Pub Date : 2025-12-09DOI: 10.1038/s41432-025-01190-z
Ankita Saikia, Therese Kvist, Amr Fawzy, Robert Anthonappa
This review assessed the quality and findings of systematic reviews on AI in dentistry, categorising advancements across various specialties. The review analyzed data from seven databases, assessed review quality with ROBIS, calculated pooled AI performance estimates, and identified research gaps through an Evidence Gap Map. This study analysed 116 included systematic reviews. Meta-analysis of twelve low-bias reviews showed AI diagnostic accuracy ranging from 82% to 95% across dental specialties. The pooled sensitivity and specificity of AI algorithms for dental diagnostics were 0.85 (95% CI: 0.76–0.93) and 0.93 (95% CI: 0.90–0.95), respectively. Advanced models, particularly Convolutional Neural Networks (CNN), demonstrated a pooled accuracy of 93.1% (95% CI: 91.19–95.05%). Corrected Covered Area analysis indicated low overlap among reviews (10%), reflecting the diverse applications of AI in dentistry. Significant heterogeneity across pooled sensitivity (I2 = 98.26%), specificity (I2 = 87.49%), area under the curve (I2 = 86.62%) and accuracy (I2 = 75.86%) were observed. AI shows strong diagnostic accuracy across dental specialties like caries detection, cephalometric landmark identification, and oral lesion diagnosis, with pooled sensitivity (0.85), specificity (0.93), and AUC (0.95) values. Advanced AI models like CNNs, Artificial Neural Networks, and larger, diverse datasets improve diagnostic accuracy, especially in image classification. Addressing research gaps and standardising methods are key to optimizing AI’s clinical impact. This review reinforces AI’s transformative potential in dentistry, enhancing tasks like diagnosis, detection, and prognosis, particularly in caries and lesion detection, to improve clinical decision-making and patient outcomes.
{"title":"Artificial Intelligence in dentistry: an overview of systematic reviews and meta-analysis","authors":"Ankita Saikia, Therese Kvist, Amr Fawzy, Robert Anthonappa","doi":"10.1038/s41432-025-01190-z","DOIUrl":"10.1038/s41432-025-01190-z","url":null,"abstract":"This review assessed the quality and findings of systematic reviews on AI in dentistry, categorising advancements across various specialties. The review analyzed data from seven databases, assessed review quality with ROBIS, calculated pooled AI performance estimates, and identified research gaps through an Evidence Gap Map. This study analysed 116 included systematic reviews. Meta-analysis of twelve low-bias reviews showed AI diagnostic accuracy ranging from 82% to 95% across dental specialties. The pooled sensitivity and specificity of AI algorithms for dental diagnostics were 0.85 (95% CI: 0.76–0.93) and 0.93 (95% CI: 0.90–0.95), respectively. Advanced models, particularly Convolutional Neural Networks (CNN), demonstrated a pooled accuracy of 93.1% (95% CI: 91.19–95.05%). Corrected Covered Area analysis indicated low overlap among reviews (10%), reflecting the diverse applications of AI in dentistry. Significant heterogeneity across pooled sensitivity (I2 = 98.26%), specificity (I2 = 87.49%), area under the curve (I2 = 86.62%) and accuracy (I2 = 75.86%) were observed. AI shows strong diagnostic accuracy across dental specialties like caries detection, cephalometric landmark identification, and oral lesion diagnosis, with pooled sensitivity (0.85), specificity (0.93), and AUC (0.95) values. Advanced AI models like CNNs, Artificial Neural Networks, and larger, diverse datasets improve diagnostic accuracy, especially in image classification. Addressing research gaps and standardising methods are key to optimizing AI’s clinical impact. This review reinforces AI’s transformative potential in dentistry, enhancing tasks like diagnosis, detection, and prognosis, particularly in caries and lesion detection, to improve clinical decision-making and patient outcomes.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"180-180"},"PeriodicalIF":2.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1038/s41432-025-01197-6
Sara Khan
Massouda J, Ghaltakhchyan N, Judd J, Bocklage C, Selden R, TumSuden O, Nanney E, Lee J, Ginnis J, Strauman T, Sawicki C, Hodges EA, Graves C, Divaris K, Jacox L. Evaluating effects of animal-assisted therapy on paediatric dental care patients: A pilot clinical trial. J Am Dent Assoc. 2025;156:447–457. https://doi.org/10.1016/j.adaj.2025.03.006 This commentary is based on the published pilot clinical trial by Massouda et al. (2025) evaluating animal-assisted therapy (AAT) in paediatric dental care. The study included children aged 7–14 undergoing invasive dental procedures, allocated to either an AAT or control group. Outcome measures included validated self-reported anxiety and pain scales, physiological stress markers, and behavioural observations. Data was synthesised narratively given pilot design and small sample size. A prospective, non-randomised pilot trial carried out in a university paediatric dental setting assessed the practicality and initial effects of integrating animal-assisted therapy (AAT) into dental treatment. Thirty-nine children aged 7–14 years scheduled for invasive dental procedures were enroled. Participants were allocated to an AAT group (n = 18) or a control group (n = 21). Inclusion criteria included the ability to assent and a willingness to interact with a certified therapy animal. Exclusion criteria included previous traumatic experiences with AAT, or significant developmental or behavioural disorders affecting cooperation. Physiological and psychological measures were recorded at baseline, during treatment, and post-operatively. Primary outcomes included self-reported pain and anxiety scores using validated scales. Secondary outcomes included heart rate monitoring, salivary cortisol, α-amylase, and video-coded behavioural relaxation. Given the small sample size, statistical analyses employed nonparametric 35 tests with significance set at P < 0.05. Children exposed to the therapy dog reported significantly lower postoperative pain scores (P = 0.001) and demonstrated smaller heart rate fluctuations during stressful procedural moments, suggesting lower physiological stress responses. Behavioural observations indicated longer periods of relaxed posture in the AAT group, though this did not reach statistical significance (P = 0.204). No significant differences were detected in salivary cortisol or α-amylase. AAT was reported as safe, well-tolerated, and feasible to implement. AAT shows potential for reducing distress in paediatric dental settings, but larger, randomised studies are required. Within the limits of a pilot design, animal-assisted therapy may reduce pain and physiological stress in paediatric dental patients. While encouraging, larger randomised trials are needed to confirm these effects, explore mechanisms, and assess practicality and cost in routine dental practice.
Massouda J, Ghaltakhchyan N, Judd J, Bocklage C, Selden R, TumSuden O, Nanney E, Lee J, Ginnis J, Strauman T, Sawicki C, Hodges EA, Graves C, Divaris K, Jacox L.动物辅助治疗在儿科牙科护理患者中的效果评价：一项初步临床试验。[J]中国生物医学工程学报，2015;16(6):447-457。https://doi.org/10.1016/j.adaj.2025.03.006资料来源：本评论基于Massouda等人（2025）发表的评估儿童牙科护理中动物辅助治疗（AAT）的试点临床试验。研究选择：该研究包括7-14岁接受侵入性牙科手术的儿童，分为AAT组和对照组。数据提取和综合：结果测量包括有效的自我报告焦虑和疼痛量表、生理应激标记物和行为观察。实验设计和小样本量的数据是叙述性的综合。设计：一项在一所大学儿科牙科机构进行的前瞻性、非随机试点试验，评估将动物辅助治疗（AAT）纳入牙科治疗的实用性和初步效果。病例选择：39名7-14岁的儿童计划进行有创牙科手术。参与者被分配到AAT组（n = 18）或对照组（n = 21）。纳入标准包括有能力同意并愿意与经过认证的治疗动物互动。排除标准包括先前的AAT创伤经历，或影响合作的显著发育或行为障碍。数据分析：记录基线、治疗期间和术后的生理和心理测量。主要结果包括自我报告的疼痛和焦虑评分，使用有效的量表。次要结果包括心率监测、唾液皮质醇、α-淀粉酶和视频编码行为放松。由于样本量小，统计分析采用非参数35检验，显著性设置为P。结果：接触治疗犬的儿童报告的术后疼痛评分显著降低（P = 0.001），并且在应激过程中表现出较小的心率波动，表明生理应激反应较低。行为观察表明，AAT组放松姿势的时间更长，但这没有达到统计学意义（P = 0.204）。唾液皮质醇和α-淀粉酶无显著差异。据报道，AAT是安全、耐受性良好、可行的。结论：AAT显示了在儿科牙科设置中减少痛苦的潜力，但需要更大规模的随机研究。在试点设计的范围内，动物辅助疗法可以减轻儿科牙科患者的疼痛和生理压力。虽然令人鼓舞，但需要更大规模的随机试验来证实这些效果，探索机制，并评估常规牙科实践的实用性和成本。
{"title":"Are therapy animals the key to happier dental visits for children?","authors":"Sara Khan","doi":"10.1038/s41432-025-01197-6","DOIUrl":"10.1038/s41432-025-01197-6","url":null,"abstract":"Massouda J, Ghaltakhchyan N, Judd J, Bocklage C, Selden R, TumSuden O, Nanney E, Lee J, Ginnis J, Strauman T, Sawicki C, Hodges EA, Graves C, Divaris K, Jacox L. Evaluating effects of animal-assisted therapy on paediatric dental care patients: A pilot clinical trial. J Am Dent Assoc. 2025;156:447–457. https://doi.org/10.1016/j.adaj.2025.03.006 This commentary is based on the published pilot clinical trial by Massouda et al. (2025) evaluating animal-assisted therapy (AAT) in paediatric dental care. The study included children aged 7–14 undergoing invasive dental procedures, allocated to either an AAT or control group. Outcome measures included validated self-reported anxiety and pain scales, physiological stress markers, and behavioural observations. Data was synthesised narratively given pilot design and small sample size. A prospective, non-randomised pilot trial carried out in a university paediatric dental setting assessed the practicality and initial effects of integrating animal-assisted therapy (AAT) into dental treatment. Thirty-nine children aged 7–14 years scheduled for invasive dental procedures were enroled. Participants were allocated to an AAT group (n = 18) or a control group (n = 21). Inclusion criteria included the ability to assent and a willingness to interact with a certified therapy animal. Exclusion criteria included previous traumatic experiences with AAT, or significant developmental or behavioural disorders affecting cooperation. Physiological and psychological measures were recorded at baseline, during treatment, and post-operatively. Primary outcomes included self-reported pain and anxiety scores using validated scales. Secondary outcomes included heart rate monitoring, salivary cortisol, α-amylase, and video-coded behavioural relaxation. Given the small sample size, statistical analyses employed nonparametric 35 tests with significance set at P < 0.05. Children exposed to the therapy dog reported significantly lower postoperative pain scores (P = 0.001) and demonstrated smaller heart rate fluctuations during stressful procedural moments, suggesting lower physiological stress responses. Behavioural observations indicated longer periods of relaxed posture in the AAT group, though this did not reach statistical significance (P = 0.204). No significant differences were detected in salivary cortisol or α-amylase. AAT was reported as safe, well-tolerated, and feasible to implement. AAT shows potential for reducing distress in paediatric dental settings, but larger, randomised studies are required. Within the limits of a pilot design, animal-assisted therapy may reduce pain and physiological stress in paediatric dental patients. While encouraging, larger randomised trials are needed to confirm these effects, explore mechanisms, and assess practicality and cost in routine dental practice.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"174-175"},"PeriodicalIF":2.3,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1038/s41432-025-01198-5
Thomas Evans, Henry David Jeffry Hogg
Alam M K, Alftaikhah S A A, Issrani R et al. Applications of artificial intelligence in the utilisation of imaging modalities in dentistry: a systematic review and meta-analysis of in-vitro studies. Heliyon 2024; https://doi.org/10.1016/j.heliyon.2024.e24221 . A systematic review of in vitro studies utilising artificial intelligence (AI) in dental imaging. Searches were carried out across multiple databases: CINAHL, Cochrane Library, Embase, Google Scholar, IEEE Xplore, PubMed/MEDLINE, Scopus, and Web of Science as well as hand-searching references from eligible articles. Studies were eligible if i) classed as in vitro, defined as simulations or laboratory tests outside a living organism, ii) studied the performance of AI techniques and iii) involved analysis of dental imaging. Studies not in English or with insufficient data were excluded. An adapted version of the CONSORT bias tool was used for the assessment of studies. Outcome measures were extracted including: odds ratios, true positive rate, true negative rate, positive predictive value, and negative predictive value. A meta-analysis using a fixed-effects model assessed accuracy with a 95% confidence interval. Heterogeneity and overall effect tests were applied to evaluate the reliability of the meta-analysis. After screening, nine studies were identified, eight of which focused on Cone Beam Computed Tomography (CBCT) imaging. Endpoints included caries detection, segmentation tasks and virtual 3D model creation. Across the nine studies, and when pooled in meta-analysis, AI performance was shown to be superior to reference standards. This systematic review of in-vitro studies highlights the potential of AI to improve the speed or quality of dental imaging tasks. However clinical studies are required to ensure evidence from laboratory studies can translate into clinical practice.
评论：Alam M K， Alftaikhah S A A， israni R等人。人工智能在牙科成像模式利用中的应用：体外研究的系统回顾和荟萃分析。Heliyon 2024;https://doi.org/10.1016/j.heliyon.2024.e24221。设计：系统回顾利用人工智能（AI）进行牙科成像的体外研究。检索是在多个数据库中进行的：CINAHL， Cochrane Library, Embase，谷歌Scholar， IEEE Xplore, PubMed/MEDLINE， Scopus和Web of Science以及从符合条件的文章中手工检索参考文献。研究选择：如果i)归类为体外研究，定义为活体生物体外的模拟或实验室测试，ii)研究人工智能技术的性能，iii)涉及牙科成像分析，则研究符合条件。非英文或资料不足的研究被排除在外。数据分析：采用CONSORT偏倚工具的改进版本对研究进行评估。结果测量包括：优势比、真阳性率、真阴性率、阳性预测值和阴性预测值。使用固定效应模型的荟萃分析以95%的置信区间评估准确性。采用异质性和总体效应检验来评价meta分析的可靠性。结果：筛选后，确定了9项研究，其中8项集中于锥束计算机断层扫描（CBCT）成像。端点包括龋齿检测、分割任务和虚拟3D模型创建。在这9项研究中，并将其汇总到荟萃分析中，人工智能的表现优于参考标准。结论：这项体外研究的系统综述强调了人工智能在提高牙科成像任务的速度和质量方面的潜力。然而，需要进行临床研究，以确保实验室研究的证据能够转化为临床实践。
{"title":"AI for dental imaging: impressive in vitro, but what about in practice?","authors":"Thomas Evans, Henry David Jeffry Hogg","doi":"10.1038/s41432-025-01198-5","DOIUrl":"10.1038/s41432-025-01198-5","url":null,"abstract":"Alam M K, Alftaikhah S A A, Issrani R et al. Applications of artificial intelligence in the utilisation of imaging modalities in dentistry: a systematic review and meta-analysis of in-vitro studies. Heliyon 2024; https://doi.org/10.1016/j.heliyon.2024.e24221 . A systematic review of in vitro studies utilising artificial intelligence (AI) in dental imaging. Searches were carried out across multiple databases: CINAHL, Cochrane Library, Embase, Google Scholar, IEEE Xplore, PubMed/MEDLINE, Scopus, and Web of Science as well as hand-searching references from eligible articles. Studies were eligible if i) classed as in vitro, defined as simulations or laboratory tests outside a living organism, ii) studied the performance of AI techniques and iii) involved analysis of dental imaging. Studies not in English or with insufficient data were excluded. An adapted version of the CONSORT bias tool was used for the assessment of studies. Outcome measures were extracted including: odds ratios, true positive rate, true negative rate, positive predictive value, and negative predictive value. A meta-analysis using a fixed-effects model assessed accuracy with a 95% confidence interval. Heterogeneity and overall effect tests were applied to evaluate the reliability of the meta-analysis. After screening, nine studies were identified, eight of which focused on Cone Beam Computed Tomography (CBCT) imaging. Endpoints included caries detection, segmentation tasks and virtual 3D model creation. Across the nine studies, and when pooled in meta-analysis, AI performance was shown to be superior to reference standards. This systematic review of in-vitro studies highlights the potential of AI to improve the speed or quality of dental imaging tasks. However clinical studies are required to ensure evidence from laboratory studies can translate into clinical practice.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"172-173"},"PeriodicalIF":2.3,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01198-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1038/s41432-025-01193-w
Shiamaa S. Al-Mashhadani
Sinha A, Kumar S, Sargaiyan V, Kottapalli RH, Sharma D, Goyal A. Comparative effectiveness of modified manual and powered toothbrushing interventions in individuals with disabilities: a randomized controlled trial assessing gingival health. J Pharm Bioallied Sci 2024; https://doi.org/10.4103/jpbs.jpbs_1171_24 . This commentary draws on data from a randomized controlled trial by Sinha et al. (2024), which compared the clinical effectiveness of manual and powered toothbrushes among individuals with disabilities. Supplementary insights were integrated from behavioral, psychological, and health systems literature to contextualize the findings. The primary study was selected for its focus on a vulnerable population and its moderate GRADE rating, which indicates methodological robustness despite limited generalizability. Supporting studies were chosen for their relevance to patient-centered care frameworks and oral health behaviors. Clinical outcomes were extracted from Sinha et al. (2024), while behavioral and patient experience themes were synthesized from a range of models including Self-Determination Theory, the Health Belief Model, and Shared Decision-Making frameworks. Preference-related data were qualitatively integrated to highlight divergence from clinical parity. The referenced trial showed no significant difference in gingival health outcomes between manual and powered brushing. However, a notable preference emerged for powered toothbrushes among participants. This preference appears driven by perceived ease of use, sensory comfort, and enhanced autonomy. Literature indicates that honoring such preferences enhances adherence, satisfaction, and long-term oral health outcomes, especially in individuals with disabilities. Clinical equivalence between interventions does not imply experiential equivalence. For individuals with disabilities, patient preferences are not secondary, they are central to sustainable, person-centered care. Future oral health promotion strategies should integrate preference-sensitive models to support autonomy, behavioral engagement, and equity in healthcare delivery.
{"title":"Do patient preferences matter when clinical outcomes are the same?","authors":"Shiamaa S. Al-Mashhadani","doi":"10.1038/s41432-025-01193-w","DOIUrl":"10.1038/s41432-025-01193-w","url":null,"abstract":"Sinha A, Kumar S, Sargaiyan V, Kottapalli RH, Sharma D, Goyal A. Comparative effectiveness of modified manual and powered toothbrushing interventions in individuals with disabilities: a randomized controlled trial assessing gingival health. J Pharm Bioallied Sci 2024; https://doi.org/10.4103/jpbs.jpbs_1171_24 . This commentary draws on data from a randomized controlled trial by Sinha et al. (2024), which compared the clinical effectiveness of manual and powered toothbrushes among individuals with disabilities. Supplementary insights were integrated from behavioral, psychological, and health systems literature to contextualize the findings. The primary study was selected for its focus on a vulnerable population and its moderate GRADE rating, which indicates methodological robustness despite limited generalizability. Supporting studies were chosen for their relevance to patient-centered care frameworks and oral health behaviors. Clinical outcomes were extracted from Sinha et al. (2024), while behavioral and patient experience themes were synthesized from a range of models including Self-Determination Theory, the Health Belief Model, and Shared Decision-Making frameworks. Preference-related data were qualitatively integrated to highlight divergence from clinical parity. The referenced trial showed no significant difference in gingival health outcomes between manual and powered brushing. However, a notable preference emerged for powered toothbrushes among participants. This preference appears driven by perceived ease of use, sensory comfort, and enhanced autonomy. Literature indicates that honoring such preferences enhances adherence, satisfaction, and long-term oral health outcomes, especially in individuals with disabilities. Clinical equivalence between interventions does not imply experiential equivalence. For individuals with disabilities, patient preferences are not secondary, they are central to sustainable, person-centered care. Future oral health promotion strategies should integrate preference-sensitive models to support autonomy, behavioral engagement, and equity in healthcare delivery.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"164-165"},"PeriodicalIF":2.3,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1038/s41432-025-01196-7
Mona Nasser, Heiko Spallek, Neeraj Gugnani
{"title":"Are we entering a new era of artificial intelligence (AI)-supported decision-making in dentistry?","authors":"Mona Nasser, Heiko Spallek, Neeraj Gugnani","doi":"10.1038/s41432-025-01196-7","DOIUrl":"10.1038/s41432-025-01196-7","url":null,"abstract":"","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"159-161"},"PeriodicalIF":2.3,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01196-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-28DOI: 10.1038/s41432-025-01194-9
Arash Shahravan
Fatima S, Andrabi S M, Alam S et al. Effect of foraminal enlargement on postoperative pain in primary endodontic treatment: a systematic review and meta-analysis. J Endod 2025; 51: 1536–1548. The purpose of this systematic review and meta-analysis was to investigate how foraminal enlargement (FE) affects postoperative pain following primary endodontic treatment. A systematic literature search was conducted across four major databases— PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library—to identify randomized controlled trials evaluating the impact of foraminal enlargement (FE) versus non-foraminal enlargement (NFE) on postoperative pain. The risk of bias in the included studies was evaluated using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. A meta-analysis was planned to quantitatively assess the impact of foraminal enlargement (FE) on pain during the first 7 days following treatment Eight randomized controlled trials (RCTs) involving a total of 802 participants met the inclusion criteria. The risk-of-bias assessment indicated that two studies were at high risk, four raised some concerns, and two were at low risk. Meta-analysis demonstrated that foraminal enlargement (FE) was associated with significantly greater postoperative pain compared to non-foraminal enlargement (NFE) at 12 h (SMD = 0.79, 95% CI [0.30, 1.28], p = 0.002; I² = 28%), 24 hours (SMD = 0.74, 95% CI [0.12, 1.36], p = 0.02; I² = 89%), and 48 h (SMD = 2.90, 95% CI [0.23, 5.57], p = 0.03; I² = 98%). This meta-analysis indicates that postoperative pain is markedly elevated following foraminal enlargement (FE) compared to non-foraminal enlargement (NFE) during the initial 48-hour period, although such pain is generally mild to moderate and transient. Future investigations are warranted to delineate the impact of FE on essential clinical outcomes, including long-term success rates, and to determine whether its prospective advantages outweigh the attendant short-term increase in discomfort.
评论：Fatima S， Andrabi S M， Alam S等。初级根管治疗中椎间孔扩大对术后疼痛的影响：系统回顾和荟萃分析。[J] end2025；51: 1536 - 1548。目的：本系统综述和荟萃分析的目的是研究椎间孔扩大（FE）如何影响初级根管治疗后的术后疼痛。数据来源：对四个主要数据库（PubMed/MEDLINE、Scopus、Web of Science和Cochrane library）进行了系统的文献检索，以确定评估椎间孔增大（FE）与非椎间孔增大（NFE）对术后疼痛影响的随机对照试验。方法：使用修订后的Cochrane随机试验风险偏倚工具评估纳入研究的偏倚风险。计划进行荟萃分析，定量评估椎间孔扩大（FE）对治疗后前7天疼痛的影响。结果：8项随机对照试验（rct）共涉及802名受试者，符合纳入标准。偏倚风险评估表明，两项研究处于高风险，四项研究引起了一些关注，两项研究处于低风险。meta分析显示，在12小时（SMD = 0.79, 95% CI [0.30, 1.28], p = 0.002; I²= 28%）、24小时（SMD = 0.74, 95% CI [0.12, 1.36], p = 0.02; I²= 89%）和48小时（SMD = 2.90, 95% CI [0.23, 5.57], p = 0.03; I²= 98%），椎间孔增大（FE）与非椎间孔增大（NFE）相比，术后疼痛明显加重。结论：这项荟萃分析表明，在最初的48小时内，椎间孔扩大（FE）术后疼痛明显高于非椎间孔扩大（NFE），尽管这种疼痛通常是轻度至中度和短暂的。未来的研究有必要描述FE对基本临床结果的影响，包括长期成功率，并确定其前景优势是否超过伴随而来的短期不适增加。
{"title":"Unpacking the evidence: a deeper look at foraminal enlargement and postoperative pain outcomes","authors":"Arash Shahravan","doi":"10.1038/s41432-025-01194-9","DOIUrl":"10.1038/s41432-025-01194-9","url":null,"abstract":"Fatima S, Andrabi S M, Alam S et al. Effect of foraminal enlargement on postoperative pain in primary endodontic treatment: a systematic review and meta-analysis. J Endod 2025; 51: 1536–1548. The purpose of this systematic review and meta-analysis was to investigate how foraminal enlargement (FE) affects postoperative pain following primary endodontic treatment. A systematic literature search was conducted across four major databases— PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library—to identify randomized controlled trials evaluating the impact of foraminal enlargement (FE) versus non-foraminal enlargement (NFE) on postoperative pain. The risk of bias in the included studies was evaluated using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. A meta-analysis was planned to quantitatively assess the impact of foraminal enlargement (FE) on pain during the first 7 days following treatment Eight randomized controlled trials (RCTs) involving a total of 802 participants met the inclusion criteria. The risk-of-bias assessment indicated that two studies were at high risk, four raised some concerns, and two were at low risk. Meta-analysis demonstrated that foraminal enlargement (FE) was associated with significantly greater postoperative pain compared to non-foraminal enlargement (NFE) at 12 h (SMD = 0.79, 95% CI [0.30, 1.28], p = 0.002; I² = 28%), 24 hours (SMD = 0.74, 95% CI [0.12, 1.36], p = 0.02; I² = 89%), and 48 h (SMD = 2.90, 95% CI [0.23, 5.57], p = 0.03; I² = 98%). This meta-analysis indicates that postoperative pain is markedly elevated following foraminal enlargement (FE) compared to non-foraminal enlargement (NFE) during the initial 48-hour period, although such pain is generally mild to moderate and transient. Future investigations are warranted to delineate the impact of FE on essential clinical outcomes, including long-term success rates, and to determine whether its prospective advantages outweigh the attendant short-term increase in discomfort.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"166-167"},"PeriodicalIF":2.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1038/s41432-025-01191-y
Soumya Narayani Thirumoorthy, Saumiya Gopal, Darshit Shah
Santonocito S, Cicciù M, Ronsivalle V. Evaluation of the impact of AI-based chatbot on orthodontic patient education: a preliminary randomized controlled trial. Clin Oral Investig 2025; 29:278. Randomized controlled trial (RCT). A sample of 100 patients was enrolled in the study between June 2023 and August 2024. Participants were randomly allocated into two intervention groups of 50 each, using a computer-generated sequence to maintain a 1:1 ratio. The Chatbot group received oral hygiene (OH) and orthodontic treatment guidance via a chatbot accessed through a QR code, while the control group was given standard educational material by means of information leaflets compiled by the leading scientific societies in orthodontics. Each main group was further divided into two subgroups: Leaflet-fixed therapy (LF, n = 27), Leaflet-aligner (LA, n = 23), Chatbot-fixed therapy (CF, n = 24), and Chatbot-aligner (CA, n = 26). The chatbot was built on the open-source Botpress platform and was refined using expert-reviewed training materials. When the participant opens the chatbot application, the interface displays a menu containing 4 questions, with the 3rd question focusing on home oral hygiene procedures. The evaluation included a clinical examination at baseline (T0) and after 5 weeks of starting orthodontic treatment (T1), along with a questionnaire at T1 assessing participants’ oral hygiene knowledge and compliance. Modified gingival index (MGI) and plaque index (PI) were used for clinical examination of oral hygiene. The questionnaire comprised four domains: Knowledge Evaluation (KE_S), Understanding Scale (US_S), Compliance and Adherence Scale (CAAS_S), and Satisfaction Scale (SS_S). It employed a 5-point Likert scale, with scores ranging from 0 (strongly negative) to 4 (strongly positive), with intermediate values representing negative, neutral, and positive responses. MGI and PI showed a statistically significant increase from T0 to T1 in both groups. While comparing the change in MGI from the start of treatment between the groups, a statistically significant increase was found in the control group than the chatbot group. Further analysis reported statistically lower increase in MGI in the CF and CA groups as compared to the LF and LA subgroups. There were no differences between the control and chatbot groups with respect to questionnaire section scores. The study concluded that the use of an AI-based chatbot positively influences patient compliance with oral hygiene maneuvers. Furthermore, it could not be established whether the AI-based chatbot enhanced the patient’s knowledge, understanding, and satisfaction with the information received compared to the information leaflets.
评论：Santonocito S， Cicciù M, Ronsivalle V.基于ai的聊天机器人对正畸患者教育影响的评估：一项初步随机对照试验。临床口腔调查2025；29:278。设计：随机对照试验（RCT）。病例选择：在2023年6月至2024年8月期间，纳入了100例患者的样本。参与者被随机分配到两个干预组，每组50人，使用计算机生成的顺序保持1:1的比例。聊天机器人组通过聊天机器人通过二维码访问获得口腔卫生（OH）和正畸治疗指导，而对照组通过正畸主要科学学会编制的信息传单获得标准教育材料。每个主组进一步分为两个亚组：leaf -fixed therapy （LF, n = 27）、leaf -aligner （LA, n = 23）、Chatbot-fixed therapy （CF, n = 24）和Chatbot-aligner （CA, n = 26）。这个聊天机器人建立在开源的Botpress平台上，并使用专家审查的培训材料进行了改进。当参与者打开聊天机器人应用程序时，界面显示一个包含4个问题的菜单，其中第三个问题是关于家庭口腔卫生程序的。数据分析：评估包括基线（T0）和开始正畸治疗5周后（T1）的临床检查，以及T1时评估参与者口腔卫生知识和依从性的问卷。采用改良牙龈指数（MGI）和菌斑指数（PI）进行口腔卫生临床检查。问卷由知识评价量表（KE_S）、理解量表（US_S）、依从性与依从性量表（CAAS_S）和满意度量表（SS_S）四个部分组成。它采用李克特5分量表，得分范围从0（强烈消极）到4（强烈积极），中间值代表消极、中性和积极的反应。结果：两组患者MGI、PI从T0到T1均有统计学意义升高。在比较两组治疗开始时MGI的变化时，发现对照组比聊天机器人组有统计学意义上的显著增加。进一步分析报告，与LF和LA亚组相比，CF和CA组MGI的增加在统计学上较低。在问卷部分得分方面，控制组和聊天机器人组之间没有差异。结论：该研究得出结论，使用基于人工智能的聊天机器人对患者遵守口腔卫生操作有积极影响。此外，与信息传单相比，基于ai的聊天机器人是否提高了患者对所接收信息的认识、理解和满意度，这一点也无法确定。
{"title":"Braces meet bots: straight teeth and straight answers?","authors":"Soumya Narayani Thirumoorthy, Saumiya Gopal, Darshit Shah","doi":"10.1038/s41432-025-01191-y","DOIUrl":"10.1038/s41432-025-01191-y","url":null,"abstract":"Santonocito S, Cicciù M, Ronsivalle V. Evaluation of the impact of AI-based chatbot on orthodontic patient education: a preliminary randomized controlled trial. Clin Oral Investig 2025; 29:278. Randomized controlled trial (RCT). A sample of 100 patients was enrolled in the study between June 2023 and August 2024. Participants were randomly allocated into two intervention groups of 50 each, using a computer-generated sequence to maintain a 1:1 ratio. The Chatbot group received oral hygiene (OH) and orthodontic treatment guidance via a chatbot accessed through a QR code, while the control group was given standard educational material by means of information leaflets compiled by the leading scientific societies in orthodontics. Each main group was further divided into two subgroups: Leaflet-fixed therapy (LF, n = 27), Leaflet-aligner (LA, n = 23), Chatbot-fixed therapy (CF, n = 24), and Chatbot-aligner (CA, n = 26). The chatbot was built on the open-source Botpress platform and was refined using expert-reviewed training materials. When the participant opens the chatbot application, the interface displays a menu containing 4 questions, with the 3rd question focusing on home oral hygiene procedures. The evaluation included a clinical examination at baseline (T0) and after 5 weeks of starting orthodontic treatment (T1), along with a questionnaire at T1 assessing participants’ oral hygiene knowledge and compliance. Modified gingival index (MGI) and plaque index (PI) were used for clinical examination of oral hygiene. The questionnaire comprised four domains: Knowledge Evaluation (KE_S), Understanding Scale (US_S), Compliance and Adherence Scale (CAAS_S), and Satisfaction Scale (SS_S). It employed a 5-point Likert scale, with scores ranging from 0 (strongly negative) to 4 (strongly positive), with intermediate values representing negative, neutral, and positive responses. MGI and PI showed a statistically significant increase from T0 to T1 in both groups. While comparing the change in MGI from the start of treatment between the groups, a statistically significant increase was found in the control group than the chatbot group. Further analysis reported statistically lower increase in MGI in the CF and CA groups as compared to the LF and LA subgroups. There were no differences between the control and chatbot groups with respect to questionnaire section scores. The study concluded that the use of an AI-based chatbot positively influences patient compliance with oral hygiene maneuvers. Furthermore, it could not be established whether the AI-based chatbot enhanced the patient’s knowledge, understanding, and satisfaction with the information received compared to the information leaflets.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"162-163"},"PeriodicalIF":2.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among various fluoride delivery methods, such as toothpaste, varnishes, and water fluoridation, mouthrinses have gained attention for their versatility, ease of use, and potential to complement other preventive strategies. The aim was to evaluate the effectiveness of mouthrinses in preventing and arresting caries by synthesizing data from existing systematic reviews. Five electronic databases, named PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and Scopus, were searched to identify systematic reviews that assessed the effect of mouthrinses containing chemical, herbal, or natural agents in comparison to standard oral care, placebo, water, or saline in the development or arrest of crown or root caries. Eligible reviews were selected, and data were extracted and assessed for bias. Three systematic reviews with meta-analysis and four without were included, with a total of eighty-three initial studies (moderate overlap). Supervised regular use of fluoride mouthrinse can reduce coronal and root caries initiation and progression in permanent teeth for an observational period of 6 months to 4 years. The only significant effect was in favor of the fluoride mouthrinse for crown caries at 36 months and root caries at 48 months follow-up time. Mouthrinses effectively reduce the occurrence of crown caries in moderate- and high-risk patients, as well as root caries in older adults. However, their anticaries benefit in populations with additional fluoride exposure remains uncertain. Given the great variability in the design, inclusion criteria set and conduct of the eligible systematic reviews, it is impossible to reach specific conclusions concerning the efficacy of any single product. However, it seems that fluoride mouthrinses are effective in preventing and/or arresting dental caries in moderate and high caries risk patients and may reduce initiation of root caries in older individuals.
目的：在各种氟化物输送方法中，如牙膏、清漆和氟化水，漱口水因其通用性、易用性和补充其他预防策略的潜力而受到关注。目的是通过综合现有系统综述的数据来评估漱口水在预防和抑制龋齿方面的有效性。方法：检索PubMed、Cochrane中央对照试验登记册、Cochrane系统评价数据库、Web of Science和Scopus等5个电子数据库，以确定与标准口腔护理、安慰剂、水或生理盐水相比，含有化学、草药或天然制剂的漱口水在牙冠或牙根龋形成或抑制方面的效果。选择符合条件的综述，提取数据并评估偏倚。结果：纳入了3篇有荟萃分析的系统综述和4篇没有荟萃分析的系统综述，共有83项初始研究（中度重叠）。在6个月至4年的观察期内，在监督下定期使用含氟漱口水可以减少恒牙冠状和根状龋齿的发生和发展。唯一显著的效果是氟化物漱口水在36个月时对冠龋和48个月时对根龋有利。结论：口腔清洁可有效降低中高危患者冠状龋的发生，以及老年人牙根龋的发生。然而，它们的抗药效果在额外接触氟化物的人群中是否有效仍不确定。临床意义：考虑到系统评价的设计、纳入标准设置和实施存在很大的可变性，不可能就任何单一产品的疗效得出具体的结论。然而，氟化物漱口水在预防和/或抑制中、高风险患者的龋齿方面似乎是有效的，并可能减少老年人牙根龋齿的发生。
{"title":"Effectiveness of mouth rinses on caries prevention and arrest: an umbrella review","authors":"Kyriaki Seremidi, Sotiria Davidopoulou, Eleftherios Kaklamanos, Christos Rahiotis, Sotiria Gizani, Panagiotis Koromantzos, Yiorgos Bobetsis, Panagiotis Karakostas, Chrysoula Giota, Konstantinos Papadimitriou, Danae Anastasia Apatzidou, William Papaioannou, Sotiris Kalfas","doi":"10.1038/s41432-025-01188-7","DOIUrl":"10.1038/s41432-025-01188-7","url":null,"abstract":"Among various fluoride delivery methods, such as toothpaste, varnishes, and water fluoridation, mouthrinses have gained attention for their versatility, ease of use, and potential to complement other preventive strategies. The aim was to evaluate the effectiveness of mouthrinses in preventing and arresting caries by synthesizing data from existing systematic reviews. Five electronic databases, named PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and Scopus, were searched to identify systematic reviews that assessed the effect of mouthrinses containing chemical, herbal, or natural agents in comparison to standard oral care, placebo, water, or saline in the development or arrest of crown or root caries. Eligible reviews were selected, and data were extracted and assessed for bias. Three systematic reviews with meta-analysis and four without were included, with a total of eighty-three initial studies (moderate overlap). Supervised regular use of fluoride mouthrinse can reduce coronal and root caries initiation and progression in permanent teeth for an observational period of 6 months to 4 years. The only significant effect was in favor of the fluoride mouthrinse for crown caries at 36 months and root caries at 48 months follow-up time. Mouthrinses effectively reduce the occurrence of crown caries in moderate- and high-risk patients, as well as root caries in older adults. However, their anticaries benefit in populations with additional fluoride exposure remains uncertain. Given the great variability in the design, inclusion criteria set and conduct of the eligible systematic reviews, it is impossible to reach specific conclusions concerning the efficacy of any single product. However, it seems that fluoride mouthrinses are effective in preventing and/or arresting dental caries in moderate and high caries risk patients and may reduce initiation of root caries in older individuals.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"179-179"},"PeriodicalIF":2.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wu Y, Jia M, Fang Y, Duangthip D, Chu C H, Gao S S. Use machine learning to predict the treatment outcome of early childhood caries. BMC Oral Health 2025; 25: 389. This was a retrospective secondary analysis of data from a randomized controlled trial published in 2020. No new participants or patient involvement were included. This study used the available data from 880 children, contributing 4157 carious tooth surfaces assessed at 30 months. These data were drawn from an original community-based RCT in Hong Kong (baseline N = 1070) that evaluated fluoride and silver interventions for arresting ECC. Six algorithms were used and compared, including logistic regression (LR), naive Bayes (NB), support-vector machine (SVM), decision tree (DT), random forest (RF), and XGBoost. A surface-level 70:30 train: test split was used. SMOTE was applied to address class imbalance. Models were tuned and evaluated using 1000 bootstrap resamples. Performance metrics were reported as accuracy, recall, precision, F1 score, AUROC, and Brier score. Model interpretability was explored through SHAP analysis to rank variable importance and visualize feature effects. All models achieved acceptable discrimination. Metrics ranged as follows: accuracy 0.674–0.740; recall 0.731–0.809; precision 0.762–0.802; F1 0.741–0.804; AUROC 0.771–0.859 (RF and XGBoost ≈ 0.86); Brier 0.134–0.227. SHAP interpretation indicated that tooth and surface location of caries, newly developed dmfs, baseline dmfs, caregiver-assisted brushing, and visible plaque index contributed most to the model’s predictions, while the fluoride and silver intervention ranked mid-to-low in importance. The original study, however, highlighted tooth and surface location of caries, newly developed dmfs, and daily snack intake as key effect modifiers influencing caries-arrest outcomes. Machine learning models, specifically ensemble tree-based methods, can discriminate which surfaces arrest by 30 months using multidomain inputs spanning clinical, behavioral, and socioeconomic features. However, participant-level splitting was not performed, allowing potential clustering leakage. External validation and detailed calibration analyses were also lacking. These methodological constraints likely inflated model performance and currently limit its generalizability and readiness for clinical implementation.
{"title":"Interpretable machine learning modeling of treatment outcomes for silver and fluoride therapy in early childhood caries","authors":"Mojtaba Mehrabanian, Shahab Kavousinejad, Ebrahim Dastouri","doi":"10.1038/s41432-025-01195-8","DOIUrl":"10.1038/s41432-025-01195-8","url":null,"abstract":"Wu Y, Jia M, Fang Y, Duangthip D, Chu C H, Gao S S. Use machine learning to predict the treatment outcome of early childhood caries. BMC Oral Health 2025; 25: 389. This was a retrospective secondary analysis of data from a randomized controlled trial published in 2020. No new participants or patient involvement were included. This study used the available data from 880 children, contributing 4157 carious tooth surfaces assessed at 30 months. These data were drawn from an original community-based RCT in Hong Kong (baseline N = 1070) that evaluated fluoride and silver interventions for arresting ECC. Six algorithms were used and compared, including logistic regression (LR), naive Bayes (NB), support-vector machine (SVM), decision tree (DT), random forest (RF), and XGBoost. A surface-level 70:30 train: test split was used. SMOTE was applied to address class imbalance. Models were tuned and evaluated using 1000 bootstrap resamples. Performance metrics were reported as accuracy, recall, precision, F1 score, AUROC, and Brier score. Model interpretability was explored through SHAP analysis to rank variable importance and visualize feature effects. All models achieved acceptable discrimination. Metrics ranged as follows: accuracy 0.674–0.740; recall 0.731–0.809; precision 0.762–0.802; F1 0.741–0.804; AUROC 0.771–0.859 (RF and XGBoost ≈ 0.86); Brier 0.134–0.227. SHAP interpretation indicated that tooth and surface location of caries, newly developed dmfs, baseline dmfs, caregiver-assisted brushing, and visible plaque index contributed most to the model’s predictions, while the fluoride and silver intervention ranked mid-to-low in importance. The original study, however, highlighted tooth and surface location of caries, newly developed dmfs, and daily snack intake as key effect modifiers influencing caries-arrest outcomes. Machine learning models, specifically ensemble tree-based methods, can discriminate which surfaces arrest by 30 months using multidomain inputs spanning clinical, behavioral, and socioeconomic features. However, participant-level splitting was not performed, allowing potential clustering leakage. External validation and detailed calibration analyses were also lacking. These methodological constraints likely inflated model performance and currently limit its generalizability and readiness for clinical implementation.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"168-169"},"PeriodicalIF":2.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1038/s41432-025-01192-x
Laura Timms, Zoe Marshman
Zheng F M, Yan I G, Duangthip D, Lo E C M, Gao S S, Chu C H. Randomized clinical trial on caries prevention of silver diamine fluoride. J Dent Res 2025; https://doi.org/10.1177/00220345251363837 . This randomised controlled trial sought to compare the effectiveness of silver diamine fluoride (SDF) to sodium fluoride varnish (NaF) for the prevention of caries in anterior primary teeth for young children. The inclusion criteria were children aged 3–4 years of age. Children were excluded if they had co-operative challenges or were on long-term medications. Children with active caries were included, lesions were considered active if they were soft on probing. The setting was kindergartens in Hong Kong. The children received either 38% SDF or 5% NaF applied to their six upper anterior primary teeth at six-monthly intervals. The primary outcome measure was the mean number of new carious surfaces per child at 30 months follow-up. Intention-to-treat analysis was used with the Mann-Whitney U test applied for the analysis of the primary outcome. Overall, 730 children were randomised, 621 (85%) were followed up and analysed at the 30 months end point for the presence of new carious surfaces (dmfs). Not all children seen at baseline were analysed, however of those that were their caries experience was similar with a mean dmfs of 0.47 ± 1.35 for the SDF group and 0.48 ± 1.53 for the NaF group. At 30 months, there were less new lesions for those in the SDF group (0.35 ± 1.09), than the NaF group (0.54 ± 1.50) (p = 0.048). The authors concluded that SDF was more effective than NaF in preventing new carious surfaces at 30 months for anterior caries in primary teeth of young children.
郑凤梅，闫益刚，段志平，罗春梅，高三生，褚春华。氟化二胺银预防龋齿的随机临床试验。J Dent Res 2025；https://doi.org/10.1177/00220345251363837。设计：本随机对照试验旨在比较氟化二胺银（SDF）和氟化钠清漆（NaF）在预防幼儿前乳牙龋齿方面的有效性。入选标准为3-4岁儿童。如果儿童有合作障碍或长期服用药物，则被排除在外。有活动性龋齿的儿童被包括在内，如果病变在探查时柔软，则认为是活动性的。背景是香港的幼儿园。这些儿童每6个月接受38%的SDF或5%的NaF治疗，用于他们的6颗上前乳牙。主要结局指标是随访30个月时每个儿童新发龋齿表面的平均数量。意向治疗分析采用Mann-Whitney U检验对主要结局进行分析。结果：总体而言，730名儿童被随机分组，621名（85%）接受了随访，并在30个月结束时分析了新龋面（dmfs）的存在。并不是所有在基线时看到的儿童都进行了分析，但是他们的龋病经历相似，SDF组的平均dmfs为0.47±1.35，NaF组的平均dmfs为0.48±1.53。30个月时，SDF组新发病灶数（0.35±1.09）少于NaF组（0.54±1.50）（p = 0.048）。结论：对于30月龄幼儿乳牙前牙，SDF比NaF更有效地预防新的龋面。
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