Porphyromonas gingivalis is a major periodontal pathogen increasingly associated with oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) due to its role in microbial dysbiosis and carcinogenesis. This study aimed to evaluate the relative abundance of P. gingivalis in healthy controls, OL, and OSCC patients and to correlate the bacterial load with immunohistochemical (IHC) markers. A total of 48 oral swab samples were collected from three study groups: (1) healthy, (2) OL, and (3) OSCC. Quantitative PCR was performed to assess the relative abundance of P. gingivalis in these groups. Immunohistochemistry was done to analyze the expression of Ki-67, Bcl-2, and β-catenin in 32 formalin-fixed paraffin-embedded tissue of OL and OSCC. The mean cycle threshold value of P. gingivalis was 23.82, 23.57, and 22.05 in healthy, OL, and OSCC, respectively, indicating a higher abundance of the bacterium in OSCC. IHC analysis revealed increased Ki-67 and Bcl-2 expression in OSCC. Additionally, β-catenin exhibited a shift from membranous in OL to cytoplasmic/nuclear localization in OSCC, suggesting its role in cancer progression. No significant correlation was observed between bacterial abundance and IHC marker expression. This study highlights the significant presence of P. gingivalis in OSCC, suggesting its potential role in oral carcinogenesis.
This systematic review investigated the osteogenic effects of platelet concentrate (PRF/PRP) when combined with non-autogenous graft materials in sinus lift procedures. Key characteristics assessed included platelet concentration, total platelet dose, leukocyte content, and fibrin-network structure. A comprehensive search of EMBASE OvidSP, PubMed, and the Cochrane Library was conducted in April 2026, resulting in the inclusion of 25 articles. Studies were broadly categorized according to whether they reported enhanced osteogenic outcomes or not: positive studies (n = 15) and negative studies (n = 10). A key finding is that positive studies used a higher total platelet dose than negative studies (8.02 × 109 vs. 3.67 × 109). A subgroup meta-analysis of eight randomized controlled trials (RCTs) found that the five high-dose studies, using approx. ≥10 × 109 platelets, demonstrated a significant increase in new bone formation (effect size: 1.04; p < 0.01). In contrast, the three low-dose studies showed a modest but nonsignificant effect (effect size: 0.49; p = 0.355). However, the difference between the two subgroups was not statistically significant. Available evidence suggests that higher platelet doses, particularly around ≥10 × 109 platelets, may be associated with more favorable osteogenic outcomes. However, this dose should not be interpreted as a clinically validated threshold.
CD73, encoded by NT5E, is an ecto-5'-nucleotidase implicated in tumour progression, but its association with glycolysis-related metabolic features in head and neck squamous cell carcinoma (HNSCC) remains unclear. In this study, we combined public transcriptomic analyses with in vitro and in vivo experiments to investigate the relationship between NT5E/CD73 and these features in HNSCC. NT5E expression was positively associated with glycolysis-related signatures, and a high glycolysis score was associated with poorer overall survival in an exploratory analysis. In CAL27 cells, NT5E knockdown reduced extracellular acidification rate and oxygen consumption rate and decreased the expression of glucose transporter 3 (GLUT3), lactate dehydrogenase A (LDHA) and pyruvate kinase M2 (PKM2), indicating a broader reduction in metabolic activity. In a xenograft model, NT5E depletion suppressed tumour growth and reduced GLUT3, LDHA and PKM2 expression. ADORA2B was upregulated in HNSCC, and its silencing decreased glycolysis-related gene expression, whereas pharmacological activation of A2B partially restored glycolysis-related protein expression and migratory capacity after NT5E knockdown. These findings support an association between NT5E/CD73 and glycolysis-related metabolic features in HNSCC and suggest that A2B signalling may contribute, at least in part, to the associated metabolic and migratory changes.
This study investigated the influence of organic solvents on the depth of cure (DOC) of resin composites. Two conventional (Filtek Universal [FU] and Beautifil II [BE]) and two bulk-fill (Filtek One Bulk Fill [FO] and Beautifil-Bulk [BB]) composites were evaluated. Cylindrical specimens were fabricated using polyvinylsiloxane molds, light-cured according to the manufacturers' recommendations, and immersed in one of four solvents: acetone, chloroform, ethanol (ETH), or tetrahydrofuran, for 48 h at 22°C (n = 10/composite/solvent). Specimens were imaged under a digital microscope, and the thicknesses of the "solvent-resistant" and "solvent-affected" zones, as well as the percentage of solvent-affected area, were measured with imagej. Knoop microhardness was measured at the top and at 1-mm intervals down to 5 mm (conventional) or 7 mm (bulk-fill). The "solvent-resistant" zone ranged from 3.1 to 4.3 mm for conventional and from 4.9 to 6.9 mm for bulk-fill composites. ETH produced the smallest solvent-affected area for all composites. The 80% bottom-to-top microhardness ratio was reached at 2.6-3.4 mm for conventional, 3.6-4.2 mm for FO, and 2.9-3.3 mm for BB. The resin composite and the organic solvent influenced the determination of DOC, and ETH was the least effective solvent.
Three-dimensional (3D) printing is widely used in dental restorations; however, optimization of photoinitiator concentration and post-curing protocols remains critical to achieve a balance between mechanical and esthetic performance. This study evaluated the combined effect of diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) concentration and post-curing time on mechanical properties and color stability of a 3D-printed restorative resin. A commercial photoinitiator-free resin (BioPrint Prov, Horus 3D) was supplemented with TPO at 0.5, 1.0, and 1.5 wt% and fabricated using a digital light processing printer. Specimens were post-cured for 30, 45, or 60 min under UV light, while non-post-cured (NoPC) samples served as controls. Flexural strength and elastic modulus were evaluated using a three-point bending test. Color stability and translucency were assessed using spectrophotometry (CIELab/ΔE00) under storage conditions, including dry storage, water immersion, and coffee aging. Data were analyzed using two-way anova and Tukey's test. The 1.0% TPO and 30 min post-curing combination provided best performance, with highest flexural strength and lowest color change after staining. Higher TPO concentration and prolonged post-curing increased color alteration and yellowness. NoPC specimens showed inferior mechanical properties and greater discoloration. Translucency remained more stable in post-curing groups. These findings indicate optimized photoinitiator concentration and controlled post-curing time improve mechanical and esthetic outcomes in 3D-printed restorative resins.
This systematic review and network meta-analysis (NMA) compared the clinical performance of adhesive strategies used in direct posterior composite restorations in permanent teeth. Randomized controlled trials were retrieved from PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Studies reporting dichotomous clinical outcomes assessed with USPHS or FDI criteria were included. A frequentist random-effects NMA estimated relative treatment effects as odds ratios with 95% confidence intervals; treatments were ranked using P-scores, and evidence certainty was assessed with the Confidence in Network Meta-Analysis (CINeMA) framework. Nine studies were identified, of which six contributed to the 12-month NMA. Multiple adhesive strategies combining different etching approaches and adhesive systems were evaluated. No significant differences were found for marginal adaptation or retention loss. Although etch-and-rinse and universal adhesives showed higher P-scores, these findings were uncertain. CINeMA indicated moderate confidence in the evidence, with imprecision as the main limitation. At 12 months, no statistically significant differences were detected among contemporary adhesive strategies for marginal adaptation or retention loss; however, the estimates were imprecise, so these results indicate a lack of demonstrated differences rather than proven equivalence between strategies.
This in vitro study evaluated the efficacy of an experimental fluoridated varnish modified with graphene oxide (GO) nanoparticles in arresting initial caries lesion progression and promoting mineral recovery in demineralized bovine enamel. Enamel blocks (6 × 4 × 2 mm) were artificially demineralized and treated with one of five varnish formulations: CTRL (experimental varnish), 10% GO (CTRL + 10% GO), 20% GO (CTRL + 20% GO), NaF/CaF2 (CTRL + NaF + CaF2), or NaF (Duraphat; Colgate-Palmolive). Following varnish application, specimens were stored in artificial saliva (37°C, 24 h) and subjected to a 7-d pH-cycling regimen. Surface hardness outcomes (%SHL, %SHR, and ΔSH) were determined using six specimens per group. Additional specimens were prepared for transverse microradiography (n = 3 per group) to determine integrated mineral loss (ΔZ) and lesion depth was measured, and the specimens were examined using field-emission scanning electron microscopy (FEG-SEM) coupled with energy-dispersive X-ray spectroscopy (EDS). (n = 9 per group) to evaluate surface morphology, Ca, P, and the Ca/P ratio. Data were analyzed using appropriate parametric or non-parametric tests (α = 0.05). Overall, the 10% GO group exhibited significantly lower %SHL and higher %SHR than the other experimental groups, whereas higher Ca/P ratios were observed in the 10% GO and NaF groups.
Along with our increased understanding of the spread of microplastic pollution, the awareness of microparticle release from medical and dental materials has increased. Still, their effects on human health are largely unknown. As the use of resin composite materials in dentistry continues to increase, it is essential to understand the formation and biological activities of microparticles generated during material fabrication and use. This study investigated the type and size of microparticles formed from two commonly used restorative resin composite materials, ground with two different dental burs, and their effects on cultured spontaneously immortalized human gingival keratinocytes. Scanning electron microscopy and laser diffraction were used to examine particle morphology and size distribution. Flow cytometry was used to analyze microparticle adhesion to the cell surface and cell viability, and cytokine release was measured. From the two composite materials, microparticles ranging from approximately 4.50 to 137 µm were released. The particles adhered to gingival keratinocytes and induced IL-8 expression of the cells but did not affect the cell viability. The grinding method and the material affected the size of released particles. Further investigation is needed to understand the impact of cellular responses and the dose dependence of the reactions.
Inflammatory conditions of teeth and their surrounding structure lead to tissue destruction and alveolar bone loss. This review critically examines the emerging role of PIWI-interacting RNAs (piRNAs) in periodontology and orthodontic tooth movement focusing on their involvement in inflammation, bone remodeling, and cellular regulation with periodontal ligament and alveolar bone. Although piRNAs were initially characterized in reproductive biology, recent studies suggest their involvement in fundamental biological basis: Both involve inflammatory responses, bone remodeling, and the regulation of cellular activities within the periodontal ligament and alveolar bone. Traditionally, research has focused on protein-coding genes, cytokines, and signaling molecules. However, the emerging role of noncoding RNAs (ncRNAs), including microRNAs, long ncRNAs, and piRNAs, is revolutionizing the understanding of oral biology. This review highlights key findings: identification of piRNA's with relevance to oral biology (piR-63049 and piR-36741); their association with Wnt/β-catenin and BMP2/METTL3-m6A pathways; evidence supporting piRNAs as potential biomarkers in saliva/gingival crevicular fluid; and the translational potential of exosome-mediated piRNA delivery for periodontal regeneration and orthodontic modulation. piRNAs thus represent a novel regulatory component, and their potential use as diagnostic biomarkers and therapeutic targets warrants the need for further investigation to establish their functional relevance in oral health and disease.
Endodontics has witnessed a significant acceleration in innovation. However, the pace at which these innovations are validated through scientific research has not kept up, creating what is referred to as the 'speed of innovation versus speed of validation gap'. This incongruence raises critical concerns about the foundation of evidence-based practice, patient safety and professional accountability. Currently, many innovations are adopted in clinical practice based on preliminary data, anecdotal evidence or popularity on digital platforms, often before thorough clinical validation is achieved. This trend challenges traditional knowledge translation frameworks and reveals significant limitations within existing governance models in dentistry. This article draws on principles of responsible innovation and healthcare regulations to examine the factors contributing to this gap in endodontics and its implications. Although recognising the necessity of innovation for the advancement of the discipline, it cautions against the uncritical and premature adoption of new techniques and technologies, as this may jeopardise clinical outcomes and erode public trust. The article advocates for a more integrated approach that combines innovation with anticipatory governance, critical appraisal and professional reflexivity. Closing this gap is imperative to ensure that advancements in endodontics are founded on robust scientific evidence and conducted in a socially responsible manner.
This study aimed to evaluate the effect of natural dentin modulators on the bond strength and adhesive interface of resin materials bonded to dentin oxidized by sodium hypochlorite. Forty bovine roots underwent endodontic treatment and were assigned to four groups: control gel, Libidibia ferrea 10% gel, Apis mellifera 10% gel, and sodium hypochlorite irrigation. Glass fiber posts were cemented using a universal adhesive system and dual-cure resin cement. Bond strength was assessed by the push-out test, and the failure pattern and resin tag penetration were also evaluated. The results showed that both L. ferrea and A. mellifera treatments enhanced bond strength and resin tag extension compared to the control and sodium hypochlorite groups, with no difference between the two natural modulators, regardless of the root canal third. Cohesive failures were more frequent in the natural modulator groups, whereas adhesive failures predominated in the control and sodium hypochlorite groups. The findings indicate that natural dentin modulators improved the adhesive performance of resin materials bonded to dentin previously oxidized by sodium hypochlorite.
Colored fiber posts facilitate clinical retrieval but could impact esthetics and bonding. This study evaluated the color stability and dentin bond strength of a novel colored fiber post designed to facilitate post-removal. Sixty premolars had root canal therapy and post space preparation. Color parameters (ΔL*, Δa*, Δb*) were measured with a spectrophotometer. Specimens were divided into two groups: control-Exacto post (Angelus); experimental-blue-colored fiber post (patent granted). A flowable resin was used for core build-up, and restoration was done with a composite resin (shade A2). Overall color change (ΔE*ab) and whiteness index variation (ΔWI) were calculated (n = 10). Push-out bond strength was assessed at 24 h (n = 10) and 12 months (n = 10). Data were analyzed using anova, Tukey's post hoc, and chi-square tests (α = 0.05). No significant differences were found between groups for ΔE*ab or ΔWI. After aging, both groups showed increased ΔE*ab and ΔWI. Bond strength was similar between groups, although both decreased over 12 months. Adhesive failure was predominant in both groups. The experimental colored fiber post demonstrated esthetic and mechanical performance comparable to a conventional fiber post, offering a potential alternative for restoring endodontically treated teeth with enhanced retreatability and safety.
This study investigated the influence of bulk-fill versus incremental placement techniques on the mechanical properties of the bottom layer of fiber- and particulate-reinforced bulk-fill resin composites following long-term water storage. Five materials were evaluated: a conventional composite, a high-viscosity bulk-fill, a fiber-reinforced flowable bulk-fill, and two particulate-reinforced flowable bulk-fills. Specimens were prepared using a custom mold to simulate clinically relevant placement techniques, either incremental or bulk-fill techniques. Specimens stored in distilled water for either 24 h or 30 d. The incremental technique produced similar flexural strength between top and bottom layers, whereas the bulk-fill technique showed higher top-layer strength, except for the fiber-reinforced composite, which maintained comparable performance across layers and conditions. Long-term storage reduced differences among bulk-fill materials. Hardness was generally higher in packable composites, with the fiber-reinforced material outperforming other flowable types. Extended water storage only reduced the hardness of the conventional composite. The fiber-reinforced bulk-fill composite exhibited stable and superior mechanical performance under all conditions, whereas particulate packable composites remained the strongest overall. Incremental placement improved deep-layer properties in particulate bulk-fill composites.
The 2018 AAP/EFP Classification of Periodontal Diseases introduced staging and grading to improve the description of periodontitis severity and factors associated with disease progression. Although widely adopted in clinical and research settings, its validation has focused mainly on inter-examiner agreement, diagnostic concordance and prognostic performance, with limited evidence on patient-centred outcomes such as comprehension, recall and behavioural relevance. Available studies suggest that patients retain staging and grading poorly and instead rely on observable and functional indicators of disease, indicating a potential mismatch between clinical constructs and patient-relevant information for decision-making. This article examines the 2018 classification from a communication perspective, distinguishing diagnostic validity from communicative validity and evaluating whether extent, stage and grade can meaningfully support patient understanding. A pragmatic conceptual model reframes these constructs as communication components describing disease distribution, current burden and progression risk. Overall, although the 2018 system provides a structured framework for periodontal classification, its effectiveness as a communication tool remains uncertain. Future research should investigate how periodontal information can be structured to improve comprehension, recall and informed decision-making in practice.
Accessory root canal anatomy, including second mesiobuccal (MB2) and middle mesial canals (MMC), is difficult to identify and may compromise endodontic outcomes when missed, supporting artificial intelligence (AI)-based diagnostic tools. This systematic review (CRD420261415943) included studies evaluating AI models for accessory canal or root canal orifice identification, emphasizing MB2, MMC, and canal orifice detection. Study characteristics, imaging modalities, AI architectures, reference standards, outcomes, and validation strategies were extracted. Risk of bias was assessed using QUADAS-2 and certainty of evidence using GRADE. Seven studies were included. Most evaluated MB2 detection or segmentation on cone-beam computed tomography (CBCT); one assessed root canal orifice detection using dental operating microscope images, and one evaluated MMC detection. AI approaches included U-Net, YOLO, CNN-based pipelines, Inception V3-based machine learning, ChatGPT-4o, and nnU-Net. For MB2 detection/classification, sensitivity or recall ranged from 80.0% to 100%, specificity from 99.4% to 100% when reported, accuracy from 84.9% to 97.8%, and area under the curve from 0.57 to approximately 0.90. Segmentation/localization outcomes were heterogeneous. AI shows promise as an adjunct for accessory canal detection, particularly MB2 on CBCT, but evidence remains limited.
Community water fluoridation has been acclaimed as an effective mode of caries control at the population level. However, a recent review has concluded that in high-income populations with widespread access to topical fluorides, water fluoridation (0.7 ppm F) has a minor effect on the development of caries. It may therefore be relevant to take a historical look at the benefits of an oral health intervention that does not rely on the use of systemic fluorides, such as toothbrushing with fluoride toothpaste. We summarize the evidence from large population studies in the Nordic countries during the past 50-yr and show that it is possible to obtain and sustain low caries levels over decades by self-performed use of fluoride toothpaste. Topical fluoride at low concentrations treats/arrests active/progressing caries lesions by controlling mineral loss in dental hard tissues, thereby reducing the development of cavities. Toothbrushing with fluoride toothpaste shifts the entire caries distribution to the left, including the right-hand tail end of the distribution, ensuring that also the more disadvantaged groups may benefit. Daily brushing with fluoride toothpaste should be promoted and trained through school-based oral health programs for children. It is time for a reappraisal of fluoride toothpaste for public oral health.
This review critically examines the rising significance of nanoparticle (NP)-loaded biomaterial scaffolds in dental tissue engineering, focusing on their translational potential, limitations, and clinical relevance. These dual-functional scaffolds imitate the extracellular matrix and promote cell adhesion and proliferation, allowing for tissue regeneration with improved antibacterial, osteoinductive, bioactive, and drug delivery capabilities via NP integration. This report covers natural and synthetic polymers, such as collagen, chitosan, alginate, PCL, polylactic acid, and poly(lactic-co-glycolic acid), as well as NPs, such as AgNPs, ZnO, and nano-hydroxyapatite, for bone, periodontal, and pulp-dentin regeneration. A comprehensive and comparative study is offered that links scaffold type, NP function, biocompatibility, and regenerative outcomes, revealing important translational obstacles. The manuscript also covers clinical translation, with an emphasis on commercialization and regulatory issues, such as nanotoxicity, biosafety, scalability, reproducibility, cost-effectiveness, and approval frameworks (Central Drugs Standard Control Organization, Food and Drug Administration, and CE). Despite considerable preclinical potential, the analysis identifies inadequate clinical evidence, standardization concerns, and regulatory constraints as significant challenges to clinical implementation. Overall, this review gives a more detailed and critical translational viewpoint on NP-based scaffolds in dental regeneration.
This study investigated the association between self-reported sexual assault and dental service utilization among Brazilian adolescents (13-17-yr), considering sex differences and the moderating role of dental pain. Cross-sectional analyses using data from the 2019 Brazilian National School Health Survey were performed with stata 18.5, applying survey weights. The outcome was dental service use in the previous year, and the exposure was lifetime self-reported sexual assault. A total of 124,106 adolescents were included; 50.4% were female and 66.3% aged 13-15-yr. Overall, 66.7% reported dental visits in the previous year, 18.6% reported dental pain, and 6.2% reported sexual abuse. Adolescents with a history of sexual assault showed lower prevalence of dental service use compared with their non-abused peers (prevalence ratio [PR] = 0.96; 95% confidence interval [CI]: 0.92-1.00), particularly among girls (PR = 0.94; 95% CI: 0.89-0.98). Dental pain was associated with a modest increase in dental service utilization across all groups, with no evidence of effect modification. These findings suggest that sexual abuse is linked to reduced engagement with dental services during adolescence, especially among females, although the magnitude of this association is modest. The results emphasize the importance of trauma-informed and intersectoral strategies to improve access to oral healthcare for vulnerable populations.
This study investigated the biomechanical effects of shield thickness in the socket shield technique under immediate implant loading using high-fidelity three-dimensional finite element analysis. A maxillary model was developed incorporating cortical bone, cancellous bone, labial root fragment (shield), implant, abutment, and crown, with high anatomical fidelity to clinical conditions. Four shield thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were evaluated. Axial (0°) and oblique (30°) loads of 158.6 N were applied, and an abutment preload of 450 N was introduced to simulate prosthetic prestress. Equivalent stress, maximum principal stress, and total deformation of the shield, implant, and peri-implant bone were quantified. The biomechanical response exhibited nonlinear characteristics. Shield stress increased from 0.5 to 1.0 mm, peaked at 1.5 mm, and decreased at 2.0 mm, whereas total deformation increased progressively with increasing thickness. Peri-implant bone stress was concentrated at the shield-labial cortical bone interface and decreased as shield thickness increased. Implant stress reached its maximum at 1.5 mm and decreased toward both thinner and thicker configurations. A shield thickness of 1.0-1.5 mm demonstrated a favorable biomechanical balance between stress distribution and deformation control, potentially contributing to peri-implant bone preservation and enhanced early implant stability under clinically relevant loading conditions.
