration, no secondary caries, and no signs of debonding. The only minor defect observed was slight chipping of one of the restorations. Conclusions: Within the limitations of this case report, the Closing Gap Technique showed stable and predictable medium- and long-term clinical performance, supporting its use as a viable restorative approach for managing cervical lesions in daily clinical practice.

Background/Objectives: The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is a useful tool for investigating the psychosocial impact of malocclusion and dental aesthetics on the quality of life of young adults. This study aimed at developing a culturally adapted Greek version, assessing its validity and reliability. Methods: The questionnaire underwent bilingual translation, followed by cultural adaptation with 10 debriefing interviews. Gr-PIDAQ along with the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) were completed by 270 young adults for the evaluation of its psychometric properties. Fifty dentists also participated, assessing its face validity. Results: Confirmatory factor analysis verified the four-factor structure of the original version of PIDAQ. The ability of Gr-PIDAQ to discriminate between individuals according to the perceived need for improvement in dental appearance was confirmed (p < 0.001). Participants exhibiting greater malocclusion severity as assessed by the IOTN-AC presented higher PIDAQ scores (p < 0.001). Face validity was confirmed by 99.6% of participants and 96% of dentists. Cronbach's alpha coefficient of the overall scale was 0.94 (the four subscales ranged from 0.78 to 0.9), while excellent repeat measurement agreement was detected (ICC = 0.95, p ˂ 0.001). Conclusions: Our findings suggest that Gr-PIDAQ is a valid and reliable tool that can be used to measure orthodontics-related quality of life in Greek speaking adults. In terms of clinical application, it can be used to assess the orthodontic treatment need and record patients' perspective both before orthodontic treatment initiation and later during the assessment of its effectiveness, serving as a Patient-Related Outcome Measure (PROM).

Background/Objectives: Alveolitis, or "dry socket," is a common complication after tooth extraction, associated with pain, inflammation and delayed healing. Standard surgical treatments are often invasive and insufficient. Laser therapy offers antimicrobial, anti-inflammatory and regenerative effects. This study aimed to compare the efficacy of 980 nm monolaser therapy and 980 nm and 1550 nm dual-wavelength therapy on alveolar socket healing in a rabbit model. Methods: In vitro tests evaluated bactericidal effects of 980 nm laser exposure. Eighteen adult male chinchilla rabbits underwent the extraction of the first incisors with the prevention of clot formation to model alveolar socket healing. On day 3, animals were randomized to three groups: mechanical curettage and antiseptic irrigation, 980 nm diode laser therapy, or combined 980 nm + 1550 nm therapy. Clinical parameters (hyperemia, edema, pain, socket closure) were assessed up to day 7. Histological and microbiological analyses were performed on days 7 and 12. Results: Laser therapy showed superior outcomes compared to mechanical treatment. In vitro, 980 nm exposure eradicated microorganisms after 3 s. By day 7, hyperemia decreased to 0.7 ± 0.6 points in the dual-laser group, versus 2.0 ± 0.0 (980 nm) and 3.0 ± 0.0 (mechanical). Complete socket closure occurred in 33% with mechanical treatment and in 67% of sites in the dual-laser group. Pain was fully resolved only after dual-laser therapy. Histology confirmed more organized granulation tissue and angiogenesis in the dual-laser group. Conclusions: Dual-wavelength laser therapy demonstrated superior anti-inflammatory, antimicrobial and regenerative effects compared with diode monotherapy and mechanical treatment. These findings highlight its promise as a minimally invasive approach for managing alveolitis, warranting further clinical evaluation.

Medication-related osteonecrosis of the jaw (MRONJ) is a devastating complication arising primarily after invasive dentoalveolar procedures in patients treated with antiresorptive, antiangiogenic, or targeted therapies. Although recognized risk factors are established, the distinctive vulnerability of jawbones compared to long bones is not fully understood. This review comprehensively synthesizes recent advances regarding the embryological, anatomical, and physiological disparities that contribute to region-specific susceptibility to MRONJ. Recent evidence suggests that jawbones diverge significantly from long bones in embryonic origin, ossification pathways, vascular architecture, innervation patterns, and regenerative capacities. These differences affect bone metabolism, healing dynamics, response to pharmacologic agents, and local cellular activities, such as enhanced bisphosphonate uptake and specialized microcirculation. Experimental and clinical evidence reveals that mandibular periosteal cells exhibit superior osteogenic and angiogenic potentials, and the jaws respond differently to metabolic challenges, trauma, and medication-induced insults. Furthermore, site-specific pharmacologic and inflammatory interactions, including altered periosteal microcirculation and leukocyte-endothelial interactions, may explain the development of MRONJ, although rare cases of medication-related osteonecrosis have also been reported in long bones. Emerging research demonstrates that immune dysregulation, particularly M1 macrophage polarization with overexpression of matrix metalloproteinase-13 (MMP-13), plays a crucial role in early MRONJ development. Understanding these mechanisms highlights the critical need for region-specific preventive measures and therapeutic strategies targeting the unique biology of jawbones. This comparative perspective offers new translational insights for designing targeted interventions, developing tissue engineering solutions, and improving patient outcomes. Future research should focus on gene expression profiling and cellular responses across skeletal regions to further delineate MRONJ pathogenesis and advance personalized therapies for affected patients.

Objectives: The aim of this study was to investigate the relationship between the diameter of iatrogenic root perforations and the fracture resistance (FR) of endodontically treated teeth. Methods: Sixty-five single-rooted teeth were sectioned at 13 mm from the anatomic apex. Their weight and the mesiodistal (MD) and buccolingual (BL) dimensions were recorded in order to ensure their allocation into five homogeneous groups (N = 13); Group 1 (control group): teeth remained intact, Group 2: teeth were instrumented but not perforated, Group 3: teeth were instrumented and perforated with a 2.1 mm bur, Group 4: teeth were instrumented and perforated with a 1 mm bur, and Group 5: teeth were instrumented and perforated with a 0.5 mm bur. All perforations were created at the same spot in the buccal surface of the roots. To further standardize the defects, an apparatus ensured that the cutting bur was positioned with a steady angle of 105° to the external root surface. A universal testing machine was used for fracture testing by applying a compressive vertical load at a speed of 1 mm/min until root fracture. The recorded forces were statistically analyzed with one-way analysis of variance (ANOVA) and post hoc Tukey test. Results: The mean fracture load was 342.68 ± 146.45 N for Group 1, 322.96 ± 98.62 N for Group 2, 214.65 ± 71.32 N for Group 3, 212.66 ± 77.89 N for Group 4, and 307.14 ± 109.16 N for Group 5. However, only the differences between groups 1-3 and 1-4 were statistically significant (p < 0.05). Conclusions: The teeth with 2.1 mm and 1 mm perforations were found to have significantly decreased FR.

Background: Smoking alters oral ecological balance, yet its influence on posterior teeth restored with lithium disilicate endocrowns is insufficiently documented. This study assessed the clinical and microbiological impact of smoking on the peri-coronal environment of endocrown-restored teeth, using an age-stratified approach to evaluate cumulative effects. Methods: A cross-sectional study was conducted on 100 adults, equally divided into smokers and non-smokers. Salivary pH, papillary bleeding index, and plaque index were clinically recorded. Subgingival samples collected from endocrown-restored posterior teeth were analyzed using a polymerase chain reaction (PCR) assay targeting major periodontal pathogens. Age-related variation in clinical and microbiological parameters was examined using one-way analysis of variance (ANOVA), followed by Tukey's HSD post hoc test. Results: Smokers showed consistently lower salivary pH and higher plaque accumulation across all age groups. Gingival bleeding was reduced in younger smokers but increased in older individuals. Microbiological analysis identified markedly elevated levels of orange-complex organisms in smokers, including Prevotella intermedia and Fusobacterium nucleatum. Clinically, endocrowns in smokers presented more frequent marginal degradation, localized inflammation, and early signs of recurrent caries. These effects intensified with age. Conclusions: Smoking adversely modifies the peri-coronal biological environment of lithium disilicate endocrowns by increasing acidity, promoting plaque maturation, and supporting dysbiotic microbial communities. Age further amplifies these changes. Considering smoking status and patient age during treatment planning may improve long-term restorative outcomes.

Background/Objectives: This study aimed to evaluate the clinical feasibility of a novel desktop micro-computed tomography (micro-CT) scanner for digital impressions through comprehensively assessing its dimensional trueness and morphological accuracy in comparison with other optical-based scanners. Methods: A modified reference model was used to create ten silicone impressions and corresponding plaster models. Four digitization protocols were evaluated: (1) direct scanning of impressions via micro-CT scanner (MCTI), (2) extraoral scanning of impressions via F8 scanner (F8I), (3) extraoral scanning of plaster models via F8 scanner (F8PM), and (4) intraoral scanning of plaster models using Trios 5 scanner (IOSPM). Dimensional trueness was quantified via six linear measurements, and morphological accuracy (trueness and precision) was assessed by 3D surface deviation analysis. Results: Statistically significant differences in linear measurements between the digital impressions and the reference model were observed (p < 0.05). MCTI, F8PM and IOSPM demonstrated higher dimensional trueness than F8I. Although all methods showed high morphological precision, F8I (398.5 ± 43.0 µm) exhibited significantly greater root mean square (RMS) deviations for morphological trueness than MCTI (114.8 ± 42.2 µm), F8PM (142.1 ± 27.7 µm) and IOSPM (134.6 ± 12.0 µm) (p < 0.01). MCTI also demonstrated the highest reliability for morphological trueness according to relative standard deviation (RSD) analysis, with RSD values of 30.83% for MCTI, 41.80% for F8I, 37.26% for F8PM, and 42.55% for IOSPM. Conclusions: The novel micro-CT scanner enables accurate and reliable direct digitization of dental impressions. Its performance is comparable to scanning plaster models with high-end scanners and significantly superior to direct optical scanning of impressions, making it a promising alternative in digital dental workflow.

Background: To assess sex-related differences in periodontal inflammation and bone loss and identify sex-specific associations with systemic and local risk factors. Methods: This cross-sectional study analyzed records from a university setting. Outcomes were bleeding on probing (BOP) and bone loss index (BLI). Predictors included smoking, diabetes mellitus, age, plaque control record (PCR), the proportion of sites with pocket depth (PD) ≥ 5 mm, and number of teeth. Sex-stratified generalized linear models were applied. Results: A total of 232 participants were included (114 men, 118 women; mean age 55.6 ± 11.6 years). Men showed higher PD ≥ 5 mm (p = 0.030), with no sex difference in mean BOP or BLI. PD ≥ 5 mm predicted higher BOP in both sexes (men p < 0.001; women p = 0.002). Smoking was associated with higher BOP in men and with increased BLI in women (p = 0.010). PCR was positively associated with BOP in women and inversely with BLI in men (p = 0.042). Conclusions: In this study, sex-specific associations between behavioral/clinical factors and periodontal outcomes were observed. PD ≥ 5 mm was related to BOP in both sexes, while smoking and plaque control showed sex-divergent patterns. These exploratory findings warrant confirmation in prospective studies.