Increasing occlusal vertical dimension can be critical in the management of severely worn dentition, yet this approach remains controversial due to potential adverse effects. This article presents a comprehensive, digitally driven workflow that integrates aligner therapy to optimize both function and esthetics in an Angle class I patient with severe erosive wear. By leveraging orthodontic pre-alignment, minimally invasive restorative protocols, and advanced visualization tools, a predictable outcome was achieved in a complex full-mouth rehabilitation case.
Because dental implant post-surgical pain is mainly driven by inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (eg, Advil\'ae, Motrin\'ae IB) or naproxen sodium (Aleve\'ae) are logical choices to address it. These drugs are highly efficacious, non-addicting, and generally well tolerated. Dental implant patients, however, are generally older than those having their impacted third molars removed and are, therefore, likely to present with more comorbidities and drug intake, leading to potentially more adverse effects and serious adverse drug interactions. Fortunately, pain following dental implant surgery is generally milder than that of impacted third molar surgery and is amenable to low over-the-counter (OTC) dosing regimens. Administering NSAIDs immediately after surgery before the local anesthesia has worn off and then around the clock for 2 to 3 days appears to be an effective strategy at not only preventing the onset of postoperative pain, but also diminishing breakthrough pain, which is typically seen with as-needed (PRN) dosing. Implant surgeons must be able to identify those patients in whom a short course of NSAIDs can be used safely and employ dosing strategies that provide optimal analgesic efficacy while limiting untoward events. This article discusses current recommendations for postoperative pain management in dental implant patients, emphasizing the role of NSAIDs while addressing patient-specific safety considerations.
Peri-implantitis represents a biologically complex, biofilm-mediated inflammatory condition characterized by progressive loss of supporting bone and soft tissue around dental implants, with a reported prevalence approaching 22%. The pathogenesis of peri-implantitis is multifactorial, involving dysregulated host immune responses, altered peri-implant tissue biology, and persistent microbial biofilm, which collectively hinder the predictability of conventional periodontal therapies. This article provides a comprehensive overview of currently available treatment modalities with an emphasis on implant surface decontamination as a critical determinant of clinical success. Both chemical and mechanical detoxification strategies are reviewed, including saline, citric acid, chlorhexidine, hydrogen peroxide, and hypochlorous acid, as well as air abrasion, implantoplasty, and emerging electrolytic cleaning technologies. While many of these approaches demonstrate the ability to reduce microbial load and clinical inflammation, no single modality has demonstrated consistent superiority, and true re-osseointegration remains difficult to achieve. Electrolytic cleaning has shown promising early evidence for facilitating re-osseointegration in preclinical and limited clinical studies, representing a potential advancement in peri-implantitis management. Clinically, effective treatment requires complete disruption of the biofilm and detoxification of the implant surface, often necessitating surgical intervention when osseous defects are present. This review highlights the advantages, limitations, and biologic implications of each modality, underscoring the need for a multifaceted, case-specific approach. Future research should focus on long-term human outcomes and optimization of combined therapeutic protocols to improve predictability and implant survival.
INTRODUCTION:A 61-year-old woman with lifelong Goldenhar syndrome was treated with a combination of zygomatic, pterygoid, and conventional dental implants using the PATZi protocol algorithm. All implants were immediately loaded and the patient received final restorations after 7 months of healing. Since that time, the patient has received yearly maintenance. RESULTS:The patient healed uneventfully and has functioned for close to 5 years from the date of surgery. DISCUSSION:Craniofacial structures affected by Goldenhar syndrome typically result in several dental complications, including malocclusion, increased potential for decay, and challenging environments for the placement of dental implants. While a few publications have reviewed treatment of children and adolescents afflicted with Goldenhar syndrome, none have documented treatment of adults. Asymmetric mandibular hypoplasia and secondary underdevelopment of associated maxillary and malar structures make prosthetic restoration of these patients difficult. These craniofacial deficits may be addressed using remote anchorage fixtures including zygomatic and pterygoid dental implants. CONCLUSION:With nearly 5 years of successful outcome, treatment of the patient in this case report indicates that remote anchorage implants may be a potential solution to address prosthetic needs of persons affected by Goldenhar syndrome.
Artificial intelligence (AI) is moving rapidly from research into everyday dental practice. Tools capable of analyzing imaging and assisting with clinical decisions are now commercially available. Systematic reviews and meta-analyses published between 2021 and 2025 demonstrate that deep learning algorithms achieve pooled diagnostic sensitivity of 0.94 for approximal caries detection on bitewing radiographs, 0.93 for periapical radiolucent lesion detection with high GRADE certainty of evidence, and 0.88 for periodontal bone loss assessment. As of late 2025, more than 44 AI-enabled dental devices had received US Food and Drug Administration 510(k) clearance as Class II Software as a Medical Device, and robotic-assisted implant surgery systems demonstrated mean angular deviations below 1.5 degrees in clinical series exceeding 270 placements. These developments raise a question the profession must now answer: at what point does the availability of validated AI tools cross from a competitive option into the standard of care? Early empirical liability research suggests that juror perceptions may increasingly favor clinicians who incorporate validated AI decision-support tools, although dental-specific legal precedent remains limited. This article reviews the clinical evidence across dental disciplines, traces the historical pattern by which technologies have reshaped practice expectations, analyzes the medicolegal framework for professional accountability, and proposes guidelines for responsible integration alongside a discussion of limitations, including automation bias, algorithmic fairness, and the gap between regulatory clearance and independent scientific validation.
Oral nicotine pouches (ONPs) are growing in popularity, particularly in younger demographics. While current evidence suggests ONPs likely pose lower toxicant exposure than combustible and smokeless forms of tobacco products, ONP use is not free from harm. Local mucosal irritation and tissue changes have been documented, and impacts on the periodontium and oral microbiome as well as carcinogenic potential have been suggested. Given the limited evidence on long-term effects and the variability in ONP product composition, clinical caution and patient monitoring among dental professionals is warranted. Dental professionals have a responsibility to screen for oral lesions associated with ONP use while providing counseling for current ONP users about the potential risks associated with these tobacco-free nicotine products. This article seeks to inform dental healthcare professionals about the prevalence of ONP use and the oral and overall health impacts of ONPs and highlight the role of the dental healthcare professional for patient education and nicotine cessation.
Resorption following tooth loss often presents challenges to both functional and esthetic outcomes of dental implant treatment for lost dentition, especially in the esthetic zone. Inadequate bone volume at the implant site is common, and bone augmentation is often required. While autogenous bone is often preferred, it is not applicable in many cases. This can necessitate multiple surgeries and extended healing times for patients. In such situations an alternate protocol, the facial allograft shield technique using an allogeneic laminar bone membrane, appears to offer a minimally invasive, effective alternative for managing type II socket defects in the esthetic zone, potentially expanding the pool of candidates eligible for immediate protocols.
Newer high-strength injectable composites are increasingly being used as a transitional restorative material for complex wear and/or erosion cases. Featuring excellent fractural strength, wear resistance, and gloss retention, these durable composites are placed using an injection-molding technique utilizing clear matrices obtained from a diagnostic wax-up. In the past, this method employed only one matrix per arch and required time-consuming isolation of individual teeth. However, the technique has evolved into one that treats alternating teeth using two matrices per arch to more efficiently facilitate bonding. This approach allows for a full-mouth rehabilitation in a single appointment, yielding immediate cosmetic and functional results and typically requiring only minimal follow-up to check occlusion and esthetics. The presented case report demonstrates this application of injection-molded composite as a transitional full-mouth restoration strategy, showing 6-year follow-up.
Misclassification of halitosis frequently results in ineffective treatment. A clinical classification system is presented that organizes halitosis into eight types based on etiology and clinical presentation. Intraoral causes include tongue biofilm, periodontal disease, peri-implant disease, and xerostomia-associated halitosis, while extraoral causes comprise airway related conditions and metabolic/systemic disorders with pulmonary elimination of bloodborne compounds. Perceptual conditions are categorized as pseudohalitosis and halitophobia. A diagnostic workflow is proposed to guide clinicians in distinguishing etiologies.
Penicillins are important beta-lactam antibiotics that are frequently used in dentistry. Many odontogenic infections are sensitive to penicillin. An allergic reaction to penicillin is an undesirable and life-threatening response mounted by the immune system. Penicillin allergies can be either Type I Anaphylactic reactions or Type IV Delayed reactions. Concerns regarding penicillin allergy over-reporting and the prescribing of potentially less effective yet more expensive alternatives have been topics of discussion in recent years. This article aims to provide a comprehensive review of the literature on penicillin allergy epidemiology, risk stratification, clinical manifestations, tests needed for allergy confirmation, allergic reaction management, antibiotic stewardship, and alternative medications to use in penicillin-allergic patients.
PURPOSE:Miniscrew-assisted rapid palatal expansion (MARPE) is often indicated to resolve transverse problems, and its potential effects at the dental, dentoalveolar, skeletal, and soft-tissue levels must be taken into account. This article evaluates these effects on adult and young adult patients using cone-beam computed tomography (CBCT). MATERIALS AND METHODS:For validation of the studies in this review, the PubMed, Scopus, and Cochrane platforms were evaluated from 1965 to 2023. The selection criteria were studies that examined the effects produced after MARPE. For the validation and level of evidence, the Oxford Centre for Evidence-Based Medicine (OCEBM) classification was used, while the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) scale was applied for the assessment of risk of bias. RESULTS:After reviewing 426 articles, the authors compared a total of 11 articles, in which the dental, dentoalveolar, skeletal, and soft-tissue effects following MARPE treatment were evaluated. The main limitation was the lack of uniformity in the use of the different devices for MARPE. CONCLUSIONS:MARPE in young adult patients is confirmed as an effective treatment for transverse problems, with increases in maxillary width observed in all studied areas; the success of the procedure, however, appears to be age-dependent with success rates decreasing after age 30.
The introduction of fluoride in drinking water to reduce the incidence of dental caries, once hailed as a major public health success, has recently come under scrutiny. In August 2024, a monograph from the National Toxicology Program (NTP) reported that fluoride at levels above 1.5 mg/L is associated with reduced intelligence quotient (IQ) in children. In September 2024, a US district judge required that the Environmental Protection Agency take action regarding the "unreasonable risk" posed by fluoride in drinking water. In May 2025, the Food and Drug Administration initiated efforts to remove ingestible fluoride prescription products. Effective May and July of 2025, Utah and Florida, respectively, became the first states to ban fluoride from public drinking water. These recent policy changes warrant a review of the history of fluoride's use for reducing caries, the evidence for fluoride in water and oral health products, the current criticism of fluoride, and the evidence for the effectiveness of fluoride alternatives.
Impacted maxillary canines present significant esthetic, functional, and surgical challenges for dental clinicians. This article introduces a CBCT-guided, 3D-assisted diagnostic and treatment protocol supported by a novel, clinically driven classification system. Three management strategies are outlined: extraction with implant placement, implant placement through the impacted canine, and prosthetic alternatives when surgical risks are excessive. The proposed framework facilitates interdisciplinary planning, improves surgical precision, and supports predictable, patient-specific outcomes in complex clinical scenarios.
Dental implants are widely used to replace missing teeth, providing a long-term solution for patients seeking functional and esthetic restoration. Concerns about implant failure and post-surgical complications, however,can arise, particularly in patients with known penicillin allergies. Because penicillin is often the first-line antibiotic used for infection prophylaxis in dental procedures, alternative antibiotics such as clindamycin are commonly prescribed for these patients. Penicillin allergy is associated with a higher risk of dental implant failure than in non-allergic patients, particularly when clindamycin is used as an alternative prophylactic antibiotic. Further research is needed to explore the optimal antibiotic regimen and minimize the risks of implant failure and infection in this patient population. This article reviews the clinical implications when caring for patients with selfreported penicillin allergies receiving dental implant therapy.
Mandibular staple implants were historically used to manage mandibular fractures and retain overdentures but are associated with long-term complications. This case report describes an 85-yearold patient with chronic infection and bone loss related to a decades-old mandibular staple implant. Digital planning facilitated safe implant removal, grafting, and reconstruction using narrow-diameter endosseous implants. The article highlights surgical challenges, risk mitigation, and successful functional rehabilitation in a severely atrophic mandible.
This case details a 7-year follow-up of an adult patient who underwent comprehensive restorative treatment for an esthetic disability managed using established risk-based protocols. Thetreatment prioritized minimal invasiveness and functional stability without the need for orthodontic intervention. The results demonstrate long-term success and managed risks highlighting the predictability of the interdisciplinary, conservative approach that was taken. The patient continues to experience functional stability, pleasing esthetics, and an enhanced quality of life.
One of the toughest challenges in esthetic dentistry is to match the shade of full-coverage crowns and resin-bonded laminate veneers on maxillary incisors. This is particularly difficult when dealing with dissimilar underlying substrates, varying levels of tooth discoloration, and different amounts of sound structure. This clinical report describes an alternative approach for matching the color shade in the anterior area to overcome substrate-related esthetic limitations. To facilitate the tooth being crowned, a core was made from high-opacity lithium-disilicate ceramic, with the shape and shade of the adjacent teeth prepared for veneers. Four veneers were fabricated from high-translucency lithiumdisilicate ceramic and bonded to the natural teeth and the lithium-disilicate core using the same resinbased composite cement to achieve a uniform shade on all restored teeth. A digital workflow was applied to design and manufacture the restorations. This case report demonstrates that the combination of a medium- or high-opacity lithium-disilicate substructure and thin veneers, supported by a digital planning workflow, can provide a viable solution for anterior cases with varying substrate discoloration and restoration thickness.
TTo achieve and maintain excellence and be profitable, dental practices must monitor and understand their business performance data. This involves tracking key performance indicators (KPIs), which are measurements that are critical to any business. Vital to a dental practice's success, KPIs serve as clear indicators of the general health of a practice and can reveal areas where the practice performs well and where its weaknesses lie. Tracking KPIs can open up opportunities for the practice to improve and succeed. This article defines what KPIs are, presents seven of the most important ones relative to dental practice production, and describes why practices need to track them. Monitoring these KPIs is intended to benefit any dental practice that is aiming to increase production, control overhead, and boost profitability.
This article presents a clinical case of a comprehensive full-mouth rehabilitation in a 26-year-old female patient with an anterior open bite and accompanying mild chronic generalized periodontitis. Contemporary digital methods involving diagnosis, modeling, and restoration fabrication were utilized. The case encompassed the use of CAD software, a Kois deprogrammer, extraction of impacted molars, cut-back technique, and artistic layering of ceramics on a lithium-disilicate framework. Significant improvements were demonstrated in both esthetics and function, with results remaining stable after 1 year of follow-up.
Adhesive bonding is a critical step in prosthetic and restorative dentistry. Over the years, the evolution of adhesives and bonding systems has focused on simplicity, efficiency, and reliability in clinical practice procedures to achieve less-invasive, long-term, durable direct and indirect restorations.1 Recently introduced universal adhesives and resin cements offer easy-to-use options that combine the strengths of previous generations of bonding agents into a versatile, user-friendly one-step solution. However, it is important to define what constitutes a "universal" system and to critically assess whether these new systems truly meet the criteria.
