Frontiers in dental medicine最新文献

Background: Understanding the performance of calcium silicate-based pulp capping materials is essential for clinicians seeking to preserve pulp vitality in cases of carious exposure, dental trauma, or developmental defects.

Objective: This study aimed to compare the physicochemical and biological properties of four pulp capping materials: Mineral Trioxide Aggregate (MTA), Biodentine®, TheraCal LC, and TheraCal PT.

Methods: Compressive strength, shear bond strength to composite resin, radiopacity, in vitro biomineralization, and cytocompatibility with human dental pulp stem cells (hDPSCs) were evaluated under standardized conditions. Statistical analysis was performed using one-way analysis of variance (ANOVA) and Tukey's post hoc test (α = 0.05).

Results: TheraCal PT exhibited the highest compressive and bond strength (p < 0.001), while MTA showed the greatest radiopacity (p < 0.001). Biodentine and MTA demonstrated superior biomineralization with abundant calcium phosphate crystal formation. In cell viability assays, Biodentine and TheraCal PT performed similarly to the control (p > 0.024), whereas Biodentine and TheraCal LC showed significantly reduced viability (p < 0.001).

Conclusions: Resin-modified materials offer advantages in mechanical performance and bonding but may compromise biomineralization and biocompatibility. Water-based materials like MTA remain superior in bioactivity and cellular response. Clinicians should balance physical properties with biological outcomes when selecting pulp capping agents.

Tissue regeneration relies on the ingrowth of blood vessels from the host for the survival and functionalization of regenerated tissues. Any holdup in this process can threaten the viability of the transplanted progenitor cells, which in turn can hinder effective tissue regeneration. Dental pulp stem cells (DPSCs) are a promising candidate cell source for dental pulp regeneration due to their potential for odontogenic and endothelial differentiation, as well as angiogenic properties. This narrative review examines the mechanisms by which DPSCs regulate angiogenesis. DPSCs modulate angiogenesis through multiple mechanisms: direct differentiation into endothelial cells, paracrine secretion of angiogenic growth factors, and functioning as mural cells to stabilise the nascent vasculature formed. Furthermore, the physical and biological interaction between DPSCs and extracellular matrices modulate the process of angiogenesis. The primary focus is on the intricate, multifaceted aspects of dental pulp regeneration; however, broader aspects of general tissue regeneration were also highlighted. The angiogenic modulation by DPSCs holds significant potential for the formulation of strategies that integrate pro-angiogenic scaffolds and signalling molecules to address the challenges associated with dental pulp tissue regeneration.

Introduction: Present literature on professionalism usually focuses on individual parts of professional identity development and mostly, as these are seen and are evaluated by the dental educators. When looking at professionalism and in particular professional identity formation, It is extremely important to listen to the voice of the students regarding their thoughts, attitudes, beliefs and ideas about how to become ethical, compassionate, and culturally competent oral health professionals. The aim of this meta-ethnographic review was therefore to explore students' perspective on learning activities regarding professionalism.

Methods: A review of the literature was conducted following the PRISMA guidelines to identify qualitative studies on professionalism teaching, focusing on dental students, covering from 2010 up to May 2024. Critical appraisal of the articles was conducted by 2 researchers using the Joana Briggs Institute and the McGill Mixed Methods Appraisal Tools. We then applied the meta-ethnographic methodology defining our aim, and proceeding with in depth reading, relating and translating of first and second order point of views before drawing our own salient themes.

Results: From the initial 6,995 studies, 11 were included in the analysis. The studies represented 6 different countries, 8 were of high and 3 of moderate quality. A conceptual preliminary matrix was developed based on the first reading and then used to compare quotations from the different studies. The overall themes in the conceptual model were phrased "Intentionality" and "Learning Context". The analysis of the quotations from the informants (first order) and the researchers (second order) yielded five sub-themes: changed self-awareness, perseverance, safe learning environment, authenticity, and shifting perspective.

Discussion: Dental educators should understand the students' perspective and needs for professional identity formation and understand their own position as role models towards this direction. Dental education should be a safe learning environment where multiple stimuli provided together with reflection and exchange of thoughts guided by educators, enhance development of students' professional behaviour.

Background: This study aimed to compare the bracket failure of metal and ceramic orthodontic brackets bonded with two different adhesives using the conventional shear bond test and a custom-made toothbrush simulator.

Methods: Forty-eight bovine teeth were extracted, bracketed, pH-cycled (14 days), randomly divided into four groups: metallic brackets bonded with B&E bonding agent (MB) and OrthoVita (MO), and ceramic brackets bonded with the B&E (CB) and the OrthoVita (CO). The bracket failure was evaluated with a universal testing machine (UTM) and a custom-made toothbrush simulator (TBS) (n = 6). Similarly, the amount of adhesive remaining on the bracket following debonding was evaluated using the Adhesive Remnant Index (ARI). Statistical Package for Social Sciences (SPSS) version 22 was used for statistical analysis. A two-way ANOVA was used for shear bond testing, while Fishers Exact test was used for the comparison of toothbrush simulator results.

Results: The mean values of shear bond strengths (± SE) were MB 58.32 ± 4.48 MPa, MO 22.57 ± 5.64 MPa, CB 27.36 ± 2.66 MPa, and lastly, CO 12.54 ± 3.64 MPa (p < 0.001). In the case of toothbrush simulation, all the samples remained intact in the group MB following 75,000 cycles. In group MO: two samples debonded < 10,000 cycles, four remained intact. In CB, three samples debonded < 10,000 cycles, one debonded < 20,000-30,000 cycles, and only two samples remained intact. In the CO group four samples debonded < 10,000 cycles, while two samples remained intact.

Conclusion: Metallic brackets and B&E Universal adhesive showed superior results. MB proved to have the strongest bonding comparatively.

Background: Conventional Glass Ionomer Cement (GIC) is widely used in restorative dentistry due to its biocompatibility and fluoride release; however, its limited mechanical strength and bioactivity restrict its broader clinical applications. Reducing glass powder particle size represents a promising approach to enhancing its physicochemical performance.

Objective: To investigate the effect of glass powder particle size reduction on the physicochemical and mechanical properties of a conventional GIC.

Methods: Four groups of conventional GIC were prepared by modifying glass powder particle size through one- or two-step ball milling. Particle size distribution (PSD) and field emission scanning electron microscopy (FE-SEM) were used to verify particle morphology, while energy dispersive x-ray spectroscopy (EDX), x-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR) confirmed chemical composition. The groups included: A - submicron (average 576.9 nm), B - nano (average 92.4 nm), C - hybrid (average 352.6 nm; composed of both nano and submicron particles), and D - control (936.8 nm, unmodified). Evaluations included pH, fluoride, and calcium ion release (over 28 days), initial setting time, compressive strength, and diametral tensile strength. Data were analyzed using one-way analysis of variance (ANOVA) with Tukey's honestly significant difference (HSD) test (p < 0.05).

Results: Group B (nano) exhibited the highest fluoride (8.4 ± 0.2 ppm at 3 h) and calcium ion release (1.3 ± 0.08 ppm at 3 h), and the most alkaline pH (6.6 ± 0.09 at day 28). Particle size reduction significantly increased ion release and pH over time but reduced compressive strength (99.02 ± 4.01 MPa) and prolonged setting time (426 ± 10.14 s). The hybrid group (Group C) demonstrated a balanced profile between ion release and mechanical strength, with no chemical alteration observed across groups.

Conclusion: Reducing GIC particle size to the nanoscale enhances ion release and alkalinity but compromises mechanical strength. A hybrid formulation incorporating both nano- and submicron-sized particles provides an optimal balance between bioactivity and strength, offering a promising direction for future development of GICs.

Cytotoxic T Lymphocyte Associated Protein 4 is a T cell-associated receptor that serves as an immune checkpoint molecule, downregulating immunosurveillance and propagating immune homeostasis. Periodontitis influences the serum levels of CTLA-4, which in turn alters the T cell activation pathways, PD-1 pathways, and CD80 activation, which has a key role in antigen presentation and implicates the B cell-mediated antibody response in periodontitis. In contrast, this elevation in CTLA-4 affects various other systemic immuno-inflammatory disorders, predominantly cancer and the efficacy of its immunotherapy. In the current article, an extensive literature review is conducted to elicit the link between the elevation of CTLA-4 in periodontitis and its possible influence on systemic immune-inflammatory disorders and their related targeted immune therapies. After investigation, CTLA-4 and its molecular therapy were found to have a crucial role in altering cancer pathogenesis, immunotherapy, and the pathogenesis of autoimmune disorders. The current article elaborates on the immuno-inflammatory pathways, molecular links, and plausible mechanisms linking periodontitis-associated CTLA-4 elevation and CTLA-4-based molecular therapy, specifically focusing on cancer immunotherapy.

Background: Digital guided implantology improves safety and precision compared to freehand methods. A survey indicated that half-guided templates are more commonly used than full-guided ones in China. This study aims to assess the accuracy of implant placements using half-guided and full-guided digital surgical templates, considering factors like jaw location, tooth position, support type, implant timing, and bone density.

Methods: 87 implants (52 half-guided, 35 full-guided) were evaluated by comparing pre- and postoperative CBCT scans to measure deviations in coronal, apical, depth, and angular positions. Bone density was also assessed in relation to the implant deviations.

Results: The findings revealed that the half-guided group exhibited significantly greater deviations in several areas: maxillary angular deviations, anterior coronal and depth deviations, posterior depth deviations, tooth-supported guide depth deviations, immediate implant coronal and angular deviations, and delayed implant depth deviations (P < 0.05). No significant differences were noted in other measurements. In the bone density analysis, only the full-guided group showed a significant negative correlation between bone density and apical deviation (P < 0.05).

Conclusion: Based on statistical results, power calculations, and subgroup effect sizes, the following clinical recommendations are derived: Half-guided templates, owing to their superior cost-effectiveness in fabrication time and cost, are recommended for use in mandibular posterior regions, mucosa-supported templates, delayed implantations, and clinical scenarios with uneven bone density distribution at implant sites. In contrast, full-guided templates are more suitable for maxillary implantations, anterior regions, tooth-supported templates, immediate implantations, and sites with homogeneous bone density distribution.

Background: The choice of restorative material in pediatric dentistry is clinically relevant for ensuring long-term tooth preservation and reducing recurrent caries. This systematic review and meta-analysis compared the clinical effectiveness of ion-releasing restorations (IRR) and composite resin (CR) in children's dental treatments.

Methods: Randomized clinical trials with ≥1-year follow-up were identified through comprehensive searches in PubMed, Cochrane Library, Scielo, Scopus, Web of Science, and Google Scholar up to January 2024. Studies reporting clinical outcomes of IRR vs. CR were analyzed. Risk of bias was assessed using RoB2.0, and evidence certainty with GRADE.

Results: Of 1,109 records screened, nine trials were included. Pooled analyzes showed no statistically significant differences between IRR and CR regarding secondary caries, marginal adaptation, or restoration survival (p > 0.05). Both materials demonstrated satisfactory longevity and clinical behavior.

Conclusions: Within the limitations of available evidence, ion-releasing and composite restorations provide comparable clinical performance in pediatric dentistry. The findings support the use of IRR as a reliable alternative for child patients, offering bioactive benefits while maintaining similar restorative success to composites.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524163, PROSPERO CRD42024524163.

Objective: Periodontal endoscopy offers a minimally invasive method to enhance subgingival visualization, potentially improving the outcomes of periodontal therapy. This systematic review and meta-analysis aim to evaluate the current evidence in the adjunctive use of periodontal endoscopy.

Methods: The protocol was registered with the International Prospective Register of Systematic Reviews "PROSPERO", managed by the Center for Reviews and Dissemination, the National Institute for Health Research, University of York, UK, under registration identification number (CRD420251051901). PubMed/MEDLINE, Google Scholar, The Cochrane Library, and ProQuest databases were searched up to June 2025 for randomized clinical trials (RCTs) published in English investigating non-surgical periodontal therapy with and without the adjunctive use of periodontal endoscopy. The authors independently with consensus extracted clinical outcomes. The RoB2, the revised Cochrane risk of bias tool for RCTs, was utilized to evaluate risk of bias. Meta-analysis was performed for quantitative assessment.

Results: Nine RCTs were identified. The narrative results of the reported clinical outcomes were diverse. Meta-analysis revealed that periodontal endoscopy was associated with significantly less residual calculus (mean difference: -1.87%, p = 0.0010, I2 = 0%), significantly longer treatment time by 6.01 min (P < 0.00001, I2 = 0%), and greater probing depth reduction (mean difference: -0.47, p = 0.004, I2 = 94%).

Conclusion: The adjunctive use of periodontal endoscopy outperformed the conventional scaling and root planing alone in calculus removal but appears to be more time-consuming. Yet, more homogeneous RCTs are necessary to attain clear evidence on additional clinical outcomes.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251051901, Identifier CRD420251051901.

Background: Periapical lesions appear as periapical radiolucency on various imaging modalities. The accuracy of dentists in diagnosing periapical radiolucency varies significantly. Recent scientific and technological advancements have enabled the development and evaluation of artificial intelligence (AI) systems for various diagnostic applications in dentistry.

Objectives: The aim was to report on the application and performance of AI-based models in the detection, segmentation, and classification of periapical lesions.

Methods and methods: A systematic effort for data acquisition began with an exploration of a wide range of reputable databases, including PubMed, Scopus, Embase, Cochrane, Web of Science, Google Scholar, and the Saudi Digital Library. Our comprehensive investigation spanned from 1st January 2000 to 31st March 2025.

Results: Twenty-eight articles fulfilled the eligibility criteria. Among these, 20 (71.4%) applied AI technology for automated detection, 3 (10.7%) for segmentation, 2 (7.2%) for periapical lesion detection and segmentation, and 3 (10.7%) for periapical lesion classification. Thirteen (46.5%) studies in this review utilized dental panoramic radiographs, 8 (28.5%) used intraoral radiographs (periapical and bitewing), and 7 (25%) employed CBCT scans. The AI models demonstrated an accuracy range of 70% to 99.65%, with sensitivity varying from 65% to 100% and specificity ranging from 62% to 100%. The risk of bias assessment using the QUADAS-2 tool, indicated 32.1% of the studies exhibited a significant risk of bias regarding the assessment of bias and applicability issues in the reference standard arm. While the certainty of evidence was evaluated through the GRADE approach, which indicated that the included studies demonstrated a moderate degree of evidence certainty.

Conclusions: According to the results of the studies presented, AI-based technologies hold significant potential to assist clinicians and enhance the reliability of clinical diagnoses, enabling less experienced clinicians to identify lesions with greater accuracy. However, prospective studies and randomized clinical trials are essential to evaluate the effectiveness and cost-efficiency of deep learning-based lesion detection in real clinical settings.

Systematic review registration: PROSPERO CRD420251011455.