Journal of Clinical and Experimental Dentistry最新文献

Background: The palate is the primary donor site for autogenous connective tissue grafts in periodontal and peri-implant plastic surgery, yet healing by secondary intention often results in morbidity. Collagen sponge (CS) and leukocyte-platelet-rich fibrin (L-PRF) have been proposed to enhance donor site repair, but comparative histological evidence in humans remains scarce. Objective: To compare the histological characteristics of palatal donor site healing following coverage with CS or L-PRF.

Material and methods: A retrospective cross-sectional histological study was performed on palatal biopsies collected four months after connective tissue graft harvesting covered with CS (n = 9) or L-PRF (n = 9). Epithelial type and thickness, lamina propria thickness, submucosal composition, inflammatory infiltrate, vascular congestion, and edema were evaluated using hematoxylin-eosin staining.

Results: Both biomaterials supported uneventful healing without necrosis or severe inflammation. Compared with CS, L-PRF was associated with thicker epithelium, a higher frequency of hyperparakeratinization, and the presence of orthokeratinization. Lamina propria thickness was slightly greater in L-PRF, while fibrous submucosa predominated in both groups. Mild leukocyte infiltration and transient edema were more common with L-PRF, suggesting a more active regenerative response.

Conclusions: CS and L-PRF both promoted favorable palatal donor site healing. L-PRF demonstrated histological features consistent with enhanced tissue regeneration, likely due to its growth factor content. These preliminary findings warrant validation in randomized controlled trials with larger sample sizes.

Background: Relevance. In recent years, robotic surgical technologies have been firmly integrated into the practice of many surgical specialties. However, their adoption in dentistry and maxillofacial surgery remains limited. This is largely due to the unique anatomical features of the facial region and the exceptionally high demands for precision and equipment adaptability. At the same time, the growing interest in minimally invasive and highly accurate surgical interventions underscores the need for a scientific evaluation of the effectiveness of such technologies. Objective. This study aimed to systematically review the available clinical evidence on the use of robot-assisted surgical systems in oral and maxillofacial procedures, focusing on their accuracy, safety, and clinical feasibility.

Material and methods: The review was conducted in accordance with the PRISMA methodology. Studies involving patients who underwent implant or other maxillofacial surgical procedures using robotic systems were included. A systematic search was performed via the Cochrane Library platform, which simultaneously searches MEDLINE (PubMed) and Embase databases. The following keywords were used: (MeSH descriptor: [Robotics] explode all trees OR MeSH descriptor: [Robotic Surgical Procedures] explode all trees OR "robotic surgery":ti,ab,kw OR "robotic assisted":ti,ab,kw OR "robot":ti,ab,kw) AND ("maxillofacial surgery":ti,ab,kw OR "dental implant":ti,ab,kw OR "oral implantology":ti,ab,kw OR "oral surgery":ti,ab,kw). The level of evidence was assessed according to the GRADE, RoB 2.0, and ROBINS-I scales. Dual screening and data extraction were independently performed by two reviewers. The review protocol was prospectively registered in the PROSPERO database (CRD420251137197).

Results: A total of 18 studies met the inclusion criteria. In nearly all studies, robotic systems demonstrated high implant placement accuracy (mean deviations less than 1 mm and 3°), substantially outperforming conventional techniques. The safety profile was consistently favorable. In transoral oncologic surgery, robotic systems showed comparable or superior functional outcomes. However, most studies were limited in sample size and follow-up duration, necessitating cautious interpretation of the results.

Conclusions: Robot-assisted technologies in implantology and maxillofacial surgery have the potential to enhance precision and safety. Nevertheless, the overall certainty of evidence (GRADE) is rated as moderate to low. Larger-scale studies are required to confirm these findings.

Oral melanoma is an aggressive neoplasm that predominantly affects older adults. The amelanotic subtype is exceedingly rare, and its diagnosis is challenging due to the absence of pigmentation. Herein, we report a rare case of oral amelanotic melanoma in an older adult, discussed in light of the available literature. A 73-year-old Brazilian female patient presented with pain and discomfort in the left transverse palatal rugae. Clinically, the lesion appeared as a single, sessile, dome-shaped nodule with a coloration similar to the adjacent mucosa. Histopathological examination revealed a spindle-cell malignant neoplasm with epithelioid nests within a fibrous stroma, lacking melanin pigmentation. Immunohistochemistry was positive for pan-cytokeratin AE1/AE3, vimentin, S100 protein, Melan-A, SOX10, NSE, and TRP-2, with a high Ki-67 index. The patient died two months after diagnosis. A review of PubMed, Scopus, Embase, and Web of Science identified 35 cases of oral amelanotic melanoma in older adults, predominantly females (n=20/57.1%) in their 60s (n=16/45.7%). This report documents the sixth case of oral amelanotic melanoma in older adults from Latin America. Clinically, the case was challenging because it mimicked a non-neoplastic proliferative process and, microscopically, presented as an amelanotic variant. An immunohistochemical panel is recommended to avoid diagnostic pitfalls; this is the first report of TRP-2 immunoexpression in oral amelanotic melanoma.

Posterior crossbite correction and mandibular arch expansion have traditionally been managed with fixed appliances, while conventional thermoformed aligners have shown limited efficacy due to material properties and biomechanical constraints. This case report describes the management of bilateral premolar crossbite and mandibular constriction in a 26-year-old female using directly 3D-printed clear aligners (DPA) fabricated with a biocompatible resin. A complete digital workflow treatment planning was employed, and twenty-six aligners were produced using high-resolution LCD printing over a treatment period of thirty-one weeks. Posttreatment evaluation confirmed successful correction of the crossbite, stable arch expansion, and maintenance of posterior inclination control. Three-dimensional superimposition and colormap analysis demonstrated minimal relapse, less than 0.5 mm, at one-year follow-up. This report highlights the potential of DPA as a clinically effective alternative to thermoformed aligners for the correction of complex occlusal discrepancies.

Background: 3D printing enhances denture fabrication, but the bond between printed teeth and bases is often weaker than traditional methods. This study investigates the effect of tooth-adhesive combinations on bond strength to enhance clinical reliability in digital dentistry.

Material and methods: Forty-eight cylindrical 3D-printed denture bases were bonded with either 3D-printed (PT) or milled (MT) teeth using three bonding materials: NextDent (ND), Super-Bond (SUP), and Unifast Trad (UNI)(n=8/group). The PT-ND group served as the control. Specimens were subjected to shear bond strength testing using a universal testing machine at 0.5 mm/min, with a 4 mm shear pin, and failure modes were analyzed under a stereomicroscope.

Results: Tooth type, bonding material, and their interaction significantly influenced bond strength (P<0.05). MT-UNI and MT-SUP demonstrated the highest values (92.33 ± 4.90 N; 87.34 ± 2.41 N), while MT-ND had the lowest (11.72 ± 1.94 N). Among PT groups, PT-SUP performed best (45.59 ± 3.47 N), followed by PT-ND (34.12 ± 3.38 N) and PT-UNI (23.68 ± 4.14 N). High-strength groups exhibited predominantly mixed failure (MT-SUP, MT-UNI, PT-SUP), while lower-strength groups showed adhesive failure. (MT-ND, PT-UNI).

Conclusions: Bond strength is influenced by both tooth material and bonding agent. From the results, Unifast Trad is optimal for milled teeth; Superbond is best suited for printed teeth. Material selection is critical for improving durability and chairside efficiency in digital prosthodontics.

Meningiomas are the most common primary tumors of the central nervous system (CNS), but their occurrence in extracranial locations such as soft tissue or skin is extremely rare. They may be congenital (Type I), ectopic soft tissue meningiomas (Type II), or secondary to an intracranial meningioma (Type III), according to the López classification. We report the case of a woman with a history of multiple intracranial atypical meningiomas (WHO grade II) who presented with a subcutaneous lesion in the left malar region. Histopathological examination confirmed the diagnosis of atypical meningioma (WHO grade II). This case represents a rare example of a Type III cutaneous meningioma according to the López classification. It underscores the importance of considering extracranial meningiomas in the differential diagnosis of facial subcutaneous masses, particularly in patients with a history of intracranial meningioma.

Background: This study aimed to evaluate root morphometry of the lateral incisor using cone beam computed tomography (CBCT) as an etiological factor in the occurrence of impacted maxillary canines (IMC).

Material and methods: A total of 99 CBCT scans from individuals of both sexes were analyzed, revealing 139 impacted maxillary canines, categorized as buccal, palatal, and bicortical, across sagittal and coronal sections of the adjacent incisors (AI). Thus, 59 contralateral incisors from the non-impacted side in unilateral cases were examined. The study evaluated several parameters: sagittal root length of the lateral incisor (SRLI), coronal root length of the lateral incisor (CRLI), sagittal root dilaceration angle (SRD), coronal root dilaceration angle (CRD), sagittal root convergence angle (SRC), and coronal root convergence angle (CRC). In total, 198 lateral incisor roots were assessed. The statistical analyses included Chi-square tests, Student's t-tests, and Tukey's tests, with a significance level set at P<0.05.

Results: The study found that cases of canine impaction were more prevalent in females, with the majority being unilateral (47.5%) and located in a palatal position. Bilateral cases were predominantly buccal (52.5%) (p=0.001). Root dimensions on the impacted side were significantly smaller in the sagittal section (14.75 mm) compared to the non-impacted side (15.67 mm) (p=0.001). In the coronal section, measurements were also smaller on the impacted side (mean difference of 0.57 mm), but this difference was not statistically significant (p=0.082). The root lengths in both coronal and sagittal sections were shortest in the bicortical group (12.67 mm and 12.95 mm, respectively) compared to the palatal (15.34 mm coronal / 15.62 mm sagittal) and buccal (14.89 mm coronal / 15.54 mm sagittal) groups (p<0.05).

Conclusions: Individuals with impacted maxillary canines (IMC) exhibit shorter root lengths of the adjacent lateral incisor compared to the non-impacted side, with bicortical IMC cases showing the shortest lengths, approximately 2 mm shorter than other types of impactions. Orthodontists should consider this condition when planning treatments involving IMC.

Background: Assessing primary stability is critical to predicting dental implant success, yet existing assessments often rely on subjective judgment. This study presents and validates a classification system based on the progressive insertion torque value (PITV) to provide objective, reproducible parameters for guiding prosthetic loading protocols.

Material and methods: An analytical observational study was conducted on 1,250 implant torque-curve interpretations. Primary stability was classified into three types according to final insertion torque (IT): high (50 Ncm), moderate (30 to <50 Ncm), and low (<30 Ncm). Types I and II included four PITV subtypes (A-D), while Type III included six subtypes (A-F) based on curve trajectory patterns. Twenty-five dentists were trained in curve interpretation, and intra- and inter-examiner agreement was assessed using Cohen's and Fleiss' kappa statistics and prevalence- and bias-adjusted kappa (PABAK). Predictive validity was assessed using receiver operating characteristic (ROC) analysis (area under the curve [AUC] with 95% confidence intervals). Calibration (intercept and slope) and the Brier score were also computed.

Results: Intraexaminer agreement was almost perfect in both general dentists and implant specialists (k = 0.82-0.95). Interexaminer agreement was also almost perfect (general dentists: k = 0.81; specialists: k = 0.89). Overall agreement was k = 0.84 (p < 0.001). The classification showed moderate predictive discrimination (AUC = 0.69, 95% CI: 0.56-0.81).

Conclusions: The classification of primary stability based on the progressive insertion torque value in edentulous maxillary ridges showed high intraexaminer and interexaminer reliability in interpreting torque-time curves. Its clinical utility, predictive performance, and prosthetic loading thresholds were not assessed in this study and warrant prospective evaluation.

Background: This study aimed to evaluate the effect of calcium hydroxide Ca(OH)2 as an intracanal medicament on postoperative pain in diabetic and non-diabetic patients with symptomatic apical periodontitis and pulp necrosis.

Material and methods: A double-blind, prospective randomized controlled clinical trial was conducted on 96 patients (48 diabetics and 48 non-diabetics) aged 30-65 years. Patients were allocated into four groups: Group A (non-diabetic with Ca(OH)2), Group B (diabetic with Ca(OH)2), Group C (non-diabetic without Ca(OH)2), and Group D (diabetic without Ca(OH)2). Endodontic treatment was performed, and postoperative pain was assessed using the Heft Parker Visual Analog Scale (HPVAS) at 6, 24, 48, 72, 96, 120, 144, and 168 hours. Statistical analysis included Kruskal-Wallis, Dunn's post hoc, and Kaplan-Meier survival tests.

Results: At baseline and 6 hours, pain scores were comparable across groups (p > 0.05). From 24 to 120 hours, significant differences were observed (p < 0.05), with Group A showing the fastest and most consistent pain reduction, while Group D reported the highest pain levels. Groups B and C demonstrated intermediate relief with comparable trends. By 168 hours, all groups achieved near-zero pain levels. Kaplan-Meier analysis confirmed the earliest median pain relief in Group A (72 hours), delayed recovery in Groups B and C (120 hours), and the slowest in Group D.

Conclusions: Calcium hydroxide significantly reduced postoperative pain, with the greatest benefit in non-diabetic patients. Its effect was more decisive than diabetes status, underscoring its clinical significance as a reliable intracanal medicament for managing postoperative pain in both healthy and systemically compromised patients.