Journal of Clinical and Experimental Dentistry最新文献

Background: Degenerative diseases of the temporomandibular joint (TMJ) represent a frequent subtype of temporomandibular disorders (TMDs), particularly prevalent among individuals over the age of 40. Although cone-beam computed tomography (CBCT) is recognized as the diagnostic gold standard for evaluating bony alterations of the TMJ, panoramic radiography remains widely utilized in clinical practice due to its accessibility and lower radiation exposure.

Material and methods: A retrospective observational pilot study was conducted at the Dental Clinic of the University Fernando Pessoa Canarias. A simple random sample of 60 panoramic radiographs from patients over 40 years of age was selected from a database comprising 323 records collected between April and October 2024. Bilateral assessment of the TMJs was performed by two independent observers according to established diagnostic criteria for degenerative alterations. Inter-observer agreement was measured using Cohen's Kappa statistics. Associations between degenerative and indeterminate findings and demographic variables were evaluated using the Chi-square (χ²) test. Descriptive statistics for age were reported as means and interquartile ranges.

Results: Among the 120 TMJs evaluated, osteophyte formation was the only degenerative finding detected (30%). Condylar flattening, considered an indeterminate sign, was observed in 85% of cases. Osteophytes were more frequently identified in males (33.33%); however, no statistically significant association was found between osteophyte presence and sex (p = 0.655). A significant association was observed between the presence of osteophytes and condylar flattening (χ² = 4.73, p = 0.030). Inter-observer agreement was moderate for degenerative signs (κ = 0.68) and minimal for indeterminate signs (κ = 0.37).

Conclusions: Osteophyte formation was the sole radiographic indicator of TMJ degeneration identified in this sample, frequently co-occurring with condylar flattening. Although panoramic radiography serves as a valuable screening modality, its diagnostic limitations underscore the need for CBCT in cases with suspected or advanced degenerative joint changes. Key words:Temporomandibular joint, Osteoarthritis, Degenerative joint disease, Panoramic radiography, Osteophyte.

Background: This study aimed to determine the prevalence of cervical and apical root resorption in maxillary central incisors of Peruvian adults without a history of orthodontic treatment, using cone beam computed tomography (CBCT).

Material and methods: This was an observational, descriptive, and cross-sectional study. The sample included 103 CBCT scans from adult individuals in a Peruvian population, comprising 71 women and 32 men (mean age: 34 ± 32 years). DICOM files were analyzed using RayScan Expert 3D software. The presence of cervical and apical root resorption in permanent maxillary central incisors was assessed by examining coronal, sagittal, and axial sections. Demographic characteristics were also recorded. Fisher's exact test and binary logistic regression were used to evaluate associations, with a significance level set at p > 0.05.

Results: The overall prevalence of root resorption was 5.8%, with cervical root resorption accounting for 1.0% and apical root resorption for 4.9%. No significant association was found between sex and the presence of root resorption (p = 0.173). Neither sex nor age had a direct influence on the occurrence of root resorption.

Conclusions: The prevalence of cervical and apical root resorption in maxillary central incisors of untreated Peruvian adults was low. Nevertheless, this condition should be considered by orthodontists during diagnosis and treatment planning. Key words:Cone-Beam Computed Tomography, Incisor, Root Resorption.

Background: The recent advent of universal resin cements provides clinicians with a versatile material that can function either as a self-adhesive or as an adhesive resin cement, depending on the specific clinical requirements. This investigation aimed to assess the shear bond strength of a contemporary self-adhesive universal resin cement (Panavia SA Cement Universal, Kuraray) when applied to enamel or dentin. For comparative analysis, its performance was benchmarked against an established control adhesive resin cement (NX3 Nexus, Kerr), both with and without the supplementary application of an adhesive bonding agent (Clearfil Universal Bond Quick, Kuraray).

Material and methods: Human molars were mounted using PVC pipes. Coronal tooth structure was removed to expose enamel or dentin. A bonding agent was applied to half of the specimens per cement and light cured. The specimens were placed in a jig and secured beneath a 2.4mm diameter mold. The resin cements were mixed according to the manufacturer's instructions, applied into the mold, and light cured (n=12). Prior to shear bond strength testing and failure mode analysis, all specimens underwent thermocycling. The resulting shear bond strength data for both enamel or dentin were statistically analyzed using one-way ANOVA and Tukey's post hoc tests (α=0.05).

Results: Our findings indicated that the universal resin cement's bond strength to enamel was not significantly influenced by the presence or absence of a bonding agent. Furthermore, its performance on enamel was comparable to that of the adhesive resin cement when a bonding agent was utilized. We observed a similar distribution of cohesive and mixed failures for the universal resin cement, regardless of whether a bonding agent was used, and for the adhesive resin cement combined with a bonding agent. Conversely, for dentin, the universal resin cement demonstrated significantly greater bond strength when a bonding agent was incorporated. However, even with a bonding agent, both universal resin cement applications (with and without bonding agent) yielded significantly lower bond strengths compared to the adhesive resin cement used with a bonding agent. Notably, a higher incidence of adhesive failures was recorded for both the adhesive and universal resin cements on dentin when no bonding agent was employed.

Conclusions: While the versatility of the novel universal resin cement (Panavia SA Cement Universal) allows for both adhesive and self-adhesive applications, our findings indicate that the adhesive resin cement (NX3 Nexus), when used with a bonding agent, consistently delivered the highest shear bond strength to dentin. However, its bond strength to enamel was comparable across the tested materials. Key words:Universal Resin Cement, Bonding Agent, Enamel, Dentin.

Background: This study aimed to evaluate the accuracy of guided endodontic access and fiberglass post removal, comparing stabilization methods such as metal sleeves and fixation pins.

Material and methods: Sixty-four extracted human teeth (32 mandibular molars and 32 single-rooted teeth) were divided into groups based on the use or non-use of fixation pins and metal sleeves. Precision was assessed using pre- and post-procedure CBCT scans to analyze deviations in bur positioning.

Results: For guided endodontic access, significant differences in angular deviation were found between the group using fixation and no sleeves (2.64°) and the group without fixation and sleeves (1.37°) (P<0.05). No other significant differences were found in either access or post removal procedures (P>0.05). Mean deviations in post removal ranged from 1.98° to 2.15°.

Conclusions: Guided endodontic techniques are highly reliable, with metal sleeves and fixation pins offering no significant improvement in precision. Key words:Guided Endodontics, Dental Post Removal, CBCT Analysis, Endodontic Guide Precision, Endodontic Access Deviation.

Background: The calcifying epithelial odontogenic tumor (CEOT) is a rare benign epithelial odontogenic neoplasm. Some cases of CEOT may undergo malignant transformation, whose characteristics are still poorly known. This study aimed to perform a systematic review of CEOT cases with malignant transformation.

Material and methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and was registered with PROSPERO (CRD42021285981). Searches for full-text articles on histopathologically confirmed CEOT cases with malignant transformation were performed in different databases (PubMed/ MEDLINE, Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, Open Grey, and CAPES Dissertation and Thesis Catalog) without year of publication or language restrictions. A qualitative descriptive and risk of bias analysis were performed.

Results: Nine cases were included, with a mean age of 59.44 (±17.07) years and a slightly higher frequency in males (55.6%). The mandible (88.9%) was the most affected site, with predominance of the mixed imaging pattern (77.8%). Histopathologically, the clear cell variant, intense mitotic activity, presence of cellular atypia, and high Ki-67 immunoexpression were the predominant findings. Isolated surgery (44.4%) was the most common treatment and recurrence of CEOT before malignant transformation was observed in five cases (55.6%). CEOT with malignant transformation recurred in three cases (33.3%). Most cases had a positive outcome (77.8%), with remission of the disease.

Conclusions: This systematic review determined the clinicopathological profile of histopathologically confirmed cases of CEOT with malignant transformation and synthesized some characteristics that can assist in the diagnosis and appropriate therapeutic approach of this rare neoplasm. Key words:Systematic review, Odontogenic tumors, Clinicopathologic features, Treatment, Prognosis.

Background: The regeneration of the dentin-pulp complex represents a pivotal challenge in endodontics, requiring a delicate balance between microbial eradication and tissue repair. This scoping review, conducted in accordance with PRISMA-ScR guidelines, synthesizes current evidence on microbiological and pharmacological factors influencing regenerative outcomes.

Material and methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library identified 242 studies, with 15 meeting inclusion criteria after screening.

Results: The review highlights the dominance of anaerobic biofilm-forming pathogens (Enterococcus faecalis, Porphyromonas gingivalis ) in periapical lesions, their virulence mechanisms (e.g., proteolytic enzymes, immune evasion), and the rising threat of antibiotic resistance driven by β-lactamases and efflux pumps. Pharmacologically, while triple/double antibiotic pastes promote dentin thickening, their cytotoxicity at high concentrations and disruption of commensal microbiota underscore the need for optimized dosing. Emerging alternatives-such as antimicrobial peptides, calcium hypochlorite, and immunomodulatory biomolecules-demonstrate superior biocompatibility and dual action against pathogens while supporting stem cell viability.

Conclusions: Future directions emphasize microbiome-targeted therapies, advanced biomaterials, and personalized approaches leveraging metagenomics. This review underscores the imperative to integrate selective antimicrobial strategies with regenerative biology to advance endodontic outcomes. Key words:Dentin-pulp regeneration, endodontic infections, biofilm, antimicrobial resistance, regenerative endodontics.

Background: We conducted a clinical trial using a modified split-mouth, double-blind, randomized approach to clinically assess template-assisted monochromatic structural colored versus universal multishade direct composite veneers over a 36-month period.Materials and Methods: A total of 88 direct composite veneers from 20 participants were included per the inclusion criteria. Each patient received at least one pair of the two types of direct veneers in two equal groups (n = 44): (group I): monochromatic structural colored veneer (OMNICHROMA) with palfique adhesive and (group II): universal multishade veneer (Ceram.x spectra) with Prime & Bond adhesive using U-veneer templates. Window-type veneer preparations were performed on the labial surface of anterior teeth (depth: 0.3-0.5 mm). Clinical assessment was conducted per modified United States Public Health Service (USPHS) criteria. The marginal integrity criterion was evaluated by scanning electron microscopy of an inverse replica of 32 randomly selected veneer restorations.

Results: The Friedman and Wilcoxon signed-rank tests revealed significant differences between group I and group II in marginal adaptation, marginal discoloration, surface texture, and color match (p <0.05). However, there no significant differences in fracture type or anatomical form existed between the two groups (p >0.05). The Mann‒Whitney U test indicated no significant differences between the groups across USPHS criteria (p >0.05). No secondary caries or hypersensitivity cases were reported during any evaluation period. The unpaired t test revealed no significant difference in the mean gap width between the two groups (p = 0.218 and 0.236, respectively). Spearman's correlation test, conducted on the related criteria in groups I and II after 12, 18, and 36 months of follow-up, revealed a positive relationship between the evaluated criteria.

Conclusions: Monochromatic structurally colored and universal multishade direct composite resin veneers demonstrated comparable satisfactory clinical performance by the end of the study period. Key words:Composite, Monochromatic, Multishade, Veneers, USPHS criteria.

Background: The objective of this study was to assess the push-out bond strength (PBS) of conventional prefabricated, universal 2-piece, and CAD/CAM-milled fiber posts cemented in root canals using a self-adhesive resin cement, as well as the Vickers microhardness (VHN) of the resin cement.

Material and methods: Thirty human uniradicular premolars roots were endodontically treated and divided into three groups (n = 10): conventional prefabricated fiber posts (PFPs), universal fiber posts (UFPs), and CAD/CAM-milled fiber posts (MFPs). After luting procedures using RelyX U200 (Solventum), six specimens were obtained of each root (two slices from each root third: cervical, middle, and apical). The first slices of each root region were subjected to PBS, and the second slices were subjected to VHN analysis. Data from the PBS and VHN tests were analyzed using two-way analysis of variance (ANOVA; post type vs. root region) and Tukey's test (α = 0.05).

Results: Regarding the PBS, MFPs and UFPs demonstrated statistically superior performance than PFPs (p < 0.001). Among the root regions, the cervical third exhibited the highest values, whereas the apical third showed the lowest (p < 0.001). Regarding VHN, PFPs and UFPs exhibited statistically superior values compared with MFPs (p < 0.001). The cervical third of the root displayed the highest VHN values, whereas the apical third presented the lowest (p < 0.001).

Conclusions: CAD/CAM-milled and universal 2-piece fiber posts may be a better alternative for restoring widened root canals. Key words:Resin Cements, CAD-CAM, Post and Core Technique, Hardness Tests, Root Canal Preparation.

Background: Large Language Models (LLMs) are transforming clinical decision-making by offering rapid, context-aware access to evidence-based knowledge. However, their efficacy in pediatric dentistry remains underexplored, especially across multiple LLM platforms.Objective: To comparatively evaluate the clinical quality, readability, and originality of responses generated by nine contemporary LLMs for pediatric dental queries.

Material and methods: A cross-sectional study assessed the performance of ChatGPT-3.5, ChatGPT-4o, Gemini 2.0, Gemini 2.5, Claude 3.5 Haiku, Claude 3.7 Sonnet, Grok-3, Grok-3 Mini, and DeepSeek-V3. Twenty pediatric dental questions were posed in one-shot queries to each LLM. Responses were evaluated by ten pediatric dental experts using the Modified Global Quality Scale (MGQS), Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Turnitin Similarity Index. ANOVA and Cohen's Kappa were used for statistical analysis.

Results: ChatGPT-4o demonstrated the highest overall MGQS (4.28 ± 0.24), followed by ChatGPT-3.5 (3.45 ± 0.27). DeepSeek-V3 scored lowest (2.18 ± 0.19). Topic-wise, ChatGPT-4o consistently outperformed others across all subdomains. FRES and FKGL scores indicated moderate readability, with Claude models exhibiting the highest linguistic complexity. Turnitin analysis revealed low-to-moderate similarity across models. Inter-rater agreement was substantial (κ = 0.78).

Conclusions: Among evaluated LLMs, ChatGPT-4o exhibited superior performance in clinical relevance, coherence, and originality, suggesting its potential utility as an adjunct in pediatric dental decision-making. Nonetheless, variability across models underscores the need for critical appraisal and cautious integration into clinical workflows. Key words:Artificial Intelligence, Clinical decision support, Health Communication, Large language models, Natural Language Processing.

Background: The retention stage has been the most controversial phase of orthodontic treatment, as there are no specific guidelines regarding the type, mode and duration of retention. The detachment of a retainer creates urgency, necessitates additional consultation time and increases the risk of tooth movement. Therefore, ensuring the stability of a retainer and preventing detachment is crucial, particularly as saliva moisture poses a risk during bonding.

Material and methods: This pilot study employs an epidemiological, observational, descriptive and longitudinal design to compare the failure rates of lower lingual retainers cemented with the NOLA retractor against those cemented with the Spandex retractor. The sample comprised 32 participants, with 16 each in the NOLA group and the relative isolation group. The NOLA group included 10 men (62.5%), while the isolation group had only 3 men (18.7%). The normality of the data was assessed using the Shapiro-Wilk test, and the Student's t-test was applied to compare changes between the NOLA and relative isolation groups.

Results: The failure rate was higher in the relative isolation group (37.5%) compared with the NOLA group (25.0%), although this difference was not statistically significant (p = 0.446). A progressive and significant increase in the Little's Irregularity Index values was observed in both groups over time. While there was a greater increase in values in the NOLA group, the difference did not reach statistical significance (p = 0.108 at 3 months and p = 0.284 at 6 months).

Conclusions: Both isolation methods demonstrated similar success rates in retaining fixed retainers over the analysed time period. Key words:Orthodontic Retainers, Fixed Orthodontic Appliance, Removable Orthodontic Appliances, Periodontal Index.