Journal of dentistry最新文献

Introduction/objective: Preconception-to-lactation oral care lacks universal standardized protocols, and the rising prevalence of pregnancy-related oral diseases demands safe, effective clinical guidelines. This study analyzed relevant literature to explore oral care strategies for women in this period.

Data/sources: A literature search was conducted in PubMed and Web of Science up to December 2025 using keywords including "perinatal", "pregnancy" and terms related to oral/dental diseases. The findings indicate that periodontal infections, pulp-involved caries and third molar pericoronitis are common oral diseases in women from preconception to lactation, with periodontitis and acute pulpitis linked to adverse pregnancy outcomes. Clinical management of oral diseases during this period must adhere to the core principles of safety, necessity, comfort, and multidisciplinary collaboration, with the second trimester being the optimal window for elective dental procedures. Dental imaging examinations are safe with lead shielding, as the radiation dose is far below the established safety threshold. Medications should prioritize low-risk options (e.g., lidocaine, amoxicillin) in accordance with FDA classification and the Pregnancy and Lactation Labeling Rule. Clinically recommended safe therapeutic approaches include basic periodontal treatment, chemomechanical minimally invasive caries excavation, and restoration with resin or glass ionomer cements. Comprehensive preconception oral examinations, standardized prenatal oral hygiene and avoiding unnecessary invasive procedures/high-risk drugs are key to protecting maternal and fetal health.

Conclusions: Women from preconception to lactation face common oral diseases linked to adverse pregnancy outcomes; second-trimester elective dental care is optimal, with safe imaging, low-risk meds and preconception exams key for maternal-fetal health.

Clinical significance: Perinatal oral disease management safeguards maternal-fetal health by following safety-core principles, adopting evidence-based safe diagnostics/therapies and prioritizing preconception screening & prenatal preventive oral care.

Objective: To evaluate the two-year clinical performance and survival rate of CAD/CAM-fabricated endocrowns with and without deep margin elevation (DME) in endodontically treated posterior teeth.

Materials and methods: This prospective clinical study included 88 patients (100 teeth) treated at Hacettepe University. Patients were divided into two groups: supragingival margins (SGM, n = 50) and subgingival margins restored using DME (SubGM, n = 50). All teeth had previously completed standardized endodontic treatment performed according to routine clinical protocols. Endodontic procedures were not part of the study protocol. In SubGM cases, the cervical margin was elevated using a highly filled flowable composite (G-ænial Universal Injectable, GC) prior to digital impression and adhesive luting with hybrid ceramic restorations (Cerasmart 270, GC). Clinical outcomes, including marginal integrity, marginal discoloration, and gingival inflammation, were evaluated using modified USPHS criteria at baseline, 6, 12, and 24 months. Survival analysis was performed using the Kaplan-Meier method.

Results: The overall 24-month survival rate was 97%. The SGM and SubGM groups showed survival rates of 98% and 96%, respectively, with no statistically significant difference (p > 0.05). Modified USPHS criteria revealed minimal degradation across parameters. No secondary caries were detected. Slightly lower Alpha scores in gingival health and patient satisfaction were observed in the SubGM group but were not statistically significant.

Conclusion: DME is a clinically viable technique for restoring deep subgingival margins in endodontically treated molars. Provided proper isolation and adhesion protocols are followed, its short-term performance is comparable to restorations with supragingival margins.

Clinical significance: Deep margin elevation in CAD/CAM indirect restorations may allow clinicians to manage subgingival margins more conservatively, potentially improving restoration longevity and facilitating adhesive procedures without surgical crown lengthening.

Objective: Conduct a systematic review of quantitative evidence comparing the adverse health impacts of dental amalgam versus other dental restorative materials.

Data sources: Bibliographic database searches, limited by a date of 2007 and English language, were supplemented by citation chasing, searches of Google Search and checking topically similar systematic reviews.

Study selection: We sought empirical studies evaluating the health impacts of materials used for direct dental restorations. Two reviewers independently conducted title and abstract and full-text screening. Data extraction and quality appraisal using the Effective Public Health Practice Project Tool were carried out by one reviewer and checked by a second. We used narrative synthesis to group studies by restorative material and health impact evaluated.

Conclusions: 195 studies (245 articles) were included, with 61 studies (87 articles) prioritised for narrative synthesis. Studies evaluated a variety of health impacts for the following restorative materials: amalgam versus composite: (n=6), amalgam only (n=52), resin-based composite (RBC) only (n=16), glass ionomer versus RBC (n=3). Both amalgam and non-amalgam materials may be associated with various health impacts. However, confidence in these findings is limited due to the small quantity of direct comparative evidence and heterogeneity of outcome measure and findings within health impact categories. Findings of this review may support policy makers and researchers to identify and address future research needs.

Clinical significance: Findings highlight what is known regarding the comparative health impacts of different restorative materials, which may inform clinical decision-making alongside consideration of international guidelines, cost, material longevity, potential environmental impacts and patient-preference.

Objectives: To evaluate the color change (CC) and hydrogen peroxide (HP) penetration into the pulp chamber of extracted teeth subjected to different commercial whitening strips, as well as the pH stability and surface morphology induced by these products.

Materials and methods: Ninety-six premolars were randomly allocated into six groups: (1) NC, negative control (no bleaching); (2) UP, Up&Up™ Timeless White Whitening Strips; (3) LX, Lumineux® Whitening Strips; (4) CT, Crest® 3DWhitestrips™; (5) WG, Walgreens® Ultra Whitening Strips; and (6) PC, positive control (6% HP, FGM WhiteClass). CC was measured using digital spectrophotometry before treatment and 14 days post-bleaching (ΔL*, Δa*, Δb*, ΔE_ab, ΔE_00,and ΔWI_D). HP penetration into the pulp chamber was analyzed using UV-Vis spectrophotometry, pH stability was measured with a pH meter, and surface morphology by scanning electron microscopy. Statistical analysis was performed using one-way ANOVA, followed by Tukey's post hoc test (α = 0.05).

Results: PC, CT, and UP showed higher ΔE_ab, ΔE₀₀, and ΔWI_D values than LX and NC. Color change was mainly driven by reductions in Δb*. HP was detected in the pulp chamber of PC, CT, and UP, with the highest levels in PC; no HP was detected in LX and NC. Only LX maintained stable pH. SEM analysis showed preserved enamel surface morphology in all groups.

Conclusion: HP-containing whitening strips promoted clinically relevant color changes with lower pulp chamber penetration than the at-home bleaching gel, despite a pH decrease. Peroxide-free strips were ineffective and showed no HP penetration.

Clinical relevance: Over-the-counter whitening strips vary in effectiveness and biological behavior according to their composition. HP-containing strips may offer effective whitening with a more conservative diffusion profile, while peroxide-free products may not achieve clinically meaningful results.

Objectives: Dental caries and developmental defects of enamel (DDE) are common conditions that impact oral health. Quantitative light-induced fluorescence (QLF) is widely used for detecting dental caries, but its ability to identify DDE remains unclear. This study aimed to investigate fluorescence differences among sound, carious, and DDE-affected teeth using QLF, and to differentiate white hypomineralization from incipient caries.

Methods: Data from 704 teeth in 137 patients under 20 years old were analyzed. QLF images were acquired, and fluorescence parameters were measured. Statistical tests included Chi-square, Fisher's exact, Mann-Whitney, Kruskal-Wallis, Linear mixed-effects models, and receiver operating characteristic (ROC) analyses.

Results: ΔF values progressively decreased and ΔR values increased from sound to DDE-affected to carious teeth (p < 0.001). Within DDE, fluorescence changes differed significantly according to defect subtype, with combined defects showing the greatest mineral loss and bacterial activity (p < 0.001 for ΔF, p = 0.008 for ΔR). White hypomineralization showed higher ΔF values and lower ΔR values than yellow/brown hypomineralization (p < 0.001). Significant fluorescence differences were observed between white hypomineralization and International Caries Detection and Assessment System scores 1 and 2 lesions (p < 0.001). ROC analysis revealed excellent accuracy for distinguishing white hypomineralization from incipient caries, with areas under the curve of 0.970 for ΔF mean and 0.979 for ΔR mean. The optimal cutoff values were -7.65 for ΔF mean and 23.50 for ΔR mean, respectively.

Conclusions: QLF provides effective quantitative support for differentiating DDE from incipient caries.

Clinical significance: Quantitative light-induced fluorescence provides objective parameters for differentiating developmental defects of enamel from incipient dental caries. By offering quantitative cutoff values, this approach supports more accurate diagnosis of clinically ambiguous white spot lesions, reduces the risk of overtreatment, and facilitates prevention-oriented and minimally invasive treatment planning in routine dental practice.

Objectives: To quantify the three-dimensional (3D) deviation between planned and achieved maxillary positions after transfer using a surgical wafer under in vitro conditions, and assess clinical acceptability and repeatability for each workflow.

Methods: A bracketed typodont mounted on a mannequin was used to define three groups-Conventional (alginate impressions/plaster casts/laboratory scanning), Trios (Trios 3 intraoral scanner (IOS)), and Prime (Primescan IOS)-each with 10 technical replicates. For each replicate, virtual surgical planning was performed, a wafer was designed and 3D-printed, and the maxilla was positioned; 3D deviation was quantified as: (1) point-based 3D positional deviation (three landmarks) and (2) matrix-based 3D translational and rotational deviations. Clinical acceptability was defined as the proportion of the 10 replicates per group with 3D deviation within predefined clinical tolerance limits (0.5 mm for positional/translational; 1.0° for rotational). Repeatability was summarized by the repeatability standard deviation (s_r) as specified in ISO 5725.

Results: The Trios and Prime groups achieved 100% clinical acceptability across all 3D deviations. In the Conventional group, acceptability was 90% for the anterior landmark's positional and translational deviation, with all others achieving 100%. The s_r was 0.13-0.20 mm (positional), 0.23 mm (translational), and 0.22° (rotational) for the Conventional group; 0.04-0.13 mm, 0.06 mm, and 0.24° for the Trios group; 0.04-0.10 mm, 0.11 mm, and 0.17° for the Prime group.

Conclusion: Under in vitro conditions, the demonstrated clinical acceptability and repeatability provide preliminary evidence supporting the clinical feasibility of a fully digital IOS-based workflow for wafer-mediated maxillary positioning.

Clinical significance: An IOS-based workflow can be considered clinically feasible for wafer-mediated maxillary positioning without compromising accuracy, as evaluated in terms of clinical acceptability and repeatability, while potentially eliminating impression-taking and cast fabrication steps.

Objectives: To compare the effects of conventional cigarette smoke (CS) and Tobacco Heating System (THS) aerosol on surface staining and discoloration of ceramic and composite veneers using a clinically relevant in vitro model.

Methods: Forty-six human premolars were restored with either lithium-disilicate ceramic or direct composite veneers and assembled in an in vitro setup model simulating adjacent teeth and gingiva. Specimens were randomly assigned to a 3-week exposure to CS or THS aerosol. Following each daily exposure, specimens were brushed with a standard toothpaste. Color change (ΔE00) and whiteness index for dentistry (WID) were measured spectrophotometrically at baseline and weeks 1, 2, and 3 after exposure. Surface staining was scored in the gingival, mesial, distal, and body areas using a modified Lobene stain index, and cervical marginal discoloration was evaluated with modified USPHS criteria.

Results: Composite veneers exposed to CS showed significantly more post-brushing discoloration (ΔE00≈ 4.0; ΔWID≈ -7.2) than ceramic veneers. THS exposure caused minimal color change in both veneer types. Surface staining was consistently greater after CS than THS exposure, but accumulated over time, even with THS, especially at interproximal and gingival regions. Cervical marginal discoloration was significantly higher in CS-exposed specimens for both veneer types.

Conclusions: Cigarette smoke leads to composite veneer discoloration exceeding the clinically perceptible threshold (ΔE00 > 2.25) and more severe marginal and interproximal staining than THS aerosol. When routine brushing was included, ceramic veneers showed high color stability under both exposures. Although THS induces less veneer discoloration than CS, meticulous interdental hygiene and smoking cessation remain critical for maintaining optimal esthetics.

Clinical significance statement: Cigarette smoking leads to discoloration and marginal staining of composite veneers, even with regular brushing, whereas ceramic veneers offer greater color stability. Although heated tobacco aerosol causes less staining than cigarette smoke, both can impact interproximal areas. This highlights the importance of materials selection, hygiene instructions, and smoking cessation counseling.

Objectives: To investigate the clinical efficacy of the cross-arch fixed dental prostheses as periodontal splints and to identify the key factors influencing its treatment outcomes.

Materials and methods: Thirty-seven patients with 51 tooth-supported cross-arch prostheses (mean follow-up: 63 months; mean bridge length: 10.24 units) were retrospectively analyzed. Survival rates, complications, alveolar bone level (ABL), probing pocket depth (PPD), bleeding on probing (BoP), plaque index (PI), prosthesis characteristics, and patient satisfaction were documented at baseline (T0), 1 year (T1), 3 years (T2) and 5 years (T3) after loading. Cumulative survival rates (CSRs) were calculated using Kaplan-Meier curves. Risk factors for changes in PPD (ΔPPD) and alveolar bone level (ΔABL) were screened by univariate analyses and assessed using multivariable generalized linear and logistic regression models.

Results: Five-year prosthesis survival was 95.16% (100% at 1- and 3-year). PPD decreased significantly from T0 (3.84 ± 0.81 mm) to T1 (3.26 ± 0.92 mm) and T2 (3.33 ± 0.84 mm; p < 0.05), while ABL remained clinically stable, and BoP and PI were maintained at low levels throughout the study period. Quadrilateral abutment configuration was significantly associated with reduced bone loss (β = -0.551, p = 0.002) and reduced ΔPPD (β = -0.704, p < 0.001). Bilateral terminal abutment prostheses (β = -0.389, p= 0.013) also showed a protective effect on ΔPPD. Patient satisfaction remained high (p > 0.05).

Conclusion: Cross-arch fixed prostheses provided predictable periodontal stabilization with high survival rates. Periodontal maintenance and prosthetic design are key determinants of outcomes.

Clinical significance: Tooth-supported cross-arch prostheses achieved long-term survival and maintained periodontal parameters in Stage III/IV periodontitis, supporting their use as long-span splints when properly planned and maintained. Abutment distribution and strict supportive periodontal care were key determinants, guiding prosthetic design and follow-up.

Objectives: To propose a novel registration method based on partial point cloud registration for transoral robot-assisted zygoma fracture surgery and validate its accuracy via a phantom study.

Methods: This study comprised two validation phases. 1) Feasibility of partial zygomatic surface point cloud registration. Forty sets of normal CT data were selected from an established normative database. After segmentation and 3D reconstruction of zygoma, point clouds from different exposure ranges on the zygomatic bone surface (Group A: Full Zygomatic Bone Outer Surface; Group B: Area Below Infraorbital Margin; and Group C: Area Below Infraorbital Foramen.) were extracted and registered to the intact zygoma using the Iterative Closest Point (ICP) algorithm. The Fiducial Registration Error (FRE) was computed for each group. 2) Accuracy of partial point cloud registration: 10 pre-operative CT scans of zygomatic fractures were selected. Registration using fiducial markers served as the control (Group A). Using a self-developed and previously validated binocular vision camera and probe, point clouds of different exposure range (Group B1, B2, and B3) on the zygomatic bone surface were collected and registered using ICP algorithm. The accuracy of partial point cloud registration for different zygomatic bone surface areas was comparatively evaluated using both FRE and Target Registration Error (TRE).

Results: Feasibility of partial zygomatic surface point cloud registration: The TRE for Group A, B, and C was 0.16 ± 0.16 mm, 0.18 ± 0.14 mm and 0.22 ± 0.13 mm (P > 0.05). Accuracy of partial point cloud registration: The TRE for Group A, B1, B2, and B3 was 0.47 ± 0.17 mm, 0.70 ± 0.17 mm, 0.70 ± 0.17 mm, 0.86 ± 0.24 mm. (P < 0.001) CONCLUSION: The proposed method, based on partial point cloud registration, demonstrated both accuracy and feasibility, offering a foundation for future advancements in transoral robot-assisted surgery of zygoma fracture.

Clinical significance: For transoral robotic-assisted zygoma reduction, the most crucial part is to enable the robot to accurately localize bone fragments following limited surgical exposure. The innovative registration approach based on partial point cloud registration has been proven to possess both accuracy and feasibility, which lays a solid foundation for the future development of transoral robot-assisted surgical techniques in the treatment of zygomatic fractures.

Objective: To validate the performance of a novel automated zygomatic implant (ZI) planning tool (Zygoplanner) in an international multicenter cohort.

Methods: Preoperative computed tomography (CT) scans from 69 patients (276 ZIs) who underwent quad zygomatic implant surgery were retrospectively analyzed using Zygoplanner. Automated ZI plans generated by Zygoplanner were compared with the corresponding clinically placed implants. The comparison metrics included three-dimensional bone-to-implant contact (3D-BIC), Zygoma Anatomy-Guided Approach (ZAGA) classification, safety distances to the orbital rim (d1) and the inferior border of the zygoma (d2), inter-implant spacing, surgeon subjective assessments, and a blinded Turing test.

Results: Compared with clinical planning, Zygoplanner achieved significantly higher 3D-BIC values (p < 0.001). In the internal dataset, automated plans showed slightly shorter orbital rim distances (4.51 vs 5.71 mm, p = 0.022) but significantly greater distances to the inferior zygomatic border (8.21 vs 7.20 mm, p = 0.015). In the external dataset, Zygoplanner demonstrated significantly larger inter-implant spacing (3.01 vs 1.18 mm, p < 0.001). Despite these differences, ZAGA classifications remained consistent between both groups. Subjective evaluations by experienced surgeons yielded high scores for stability (4.63/5), feasibility (4.51/5), and safety (4.25/5). In the blinded Turing test, Zygoplanner-generated plans were identified as human expert in 65.2% of cases, significantly exceeds the 50% random guessing threshold (p = 0.0075).

Conclusion: Zygoplanner automatically generates clinically acceptable quad ZI plans with improved 3D-BIC, which effectively reduces the planning complexity and facilitates better preoperative ZI planning.

Clinical significance: Zygoplanner shows strong potential to automate and standardize quad zygomatic implant planning, thereby improving surgical predictability and safety while simplifying the planning workflow. Its automated workflow supports more consistent outcomes and may broaden access to advanced implant rehabilitation for patients with edentulous maxillae.