Background: Autologous bone grafting is considered as "gold standard" in the alveolar ridge augmentation techniques. In situ onlay grafting uses grafts adjacent to edentulous sites without a separate donor site. Several studies have revealed the satisfactory short-term performance of this less invasive modified technique, but no information is available of stability of alveolar ridge reconstructed by in situ onlay grafting and implant performance after occlusal loading in a mid-term follow-up. This study is to retrospectively evaluate the radiographic and patient reported outcomes (PROMs) of a modified onlay grafting technique and the subsequent implantation in anterior maxilla using in situ grafts without a second bone harvesting region.
Methods: A total of 83 patients contributed 119 edentulous deficiency sites, and 104 implants were placed in anterior maxilla. 44 patients received in situ onlay grafting using subnasal grafts and 39 patients received ex situ onlay grafting using mandibular symphysis grafts. Alveolar ridge height and multileveled widths were assessed using cone-beam computed tomography (CBCT) prior grafting and at five subsequent time points. Clinical parameters and PROMs were evaluated with a visual analog scale (VAS) during the follow-up. Approximately 6 months after onlay grafting, dental implants were placed followed by fixed prosthetic rehabilitation. Implant survival and success rates were assessed with a mean follow-up of 42.90 months.
Results: The horizontal bone resorption at cervical level after 1-year occlusal loading of in situ group (1.73% ± 1.29%) was lower than that of ex situ (3.85% ± 1.50%) group (P = 0.04). No other significant difference regarding bone resorption was found. The patient reported pain scores at 7 days after surgery of in situ group (2.43 ± 1.17) was lower than that of ex situ group (3.47 ± 2.08, P = 0.02). No implant loss was observed. The implant success rates were 96.36% in in-situ group and 97.96% in ex-situ group.
Conclusions: Within the limitations of the present retrospective study, the findings suggest that in situ onlay grafting may be a promising approach for reconstructing the anterior maxillary alveolar ridge and facilitating subsequent implant placement. These preliminary results are hypothesis-generating and warrant further validation through prospective, long-term investigations.
Trial registration: This study was retrospectively registered in Chinese Clinical Trial Registry (Registration number: ChiCTR2400083954, Registration date: 2024-05-08).
Background: With the rapid advancement of digital technologies, digital intraoral scanning offers potential advantages for post-and-core impressions. However, its accuracy in relation to the complete spectrum of clinically relevant post space diameters, particularly smaller conservative preparations, requires comprehensive evaluation. This in vitro study aimed to systematically assess the accuracy of direct digital impressions compared to conventional impressions across four diameters and varying depths.
Methods: Forty extracted single-rooted teeth were divided into four groups (n = 10/group) based on post space diameter: 1.0, 1.5, 2.0, and 2.5 mm. Each specimen was scanned using an intraoral scanner (TRIOS 5). Silicone impressions scanned with an extraoral scanner served as the reference. Root mean square (RMS) deviations were analyzed at four depths (1.65, 5.0, 7.0, 9.0 mm). Statistical analysis employed linear mixed-effects models.
Results: The scanner completely failed to capture data for the 1.0 mm diameter at depths ≥ 7 mm and for the 1.5 mm diameter at 9 mm. A significant diameter-by-depth interaction was found (p < 0.001). For diameters ≥ 1.5 mm and depths ≤ 7 mm, accuracy was clinically acceptable. At the 9 mm depth, the 2.0 mm and diameter group showed significantly higher deviation and critically high variability (135.0 ± 79.5 μm, CV 59.0%), while the 2.5 mm group maintained superior and more reliable accuracy (41.4 ± 28.8 μm).
Conclusions: Direct intraoral scanning is a viable option for post spaces with a diameter ≥ 1.5 mm and depth ≤ 7 mm. Its application is strictly limited in narrow canals (≤ 1.5 mm). For deep preparations (9 mm), a minimum diameter of 2.0 mm allows data capture but with poor reliability, whereas a diameter ≥ 2.5 mm ensures acceptable and predictable accuracy. Clinical adoption requires careful consideration of these diameter- and depth-dependent performance boundaries.
Background: Biomolecules in body fluids such as gingival crevicular fluid and saliva are used for the diagnosis of periodontitis. Saliva is easy to collect and salivary biomarkers are useful in screening periodontitis. The suitable salivary biomarkers and their measuring system are important for screening periodontitis in mass dental examination. Therefore, this study examined the potential of few salivary biomarkers for screening and diagnosis of periodontitis and aimed to evaluate more effective biomarkers and their measuring methods in dental examination.
Methods: Ninety-three individuals with and without periodontitis participated in this clinical examination and were classified into the non-periodontal diseases or stage I periodontitis (control, n = 26) and stage II-IV periodontitis groups (periodontitis, n = 67) after periodontal examinations. Unstimulated saliva samples were collected from participants. The levels of salivary biomarkers including calprotectin, hemoglobin (Hb), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), alanine aminotransferase and aspartate aminotransferase (AST) were automatically measured using the latex agglutination turbidimetric immunoassay (LATIA) and enzyme assay systems. Differences in clinical indicator and biomarker levels in the control and periodontitis groups and their correlations were statistically analyzed. A receiver operating characteristic (ROC) analysis of the ability of salivary biomarkers to predict periodontitis was also performed.
Results: Salivary calprotectin, Hb, LDH, ALP and AST levels were significantly higher in the periodontitis group than that in the control group. At the initial stage of periodontitis, a significant difference was only observed in calprotectin levels. Calprotectin and LDH levels strongly correlated with clinical indicators including probing pocket depth, clinical attachment level, bleeding on probing, gingival index and periodontal inflamed surface area with high correlation coefficient (calprotectin: 0.582-0.660, LDH: 0.534-0.614). Calprotectin showed a higher area under the ROC curve value (0.894), with 91% sensitivity and 73% specificity, than the other salivary biomarkers.
Conclusions: Salivary calprotectin showed a high effectiveness for the diagnosis of periodontitis, and the measurement of salivary calprotectin using the LATIA system that is a high throughput method is suitable for population-based screening of periodontal diseases.
Background: Oral cancer remains a major global health concern with low survival in late stages. In Palestine, the burden is amplified by delayed detection and limited healthcare resources, yet public awareness has never been assessed. This study aimed to evaluate knowledge and awareness of oral cancer risk factors, symptoms, and preventive measures among Palestinian adults.
Methods: A cross-sectional, web-based survey was conducted between May and August 2025 using an anonymous bilingual (Arabic/English) questionnaire adapted from a validated Middle East-North Africa tool. Palestinian adults aged ≥ 18 years were eligible, excluding health-related professionals and students. Snowball sampling via social media produced 753 valid responses. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression to identify predictors of good knowledge (≥ 4 correct responses per domain).
Results: Participants were predominantly female (66.3%) and university educated (72.6%). Overall, 46.7% demonstrated good knowledge of risk factors, 32.5% of symptoms, and 53.7% of protective measures. Awareness was highest for tobacco (79.2%) and lowest for HPV infection (38.5%) and alcohol-containing mouthwash (34.1%). Females and university graduates consistently showed better knowledge across all domains (p < 0.001). Current smokers had significantly poorer awareness of risk and protective factors (p < 0.001). Logistic regression identified female gender (OR = 1.59-1.65) and university education (OR = 2.22) as independent predictors of higher knowledge, while current smoking predicted lower protective awareness (OR = 0.65). Receiving oral cancer education from a dentist was the strongest predictor of good knowledge across all domains (risk factors OR = 3.79; symptoms OR = 2.16; protective measures OR = 1.95; all p < 0.01).
Conclusion: The surveyed Palestinian sample demonstrated limited awareness of oral cancer, especially regarding symptoms and less-recognized risk factors. Dentist-led education markedly improves knowledge, suggesting that integrating standardized awareness materials into routine dental visits and community campaigns could strengthen early detection and national prevention efforts.
Objectives: To investigate the in vitro implant accuracy of robotic technology in mandibular all-on-4 phantoms under an improved process and positioning marker as well as the maximum lateral force exerted on the drill.
Methods: Four implants were placed in the mandibular phantom under the navigation of the task-autonomous robot using an improved process and positioning marker. Crestal, bottom, and angle deviations between the planned and placed implants were measured and the maximum lateral force experienced by different drills at different implant inclinations was recorded.
Results: A total of 52 implants were placed in 13 mandibular phantoms. The implant placement angle showed no significant effect on crestal, bottom, and angle deviation. A significant increasing trend in the maximum lateral force experienced by milling cutters and pilot drills was observed with increased implant placement angles. The maximum lateral force on milling cutters was significantly greater than the other drills in the same site (upright or tilted), and the maximum lateral force on pilot drills was significantly greater than that on twist drills in the same upright site (30° tilted site or 45° tilted site).
Conclusions: The task-autonomous robot using an improved process and positioning marker achieved acceptable implantation accuracy in the mandibular all-on-4 phantom. Implant accuracy was not affected by the different implant angles. The entrance slope and the implant placement angle significantly affected the maximum lateral force on milling cutters and pilot drills.
Clinical significance: This in vitro study provides an improved process, with acceptable implant accuracy, for the task-autonomous robot in the mandibular all-on-4 implant surgery.
Background: The choice of endodontic sealer plays a crucial role in preventing microleakage, maintaining apical integrity, and ensuring durable clinical performance. Among available materials, bioceramic sealers offer bioactivity and chemical bonding potential, whereas epoxy resin-based sealers provide proven stability and low solubility. This study aimed to compare the physicochemical properties of four bioceramic root canal sealers with an epoxy resin-based reference material (AH Plus), focusing on setting time, solubility (with and without thermal cycling), and dimensional change.
Materials and methods: Five sealers were tested: EndoSeal MTA, CeraSeal, Nano-MTA, NeoSealer Flo (bioceramic), and AH Plus (epoxy resin-based). Setting time was determined according to ISO 6876:2012 using Gilmore needles. Solubility was evaluated under thermocycled (1000 cycles, 5-55 °C) and non-thermocycled conditions. Dimensional change was assessed via pre- and post-immersion micro-CT imaging after 7 days in distilled water.
Results: EndoSeal MTA had the shortest setting time, and NeoSealer Flo the longest (p < 0.0001). AH Plus showed the lowest solubility; NeoSealer Flo had the highest. Thermal cycling did not significantly affect solubility (p > 0.05), but a strong correlation was found between thermocycled and non-thermocycled values (r² = 0.8084, p < 0.0001). AH Plus demonstrated significant volumetric increase, while bioceramic sealers showed varying degrees of shrinkage (p < 0.0001).
Conclusion: Bioceramic sealers demonstrated comparable or superior solubility and adaptation compared with the epoxy resin-based control, although differences in setting time and dimensional change were material-dependent. These findings suggest that selecting sealers according to their physicochemical performance, such as faster setting in single-visit treatments or higher dimensional change in retreatments, may improve the long-term prognosis and clinical success of root canal therapy.
Clinical relevance: This study identifies material-specific strengths and weaknesses that can guide evidence-based selection. Matching the sealer's physicochemical profile to the clinical scenario can optimize treatment longevity and reduce failure risk.
Introduction: This study aimed to test the performance of DentalMonitoring's (DM) artificial intelligence (AI) in detecting aligner tracking issues.
Methods: This multicenter retrospective comparative study analyzed 3,323 assessments from 623 patients treated at multiple U.S. sites. DM's AI performance was evaluated using a binary model (seated vs. unseated) and a three-level model (seated, slight unseat, noticeable unseat). AI outputs were compared against a reference standard established through independent case reviews performed by a panel of three U.S.-based orthodontic residents. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Results: For the binary comparison (seat vs. unseat), sensitivity was 93.2% and specificity 86.2%, with a PPV of 89.2% and an NPV of 94.4%. For the three-level comparison, the noticeable-unseat category demonstrated a sensitivity of 91.1% and a specificity of 90.5%, with a PPV of 66.1% and an NPV of 98.3%. The high NPV values across both models indicate that DM's AI was particularly reliable in ruling out clinically meaningful unseat events. The lower PPV in the noticeable-unseat category reflects the low prevalence of noticeable unseats in the dataset.
Conclusion: DM's AI system demonstrated high sensitivity and negative predictive values in identifying unseat events and in differentiating noticeable from slight unseats within the positive subset. These results indicate that the model performed reliably within the parameters and dataset evaluated, particularly in minimizing false-negative assessments of clinically meaningful misfits. Further validation in independent cohorts and across broader clinical contexts is warranted to confirm generalizability.
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