BDJ Open最新文献

Objectives: The relationship between blood cadmium levels and the risk of periodontitis remains unclear. This study aimed to explore the association between blood cadmium concentrations and periodontitis in a large sample of the U.S. population from 2011 to 2014.

Methods: This cross-sectional study analyzed data from 5215 participants in the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Blood cadmium levels were the exposure variable, and periodontitis was the outcome variable. Multivariate logistic regression and a two-piecewise linear regression model were used to examine the nonlinear relationship between blood cadmium levels and periodontitis. Stratified analyses were conducted to identify subgroups at higher risk.

Results: The study identified a nonlinear relationship between blood cadmium levels and periodontitis risk. The threshold effect was observed at 0.37 µg/L and 1.20 µg/L. When blood cadmium levels were below 0.37 µg/L, the odds ratio (OR) for periodontitis was 0.88 (95% CI: 0.31, 2.48; p = 0.81). For cadmium levels between 0.37 and 1.20 µg/L, the OR increased significantly to 12.40 (95% CI: 2.77, 55.57; p < 0.001). When cadmium levels exceeded 1.20 µg/L, the OR decreased to 0.45 (95% CI: 0.06, 3.39; p = 0.44).

Conclusions: The study found a nonlinear association between blood cadmium levels and periodontitis risk in U.S. adults. The risk of periodontitis increased significantly when blood cadmium levels were between 0.37 and 1.20 µg/L.

Aims: This study evaluated the influence of different root canal irrigants, 3% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and a NaOCl-HEDP combination (Dual Rinse), on the mechanical behavior of nickel-titanium (NiTi) endodontic instruments with identical geometry but varying heat treatments.

Method: A total of 720 One Curve NiTi files (MicroMega, Besançon, France) with three heat treatments (none, C.Wire, S.Wire) were allocated into subgroups exposed to four irrigants (distilled water, NaOCl, NaOCl-HEDP, EDTA) at 21 °C and 35 °C for 1, 5, or 10 min. Mechanical tests were conducted in accordance with ISO 3630-1 to assess bending resistance, maximum torsional resistance, and angular deflection at fracture. Profilometric analysis was performed to identify potential signs of corrosion.

Results: No significant differences were found in maximum bending or torsional torque across irrigant groups. However, EDTA exposure resulted in increased angular deflection at fracture, followed by distilled water. NaOCl showed the lowest angular deflection, while NaOCl-HEDP exhibited intermediate behavior. Heat-treated instruments, particularly S.Wire, consistently showed superior mechanical performance across all test conditions.

Purpose: This study aimed to evaluate the influence of scan body geometry on the trueness of intraoral scanner (IOS) acquisitions.

Methods: An in vitro study was conducted using three groups of scan bodies with varying designs. Trueness was assessed by measuring deviations from a reference model obtained using a high-precision industrial scanner. Three model types were analyzed: a fully edentulous with six implants, a partially dentate with four implants, and a partially dentate with two implants.

Results: In all models, the reduced-length scan body (Group 2) showed the highest trueness, with the lowest mean deviations: 87 μm (6-implant model), 104 μm (4-implant model), and 10 μm (2-implant model). The standard design (Group 1) showed moderate deviations, while the more complex design with three flat surfaces (Group 3) consistently showed the highest deviations. Shorter, simpler designs performed best across all configurations.

Conclusions: Scan body geometry, particularly length and head design, plays a critical role in scanning accuracy. Simplified, shorter scan bodies enhance trueness, while greater height or geometric complexity may compromise it. These findings suggest that optimizing scan body geometry-particularly reducing height-can enhance the accuracy of digital implant impressions, with potential implications for improving reliability in implant-supported prosthetic workflows.

Objective: This systematic review and meta-analysis compare the diagnostic accuracy of intraoral scanners (IOS) and intraoral cameras (IOC) against traditional radiographic and histological methods for caries detection. Due to variation in sensitivity (SE) and specificity (SP) among diagnostic tools, this study evaluated their performance based on lesion type, lesion location, and examiner-dependent factors.

Methods: A comprehensive literature search was conducted using keyword-based search strings in Scopus, Web of Science, PubMed, Cochrane Library, and Dentistry & Oral Sciences Source, following PRISMA-DTA guidelines. Studies comparing IOS or IOC to radiographic or histological reference standards were included. Three independent reviewers assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, with disagreements resolved by discussion and Fleiss's kappa (κ) analysis. Meta-analysis was performed using a bivariate random-effects model to estimate pooled SE and SP. Subgroup analyses examined the impact of lesion type, lesion location, and examiner-dependent variabilities, using the Python programming language.

Results: Twenty-eight studies met the inclusion criteria, with 16 studies included in the meta-analysis. Pooled SE and SP of IOS and IOC were 50%, indicating moderate diagnostic accuracy. Radiographic methods had the highest SP, making them more effective at avoiding false positives. In contrast, IOSs and IOCs demonstrated higher SE for occlusal and dentin lesions, suggesting their utility in early caries detection. Lesion location significantly influenced diagnostic accuracy, with IOS and IOC showing superior SE for occlusal lesions but lower SE for supragingival lesions. Examiner-dependent differences in SE reached up to 32%, emphasizing the need for structured training and calibration protocols.

Conclusions: IOSs and IOCs showed promise for early caries detection due to their higher SE for occlusal and dentin lesions. However, their lower SP compared to radiographic methods raises concerns about false positives. Standardized examiner training and improved diagnostic protocols are essential to enhance the reliability of these digital imaging techniques.

Background: Periodontal disease affects 3.5 billion people globally, resulting in annual treatment costs exceeding $54 billion. Guided tissue regeneration (GTR) membranes are essential for periodontal therapy, but commercially available options often suffer from limitations, including high cost, limited accessibility in resource-limited settings, and suboptimal mechanical properties. This study aimed to develop and characterize a novel porcine cholecystic extracellular matrix (CECM)-based GTR membrane and comprehensively evaluate its physicochemical properties, cytocompatibility, and in vivo biocompatibility compared to the commercially available Healiguide® membrane.

Methods: CECM membranes were fabricated through systematic decellularization, lyophilization, and ethylene oxide (ETO) sterilization of porcine gallbladders. Surface characterization was performed using scanning electron microscopy (SEM) with quantitative pore analysis, and biochemical composition was assessed via Fourier Transform Infrared Spectroscopy (FTIR). MTT assays were performed on L929 fibroblast cells to evaluate cytocompatibility. Wound healing capacity was assessed using scratch assays monitored over 72 h. In vivo biocompatibility was evaluated through subcutaneous implantation in Sprague-Dawley rats, with histological analysis performed at 1, 2, 3, and 4 weeks post-implantation.

Results: SEM analysis revealed that CECM membranes exhibited a heterogeneous, multilayered structure with larger average pore sizes compared to Healiguide® (18.2 ± 4.6 µm vs. 12.5 ± 3.2 µm, p < 0.05), facilitating enhanced cellular infiltration. FTIR confirmed the preserved integrity of collagen in both membranes, with CECM showing an enhanced glycoprotein content indicative of retained bioactive components. Cytocompatibility assessment demonstrated excellent cell viability for CECM, showing 97.4 ± 1.6%, 94.2 ± 1.8%, and 90.8 ± 1.4% viability at 20, 50, and 100 µg/mL CECM extracts, respectively. The scratch assay demonstrated superior wound healing capacity for CECM, with significantly enhanced wound closure at 72 h compared to Healiguide® (89.7 ± 6.1% vs. 79.4 ± 5.8%, p < 0.05). Subcutaneous implantation studies confirmed excellent in vivo biocompatibility, with CECM showing lower initial inflammatory response (inflammation score: 2.3 ± 0.5 vs 2.8 ± 0.6 at week 1, p < 0.05), enhanced vascularization (12.3 ± 2.1 vs 9.7 ± 1.8 vessels/hpf at week 3, p < 0.05), and superior tissue integration compared to commercial controls.

Conclusion: The porcine CECM membrane demonstrated favorable physicochemical properties, excellent cytocompatibility, enhanced wound healing potential, and superior tissue integration characteristics compared to commercial GTR membranes. These preliminary findings provide a strong scientific foundation supporting the development of the GTR membrane for periodontal regenerative therapy.

Objective: The objective was to assess the effectiveness of the theory-based educational intervention tailored to the Theory of Planned Behavior (TPB) and behavior change techniques (BCTs) on oral hygiene behavior among university students through the oral hygiene behavior index and oral health outcomes.

Materials and methods: A randomized controlled trial involving university students was conducted from November 2022 to March 2023 (n = 71). Participants were randomly assigned to a control group (n = 38) or an intervention group (n = 33). The control group received conventional dental health education, whereas the intervention group underwent a 21-day TPB-based educational intervention delivered through a three-minute video. Oral hygiene behavior index (OHBI) and oral health outcomes, including caries activity, salivary hemoglobin level, and total bacterial count, were assessed at baseline and three-month post-intervention.

Results: Statistically significant improvements were seen in the OHBI score between groups and within the intervention group at three-month follow-up, with higher scores indicating better oral hygiene behavior. In addition, caries activity and salivary hemoglobin level were also improved. The total bacterial count in the intervention group did not show any statistically significant difference, even though it was lower than that of the control group.

Conclusion: This study indicates that theory-based educational intervention tailored to TPB and BCTs improves oral hygiene behavior and certain oral health outcomes. Future studies should examine the long-term effects and generalizability in diverse populations.

Trial registration: Thailand Clinical Trial TCTR20230105003.

Aim: This study aimed to evaluate the aesthetic preferences of traditional digital smile designs and artificial intelligence (AI)-generated smile designs among dentists, dental students, and laypersons, addressing gaps in previous research on the clinical acceptability of AI in prosthodontic aesthetics.

Materials and methods: A cross-sectional, questionnaire-based study was conducted via an online survey distributed across India between 2024 and 2025. A total of 320 participants, including dental students, dentists, and nondental professionals, were recruited on the basis of calculated sample size requirements. Smile designs were created for four clinical cases via Exo-CAD software, employing two methods: conventional manual design by prosthodontists and AI-based automated design. The participants evaluated paired smile designs and indicated their aesthetic preferences. Demographic data were also collected. Chi-square (χ²) tests were applied for statistical analysis, with a significance level set at p < 0.05.

Results: No significant differences in aesthetic preferences were observed based on sex, age, or occupation. Overall, manually crafted smile designs were consistently preferred across all the participant categories. However, AI-generated smiles for Cases 3 and 4 presented relatively higher acceptance rates (39.4% and 39.7%, respectively) than those for Cases 1 and 2 did. The findings suggest that while AI algorithms can achieve acceptable levels of aesthetic appeal, they still lack the human touch essential for capturing nuanced facial dynamics and emotional context.

Conclusion: Although AI-based smile design systems demonstrate promise in improving workflow efficiency and consistency, they are currently unable to replicate the individualized artistic judgment of experienced clinicians. Manual intervention remains critical for achieving truly personalized and aesthetically harmonious outcomes. Future approaches should consider hybrid models that combine AI automation with clinician-led customization to increase both the efficiency and patient satisfaction of smile aesthetics.

Background: Artificial Intelligence (AI) has become increasingly integrated into dental diagnostics, particularly for detecting carious lesions. While AI offers benefits such as improved accuracy and efficiency, its use raises important ethical concerns, including transparency, patient privacy, autonomy, diversity and accountability. This scoping review aims to identify these ethical concerns using a structured ethical framework.

Methodology: Three databases were searched for papers regarding caries detection using AI. An established ethical framework was used to screen each paper for potential areas of concern.

Results: A total of 351 abstracts were screened, of which 7 articles were included in this review. Each article was screened for established ethical principles including transparency, diversity, wellness, autonomy, privacy, accountability, equity, prudence, sustainable development, solidarity and governance. Diversity was the main ethical concern. Concerns related to accountability, equity and transparency were identified in 2 of the articles whereas ethical issue of privacy was identified in 4 of the articles. Only one study mentioned that no ethical approval was taken prior to commencement of study.

Conclusion: AI in caries detection faces ethical issues like data bias, privacy risks, and equity concerns, potentially leading to flawed AI models. These issues can be addressed by creating a more specialized ethical framework that is specific to AI in dentistry.

Clinical relevance: Understanding ethical challenges in AI-driven caries detection is critical to ensure accurate diagnostics, maintain patient trust, protect privacy, and support informed decision-making. Clinicians must be equipped to navigate these challenges as AI tools become more prevalent in dental practice.

Background: Virtual reality (VR) technologies are increasingly being adopted in dental education, particularly in restorative dentistry, due to their capacity to simulate realistic clinical scenarios and enhance student learning. However, despite the growing interest, the overall research landscape in this field remains unclear. This study aimed to conduct a bibliometric analysis to evaluate the most influential research contributions, publication trends, and collaborative patterns related to VR in restorative dentistry.

Methods: An advanced search of the Web of Science Core Collection (WoS-CC) database was performed on 29th October 2024 using a combination of keywords and Medical Subject Headings (MeSH) terms relevant to VR and restorative dentistry. Only original research and review articles in English were included. Bibliometric parameters such as citation metrics, authorship, institutional affiliations, countries of origin, and keywords were extracted and analyzed using Bibliometrix (R) and VOSviewer software.

Results: Out of 434 retrieved records, 62 articles met the inclusion criteria. A marked increase in publications was observed after 2019, with the USA, UK, and Netherlands emerging as the leading contributors. The most cited article received 73 citations, focusing on haptic simulators for motor skill acquisition. The Journal of Dental Education, the European Journal of Dental Education, and BMC Medical Education were among the most prolific journals. Despite global contributions, the analysis revealed limited interdisciplinary and international collaboration.

Conclusion: This bibliometric study highlights the increasing research activity surrounding VR in restorative dentistry and its potential to transform dental education. While considerable progress has been made, further high-quality research and broader collaborative efforts are necessary to address existing gaps and fully harness the capabilities of VR and related immersive technologies in dental education.

Objective: To evaluate the clinical performance of nitric acid associated with a mineral-enriched adhesive system compared to the conventional approach of phosphoric acid and a universal adhesive in cervical carious lesion restorations.

Materials and methods: Twenty-six individuals with 44 cervical anterior carious lesions were randomized into two equal parallel groups. The intervention group received a nitric acid etch (Clean and Boost dentin enamel cleanser, Vista Apex, USA) in conjunction with a mineral-enriched adhesive and a flowable composite liner (RE-GEN, Vista Apex, USA). Control group treated with phosphoric acid (Scotchbond Universal Etchant, 3 M ESPE), a universal adhesive (Single Bond Universal Adhesive, 3 M ESPE), and a standard liner (Filtek Supreme, 3 M ESPE). All cavities were restored using nanohybrid resin composite (Filtek Z350XT, 3 M ESPE). Postoperative sensitivity was assessed both qualitatively, using the modified USPHS criteria, and quantitatively, using a visual analog scale (VAS), as the primary outcome. In addition, clinical performance regarding marginal discoloration, adaptation, secondary caries, and retention was evaluated as secondary outcomes using modified USPHS criteria. Outcomes were assessed at 24 h, 6, 12, and 18 months. The data was statistically analyzed using intention-to-treat analysis. Intergroup comparisons were performed using the Chi-Squared test with a significance level (p ≤ 0.05), and intragroup comparisons were analyzed using Cochran's Q test with a confidence level of 95% and a study power of 80%. Relative risk was used to assess clinical significance. The survival rate was analyzed using the Kaplan-Meier and Log-rank tests. The study was conducted following the CONSORT 2025 guidelines.

Results: Both groups demonstrated similar performance in terms of postoperative sensitivity, retention, secondary caries, and marginal adaptation, as assessed using modified USPHS criteria. However, there was a significant increase in marginal discoloration within the phosphoric acid groups after 18 months. There was 50% less risk of sensitivity with nitric acid compared to phosphoric acid using the VAS scale (CI (0.2512 to 0.9953); p = 0.0485). The tested groups showed an equal survival rate (p = 0.3771).

Conclusion: Combining nitric acid with a mineral-enriched system is a promising approach for restoring cervical carious lesions.