A Commentary on Harris et al. RETURN randomized controlled trial to increase adult routine dental visits. J Dent Res 2026; https://doi.org/10.1177/00220345261425929 . Two-arm, parallel-group, open-label, superiority randomised controlled trial evaluating whether RETURN (InteRvention to rEduce inequaliTies in the Uptake of Routine deNtal care) could increase routine dental attendance in adults attending for urgent care. The RETURN intervention involved a conversation with trained dental nurses using a set of booklets and videos to discuss participants’ perceived barriers to routine dental care and to support participants in setting a dental visiting goal and action plan. A total of 1176 adults attending urgent dental care at 13 dental practices, or Liverpool Dental Hospital in North-West England, were recruited, consented, and randomised. Of these, 591 were allocated to RETURN and 585 to standard care. Participants and those delivering the intervention and conducting follow-up were therefore aware of treatment allocation. Eligible participants had not attended a dentist for a non-emergency appointment for at least 2 years, did not have a dentist for routine care, had adequate English language skills and were responsible for arranging their own appointments. The two primary outcomes were, (i) attendance at a routine NHS dental appointment within 12-months, measured using Business Services Authority administrative records, and (ii) oral health-related quality of life, measured using OHIP-14 scores at 12-months adjusted for baseline values. Secondary outcomes included follow-up at 6- and 18-month time points, hospital/private care use, self-reported attempts to obtain routine care, dental anxiety, urgent dental attendance, prescriptions, and treatment received. The analysis followed the intention-to-treat principle. Analyses were carried out using mixed-effects regression models adjusted for relevant design factors. Sensitivity analyses examined alternative approaches to administrative record matching, adjustment for baseline characteristics, and missing data. At 12 months, those in the intervention group saw a 21% increase in the odds of routine dental attendance (odds ratio [OR]: 1.21; 97.5% confidence interval [CI]: 0.86 to 1.70). Because the estimate was imprecise, the confidence interval was compatible with both a modest reduction and a substantial increase in attendance. Similarly, there was improvement in oral-health-related quality of life at 12 months (mean difference −1.12; 97.5% CI: −3.08 to 0.83). Whilst these results did not reach the threshold for “statistical significance”, it should always be remembered that “significance” is, at best, a crude threshold. In terms of secondary outcomes, at 18 months, participants in the intervention arm were substantially more likely to report attempting to make a routine dental appointment (OR: 3.39; 97.5% CI: 1.83 to 6.27). There was also evidence of a small reduction in dental anxiety at 18 months. This study suggests that behavioural interventions delivered during urgent dental care may have a small effect on routine attendance and oral health-related quality of life, though the estimates were imprecise. The trial was conducted in a context of limited routine dental appointment availability, which may have constrained the extent to which increased attempts to obtain care translated into realised attendance. Importantly, the authors emphasised that behavioural interventions are a complement, not a replacement, for structural reforms to address accessibility.
Rao S, Zhou J, Niu W, Dong C, Pan S, Sun W. Partially demineralised allogeneic cancellous bone plug versus deproteinized bovine bone mineral for guided bone regeneration: a pilot randomised controlled clinical trial. Clin Oral Investig. 2026;30:228. https://doi.org/10.1007/s00784-026-06914-8 . The present pilot randomised controlled clinical trial (RCT) evaluated the regenerative potential of a partially demineralised allogeneic cancellous bone plug (ACBP) by comparing it with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR). The authors included 25 adults aged 18–65 years requiring GBR before implant placement and randomly allocated them to ACBP (n = 12) or DBBM (n = 13). The selected sites included posterior mandibular extraction sockets with horizontal defects >5 mm and 3- or 4-wall defects, and maxillary posterior sites with remaining bone height <5 mm that needed lateral-window sinus floor elevation. Post 6 months before implant placement, CBCT assessment was done to measure bone dimensions, and 3-mm trephine bone biopsies were collected for histological and histomorphometric assessment. Histomorphometric analysis of RG% and VB% was conducted on H&E-stained 3-mm bone core biopsies, while CBCT assessed bone dimensional changes in the sinus floor elevation and socket preservation subgroups. Statistical analysis was performed using SPSS 25.0; normality was assessed using the Shapiro–Wilk test, and between-group comparisons used independent-samples or Welch’s t-tests, as appropriate. Exploratory ANCOVA adjusted 6-month sinus height gain for baseline residual subantral bone height. Statistical significance was set at two-sided P < 0.05. Both ACBP and DBBM groups did not show statistically significant differences in terms of regenerative and dimensional outcomes, except that at 6 months RG% was less in ACBP when compared to DBBM. Histologic and Histomorphometric evaluation showed no significant difference in newly formed VB% between ACBP and DBBM (38.84 ± 8.37% vs 32.18 ± 11.04%; P = 0.105), however, RG% remained significantly lower in the ACBP group (11.18 ± 5.48% vs 19.80 ± 8.23% in the DBBM group, with P = 0.006). Whereas in the sinus floor elevation subgroup after 6 months, mean height gain was non-significant between the groups (7.82 ± 1.52 mm in ACBP vs 8.21 ± 4.30 mm in DBBM, with P = 0.852), and the difference in 6-month augmented bone height remained non-significant after adjustment for baseline residual subantral bone height (P = 0.801). In the extraction socket preservation subgroup, changes in ridge height and width at 8, 10, and 12 mm after 6 months were also not significantly different between groups (P > 0.05). The present RCT indicates that ACBP, a relatively less established grafting material, did not demonstrate statistically significant differences from the widely used and well-documented DBBM for most regenerative and dimensional outcomes, except for a lower residual graft fraction at the ACBP site after 6 months. These findings provide preliminary evidence regarding the potential of ACBP in guided bone regeneration. However, further multicentre studies, larger sample sizes, longer follow-up, and indication-specific evaluation are required to establish its long-term clinical effectiveness and applicability.
Pai Khot AJ, Varghese AS, Ankola AV, Sankeshwari RM, Hampiholi V, Sutar KP, … Kumar RS. Clinical Effectiveness of Ocimum basilicum Mouthwash as an Adjunct to Toothbrushing in Managing Patients With Plaque-Induced Gingivitis: A Randomized Controlled Trial, Int J Dent Hyg 2026:24; 188–196. https://doi.org/10.1111/idh.70017 . A double-blinded parallel-arm randomized controlled study compared 30% Ocimum basilicum (OB) mouthwash to 0.2% chlorhexidine (CHX) over 21 days. 70 adults with plaque-induced gingivitis (n = 35 per arm). Both groups demonstrated statistically significant reductions in the gingival index (GI) and plaque index (PI) from baseline; all values are expressed as mean ± SD. CHX produced significantly greater reductions at 21 days (GI: 0.48 ± 0.18; PI: 0.59 ± 0.14) compared to OB (GI: 0.72 ± 0.22; PI: 0.77 ± 0.19). The study authors concluded that OB was non-inferior (NI) to CHX. This commentary finds that conclusion unsupported: no formal non-inferiority analysis was performed; the trial was substantially underpowered for the claimed design, and the margin was not anchored to CHX’s effect versus placebo.
The relationship between systemic lupus erythematosus (SLE) and periodontal disease remains incompletely understood, with conflicting evidence regarding the extent and nature of periodontal involvement in affected individuals. Given the systemic inflammatory burden and immune dysregulation characteristic of SLE, a clearer understanding of its potential impact on periodontal health is clinically relevant. A systematic review and meta-analysis of observational studies was conducted following predefined eligibility criteria, with each study classified according to its actual sampling and measurement structure rather than the design label reported by the original authors. Multiple electronic databases were searched, and studies comparing periodontal parameters between patients with SLE and systemically healthy controls were included. Outcomes assessed comprised periodontitis prevalence, probing depth, clinical attachment level, bleeding on probing, plaque-related indices, and other periodontal and oral health parameters. Random-effects models were used to calculate pooled effect estimates, and heterogeneity was assessed using the I² statistic. Two sets of sensitivity analyses were performed, one a targeted single-study exclusion of the study with the most extreme effect estimate for outcomes with marked heterogeneity, and another removing studies whose values were derived from medians and interquartile ranges. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E) tool, and a formal audit for overlapping participant cohorts was undertaken. A total of 20 studies comprising 174,477 participants (3,021 with SLE and 171,456 controls) were included, after excluding two reports for cohort overlap and one conference abstract. Patients with SLE showed a significantly higher prevalence of periodontitis (RR = 1.60; 95% CI: 1.10–2.33; p = 0.01), an estimate that was attenuated but remained significant after removal of the study with the most extreme effect estimate (RR = 1.42; 95% CI: 1.03–1.95) and carried a wide 95% prediction interval (0.40–6.34). No significant differences were found between groups for clinical attachment level, bleeding on probing, probing depth, or plaque index. Gingival index could not be pooled, as only two studies reported it in different age strata, and visible plaque index and salivary pH are reported descriptively rather than as pooled estimates. Salivary pH was consistently lower among patients with SLE in both contributing studies. Neither set of sensitivity analyses, addressing single extreme studies or median-derived values, changed the statistical significance of any outcome, although the magnitude of the periodontitis estimate remained uncertain. Risk of bias, assessed using ROBINS-E, reflected some concerns or high risk in all but one study, driven largely by unadjusted or unreported medication exposure. Certainty of evidence was very low across all seven quantitatively synthesized outcomes. The available evidence suggests a possible association between SLE and a higher prevalence of periodontitis, without corresponding significant differences in most continuous periodontal parameters. These findings should be interpreted with caution given the observational and cross-sectional nature of all included studies, pervasive risk of bias related to unadjusted medication exposure, and very low certainty of evidence throughout. Well-designed prospective studies with standardized periodontal assessment and explicit stratification by disease activity and medication class are needed to clarify the nature and clinical relevance of this relationship.
This systematic review aimed to summarize the factors that can influence the success rate of restoration repair. A search was carried out in the PubMed, Scopus, EMBASE, Web of Science and ProQuest databases in January 2026. Inclusion criteria were randomised controlled trials (RCTs) or non-randomised studies of interventions (NRSIs) with data on restoration repair; and exclusion criteria were follow-up less than 12 months, loss to follow-up higher than 30%, studies, evaluating anterior teeth and unclear evaluation criteria. The risk of bias was assessed using the RoB 2 tool for RCTs and ROBINS-I for NRSIs, and the certainty of evidence with the GRADE tool. A single-arm meta-analysis assessed the pooled proportion (95% CI) of repair success rates. Subgroup meta-analyses were also performed. Ten studies were included in the final qualitative and quantitative synthesis; however, only seven studies (five RCTs and two NRSIs) were eligible for meta-analysis after stratification by follow-up time. The studies included 302 participants and 542 repaired restorations. The most consistently reported follow-up periods for quantitative analysis were 24 and 120 months. The estimated overall success rates ranged from 78% (95% CI: 67 to 88) in RCTs to 82% (95% CI: 57 to 100) in NRSIs. No factors were identified as significantly influencing repair success, likely reflecting the limited number of studies and the substantial heterogeneity of the available evidence. Most RCTs presented some concerns regarding risk of bias, especially related to study registration and deviations from intended interventions. Among NRSIs, risk of bias varied from low to moderate due to missing data. Only studies involving permanent teeth were eligible. Interpretation of these findings is limited by the low to very low certainty of the evidence, the small number of eligible studies, substantial methodological heterogeneity, and imprecision of the pooled estimates. Although the available evidence suggests favourable long-term outcomes for retoration repair in permanent teeth, the low to very-low certainty of evidence and substancial heterogeneity limit confidence in these findings. Further well-designed studies are needed to clarify the determinants of repair outcomes and strengthen evidence-based clinical decision-making.
