Frontiers in dental medicine最新文献

Introduction: Children with Down syndrome (DS) and autism spectrum disorder (ASD) are at increased risk for oral health problems due to anatomical, behavioral, and socioeconomic factors. However, evidence on their caries experience and oral hygiene remains inconsistent. This study systematically reviewed and meta-analyzed case-control and cross-sectional studies comparing oral health indices in children with DS or ASD to neurotypical peers.

Methods: A systematic search was conducted in PubMed, Web of Science, Science Direct, and Google Scholar using a standardized strategy. Eligible studies included children aged 0-18 years. Pooled mean differences (MD) in Plaque Index (PI), Gingival Index (GI), DMFT (decayed, missing, and filled permanent teeth), dmft (primary teeth), and Simplified Oral Hygiene Index (OHI-S) with 95% confidence intervals (CI) were calculated in R using meta and metafor packages.

Results: Twenty-four studies were included (527 children with DS, 1,221 with ASD, 1,875 controls). For PI, children with DS had MD = 0.53 (95% CI: -0.13-1.18; I ² = 90%) and children with ASD 0.28 (95% CI: -0.05-0.61; I ² = 93.3%) compared to controls. GI was MD = 12.10 (95% CI: -0.14-162.92; I ² = 99.7%) for DS and 0.33 (95% CI: -0.13-0.78; I ² = 93.1%) for ASD. DMFT showed MD = -0.29 (95% CI: -0.97-0.39; I ² = 54.7%) for DS and 0.29 (95% CI: -0.53-1.11; I ² = 97.6%) for ASD. dmft was MD = -0.14 (95% CI: -0.61-0.33; I ² = 0%) for DS and -0.33 (95% CI: -1.49-0.82; I ² = 94.6%) for ASD. OHI-S was MD = 0.28 (95% CI: -0.92-1.47; I ² = 92.2%) for DS and 0.31 (95% CI: -1.37-1.98; I ² = 65.7%) for ASD. Most differences were not significant due to high heterogeneity. Sensitivity analysis identified one influential study affecting PI; excluding it strengthened the effect (MD = 0.43; 95% CI: 0.17-0.70; p = 0.0047). No publication bias was detected for DMFT and dmft indices. Overall certainty of evidence was low.

Conclusions: Children with DS and ASD showed no consistent differences in PI, GI, DMFT, dmft, or OHI-S scores compared to neurotypical peers. Public health strategies should focus on inclusive oral health education, provider training, and equitable access to dental services to improve outcomes for children with neurodevelopmental disorders.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251155866, identifier: CRD420251155866.

Background: Artificial intelligence (AI) has been increasingly applied to periodontal diagnostics across periapical, bitewing, panoramic radiographs, cone-beam computed tomography (CBCT), and intraoral photographs. Recent multicenter, external validation, and explainability-focused studies have advanced the field, yet variability in datasets, anatomical sites, reference standards, model architectures, and reporting practices introduces significant heterogeneity. A structured synthesis of current evidence is therefore warranted.

Main text: This review synthesizes 35 studies published between 2019 and 2025, evaluating AI applications in four diagnostic domains: detection of periodontal bone loss, measurement of alveolar bone levels, identification of furcation involvement, and detection of periapical lesions. Convolutional neural network (CNN)-based models using periapical radiographs achieved moderate-to-high diagnostic accuracy (0.82-0.85) and AUCs above 0.88, comparable to clinician performance. Panoramic radiographs yielded lower sensitivity and specificity than CBCT, where deep learning systems reached higher accuracy (up to 0.91) and superior volumetric assessment. Intraoral photographic analyses showed variable performance (0.46-1.00), largely due to inconsistent imaging and reference standards. Emerging trends include hybrid segmentation-classification architectures, transformer-based networks, and clinician-in-the-loop approaches. Determinants of performance encompass reference standard quality, dataset diversity, anatomical complexity, and adherence to STARD-AI and TRIPOD-AI reporting frameworks.

Conclusions: AI demonstrates clinically relevant diagnostic accuracy in periodontal imaging, especially for measurement standardization and decision support. Although autonomous diagnosis remains premature, integrating explainable, externally validated AI systems within clinician-guided workflows supported by standardized reporting offers a practical route toward clinical translation.

Aim: This systematic review and meta-analysis aimed to evaluate the fracture resistance of permanent teeth restored with polyethylene fiber-reinforced composite resin restoration.

Material and methods: The following PICOS framework used was: Population, permanent teeth requiring restorative treatment; Intervention, polyethylene fiber use; Control, composite resin restorations without fiber reinforcement, or conventional fiber posts; Outcome, fracture resistance (in Newtons); Study design, in vitro studies. A literature search was conducted independently by two reviewers up to May 18, 2025, using electronic databases (PubMed, ISI Web of Science, SciELO, Scopus, and Embase). In vitro studies examining the fracture resistance of permanent teeth restored with polyethylene fiber-reinforced resin composite restorations were included. Meta analyses were performed by comparing the standardized mean differences in the fracture resistance of teeth restored using polyethylene fibers and the teeth restored only with resin composite. Additional analysis was performed comparing the risk difference of the number of unfavorable fractures. Separate analyses were performed when fiber posts were used. A p-value of less than 0.05 was considered statistically significant.

Results: The fracture resistance of polyethylene fiber-reinforced restorations was higher compared to non-fiber reinforced composite restorations (p < 0.001). Also, the number of unfavorable fractures were significant lower when polyethylene fibers were used (p < 0.001).

Conclusion: The findings suggest that the fracture resistance of permanent teeth may be improved with the use of polyethylene fibers. However, clinical performance outcomes are necessary to validate these in vitro results.

Systematic review registration: The protocol for the systematic review was developed a priori and can be accessed at: https://doi.org/10.17605/OSF.IO/5K8XB.

Aim: To evaluate the influence of zirconium oxide (ZrO₂) nanoparticle reinforcement and housing retaining material on the flexural performance of implant-supported overdenture acrylic resin bases.

Materials and methods: Thirty-six standardized bar-shaped heat-cured polymethylmethacrylate (PMMA) specimens were fabricated in accordance with ISO 20795-1 and divided into six groups (n = 6) based on ZrO₂ nanoparticle concentration (0%, 3%, and 7% by weight) and housing retaining material (autopolymerising PMMA or UfiGel Hard). Specimens were subjected to thermocycling to simulate oral aging and tested under three-point bending to determine flexural strength. Surface characteristics were qualitatively assessed using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Data were analyzed using one-way ANOVA with Tukey's post hoc test (α = 0.05).

Results: ZrO₂ nanoparticle reinforcement significantly enhanced flexural strength across both retaining materials. Specimens containing 7 wt% ZrO₂ demonstrated approximately 75%-90% higher flexural strength compared with non-reinforced controls, depending on the retaining material employed. All reinforced groups exceeded the minimum flexural strength requirement of 65 MPa specified by ISO 20795-1 for denture base polymers. Autopolymerising PMMA consistently exhibited higher flexural strength than UfiGel Hard. SEM revealed differences in nanoparticle dispersion with increasing concentration, while AFM demonstrated increased surface roughness at higher ZrO₂ levels. These improvements suggest enhanced resistance to housing-related fracture, a common clinical complication in implant-supported overdentures.

Conclusion: Zirconium oxide nanoparticle reinforcement significantly enhanced the flexural strength of implant-supported overdenture acrylic resin bases, with superior performance observed when autopolymerising PMMA was used as the housing retaining material. These findings suggest a material-based approach to improving overdenture base fracture resistance; however, clinical extrapolation should be approached with caution, and further studies incorporating fatigue loading and long-term aging are warranted.

Objective: The evidence on postoperative pain and clinical outcomes in patients receiving primary non-surgical root canal therapy with bioceramic vs. resin-based sealers was compiled in this comprehensive review from systematic reviews and meta-analyses.

Methods: The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42023461029). Systematic reviews included randomized or quasi-randomized trials of adult patients having treatment with either sealer type for postoperative pain, and used validated scales. Screening, data extraction, and quality assessment by A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) were completed independently by two reviewers and review overlap was measured with the Corrected Covered Area (CCA). Where feasible, de novo random-effects meta-analyses were conducted to estimate standardized mean differences (SMD) in pain at 24 and 48 h. Heterogeneity was measured using the I ² statistic and certainty of evidence with GRADE.

Results: Seven reviews (2020-2024) met eligibility, five with quantitative synthesis. Pooled analyses showed no significant differences in pain between sealer types within the first 6-48 h. Detected differences were small and clinically negligible. Both sealers showed similar analgesic use and flare-up rates. Methodological quality ranged from moderate to low; certainty of evidence for early pain was moderate and low for pain at >48 h due to study inconsistency and imprecision.

Conclusions: Bioceramic sealers offer only a minimal, clinically insignificant reduction in early postoperative pain compared to resin-based sealers. Both nevertheless remain suitable options for reducing patient discomfort. Future studies should standardize pain evaluation, include retreatment cases, and explain clinically significant findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023461029, PROSPERO CRD42023461029.

Aim: Bone regeneration in oral and maxillofacial surgery remains a clinical challenge, particularly in cases of severe alveolar atrophy or large post-pathological bone defects. Autologous biomaterials including dentin grafts processed with the Tooth Transformer® device and platelet concentrates such as Concentrated Growth Factors (CGF), PRF, i-PRF, and TPRF-have gained attention due to their biocompatibility and regenerative potential. However, no direct head-to-head clinical studies comparing these autologous approaches are currently available.

Materials and methods: This review was conducted according to PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus and Web of Science for clinical studies published in English between January 2010 and December 2025. Eligible designs included randomized trials, prospective/retrospective studies, and case series with ≥5 patients. Owing to the paucity of CGF-only studies, the comparison was broadened to include platelet concentrates (CGF/PRF/L-PRF/i-PRF/TPRF). Outcomes included bone volume gain, radiographic density, histologic new bone formation, healing time, implant survival, and postoperative complications.

Results: The search yielded 1,004 records; 10 studies met the inclusion criteria. Autologous dentin grafts demonstrated favorable volumetric stability and bone density compatible with mature bone, while platelet concentrates consistently improved early healing, angiogenesis, and trabecular organization-particularly in contained defects. Substantial methodological heterogeneity and the absence of direct comparative trials precluded quantitative synthesis.

Conclusions: Autologous dentin grafts and platelet concentrates appear to play complementary roles: the former provides a structural scaffold for three-dimensional augmentation, whereas the latter enhances biological healing and tissue maturation. Combined protocols show promise but require validation through well-designed, multicenter randomized controlled trials.

Growing evidence links chronic systemic inflammation, particularly from periodontitis, to neurodegenerative processes, which have been reported to share common pathways. Early detection of neurodegenerative diseases such as Alzheimer's disease is crucial, given that underlying neuropathological processes evolve silently for decades before diagnosis. The gingival crevicular fluid (GCF), a serum-derived exudate from the gingival sulcus, mirrors both local periodontal inflammation and systemic conditions. Its molecular composition-rich in cytokines, enzymes, oxidative stress markers, and microbial metabolites-makes it a potential source of biomarkers reflecting neuroinflammatory pathways. This review discusses the biological rationale and emerging evidence supporting the use of GCF as a functionalized biofluid for early detection of dementia or asymptomatic neurodegeneration. By integrating advances in biosensing and lab-on-a-chip technologies, GCF analysis could become a minimally invasive, point-of-care approach to identify individuals at risk of neurodegenerative diseases. Exploring this oral-brain connection may open new perspectives in preventive medicine and personalized diagnostics.

Purpose: To assess the diagnostic accuracy and treatment planning agreement among Jordanian dentists when using teledentistry.

Methods: Thirty children underwent dental examinations. Standardized intraoral photographs and brief case histories from pediatric patients were compiled into clinical case scenarios. Eight representative cases were selected and presented in a Google Forms survey to licensed dentists in Jordan. Participants reviewed the cases, providing clinical diagnoses and proposing treatment plans. Responses were analyzed to determine diagnostic accuracy and agreement on treatment planning.

Results: Diagnostic agreement was highest for cases with distinct clinical presentations. Case #5 (early childhood caries) showed the highest agreement at 92.1%, followed by Case #3 (avulsion; 91.1%) and Case #6 (ectopic eruption; 85.1%). Treatment planning agreement followed a similar pattern. The highest concordance was reported for Case #4 (molar-incisor hypomineralization; 64.4%) and Case #7(Functional class III/anterior crossbite 59.4%).

Conclusion: Teledentistry enables high diagnostic accuracy among Jordanian dentists, especially in pediatric cases with well-defined presentations. However, the observed variability in treatment planning highlights the need for standardized clinical guidelines and targeted professional development to optimize teledentistry's integration into routine dental care.

Objective: This meta-analysis assessed the efficacy of various anesthetic protocols for symptomatic irreversible pulpitis, comparing techniques and agents to identify the optimal anesthesia approach.

Methods: We conducted a comprehensive search of the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases up to July 10, 2025, identifying relevant studies based on predefined inclusion and exclusion criteria. The primary outcome was the success rate of anesthesia. Data extraction and quality assessment were performed using a pre-designed form and the revised Cochrane Risk of Bias Tool. A fixed-effect model was used for meta-analysis when heterogeneity was low (I ² ≤ 50%, p ≥ 0.1); otherwise, a random-effects model was adopted. Additionally, another model was employed for validation, and the results from both models were compared to derive more reasonable conclusions. Publication bias was assessed using funnel plots and the Egger test.

Results: Fourteen RCTs were included in the meta-analysis. Pooled analysis showed that modified anesthetic protocols for SIP were 3.62 times more successful than conventional inferior alveolar nerve block (IANB) using standard 2% lidocaine with epinephrine (OR = 3.34; 95% CI: 2.49-4.48). Studies conducted in Iran had the highest success rate (OR = 4.31; 95% CI: 3.59-5.17, p < 0.001). Inferior alveolar nerve block (IANB) was more effective than buccal infiltration (OR = 4.03; 95% CI: 3.38-4.81, p < 0.001), and 4% articaine demonstrated the highest efficacy (OR = 4.18; 95% CI: 2.85-6.16, p < 0.001).

Conclusion: This meta-analysis assessed the efficacy of various anesthetic protocols for SIP, comparing techniques and agents to identify the optimal anesthesia approach.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO database CRD42025638427.