A 47-year-old woman presents with a lesión radiolucent lesión well delimited in the right mandible, when performing an inciosnal biopsy, purulent serous fluid is observed, enucleation of the lesion and curettage is performed, which evolves favorably. Later she presents problems and radiographic changes, an incisional bioispia is performed again, the histological result reports a central ossifying fibroma. A mandibulectomy is performed with reconstruction based on morphogenetic protein and plasma fibrin with Chuckron technique together, a titanium bar and titanium mesh was utilized for containing de autologus harvest, three Nobel replace conical connection implants were placed and three screw-retained crowns were made in metal ceramic. In this clinical case the authors presents a multidisciplinary aproach with a follow up of 19 years.
Background: Artificial intelligence (AI) is increasingly integrated into digital implant workflows, including radiographic interpretation, virtual planning, and guided or navigated implant placement. Despite rapid adoption, the magnitude of the accuracy gains attributable to AI-assisted systems relative to conventional approaches remains unclear. Objective: To systematically evaluate clinical evidence on AI-assisted implant planning and guidance and to quantify differences in implant placement accuracy compared with conventional workflows. Methods: This systematic review was conducted according to PRISMA 2020. PubMed, Scopus, and Web of Science were searched from January 2015 to February 2025. Eligible studies were human clinical investigations that compared AI-assisted guided or navigated implant workflows with conventional approaches and reported quantitative accuracy outcomes, including coronal deviation (mm), apical deviation (mm), and angular deviation (degrees). Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Random-effects meta-analyses were conducted for outcomes reported by at least three studies. Results: The review included clinical studies evaluating AI-assisted planning and guidance across diverse systems and operative settings. Meta-analysis showed that AI-assisted workflows were associated with improved implant placement accuracy, with reduced apical and coronal deviations and lower angular deviation compared with conventional approaches; however, heterogeneity was substantial across studies due to differences in navigation modality, guide manufacturing, operator experience, and reference standards. Conclusions: AI-assisted implant workflows appear to improve implant placement accuracy compared with conventional techniques, although certainty is limited by heterogeneity and risk of bias in the available evidence. Standardized reporting and well-designed multicenter trials are needed to establish clinically meaningful thresholds for accuracy improvements and to clarify how AI contributes beyond conventional digital planning.
Background: Rehabilitation of the atrophic posterior maxilla is a complex procedure often requiring invasive bone augmentation techniques, such as sinus floor elevation. Tilted implants have emerged as a minimally invasive alternative to bypass anatomical constraints and utilize residual bone. This case report evaluates the clinical efficacy of combining tilted and axial implants with 3D digital planning for the immediate rehabilitation of a posterior atrophic maxilla. Case Presentation: A 59-year-old female patient presented with a failing fixed prosthesis in the second quadrant and significant bone atrophy. A digital workflow was employed, utilizing CBCT and 3D planning software to design a surgery involving the extraction of compromised teeth and the immediate placement of three implants. To avoid sinus elevation, one axial implant and two implants tilted at 35° were placed, engaging the residual bone anterior and posterior to the maxillary sinus. High primary stability (>30 Ncm) allowed for immediate loading with a screw-retained provisional prosthesis. Results: The use of 3D planning ensured high accuracy in implant positioning and prosthetic emergence. The post-operative course was uneventful, with complete soft tissue healing and successful osseointegration confirmed at follow-up. The definitive rehabilitation was delivered three months post-surgery. Conclusions: The strategic use of tilted implants, supported by rigorous 3D digital planning, represents a safe and predictable treatment option. This approach allows for the bypass of the maxillary sinus and immediate function, significantly reducing treatment time, invasiveness, and patient morbidity compared to traditional regenerative procedures.
The aim of this study was to evaluate the presence and relevance of surface defects in each of five widely used NiTi systems: I-File (Henry Schein Endodontics, which is also commercialized as Onyx, EdgeEndo, USA), Mtwo (Sweden Martina, Italy), WaveOne Gold (Dentsply, USA) Reciproc Mwire, and Reciproc Blue (VDW, Germany). Each group uses a different type of alloy and manufacturing procedures, with differences in manufacturing and metallurgy that might yield observable differences in surface defect profiles. The null hypothesis tested was that there would be no significant difference in the prevalence or severity of external surface defects among the five brands, nor between heat-treated and non-heat-treated instruments. SEM imaging was performed using a scanning electron microscope (Quanta FEG 400, FEI, USA) at 100×, 500×, and 1000× magnification. Data were collected and statistically analyzed. Intergroup comparisons were performed using the Kruskal–Wallis test. Pairwise comparisons were adjusted with Bonferroni correction. Significance was set at α = 0.05. All instrument groups exhibited some degree of external surface irregularities, predominantly machining grooves and minor pits. Microcracks and protrusions were less frequent. No statistically significant differences were detected among the five brands for any defect category or total score. More precise statistical analysis revealed no significant differences among the five instrument systems in total surface defect scores (H(4) = 1.32, p = 0.86). Similarly, individual defect categories, including machining grooves, pits, microcracks, protrusions, and irregularities, did not differ significantly between brands (p > 0.05 for all comparisons). Across all systems, most defects were minor (score 1), with very few severe defects (score 3). No instrument exhibited severe microcrack scores >1. Within the limitations of this SEM analysis, the five NiTi instrument brands (I-File/Onyx, Mtwo, Reciproc Mwire, Reciproc Blue, and WaveOne Gold) demonstrated comparable external surface integrity, regardless of the grinding device or heat treatment.
The oral mucosa is constantly exposed to various irritants and allergens, including noble metals such as palladium (Pd), a metal with suitable biocompatibility and anticorrosive properties. Based on recent literature, this work focuses on Pd allergy in dental practice, covering clinical symptomatology, epidemiological data, and immune mechanisms. Predominant manifestations of Pd allergy include oral lichenoid contact injury, systemic or oral allergic contact dermatitis/mucositis (ACD), cheilitis, and burning mouth syndrome. Studies on allergy diagnosis have revealed that Pd is the principal dental metallic allergen in extended patch test batteries. Being less allergenic than nickel, chrome, or cobalt, Pd allergy affects over 6% of ACD-suspected patients, but up to 51% of oral allergy subjects exposed to the culprit allergen who also presented antecedent metal hypersensitivity reactions, often as cross-reactivity to nickel. Recent evidence indicates that a solely Pd-related allergy can cause oral symptoms in patients without skin lesions in metal-exposed regions. Pd allergy frequently affects females and dentistry practitioners and technicians, despite the recent restriction on nickel use. As a cellular allergy type, Pd hypersensitivity represents a mixture of T-cell interactions, in which variable region complementarity-determining region 3 of specific CD8+ T-cell receptors recognize the complex primary histocompatibility class I/peptide on the antigen-presenting cell surface, activating also further immune cells like NK T and a mixture of T helper (Th) ones. A combination of stimulated Th1, Th2, and Th17 cells, as well as eosinophil infiltrations in Pd allergy, corresponds to cytotoxic (and potentially compensatory antitoxic) effects during high-concentration allergen exposures that may also extend mucosal inflammatory processes, as in the case of BIDEAR (Barrier Integrity Damage-Elicited Allergic Response). This work concludes that Pd allergy occurs more frequently than previously suspected, and that suitable materials can successfully replace dental Pd-containing structures following metal analysis.
Introduction: Managing Class III malocclusions remains a complex issue in orthodontics today. While traditional functional approaches have often led to favorable outcomes, newer alternatives such as elastodontic devices have recently gained attention as a more advanced iteration of conventional methods. These appliances may offer a promising early intervention strategy for growing patients presenting with Class III malocclusions. Aim: This retrospective study aims to investigate the clinical effectiveness of the AMCOP® TC bioactivator in addressing dento-skeletal Class III malocclusions. Additionally, the study presents four selected clinical cases to illustrate the outcomes. Materials and Methods: A total of 11 pediatric patients (5 boys and 6 girls) aged between 6 and 12 years were included in the study. All patients exhibited Class III malocclusion and were treated with the AMCOP® TC elastodontic appliance. The device was worn for two hours in the afternoon and overnight for an initial period of 6–8 months, followed by exclusive nighttime wear. Lateral cephalometric radiographs were taken at the start (T0) and end (T1) of the treatment. All radiographic data were evaluated using DeltaDent® software. Conclusions: The AMCOP® TC elastodontic device effectively contributed to the correction of dento-skeletal Class III malocclusion and supported the postural improvement of the cervical spine, specifically the first vertebra. Despite the need for additional clinical studies, the results suggest that this treatment may serve as a non-invasive and well-tolerated option for interceptive orthodontic care.
The primary objective of this randomized clinical study was to radiologically assess the net bone gain and the reduction of graft volume achieved with the combination of mixed autologous and heterologous bone grafting (BG) alongside hyaluronic acid (HA), providing a comprehensive evaluation of the procedure’s efficacy and safety. Materials and Methods: Participants were selected from patients seeking implant treatment at the university hospital between February 2022 and January 2024. The procedure involved sinus elevation using techniques such as physiological water jet pressure (CasKIT), mechanical lifting tips (M.I.S.E.), and the Summers osteotome method. Bone graft biomaterials were introduced after sinus membrane elevation, followed by simultaneous implant placement. Radiological imaging included pre- and postoperative CBCT scans, orthopantomography (OPG), and intraoral periapical radiographs. Results: The study initially involved 16 maxillary sinuses from 8 patients. There was a significant increase in bone height in the Bone Graft (BG) and Hyaluronic acid (HA) groups from the initial measurement (T0) to the first (T1) and second follow-ups (T2). However, there was a significant decrease in bone height between the first and second follow-ups. Conclusion: Both types of grafts are appropriate for maxillary sinus elevation with immediate implant placement. The HA contributed to graft augmentation and stabilization, fostering blood clot formation and preserving its stability.
The purpose of this study is to assess the safety and effectiveness of single-session surgery for cystic lesions in the oral and maxillofacial region that are complicated by secondary purulent inflammation. Methods: A case series of patients with suppurated cystic lesions was carried out. Every patient received a single surgical procedure that included complete debridement, cyst enucleation, and prompt reconstruction with “Sticky Bone” composite and Advanced Platelet-Rich Fibrin (A-PRF). In an ambulatory setting, procedures were carried out under local anesthesia. Results: Every case with primary healing (per primam) had a full resolution. During follow-up periods of six to eighteen months, no significant complications or recurrences were noted. Bone regeneration and optimal tissue healing were made possible by the incorporation of regenerative materials. Conclusion: single-session surgical management is a practical and effective alternative to traditional staged protocols, significantly reducing treatment duration, medical expenses, and patient morbidity while preserving superior clinical outcomes.
Objective: To compare the clinical and radiographic outcomes of two implant systems with different implant–abutment connection designs—KS BA (4.0 mm diameter, 15° internal taper) and TS III BA (4.5 mm diameter, 11° internal connection)—used for molar rehabilitation. Materials and Methods: This multicenter, split-mouth, randomized controlled trial involved 42 patients, each receiving one KS and one TSIII implant. Inclusion criteria required healed posterior sites suitable for implants at least 8.5 mm long. Surgeries followed standardized protocols, and patients were rehabilitated with monolithic zirconia crowns bonded to titanium bases. Clinical follow-up was conducted at 6 months after prosthesis delivery. Primary outcomes were implant and prosthesis survival rates and any complications. Marginal bone levels (MBL) were measured radiographically at implant placement, prosthesis delivery, and 6-month follow-up. Patient satisfaction were also recorded. Results: A total of 87 implants (44 KS and 43 TSIII) were placed. At the time of analysis, 27 patients with 53 implants completed the 6-month follow-up. No implant or prosthesis failures and no complications were observed. At prosthesis delivery, mean MBL was 0.32 ± 0.27 mm for TSIII and 0.18 ± 0.32 mm for KS implants (P = 0.029). At 6 months, MBL increased to 0.34 ± 0.27 mm (TSIII) and 0.21 ± 0.32 mm (KS), with a statistically significant difference favoring the KS group (P = 0.034). All patients reported full satisfaction with functional and aesthetic outcomes. Conclusion: The KS implant system demonstrated significantly less marginal bone loss than the TSIII system, despite its narrower diameter. These preliminary findings support the clinical efficacy and mechanical reliability of the KS implant for molar restoration, suggesting it as a viable alternative in posterior sites, especially where bone volume is limited.
Objective: To develop an integrated classification of cranio-cervical-mandibular disorders (CCMD) and oro-cervical-facial pain (OCFP), based on anatomical units, to allow for a more precise and useful clinical approach. Method: A multicenter study was conducted involving 8 clinical specialists from Chilean and Italian universities, as well as 14 students serving as collaborators. The methodology involved organizing the participants into subgroups and holding periodic discussion sessions. Successive drafts were produced until a final classification was agreed upon. Once completed, each included pathology was defined. Results: The classification is organized into four hierarchical levels: (1) anatomical structure/origin (muscular, osteoarticular, nervous/neurovascular, and associated structures), (2) pathogenetic mechanism (pain/inflammation/degeneration, dysfunction/mobility, growth/development/genetics), (3) pathophysiology, and (4) associated local or systemic pathologies. A list of specific conditions that can affect the suprascapular unit was also included. Conclusion: The proposal addresses shortcomings in previous organizations by establishing a clear, logical, and hierarchical structure. This first integrative classification favors a more precise, inferential organization of cranio-cervical disorders (CCD) and temporomandibular disorders (TMD), including OCFP. It offers an initial framework that is susceptible to future expansion and adjustments. It also represents a step towards standardizing diagnoses and optimizing treatments in this area.
Background: In recent years, Artificial Intelligence (AI) has emerged as a transformative force across various healthcare domains, offering innovative tools to support clinical decision-making and improve patient outcomes. In dentistry, especially in endodontics, AI is gaining increasing attention for its ability to enhance diagnostic precision and streamline therapeutic workflows. Endodontic procedures often require high-resolution imaging and accurate interpretation of complex anatomical structures. Empowered by machine learning and deep learning algorithms, AI can analyse large datasets derived from radiographic sources, such as Cone Beam Computed Tomography (CBCT), periapical intraoral radiographs, and panoramic images, with the potential to assist in detecting root canal calcifications, segmenting periapical lesions, assessing treatment quality, and predicting prognosis. Despite promising preliminary findings, a systematic evaluation of AI’s practical applications and performance in endodontics is needed to understand its true clinical value and future integration into routine practice. Conclusions: Artificial Intelligence (AI) demonstrates strong potential in endodontics, offering diagnostic accuracy comparable to that of expert clinicians and enabling personalized treatment planning through advanced image analysis. Its potential extends to education, supporting students and practitioners in interpreting complex cases. Nonetheless, widespread adoption remains limited by challenges such as the need for robust datasets, technical and financial demands, and the predominance of retrospective studies. Future research should focus on prospective validation, improved model transparency, and ethical integration to fully realize AI’s potential to enhance clinical outcomes.
Objective: The mental foramen is a crucial anatomical feature within the mandible, facilitating nerve pathways that enable the sensation of teeth and lips. Its precise location is essential for the efficacy of infiltration injections and for minimizing potential injury during dental interventions. Panoramic radiography is frequently employed to evaluate oral structures in pediatric patients. This study sought to determine the vertical and horizontal positions of the mental foramen in children aged 4 to 18 years, utilizing panoramic radiographs. Methods: A retrospective analysis of 283 panoramic radiographs was conducted, dividing subjects into age groups of 4–6, 6–12, and 12–18 years. The horizontal and vertical positions of the mental foramen were evaluated relative to primary and permanent dentition and the mandibular body utilizing SCANORA Lite software. Differences based on age and gender were assessed using Fisher’s exact test and Chi-square tests, with a significance level established at P<0.05. Results: The most frequent horizontal location was at the distal root of the first primary molar and between the first and second premolars. Vertically, the mental foramen was most commonly located in the middle third of the mandibular body, with its frequency increasing with age. No significant differences in vertical position were found across age groups (p=0.074). A significant difference was noted between boys and girls in the horizontal location relative to permanent teeth (p=0.044), but no significant gender differences were observed for primary teeth or vertical location. Conclusion: The horizontal position of the mental foramen shifts distally with age, whilst the vertical position predominantly remains within the middle third of the mandible. These age-related alterations underscore the necessity for further research involving larger sample sizes to substantiate the findings.
Background: Dry socket (alveolar osteitis) is a painful complication following tooth extraction, particularly after mandibular third molar removal. Conventional management relies mainly on antiseptic dressings; however, locally applied antibiotics may provide superior pain control and enhanced healing. Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA and PICO guidelines. Ten randomized controlled trials (RCTs), published between 1998 and 2024, were included, comprising a total of 843 patients. Interventions involved the local application of clindamycin, tetracycline, or metronidazole, compared with placebo or standard treatments. Primary outcomes were pain reduction, assessed using the Visual Analog Scale (VAS), and improvement in socket healing. Results: Pooled analysis demonstrated a significant reduction in pain by Day 3 post-treatment, with a mean difference (MD) of −2.19 (95% CI: −2.50 to −1.88; p < 0.001). Among the antibiotics evaluated, clindamycin showed the greatest analgesic effect (MD = −2.5), followed by tetracycline (MD = −2.1) and metronidazole (MD = −1.8). Healing outcomes also improved significantly, with an overall pooled increase of 33.8% in the antibiotic groups. Moderate heterogeneity was observed (I 2 = 58%). The certainty of evidence was rated as moderate for pain reduction and low for healing improvement. Adverse events were infrequent and mild, occurring in 6.3% of patients receiving antibiotics and 5.1% of controls, with no serious complications reported. Conclusion: Locally applied antibiotics significantly reduce pain and enhance healing in the management of dry socket compared with conventional treatments. Clindamycin demonstrated the greatest clinical efficacy. These findings support the targeted use of topical antibiotics in selected high-risk patients, although further studies are required to establish standardized dosing protocols.
AIM: Zygomatic implantology offers an effective solution for the rehabilitation of patients suffering from severe maxillary atrophy, allowing for the placement of dental implants anchored to the zygomatic bone. The preparation of the implant site in this procedure, traditionally performed with rotating burs, can now also be performed with piezosurgery. Materials and methods: A 76-year-old male patient presented for evaluation by the authors for rehabilitation of an atrophic maxilla. Results: The patient was successfully treated, and good clinical conditions were observed at the 2-year follow-up. Conclusions: A combined approach, integrating both techniques, may represent the ideal solution to optimize the procedure and ensure maximum safety and predictability. This case report explores the characteristics, advantages, and disadvantages of traditional burs and piezosurgery in zygomatic implantology, analyzing the clinical applications of a combined approach.
Background: Jones syndrome is an extremely rare genetic condition characterized by the coexistence of gingival fibromatosis and progressive sensorineural hearing loss. It is an autosomal dominant disorder whose genetic basis has been identified, through exome sequencing technology, as pathogenic mutations in exon 5 of the Repressor Element 1 Silencing Transcription Factor (REST) gene. This review aimed to evaluate whether integrating genetic testing improves the diagnostic accuracy of Jones syndrome compared with clinical assessment alone. Methods: An electronic and manual search was conducted in August 2025 across multiple databases (PubMed, Cochrane Library, Google Scholar, Scopus, and Web of Science) in accordance with PRISMA guidelines. Two independent reviewers performed the search. From eligible studies, the following data were extracted: author and year of publication, study design, patient age and sex, oral manifestations, systemic manifestations, diagnostic and therapeutic approaches, severity of gingival fibromatosis, and degree of sensorineural hearing loss (SNHL). Any disagreements were resolved through discussion with a third reviewer and by consensus. Results: The electronic and manual search retrieved 9,864 records. After removal of duplicates (n = 15) and title screening, 9,837 articles were excluded, leaving 12 articles for abstract and full-text screening. Two articles were excluded because their full texts were unavailable. After full-text assessment, four additional articles were excluded, resulting in six studies included in the review. The included studies comprised four case reports without genetic analysis and two studies that included analysis of the Repressor Element 1 Silencing Transcription Factor (REST) gene, documenting familial cosegregation. Conclusions: REST gene analysis currently represents an essential diagnostic tool, as it complements the clinical workup, increases diagnostic accuracy, and opens new perspectives for the management and support of patients with Jones syndrome.
Objectives: This study aimed to assess the effect of a metal artifact removal (MAR) algorithm on the visibility of the second mesiobuccal canal (MB2) of maxillary molars on cone-beam computed tomography (CBCT) scans. Materials and Methods: This cross-sectional study evaluated 41 CBCT scans of patients retrieved from the radiology clinic’s archives. The CBCT scans were saved with and without the MAR algorithm applied. The images were coded and evaluated by two endodontists to assess MB2 detection in maxillary molars and its visibility level using a 5-point Likert scale. Of the 164 samples, 32 were excluded from the study, and 132 teeth were examined. The Wilcoxon test was used to compare images with and without MAR with respect to MB2 visibility (alpha=0.05). Results: No significant difference existed between images with and without MAR regarding the visibility of MB2 of maxillary first and second molars in apical (OR= 0.96, 95% CI; 0.58–1.59), middle (OR= 1.01, 95% CI; 0.65 – 1.59) and coronal (OR= 1.02, 95% CI; 0.63–1.64) thirds of the root by adjusting the effect of other variables. Conclusion: According to the present results, the application of the MAR algorithm did not significantly change the visibility of MB2 in the maxillary first and second molars on CBCT scans.
Background: Our study aims to verify the accuracy of maxillary positioning in orthognathic surgery using CAD-CAM cutting guides and custom-made osteosynthesis plates, comparing the preoperative 3D surgical plan with the final positioning determined from postoperative CT scans. Methods: This prospective monocentric study included eight patients (aged 18–30) with dentofacial deformities (six Class III and two Class II malocclusions) who underwent bimaxillary orthognathic surgery. The digital workflow integrated CT scans and intraoral digital impressions. Customized cutting guides and selective laser-melted (SLM) titanium plates were designed to transfer the 3D-VSP to the operative field. Accuracy was assessed one month postoperatively by superimposing the surgical plan onto postoperative CT scans. Surface deviations were quantified and visualized using color maps. Results: The transfer of the virtual plan was successful in all cases with no intraoperative complications. A 100% accuracy rate was achieved, defined as a three-dimensional deviation of less than 1.5 mm. The overall mean linear error was −0.24 mm (± 0.35 mm SD). Visual analysis via color maps confirmed a marked prevalence of discrepancies ≤ 1.0 mm (green zones) across all maxillary surfaces. Statistical analysis using a paired t-test showed no significant differences between the planned and achieved positions ($p > 0.05$), indicating an absence of systematic errors. Conclusions: The reported findings suggest that CAD-CAM cutting guides and custom-made osteosynthesis plates tend to improve the accuracy in the maxillary positioning. Furthermore, custom-made osteotomy guides and plates increase the predictability and security of the surgical procedure.
The present study aimed to evaluate the morphology and mechanical properties of two orifice openers produced by the same manufacturer, with the same design and heat treatment but different dimensions. Twenty I-File/Onyx Orifice Openers for each of the following sizes (09.09 versus 20.07) were selected for the study. The instruments were initially examined with SEM at ×200 and measured to ensure dimensional accuracy. Then they were randomly divided into two identical groups (n=10). For each size, one group was tested for cyclic fatigue and the other for ISO torsional resistance, using methods already validated in the authors’ previous studies (16–20). The same expert operator performed each test to minimize errors caused by differences in operator skill. For each size and test, 10 instruments were analyzed for each brand. The data were collected and statistically analyzed using 1-way ANOVA followed by a post hoc Tukey test at the 95% confidence level. The D0 diameters showed very good dimensional accuracy, with small standard deviations and mean values compatible with ISO dimensional tolerance (0.02). No significant statistical differences were noted between the two groups for maximum torque at failure (TAF) (P>0.05). In contrast, significant differences were noted for the deflection angle and resistance to cyclic fatigue (P<0.05). In both cases, the 09.09 orifice opener performed better. The newly developed 09.09 orifice opener showed very interesting mechanical properties compared with a more traditional orifice opener, suggesting its possible routine use, with the majority of benefits in more complex cases. The present study also showed precise manufacturing despite a very small tip size and a heat treatment.
Background: Effective pain management is a cornerstone of pediatric dental care, as procedural pain and anxiety can substantially affect both the immediate success of treatment and children’s long-term oral health behaviors. A wide range of pharmacological and non-pharmacological analgesia protocols have been proposed to ensure safe, effective, and patient-centered care in pediatric dentistry. Objectives: This systematic review and meta-analysis aimed to synthesize current evidence on the effectiveness of analgesia protocols used in pediatric dental procedures, with particular attention to both pharmacological and behavioral interventions. Methods: A systematic search of PubMed, Scopus, Web of Science, and EMBASE was conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing different analgesia protocols in children (≤18 years) undergoing dental treatment were included. Two independent reviewers assessed study eligibility, extracted data, and evaluated risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Meta-analyses were performed using a random-effects model, calculating pooled standardized mean differences (SMDs) for pain and anxiety outcomes. Results: Five studies involving a total of 1,260 pediatric patients met the inclusion criteria. Multimodal analgesia protocols, combining pharmacological and behavioral approaches, were associated with a significant reduction in intraoperative pain (SMD = −0.72; 95% CI: −0.95 to −0.50; p < 0.0001), with moderate heterogeneity (I 2 = 48%). Anxiety scores were also significantly reduced (SMD = −0.68; 95% CI: −0.90 to −0.46; p < 0.0001). Conclusions: The current evidence base is limited, consisting of only five moderately heterogeneous studies. Although multimodal analgesia appears promising, results should be interpreted with caution and do not support prescriptive clinical recommendations. Larger, high-quality trials with standardized outcomes and longer follow-up are required to inform evidence-based guidelines.
Aim: To evaluate whether the use of an electric toothbrush represents a more effective option than a manual toothbrush in preventing dental plaque accumulation and managing daily oral hygiene in patients undergoing fixed orthodontic treatment, considering the increased cleaning challenges associated with the presence of orthodontic appliances. This study provides a comprehensive five-year literature update on the subject. Materials and methods: A thorough literature search was conducted in PubMed for articles published from January 2020 to June 2025. This retrospective review was designed according to the guidelines of the Cochrane Handbook for Systematic Reviews and is reported in accordance with the PRISMA guidelines. To evaluate the methodological quality of the included randomized controlled trials, the Risk of Bias 2 (RoB 2) tool was employed. Results: A total of 666 articles were analyzed. Based on the inclusion and exclusion criteria, four studies met the criteria for the final review. According to the RoB 2 assessment, three studies were judged to have ‘some concerns’ regarding the risk of bias, and only one article was at low risk of bias. Conclusion: The data from the studies analyzed indicate that, in the short term, the use of an electric toothbrush results in a significant improvement in plaque removal and a reduction in gingival conditions and bleeding on probing compared to a manual toothbrush; conversely, in the long term, the differences between the two types of toothbrush tend to decrease significantly. From this perspective, it becomes essential to consider the electric toothbrush as part of an integrated, personalized approach that includes continuous education, motivational strategies, and consistent follow-up to ensure adequate compliance throughout the entire orthodontic treatment period.
