Introduction and aims Artificial intelligence – assisted diagnostic tools are increasingly introduced into dental practice, yet their impact on clinician performance in routine panoramic radiograph interpretation remains incompletely defined. This multicentre reader study evaluated whether AI assistance improves diagnostic accuracy, efficiency, and inter-reader consistency in caries detection, particularly among early-career dentists. Methods Twelve early-career dentists (≤3 years’ experience) and three senior dentists (>10 years’ experience) independently interpreted 402 anonymized panoramic radiographs under four conditions: unassisted reading, AI-assisted reading, AI-only analysis, and expert reference. Diagnostic performance was compared with a standardized expert-derived reference standard established by three experienced dentists using pixel-level annotations. Sensitivity, specificity, area under the receiver operating characteristic curve, interpretation time, and inter-reader agreement were analysed. Results AI assistance increased tooth-level sensitivity (82.4% vs 67.4%, P < .001) without compromising specificity (97.4% vs 97.2%), and reduced mean interpretation time (50.37 vs 65.12 seconds, P = .003). Case-level sensitivity improved from 84.7% to 93.3% (P < .001). Inter-reader agreement increased from κ = 0.61 to 0.73. The standalone AI system achieved a sensitivity of 79.2% (95% CI, 76.0-82.4) and specificity of 98.4% (95% CI, 76.0-82.4), and AUC of 0.938 (95% CI, 0.934–0.941). Conclusion AI assistance improved diagnostic sensitivity, efficiency, and consistency among early-career dentists interpreting panoramic radiographs for caries detection, without increasing false-positive rates. Clinical relevance AI-supported interpretation may help reduce experience-related variability in panoramic radiograph assessment and improve diagnostic efficiency in routine dental practice, particularly in settings with limited access to senior supervision.
INTRODUCTION:Lip and oral cavity cancer (LOCC) is a major global health burden, disproportionately affecting South and South-East Asia, including Sri Lanka, where tobacco use, betel quid chewing, and alcohol consumption remain key risk factors. Despite its preventable nature, incidence continues to rise, particularly among males and older adults. METHODS:Data from the Sri Lanka Cancer Registry were analysed for LOCC. Age-standardised incidence rates (ASIRs) were calculated for LOCC, while age-standardised mortality rates (ASMRs) were obtained from Vital Statistics for lip, oral cavity, and pharyngeal cancers (LOCP); corresponding ASIRs for LOCP were also derived for incidence-mortality comparisons. Temporal trends were assessed using Joinpoint regression (APC, AAPC). Mortality-to-incidence ratio (MIR) was used as a proxy for survival, and lifetime risk for 0 to 64 and 0 to 74 years was estimated to assess cumulative disease burden. RESULTS:A total of 42,526 LOCC cases were identified in Sri Lanka from 2005 to 2022, with a male: female ratio of 3.65:1. LOCC ASIR increased markedly from 9.8 to 26.1 per 100,000 in males and from 2.9 to 5.7 in females, representing 2.7-fold and 2.0-fold increases, respectively. Overall, LOCC showed a significant upward trend (AAPC 4.26%, 95% CI: 3.24-5.28; P < .001), with steeper increases in males (4.90%) than females (3.00%). The greatest rise was observed in the 0 to 34-year group (AAPC 6.03%), suggesting an increasing burden among younger age groups. MIR decreased steadily, with estimated survival improving from 54.7% to 74.0% in males and from 43.7% to 70.5% in females. CONCLUSION:LOCC incidence in Sri Lanka increased substantially, driven by oral cavity cancers, particularly among males and across younger and older age groups. Findings of this study provides evidence to strengthen oral cancer control policies and support stronger risk-factor control, risk-based screening, and earlier detection to reduce the oral cancer burden in Sri Lanka.
BACKGROUND:Dentists contribute substantially to the global burden of antibiotic use, accounting for approximately 10% of all prescriptions, of which up to 90% might be unnecessary. This exploratory study aimed to assess dental students' knowledge, attitudes, and antibiotic prescribing practices across ten Arab countries. METHODS:This cross-sectional study used convenience sampling to recruit dental students in clinical years from ten Arab nations: Palestine, Jordan, Syria, Lebanon, Iraq, Egypt, Tunisia, Libya, Kuwait, and Saudi Arabia. From these nations, 2168 dental students completed the survey. Hierarchical multiple regression was used to examine factors associated with inappropriate antibiotic prescribing practices, while linear regression assessed factors associated with attitudes toward appropriate antibiotic prescription. RESULTS:In Step 1 of the hierarchical regression, demographic variables explained 6.1% of the variance in prescribing practices. Adding access to antibiotic guidance in Step 2 significantly increased the explained variance to 24.5%, while inclusion of actual knowledge, perceived knowledge, and environmental awareness in Step 3 further increased the explained variance to 33.2%. In the final step, adding attitude and confidence scales resulted in a small additional contribution, explaining 33.7% of the variance. Being a female student, an intern, and coming from a middle-income country were associated with less inappropriate antibiotic prescribing. Perceived knowledge (β = -0.392) had a stronger association with appropriate prescribing than actual knowledge (β = -0.092). More favourable attitudes toward antibiotic use were significantly associated with reduced inappropriate prescribing (β = -0.149). CONCLUSIONS:Appropriate antibiotic prescribing among dental students was associated with demographic characteristics, access to antibiotic guidance, knowledge, and attitudes toward antibiotic use. Perceived knowledge showed a stronger association with prescribing practices than actual knowledge, while favourable attitudes toward antibiotic stewardship were associated with less inappropriate prescribing. These findings suggest that educational interventions should extend beyond factual knowledge to strengthen self-efficacy and stewardship.
Introduction and aims Evidence regarding the biological responses of human dental pulp cells (hDPCs) to freshly mixed hydraulic silicate cements remains limited. This study aimed to evaluate the biocompatibility, mineralisation potential, and immunomodulatory effects of five hydraulic silicate cements (ProRoot MTA, Biodentine, TotalFill BC Putty, CeraPutty, and C-Root BP) at different stages of setting on hDPCs. Methods hDPCs were isolated from human third molars. Extraction media were prepared from the different pulp dressing materials at 15 minutes, 24 hours, and 7 days after mixing. Cell viability was assessed using the MTT assay and live/dead staining. Odonto/osteogenic differentiation was evaluated using Alizarin Red S staining. RNA extraction and quantitative real-time polymerase chain reaction were conducted to investigate the mRNA expression of inflammatory and immunomodulatory-related genes. Results Undiluted extraction media obtained from all five freshly mixed hydraulic silicate cements (15 minutes after mixing) were cytotoxic to hDPCs. In contrast, the extraction media collected after a longer setting period (7 days post-mixing) showed no cytotoxicity, except for C-Root BP. Enhanced mineralisation was observed in cells treated with extraction media derived from ProRoot MTA, Biodentine, and TotalFill BC Putty at all time points. By contrast, cells exposed to extraction media from C-Root BP and CeraPutty at the 24-hour and 7-day setting time points exhibited markedly reduced mineral deposition. Additionally, the extraction medium derived from TotalFill BC Putty downregulated the expression of inflammation-related genes in hDPCs. Conclusion TotalFill BC Putty, Biodentine, and ProRoot MTA demonstrated superior performance in reference to the investigated parameters compared with CeraPutty and C-Root BP, suggesting their suitability as pulp dressing materials for vital pulp therapy procedures. Clinical relevance The data may guide clinicians in selecting the most appropriate pulp dressing material based on the investigated biological parameters.
Objective Carbon fiber-reinforced polyetheretherketone (CF/PEEK) possesses the elastic modulus similar to that of natural bone, yet its inherent surface hydrophobicity and bio-inertness restrict its application in oral implantation. To overcome this limitation, this study proposes the layer-by-layer surface functionalization strategy to construct the multifunctional CF/PEEK-based composite that integrates long-term antibacterial activity with synergistic osteogenic functions. Methods After sulfonation of CF/PEEK with 98% H₂SO₄, the polydopamine-assisted nanohydroxyapatite (PDA-nHA) intermediate layer and the zinc-loaded carboxymethyl chitosan (Zn/CMCS) coating were sequentially constructed, yielding the SCP-PHA-Zn/CMCS composite. A series of Characterizations including surface morphology, in vitro mineralization, antibacterial evaluation, cytocompatibility, osteogenic property, and osteogenesis-related gene mRNA expression levels were performed to assess in vitro biocompatibility and osteogenic performance. Results SEM showed SCP-PHA-Zn/CMCS possessed the 3D porous network, with uniformly deposited PDA-nHA presenting a fibrous network after Zn-CMCS wrapping. After SBF immersion, spherical apatite particles deposited on all samples. Water contact angles of SCP-PHA and SCP-PHA-Zn/CMCS were significantly lower than SCF/PEEK. SCP-PHA-Zn/CMCS significantly inhibited Staphylococcus aureus and Escherichia coli. All groups showed good biocompatibility and long-term biosafety. rBMSCs on SCP-PHA-Zn/CMCS showed the highest adhesion density, proliferation, ALP activity, matrix mineralization, and osteogenesis-related gene mRNA expression levels, significantly outperforming the other groups and demonstrating the best in vitro osteogenic capacity. Conclusion To address the surface hydrophobicity and bioinertia of CF/PEEK, this study successfully constructed the multifunctional SCP-PHA-Zn/CMCS composite using sulfonation pretreatment and the layer-by-layer functionalization assembly strategy. The obtained material exhibited favorable physicochemical properties, excellent biocompatibility and antibacterial performance, and significantly promoted the adhesion and proliferation of rBMSCs, enhanced ALP activity, matrix mineralization, and osteogenesis-related gene mRNA expression levels, demonstrating outstanding in vitro osteogenic capacity. These findings provide experimental evidence and a novel design strategy for the clinical translation of CF/PEEK in oral implantation and bone defect repair.
Aim This in vitro study evaluated the effects of immediate dentin sealing (IDS) versus delayed dentin sealing (DDS), dentin pretreatment with quercetin (Qu), and their combination on the fracture strength (FS) of diabetic and non-diabetic premolars restored with ceramic inlays after thermomechanical aging. Methods Forty-eight extracted premolars from diabetic individuals and forty-eight from non-diabetic individuals were collected and prepared for standardized MOD lithium disilicate ceramic inlays. Each category of teeth was divided into four groups according to the cementation technique (IDS or DDS) and the presence or absence of Qu pretreatment during inlay cementation. For IDS, the same adhesive was applied in combination with a flowable composite. All restored premolars underwent thermomechanical aging followed by FS testing under axial compression. Data were analyzed using three-way ANOVA and t-tests (P = .05). Results Technique, Qu treatment, diabetes mellitus (DM), and the interactions between DM and Qu (P = .004) and between DM and technique (P = .021) were significant. The interaction among all three factors and the interaction between technique and Qu were not significant. In all groups except DDS/Qu, diabetic premolars exhibited lower FS than non-diabetic premolars (P < .001). IDS resulted in significantly higher FS in both tooth types (P < .001). The positive effect of Qu pretreatment was observed only in diabetic premolars (P < .001). Conclusion In diabetic premolars, IDS and Qu pretreatment substantially enhanced the FS of teeth restored with ceramic inlays, with the greatest improvement observed when both were combined. In non-diabetic premolars, a significant improvement was observed only with IDS. Clinical relevance Diabetes-related changes in dentin may compromise the performance of adhesive restorations. Understanding the effects of dentin sealing techniques and the potential benefits of Qu may help improve the durability of indirect restorations in patients with diabetes.
BACKGROUND:Dynamic navigation (DN) and static navigation (SN) in endodontic microsurgery (EMS) have been shown to improve the precision of osteotomy and root-end resection (RER). However, the impact of minimal incisions on DN- and SN-guided EMS remains unclear. This study assessed the accuracy of DN and SN in EMS performed via a single vertical incision at the apex (SVIA), and identified technique-specific accuracy predictors. METHODS:A retrospective analysis included 60 teeth treated with SVIA EMS, comprising 30 osteotomies and RERs each in the SN and DN groups. Preoperative variables - sex, age, tooth position, arch type, drilling depth, lesion size, and buccal bone integrity - were recorded. Postoperative cone-beam computed tomography (CBCT) scans were superimposed with preoperative plans to evaluate accuracy. Group comparisons used independent t-tests or Mann-Whitney U tests (α = 0.01); general linear model examined the interaction effects between the technique and preoperative variables on accuracy; multivariate regression (α = 0.017) identified independent predictors within each group. RESULTS:No significant differences in accuracy parameters were observed between DN and SN (P > .01). Interaction effects were nonsignificant (P > .05). Intragroup analysis indicated that for DN, a lesion diameter > 9 mm predicted increased resection angle deviation (RAD) (B = 3.13, P < .017), while for SN, posterior tooth location predicted reduced RAD (B = -5.80, P < .017). CONCLUSIONS:DN and SN exhibited comparable overall accuracy in SVIA EMS. However, DN was less accurate in cases with large lesions, whereas SN achieved higher accuracy in posterior regions. These preliminary findings support the evidence-based selection of guidance techniques according to anatomic specifics in SVIA EMS.
Introduction and aims The temporomandibular joint condyle (TMJC) is essential for mandibular and temporomandibular joint (TMJ) development. However, its cellular and molecular dynamics during human embryogenesis remain poorly understood. Methods We constructed a single-cell transcriptomic atlas of the human TMJC spanning five embryonic stages from 12 to 25 gestational weeks (GW12-25). Single-cell RNA sequencing was performed to identify cell types, and Monocle 3 and SCENIC analyses were used to infer developmental trajectories and identify key transcriptional regulators. Candidate regulators were functionally validated using zebrafish models. Results Single-cell RNA sequencing identified 20 major cell types within the TMJC. Immune cells were sparse at GW19 but expanded markedly by GW22. Trajectory analysis revealed a differentiation pathway from mesenchymal stem cells to chondrocytes. SCENIC analysis highlighted multiple transcription factors regulating distinct cell populations, among which MXD4 was identified for the first time as a candidate transcriptional regulator of cartilage development. Functional studies showed that mxd4 knockout in zebrafish led to craniofacial developmental abnormalities. Conclusion This single-cell atlas provides a comprehensive resource for understanding the cellular and molecular mechanisms underlying TMJC development. MXD4 is identified as a candidate regulator in condylar morphogenesis. Clinical relevance Preliminary investigation of the potential regulatory role of MXD4 in condylar cartilage formation may provide a theoretical basis for diagnostic, therapeutic, and translational studies of craniofacial malformations associated with condylar hypoplasia.
INTRODUCTION AND AIMS:For dental patients with systemic diseases, multidisciplinary care via referral letters is essential for clinical safety. This study evaluated the clinical feasibility and quality of dental-to-medical referral letters generated by Large Language Models (LLMs). METHODS:Using 153 paired datasets, three LLMs - Gemini-2.5-Pro, GPT-5 and MedGemma - generated referral letters via a standardised prompting framework. Two dental clinicians performed a blinded assessment across nine sub-criteria covering content, style and correctness. GPT-5 also performed an automated evaluation. Statistical significance was analysed using Friedman and Wilcoxon signed-rank tests with Holm correction. RESULTS:In the human clinical evaluation, Gemini-2.5-Pro achieved the highest overall performance (TOTAL mean SCORE: 2.9487 with a bootstrap 95% confidence interval [CI] of 2.9345-2.9606), significantly outperforming GPT-5 (2.8818 with 95% CI of 2.8613-2.9008) and MedGemma (2.8613 with 95% CI of 2.8338-2.8865) (P < .05). While GPT-5 showed high clarity in systemic problem descriptions, MedGemma excelled in structural adherence. The overall performance difference between GPT-5 and MedGemma was not statistically significant (P = .3519). Inter-rater reliability was strong in the prompt search dataset (QWK: 0.7175) but lower in the independent test dataset (QWK: 0.1505), reflecting the subjective nature of clinical document assessment; therefore, final human scores were reported as average ratings from two blinded clinicians with bootstrap confidence intervals. Notably, GPT-5's self-evaluation results deviated from human judgment, exhibiting potential model-based bias. CONCLUSION:This preliminary study suggests the potential of Gemini-2.5-Pro for automated consult letter generation, though the low test-set inter-rater reliability (QWK: 0.1505) highlights the subjective complexity of clinical text. To integrate these assistive prototypes into routine clinical application, more systematic studies are required. CLINICAL RELEVANCE:Integrating LLMs offers a promising approach to assisting with dental-to-medical referrals, presenting a potential future benefit of reducing administrative workloads and enabling healthcare providers to focus on safe, empathetic patient care.
BACKGROUND:Peri-implantitis, a major cause of implant failure, is driven by disrupted bone homeostasis. Semaphorin 3A (Sema3A) bidirectionally regulates bone remodelling, yet its role in peri-implantitis remains poorly defined. This study aimed to elucidate the mechanisms by which Sema3A modulates bone homeostasis in peri-implantitis. MATERIALS AND METHODS:Single-cell transcriptomic analysis (GSE171213) was performed on a periodontitis-derived periodontal tissue dataset to characterize bone-related cell communication. A murine peri-implantitis model was established via silk ligation, and bone loss was assessed by micro‑CT. In vitro, MC3T3-E1 osteoblasts were exposed to Porphyromonas gingivalis LPS and transduced with Sema3A‑overexpressing lentivirus. Proliferation, migration, osteogenic differentiation, and the PI3K/AKT pathway were evaluated. An osteoblast-osteoclast coculture system was used to assess osteoclastogenesis. RESULTS:Reanalysis of a periodontitis-derived single-cell dataset showed reduced SEMA3A expression and a lower osteogenic-lineage score in sparsely represented osteogenic-lineage-like cell populations under inflammatory conditions. Peri‑implantitis mice exhibited reduced SEMA3A, decreased P1NP, elevated CTX‑1, and significant bone loss (P < .05). Sema3A overexpression significantly rescued LPS‑impaired osteoblast proliferation, migration, and osteogenic differentiation (P < .01). RNA‑seq identified PI3K/AKT pathway enrichment; Sema3A increased phosphorylated AKT, and the PI3K/AKT inhibitor Palomid 529 abolished these protective effects. In coculture, Sema3A‑overexpressing osteoblasts suppressed osteoclast differentiation, reducing TRAP⁺ cells, Nfatc1, and Ctsk (P < .01). CONCLUSIONS:Sema3A restores osteoblast function under inflammatory conditions, partly through PI3K/AKT signalling, and suppresses osteoclast differentiation indirectly in an osteoblast-osteoclast coculture system. Notably, Sema3A overexpression alone had no effect under normal conditions but specifically counteracted inflammatory damage. These findings suggest Sema3A is a potential therapeutic target for peri‑implantitis. CLINICAL SIGNIFICANCE:Sema3A simultaneously enhances osteogenesis and inhibits bone resorption specifically under inflammatory conditions, while preserving basal bone homeostasis, thereby representing a targeted bone-protective strategy for peri-implantitis that may improve implant survival and reduce the need for invasive surgical interventions.
Objective The physiological occlusal force generated by mastication plays a critical role in tooth replantation after complete avulsion by promoting periodontal ligament healing. Heme oxygenase-1 (HO-1), a classical cytoprotective factor, exhibits mechanoresponsive expression in periodontal ligament cells (PDLCs). This study aims to investigate whether occlusal force can reduce replacement root resorption during the healing of periodontal ligament in replanted teeth and its potential mechanisms. Methods A tooth avulsion model was established in occlusal group rats and occlusal deprivation group rats. The healing of periodontal ligament was evaluated at 7 and 28 days post-replantation using micro-computed tomography, histological analysis, and immunohistochemistry. PDLCs were isolated to construct the injured periodontal ligament cells (iPDLCs) model. Following the application of cyclic tensile force, collagen synthesis level and the expression changes of HO-1 and transforming growth factor-beta 1 (TGF-β1) were assessed. Results The physiological occlusal force reduced replacement root resorption, promoted periodontal healing and the conversion of type III collagen (COL Ⅲ) to type I collagen (COL Ⅰ), and increased HO-1 expression in the periodontal ligament of replanted rat teeth. The cyclic tensile force (4% strain, 0.5 Hz) applied for 4 hours upregulated the expression of HO-1, COL Ⅰ, and COL III in iPDLCs. Enhanced HO-1 expression increased the levels of TGF-β1, COL I, and COL III, whereas inhibition of HO-1 or blockade of TGF-β1 reduced COL I and COL III expression. Simultaneous upregulation of HO-1 and inhibition of TGF-β1 resulted in decreased COL I and COL III expression. Conclusion Physiological occlusal force may be associated with reduced replacement root resorption and elevated HO-1 expression, while also promoting collagen synthesis in the injured periodontal ligament. Low deformation with short-term cyclic tensile force induces HO-1 expression, thereby promoting COL I and COL III synthesis in iPDLCs. This process is closely associated with the TGF-β1 signaling pathway.
Introduction and aims Robot-assisted implant surgery (RAIS) signifies a major advancement in computer-guided implant technology. In comparison to traditional hand-guided placement, RAIS enhances the precision and standardization of implant positioning. However, the increased technical complexity introduces potential error sources at various stages of the digital workflow. This review aims to systematically evaluate the potential risks associated with RAIS and explore relevant management strategies and future technological advancements. Methods This review adhered to the Scale for the Assessment of Narrative Review Articles guidelines. A structured literature search was performed across the PubMed, Embase, and Web of Science databases, covering publications from January 2000 to May 2026. Studies reporting clinical outcomes, accuracy, technical performance, safety, complications, and workflow-related issues of RAIS were included. Evidence was narratively synthesized according to predefined thematic domains and appraised using Evidence-Based Medicine principles. Results Robot-assisted dental implant surgery demonstrates significantly enhanced implant placement precision compared to conventional freehand surgery and navigation-guided surgery. Nonetheless, risks remain throughout the workflow, including imaging and planning errors, registration inaccuracies, inappropriate patient selection, system failures, tracking interruptions, thermal and mechanical injury, patient movement, and limitations in complex clinical scenarios. Additional concerns include system compatibility and instrument-related infection risks. Implementation of standardized operational workflows, systematic training protocols, and technological optimizations may mitigate these risks to some extent. Conclusion Despite the considerable potential of RAIS to enhance surgical precision and standardize operations, it remains in a developmental stage with inherent limitations. Future efforts should prioritize technological advancements and rigorous clinical trials to establish long-term safety and efficacy. Clinical relevance Establishing the evidence base for potential risks associated with RAIS and its clinical relevance allows clinicians to optimize patient selection, improve operational workflow management, and develop targeted risk control strategies, thus enhancing the safety, predictability, and clinical value of this technology.
OBJECTIVES:To evaluate whether a structured microskill stepwise progression model improves procedural competence and reduces performance variability in undergraduate tooth extraction training compared with traditional apprenticeship-based teaching. METHODS:This randomized mixed-methods pilot study allocated 40 fifth-year dental students (1:1) to traditional apprenticeship teaching or a microskill stepwise progression model during an 8-week oral surgery rotation. The intervention divided tooth extraction into nine stages, requiring five targeted observations and five successful supervised performances before progression. End-of-rotation competence was assessed using a modified Direct Observation of Procedural Skills (DOPS) scale by two blinded examiners. Between-group differences and score variability were analysed using Welch's t test and the F-test. Questionnaires and qualitative feedback explored learner and instructor perceptions. RESULTS:Baseline theoretical examination scores were comparable between groups. Inter-rater reliability for the total modified DOPS scores was good (ICC = 0.86; 95% CI, 0.74-0.93; P < .001). The intervention group achieved higher modified DOPS scores than the control group (94.60 ± 3.97 vs 88.25 ± 6.41; mean difference, 6.35; 95% CI, 2.94-9.76; P < .001; Cohen's d = 1.19) and lower score variability (F = 2.616; P = .042), with a narrower score range (87-100 vs 75-96). Qualitative findings suggested clearer progression and more consistent competence development. Questionnaire findings were exploratory; four item-level differences remained significant after Benjamini-Hochberg correction. CONCLUSIONS:The microskill stepwise model was associated with improved tooth extraction performance and reduced variability in assessed procedural competence compared with traditional teaching. This mastery-oriented approach may support more structured supervision and more consistent educational readiness in oral surgery training. CLINICAL RELEVANCE:This framework helps educators organize undergraduate tooth extraction training using procedure-specific stages, supervised-performance thresholds, and documented progression criteria. It may promote consistent standards and transparent entrustment decisions, but should be adapted to local case availability and supervisor workload.
Introduction and aims The relationship between carotid artery calcification (CAC) detected on panoramic radiographs and oral health remains unclear due to potential confounding factors. This study aimed to evaluate this association after adjusting for these confounders and explore potential effect modification by lifestyle behaviours. Methods This cross-sectional study assessed the association between CAC on panoramic radiographs and oral health outcomes, including decayed, missing, and filled teeth (DMFT) index, periodontal disease, and apical periodontitis. Directed acyclic graphs were used to determine the minimal sufficient adjustment set, including sociodemographic factors, medical conditions (hypertension, hyperlipidaemia, and diabetes mellitus), and lifestyle habits (alcohol consumption, betel quid chewing, and smoking). A complete dataset was obtained after multiple imputation of missing values. Associations were examined using regression models, and effect modification by lifestyle behaviours was assessed using interaction terms, with stratified analyses performed for significant interactions. Results The prevalence of CAC (670 patients) was 21.49%. CAC patients had a DMFT index 2.026 units higher, 0.290 more teeth with apical periodontitis, 1.873-fold higher odds of periodontal disease, and 1.554-fold higher odds of concurrent periodontal and apical diseases. After adjustment for confounders, the association between CAC and oral health outcomes disappeared. Age was associated with higher DMFT index (0.279 units), more teeth with apical periodontitis (0.017 units), and higher odds of periodontal and apical disease (3.5%-7.8% per year) (P < .001). Males were associated with periodontal disease. A significant interaction between CAC and alcohol consumption was observed, with CAC significantly associated with periodontal disease among drinkers (odds ratio = 9.051). Conclusion After adjustment for confounders, associations between CAC and oral health outcomes disappeared. Alcohol consumption modified the association between CAC and periodontal disease, with an association observed among drinkers. Clinical relevance While radiographic detection of CAC facilitates cardiovascular risk identification and referral, alcohol consumption modifies the association between CAC and periodontal disease.
Introduction and Aims Lip, oral cavity, and pharyngeal (LOCP) cancers comprise a heterogeneous group of malignancies with a substantial and evolving disease burden in China. This study aimed to systematically evaluate the burden of LOCP cancers in China and to project future trends. Methods Estimates from the GLOBOCAN database were used to quantify the incidence, mortality, and prevalence of LOCP cancers in China in 2022. Future trends were projected through 2050. Subsite-specific analyses were conducted to assess epidemiologic variations and temporal dynamics across different anatomic locations. Results In 2022, an estimated 116,142 new LOCP cancer cases occurred in China, with a pronounced male predominance. Nasopharyngeal cancer and lip and oral cavity cancer were the major contributors, accounting for 43.9% and 32.0% of cases, respectively, whereas oropharyngeal cancer remained relatively uncommon. Projections indicate a sustained increase in both incidence and mortality across all LOCP cancers through 2050. Notably, lip and oral cavity cancer is expected to show the most pronounced growth, with a potential shift towards becoming a leading contributor, particularly among females. Conclusions LOCP cancers impose a substantial and growing burden in China, characterised by marked subsite heterogeneity and evolving epidemiologic trends. These findings highlight the necessity for subsite-specific prevention, early detection, and targeted intervention strategies, as well as the importance of strengthening precision-oriented cancer control frameworks to mitigate future disease burden. Clinical Relevance These findings provide critical evidence to inform national cancer control strategies and advance the paradigm shift towards precision public health and proactive, anticipatory cancer prevention strategies. The observed subsite heterogeneity, coupled with projected increases in lip and oral cavity cancer incidence, underscores the urgent need for more precise, anatomically targeted prevention and early detection frameworks.
BACKGROUND:Ameloblastoma is a locally aggressive odontogenic tumour whose reported occurrence varies geographically. In South Sulawesi, Indonesia, epidemiological data remain scarce and district-level disparities are undocumented. This study mapped the residential distribution of patients treated at a tertiary referral hospital and examined area-level correlates of that distribution. METHODS:An analytical ecological study used the 24 districts/cities of South Sulawesi as spatial units. All histopathologically confirmed cases (n = 160, 2022-2024) were attributed to district of residence and ecologically associated with district-level health system capacity and socioeconomic indicators. Spatial distribution was assessed by choropleth mapping with Jenks classification, and population-adjusted rates per 100,000 were calculated. Differences across urban, peri-urban, and rural groupings were evaluated using Kruskal-Wallis and pairwise Poisson tests, and ecological associations using Pearson's correlation and exploratory geographically weighted regression. RESULTS:Cases concentrated in the southwestern corridor, mainly in urban areas. Parepare recorded the highest reported case rate (15.54 per 100,000), whereas Makassar ranked sixth (1.84 per 100,000). Urban (rate ratios = 3.27) and peri-urban (rate ratios = 3.59) districts showed higher rates than rural districts (both P < .001), although the Kruskal-Wallis omnibus test was not significant (P = .076), plausibly reflecting limited power with unequal group sizes. Reported rates correlated strongly with health system capacity indicators (r ≈ 0.83-0.89; P < .0001), negatively with poverty (r = -0.493) and positively with expenditure, schooling and unemployment (r = 0.617-0.698; P < .01), reflecting ecological patterns of case detection rather than individual risk. Exploratory geographically weighted regression indicated spatial nonstationarity, with 22 districts showing at least one locally significant socioeconomic variable. CONCLUSION:Reported ameloblastoma rates concentrate in urban referral centres and track health system capacity, indicating patterns of case detection and diagnostic access rather than true disease occurrence. These hypothesis-generating findings support district-specific strategies to improve diagnostic equity rather than uniform interventions.
Autonomous artificial intelligence (AI), such as Medical Intelligence for Reasoning and Action and Articulate Medical Intelligence Explorer, represents an evolution in healthcare AI, extending its capabilities beyond task-specific decision support towards longitudinal clinical reasoning and patient management. Although these systems have been developed in medicine, they raise important questions regarding the future of oral healthcare. This perspective proposes agentic dentistry as a conceptual framework for considering how autonomous AI could eventually influence dental practice. We discuss the potential opportunities of agentic AI to enhance clinical decision-making, care coordination, continuity of care, and personalised treatment, while critically examining the scientific, ethical, educational, regulatory, and professional challenges associated with its translation into dentistry. Finally, we propose a research and policy agenda to support the responsible development of autonomous AI in oral healthcare. By initiating this discussion before widespread clinical adoption, dentistry can proactively shape the future integration of agentic AI.
Introduction and Aims Periodontitis and type 2 diabetes mellitus (T2DM) are interrelated, potentially linked through intestinal barrier dysfunction. Yet, whether their comorbidity is associated with worsened barrier integrity and how this relates to insulin resistance remain unclear. This study examined associations between periodontitis, gut barrier disruption, Toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NF-κB) activation, and metabolic parameters in a T2DM mouse model. Methods Twenty-four C57BL/6 mice were randomised into 4 groups (n = 6): healthy control, chronic periodontitis, T2DM without periodontitis (DNP), and T2DM with periodontitis (DP). Glucose homeostasis was assessed by measuring fasting blood glucose and the area under the curve of oral glucose tolerance tests and insulin tolerance tests. The colonic barrier’s biological, chemical, physical, and immune properties were evaluated using 16S ribosomal RNA sequencing, haematoxylin and eosin staining, transmission electron microscopy, reverse transcription polymerase chain reaction, Western blotting, and flow cytometry. Furthermore, serum insulin and inflammatory cytokines were quantified by enzyme-linked immunosorbent assay. Results The composition of both the periodontal and faecal microbiota in the DP group was markedly different from that in the DNP group. In the DP group, transmission electron microscopy revealed severe damage to colonic mucosal ultrastructure; messenger RNA and protein expression levels of MUC2 and tight junctions (including occludin, claudin-1, and ZO-1) were significantly decreased; the proportion of regulatory T cells diminished, while Th17 cells increased, resulting in an imbalanced regulatory T-cell/Th17 ratio. Proinflammatory cytokines in intestinal tissues and serum were raised, whereas anti-inflammatory cytokines were decreased. Moreover, in the DP group, activation of the TLR4/NF-κB pathway was observed in intestinal tissue. Notably, levels of fasting blood glucose, serum insulin, and area under the curve for oral glucose tolerance tests and insulin tolerance tests were all higher in the DP group than in the DNP group. Conclusions Periodontitis is related to intestinal barrier disruption, TLR4/NF-κB signalling activation, and worsened metabolic parameters in T2DM mice. Clinical Relevance These findings may establish periodontitis as a potent driver of gut barrier dysfunction, systemic inflammation, and insulin resistance, highlighting its profound impact on metabolic health.
Introduction and Aims To investigate whether generatively designed (GD) patient-specific implants are equivalent to manually designed (MD) PSIs for orthognathic surgery in the in silico setting. Methods Twelve pairs of GD and MD fixation plates for Le Fort I osteotomy and genioplasty were compared regarding plate-bone shape fit, biomechanical performance, plate size, and design time. Shape fit was measured as the signed distance from the plate vertices to the underlying bone surface to estimate potential surgical accuracy. Biomechanical performance (von Mises stress and deformation) was analysed using finite element analysis. Plate size was quantified by both surface area and volume. Hands-on design time was recorded for GD by stage, and historical data on MD time were referenced for context. Results GD plates demonstrated better shape fit, with a lower mean plate-bone distance (0.95 ± 0.17 mm) than MD plates (1.12 ± 0.28 mm; P < .05). The maximum von Mises stresses of both plates were within the ultimate tensile strength of titanium (345 MPa), and the greatest deformations were within 0.55 mm, demonstrating sufficient biomechanical stability. GD plates reduced the surface area by 16% (P < .001) and volume by 18% (P < .05) compared to MD plates. Average hands-on design time for GD plates was 94.3 ± 14.2 minutes for Le Fort I and 45.0 ± 7.3 minutes for genioplasty, which was substantially shorter than MD time reported in prior in-house workflows. Conclusions GD fixation plates demonstrated improved shape fit, adequate mechanical strength, smaller size, and reduced design time compared with MD plates. Clinical Relevance The objective analysis of GD fixation plates in silico is important for justifying further application in clinical trials.
Introduction and Aims Limited evidence exists on prosthetic dental care in Myanmar. This study aimed to assess prosthodontic service capacity, practitioner-perceived barriers, teledentistry use, and training needs. Methods A cross-sectional online survey was conducted among dentists providing prosthodontic treatment in Myanmar (November-December 2025), using convenience sampling. The questionnaire covered demographics, service capacity, barriers, teledentistry, and training needs. Descriptive statistics, chi-square tests with Bonferroni correction, and logistic regression were used. Results Among 367 dentists, most practiced in urban areas (71.9%) and private clinics (79.0%). The majority of respondents reported providing crowns, bridges, and dentures, while 29.4% offered implants. High-volume delivery (>50 units/month) was reported by 36.2%, associated with male sex (adjusted odds ratio, 2.88) and ≥10 years’ experience (adjusted odds ratio, 3.60). Leading barriers to providing prosthetics were patients’ financial constraints (87.5%), low patient awareness regarding prosthetic treatment options (71.4%), and high prosthetic material costs (70.8%). Barriers related to material and equipment availability, patient fear, and technician access varied significantly across geographic regions (P < .05). Teledentistry use was low (30.8%), and top training needs were digital dentistry (88.6%) and implant prosthodontics (82.0%). Conclusions Prosthodontic services in Myanmar remain predominantly urban-centred and privately delivered, with significant structural, geographic, and economic barriers affecting equitable access to care. Workforce development, laboratory support, and digital dentistry training may strengthen service delivery. Teledentistry remains underutilised; while early adopters view it positively, poor internet and training gaps are major barriers to wider implementation. Clinical Relevance This study provides preliminary practitioner-based evidence regarding prosthetic dental service capacity and barriers to care in Myanmar and may help inform workforce planning and digital oral health strategies in similar low-resource settings.
