A COMMENTARY ON:Bilmez Selen M, Kuru B. Effect of preoperative ibuprofen on pain perception and pulse rate in paediatric patients with deep caries: a randomised controlled trial. Eur J Paediatr Dent. 2026:1. https://doi.org/10.23804/ejpd.2026.2598 . DESIGN:A prospective, parallel single-blinded randomised controlled trial aimed to evaluate the effect of pre-operative ibuprofen administration on pain control during vital pulp therapy (VPT) procedures for a mandibular molar diagnosed with reversible pulpitis. Participants were randomised through a computer-generated random sequence that was concealed in sealed envelopes. Participants received either oral ibuprofen (10 mg/kg) 40 minutes before treatment (intervention group) or no pre-operative analgesia (control group). CASE SELECTION:A total of 46 participants, aged 7-13 years, were recruited from the Department of Paediatric Dentistry at the Faculty of Dentistry in Malatya, Türkiye. The sample size was based on a power calculation, determining the estimated effect size from a prior study restoring teeth in children with MIH. One participant from each group was excluded (suspected irreversible pulpitis) prior to randomising. Inclusion criteria included no history of systemic disease, cooperative behaviour, a clinical and radiographic diagnosis of reversible pulpitis (positive cold test response and no swelling, abscess or periapical pathology), in a mandibular molar, due to dental caries (ICDAS 5-6). A standardised treatment protocol was provided and undertaken by a single paediatric dentist. The type of VPT included protective liner, direct pulp capping, partial pulpotomy, or coronal pulpotomy, and was determined by the operator and based on cavity depth and presence, or not, of a pulp exposure. DATA ANALYSIS:The primary outcome measured was intraoperative pain intensity, assessed using the visual analogue scale (VAS; 0-10) at the point of <1 mm pulpal proximity during the vital pulp therapy component of the treatment. Secondary outcomes measured include patients' intraoperative pulse rate (bpm), at baseline and at the same point as the primary outcome, and post-operative pain, using VAS, post-operatively at days 1, 3, and 7. Data were collected by an independent investigator, who was blinded to the randomisation. Data were tested for normality, and statistically analysed, using appropriate non-parametric tests. RESULTS:A total of 44 patients (30 girls, 14 boys) diagnosed with hyperaemic pulp were included in the study, with a mean age of 9.45 ± 1.76 years. The mean intraoperative VAS score was significantly lower in the intervention group (0.64 ± 1.14) compared to the control group (5.05 ± 3.51) [mean difference = -4.41; 95% confidence interval (CI): -5.78 to -3.04], p < 0.001. There was no statistically significant difference in postoperative VAS scores between the groups on days 1, 3 or 7. Pulse rate increased significantly in both groups during pulp proximity; however, the increase was significantly lower in the intervention group. No statistically significant differences were observed in VAS scores between individuals with open and closed apices in either the intervention group (p = 0.49) or the control group (p = 0.69) (Table 4). CONCLUSIONS:The study concluded that preoperative ibuprofen significantly improved intraoperative pain control and reduced stress responses during VPT in children. It was suggested that preoperative ibuprofen should be incorporated into routine practice for paediatric patients with reversible pulpitis as it will improve cooperation, reduce stress, and enhance overall treatment efficiency.
AIMS/OBJECTIVES:This systematic review aimed to assess whether supplementation with vitamin D compared to no supplementation or placebo might provide a significant benefit for periodontal and peri-implant health in terms of changes in probing pocket depth (PPD), clinical attachment level (CAL), tooth loss and implant loss. METHODS:Three databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) looking at the effect of vitamin supplementation on periodontal and peri-implant health with a minimum follow-up of 1 month. Meta-analysis of the weighted mean differences (MD), with 95% confidence intervals (CI) was performed when ≥3 studies with the same characteristics and follow-up were identified. RESULTS:Fourteen articles (13 RCTs and 1 CCT) were included for qualitative assessment, but none assessed the impact of vitamin D on peri-implant health. Three studies assessing the impact of vitamin D supplementation to non-surgical periodontal therapy with a total of four subset of subjects were included in the meta-analysis on changes in PPD with an estimated mean difference of 0.0023 mm (95% CI: -0.0378 mm to 0.0424 mm), which was not statistically significant (p = 0.9110). DISCUSSION:Vitamin D supplementation does not confer a statistically significant additional benefit to non-surgical periodontal therapy in reducing probing pocket depth. Although vitamin D may exert anti-inflammatory effects on gingival tissues, current evidence is limited, heterogeneous, and insufficient to support a clear clinical recommendation. No studies addressing peri-implant health outcomes were identified, underscoring a gap in the literature. Well-designed, long-term randomized controlled trials that control for confounding variables are needed to determine the role of vitamin D supplementation in periodontal health.
AIMS/OBJECTIVES:Periodontitis, a multifactorial chronic inflammatory disease that destroys the supporting structures of the teeth, is conventionally managed with treatments focusing on biofilm removal; however, these therapies do not fully address the dysregulated host response central to disease progression. To address this, chemically modified curcumin (CMC) analogues have been developed by modifying curcumin, a derivative of Curcuma longa, a host-modulating agent with potent anti-inflammatory and antioxidant properties. Recently, CMCs have been used to manage periodontitis. This scoping review systematically maps the available evidence on the therapeutic potential of CMCs and their analogues in managing periodontal disease. METHODS:A comprehensive literature search in online databases (PubMed, EMBASE, Scopus and Web of Science) using the keywords "chemically modified curcumin" AND "periodontitis" yielded 76 results. Among them, 15 original research studies that evaluated the effects of CMC analogues on periodontitis were reviewed according to the PRISMA-ScR guidelines. RESULTS:CMC2.24 was the most common analogue studied, followed by CMC 2.5, the mono-carbonyl analogue of curcumin (e.g., 1A) and iron-curcumin nanoparticles. They produced consistent anti-inflammatory and bone-protective effects across multiple in vitro, ex vivo and animal models. They suppressed the pathologically elevated MMP-9 and pro-inflammatory cytokines, including IL-1β, TNF-α and IL-6. Furthermore, they enhanced pro-resolving mediators, such as Resolvin D1. CMCs were superior to traditional curcumin, owing to their improved stability and bioavailability. DISCUSSION:Analysis of the extracted data from the included studies revealed that the CMC analogues effectively reduced excessive inflammation, tissue degradation and dysregulated immune response in periodontitis. CONCLUSION:CMC2.24 was a promising host-modulating agent in periodontal therapy. However, the results are mainly derived from preclinical studies and further human clinical trials are required to apply CMCs into everyday practice.
OBJECTIVE:To evaluate the accuracy and reliability of three AI platforms ChatGPT, Perplexity, and Google Gemini in assessing the methodological quality of systematic reviews using the AMSTAR 2 checklist, compared with expert manual evaluation in dental research. METHODS:A cross-sectional comparative study was conducted to assess the performance of three AI platforms ChatGPT, Perplexity, and Google Gemini in evaluating the methodological quality of 35 systematic reviews using the AMSTAR 2 checklist. Manual assessments by a domain expert served as the reference standard. Each AI system was prompted with a standardized AMSTAR 2 query, and item-level outputs were collected for direct comparison. Key metrics included percentage agreement, error proportions, and inter-rater reliability measured by Cohen's kappa. Error proportions represent the proportion of discordant assessments out of total valid pairwise comparisons across 16 AMSTAR-2 items. Differences between LLM-generated and reference AMSTAR-2 ratings were summarized using effect estimates with corresponding 95% confidence intervals. Comparative performance across platforms was assessed based on confidence-interval overlap rather than hypothesis testing. Results are presented as effect estimates with corresponding 95% confidence intervals, without hypothesis testing or statistical dichotomization. This approach provided a robust and reproducible framework to benchmark AI-assisted quality appraisal in dental evidence synthesis. RESULTS:Among 35 systematic reviews assessed, Perplexity demonstrated the highest agreement with expert AMSTAR-2 ratings (error proportion: 19.0%; weighted κ_w: 0.78, 95% CI 0.71-0.85), followed by ChatGPT (error proportion: 22.9%; weighted κ_w: 0.62, 95% CI 0.54-0.70) and Google Gemini (error proportion: 43.9%; weighted κ_w: 0.41, 95% CI 0.33-0.49). Perplexity also achieved the best sensitivity (81.3%, 95% CI 76.5-85.4%) and specificity (82.7%, 95% CI 78.1-86.5%) for correctly identifying high-quality reviews. Non-overlapping 95% confidence intervals suggest meaningful differences in performances among platforms, with Perplexity showing superior agreement across all metrics. Across all platforms, agreement was generally higher for non-critical AMSTAR-2 domains involving clear and structured reporting, whereas performance was weaker for critical domains requiring interpretation of complex methodological details, risk-of-bias considerations, and evidence synthesis procedures. CONCLUSIONS:Perplexity demonstrated the highest accuracy and agreement with expert assessments of the methodological quality of systematic reviews, suggesting its potential as a supportive AI tool for AMSTAR-2-based appraisal in dental evidence synthesis. In contrast, systematic biases observed in ChatGPT and Google Gemini underscore the continued need for human oversight to ensure the validity of methodological assessments. Differences in agreement and error proportions were observed across all models when compared with expert AMSTAR-2 evaluations, indicating meaningful variability in methodological appraisal performance, reinforcing that AI-assisted appraisal of systematic review methodology should complement rather than replace expert human judgment in dental research.
A COMMENTARY ON:Awawdeh L, Almesleh B, Hammouri H, Al-Qudah A. The outcome of pulp revascularization of necrotic mature permanent teeth with periapical lesions using platelet-rich fibrin versus induced bleeding: a prospective preliminary randomized clinical trial. Clinical Oral Investigations. 2026; https://doi.org/10.1007/s00784-026-06877-w . DESIGN:A single-centre, prospective, two-arm parallel randomised clinical trial presented as a preliminary (early-phase) investigation. CASE SELECTION:Fifty adults presenting with mature permanent teeth where the pulpal status was diagnosed as necrotic with associated periapical lesions were included. The pool of patients was allocated to one of two regenerative endodontic treatment protocols, each containing 25 patients. In one group, 25 patients underwent a procedure where a canal scaffold was generated by deliberately provoking bleeding from the periapical tissues (induced bleeding, IB). In the second group of patients, an autologous platelet-rich fibrin (PRF) membrane was placed to serve as a biological barrier. A clinical and radiographic review was done at baseline, 6 months, and 12 months after treatment completion. DATA ANALYSIS:Pre-specified endpoints were set to determine, firstly, tooth survival and overall treatment success and secondly, periradicular healing through radiographic evaluation. Within- and between-group comparisons were made using the appropriate statistical tests and statistical significance was set at p < 0.05. RESULTS:At the one-year mark, 98% of teeth had survived (47/48). Interestingly, survival did not differ meaningfully between the two treatment groups (p = 0.166). Both treatment options produced healing with a statistically significant reduction in periradicular pathology compared with baseline at the six- and twelve-month reviews (p < 0.001). Also, a statistically significant impact was found on the overall success rate at the endpoint (p = 0.022). In the IB group, a 100% success rate was achieved (23/23) compared to 75% in the PRF group (18/24), with a combined overall success of 85.4%. CONCLUSIONS:Whichever treatment pathway was followed, all teeth survived the chosen regenerative endodontic procedure after 12 months. The preliminary results indicated that results and clinical outcomes were comparable. Although the IB option showed a higher overall success rate, this finding should be interpreted with caution as the results fall within the early phase clinical evidence framework. Further investigations are required to determine the superiority of one method over the other.
BACKGROUND:Ozonated water is increasingly being explored as a gentler alternative to chlorhexidine for chemical plaque control because of its antimicrobial and anti-inflammatory properties and the absence of common side effects such as staining or altered taste. However, the evidence on its effectiveness-especially in healthy individuals-remains unclear. This systematic review and meta-analysis aimed to determine whether ozonated water is more effective than placebo or chlorhexidine mouthwash in reducing dental plaque. METHODS:An extensive literature search was carried out across PubMed, Cochrane Library, Scopus, Web of Science, LILACS, ScienceDirect, EBSCOhost, and Google Scholar up to August 5, 2025. Randomized controlled trials involving healthy participants and comparing ozonated water with placebo or chlorhexidine were included. In total, five studies were selected for qualitative synthesis, of which four were included in the meta-analysis. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. A random-effects model was applied to calculate standardized mean differences (SMDs) with 95% confidence intervals. RESULTS:The meta-analysis suggested that ozonated water may provide slightly better short-term plaque reduction than placebo or chlorhexidine (SMD = -1.35; 95% CI: -2.77 to 0.06). However, as the confidence interval crossed the line of no effect, this difference was not statistically significant. Risk of bias was high in one study, unclear in three studies, and low in one study. The overall certainty for plaque reduction was rated as "low". CONCLUSION:While ozonated water appears to be a promising short-term option for plaque control-especially for individuals unable to tolerate chlorhexidine-the current evidence is not strong enough to confirm that it works better than standard rinses or even plain water. Well-designed, longer-term clinical trials are needed before ozonated water can be recommended for routine daily use.
A COMMENTARY ON:Albashaireh ZS, Altallaq MK. Assessment of patient satisfaction and esthetic outcomes following treatment of post-orthodontic white spot lesions using a bioactive adhesive and resin infiltrant: a randomized split-mouth clinical trial. Journal of Dentistry. 2026;167:106565. DESIGN:Split-mouth randomized clinical trial of 20 orthodontically treated patients (13 female, 7 male) involving 120 teeth with anterior white spot lesions (WSLs). Each participant received ICON resin infiltration or Hi-Bond Universal in contralateral quadrants. Esthetic changes were assessed by the patients and by two independent clinicians using a 100-point visual analogue scale (VAS) at one-month recall. CASE SELECTION:Participants aged 16-30 years and who had completed fixed orthodontic treatment at least one month before enrollment were included. Eligible participants presented with at least one visible WSL on the labial surfaces of the anterior teeth or premolars on contralateral quadrants. All participants were required to have good oral hygiene, clinically healthy gingival tissues, and no evidence of active periodontal disease. DATA ANALYSIS:Categorical outcome data were presented using descriptive summary measures including frequencies and percentages. The proportion of satisfactory vs. unsatisfactory outcomes (paired binary data) was compared between the Hi-Bond Universal and ICON treatments using the McNemar test. RESULTS:Overall patient satisfaction was equally high (80%) for both treatments, and there were no significant differences between patient or clinician ratings. Inter-assessor agreement was deemed "fair" for both groups (Cohen's kappa 0.318-0.340). Thus, both ICON and Hi-Bond Universal effectively masked WSLs, as deemed by subjective esthetic evaluation. CONCLUSION:Both bioactive adhesives and resin infiltration achieve satisfactory esthetic outcomes in masking demineralized enamel, at least in the short-term. Further longitudinal studies comparing the outcomes of these materials would be beneficial to determine whether these effects are sustained over time.
A COMMENTARY ON:Lucchesi, VH, Giorgetti, APO, Corrêa, MG. et al. Impact of systemic resveratrol on non-surgical periodontal treatment of smokers: A 12-month randomized clinical trial. Clin Oral Invest 2025;29:428. https://doi.org/10.1007/s00784-025-06517-9 DESIGN: This double-blind, placebo-controlled randomized clinical trial evaluated whether systemic resveratrol (500 mg/day for 180 days) improves outcomes of non-surgical periodontal therapy in smokers with Stage III or IV, Grade C periodontitis. CASE SELECTION:Thirty-eight adult smokers were recruited from a university periodontal clinic and randomly assigned to receive full-mouth ultrasonic debridement combined with either systemic resveratrol or placebo (n = 19 per group). Eligible participants had at least 20 teeth, smoked a minimum of 10 cigarettes daily for at least five years, and presented with multiple periodontal sites exhibiting probing depth (PD) and clinical attachment loss ≥5 mm; patients with recent periodontal therapy, systemic diseases, pregnancy, or recent use of antibiotics or anti-inflammatory medications were excluded. Clinical parameters, including PD, clinical attachment level (CAL), position of gingival margin (PGM), full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS), were assessed at baseline and at 3-, 6-, and 12-month follow-up, alongside microbiological and immunoinflammatory markers. DATA ANALYSIS:The primary outcome was CAL, while secondary outcomes included PD, PGM, FMPS, subgingival microbiological profiles, and inflammatory cytokine concentrations. Data distribution was assessed using exploratory and normality testing, with appropriate transformations applied where necessary. Repeated clinical measures were analyzed using restricted maximum likelihood models and generalized estimating equations, while microbiological and immunological outcomes were compared using non-parametric tests. Missing data were addressed using multiple imputation, and statistical significance was set at p < 0.05. RESULTS:Compared with placebo, the resveratrol group demonstrated significantly lower PD and improved CAL throughout follow-up. At 12 months, PD was 2.80 mm in the resveratrol group versus 3.02 mm in controls, while CAL was 3.87 mm versus 4.39 mm, respectively. Resveratrol was also associated with lower levels of Aggregatibacter actinomycetemcomitans, reduced IL-1β at 3 months, and reduced IL-6 at 3 and 12 months. Both groups showed substantial improvements following therapy, and no major adverse effects were reported. CONCLUSIONS:Systemic resveratrol may improve clinical, microbiological, and inflammatory outcomes when used as an adjunct to non-surgical periodontal therapy in smokers with Stage III or IV, Grade C periodontitis.
A COMMENTARY ON:Chen H, Ji L, Wang Y, Klineberg I, Chen H. Dentition-Cognition Relationship in Aging Populations: A Meta-Analysis of Longitudinal Data. J Oral Rehabil 2026; 53: 924-38. DESIGN:Systematic review and meta-analysis of longitudinal observational studies. CASE SELECTION:Longitudinal cohort and case-control studies assessing dentition status (tooth loss or edentulism) and cognitive outcomes (dementia or mild cognitive impairment [MCI]) were included. Twenty-one studies with approximately 35.7 million participants and a mean follow-up of 8.9 years were analysed. DATA ANALYSIS:Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models depending on heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS:Tooth loss was associated with an increased risk of both dementia (OR 1.26, 95% CI 1.07-1.49) and MCI (OR 1.40, 95% CI 1.14-1.71), with stronger associations observed in individuals with edentulism, particularly for MCI (OR 1.90, 95% CI 1.07-3.35) and to a lesser extent dementia (OR 1.16, 95% CI 1.09-1.23). Findings also suggested a dose-response relationship, whereby increasing severity of tooth loss corresponded to greater cognitive risk. Subgroup analyses indicated higher risks in women and Western populations. Limited evidence also suggested that denture use attenuated this association, showing no significant increased dementia risk among denture wearers (OR 1.03, 95% CI 0.82-1.28). CONCLUSIONS:Tooth loss is associated with an increased risk of cognitive decline and dementia, with more severe tooth loss conferring greater risk. Prosthodontic rehabilitation may mitigate this association, suggesting a potential role for oral health in supporting cognitive ageing.
A COMMENTARY ON:Bomicke W, Schmitter M, Waldecker M, et al. Ceramic crowns and sleep bruxism: 3-year results of a randomized controlled trial. J Dent 2026;170:106691. https://doi.org/10.1016/j.jdent.2026.106691 . DESIGN:Prospective randomized controlled clinical trial with a 3-year follow-up evaluating the influence of Sleep Bruxism (SB) on the clinical performance of monolithic ceramic molar crowns. CASE SELECTION:A total of 109 patients requiring a single molar crown were enrolled. SB diagnosis included a structured questionnaire, clinical examination, and portable electromyography device (BruxOFF). Participants were allocated into four groups: lithium disilicate with SB, lithium disilicate without SB, zirconia with SB, and zirconia without SB. Standardized crown preparation, fabrication, and cementation protocols were used. Outcomes assessed were technical complications, survival, and success rates. The study time points were 1 week, 6 months, and 1, 2, and 3 years. DATA ANALYSIS:Survival was defined as restoration remaining in situ without replacement. Success is defined as restoration without biological or technical complications. Fisher's exact test was used to compare outcomes between SB and non-SB groups, with statistical significance set at α = 0.05. RESULTS:No technical complications occurred during the 3-year observation period. Survival rates remained high across all groups (95.2-100%), while success rates ranged from 81.5% to 95.8% for both ceramic materials. No statistically significant differences were observed between SB and non-SB patients or between lithium disilicate and zirconia crowns. CONCLUSIONS:Monolithic lithium disilicate and zirconia molar crowns demonstrated favorable clinical performance over three years, and SB was not associated with increased failure or complication risk.
BACKGROUND:"Spin" refers to the manipulation of language to suggest benefits when none exist, commonly observed in randomized controlled trials (RCTs). This study investigates the extent, strategies, and reporting quality of spin in digital dental implant RCT abstracts, and explores study characteristics associated with spin. METHODS:RCTs related to digital dental implants were retrieved from PubMed, Web of Science, Embase, Scopus, and the Cochrane Library. Spin was identified using predefined strategies, and logistic regression was performed to assess factors associated with its occurrence. Reporting quality was evaluated with the original 16-item CONSORT checklist for abstracts. RESULTS:We analyzed 19,795 articles, and a total of 127 abstracts were finally included in the reporting quality analyses, with spin identified in 51 abstracts (40.2%), where 24 abstracts (18.9%) exhibited spin in both "Results and conclusions" sections. A significantly lower presence of spin was observed in studies reporting exact p-values (OR: 0.317; 95% CI: 0.134-0.727; p = 0.007) and shorter abstract word limits for journal submission (moderate: OR = 0.185, p = 0.01; low: OR = 0.138, p = 0.02). CONCLUSIONS:The prevalence of spin in digital implant surgery RCTs is concerning. Given that busy clinicians often rely solely on abstracts for clinical interpretation, such distorted reporting may mislead practitioners into adopting expensive or complex digital technologies without robust evidence of superiority. It is essential for all stakeholders to prioritize transparent reporting to prevent biased clinical decision-making and safeguard the integrity of evidence-based dentistry.
A COMMENTARY ON:Ibrahim WI, Abdeen RM, Denewar MM, Kortam SA. Retention of telescopic versus LOCATOR attachments and marginal bone loss surrounding implant-retained maxillary overdentures: A 2-year randomized clinical trial. J Prosthet Dent. 2026;135:778-786. DESIGN:Prospective two-arm parallel randomised controlled trial (RCT) comparing telescopic and LOCATOR attachments for four-implant retained maxillary overdentures over 24 months. CASE SELECTION:40 patients with complete edentulism received four maxillary implants to retain a maxillary overdenture and two mandibular implants to retain an opposing mandibular overdenture. Patients were randomly allocated to telescopic or LOCATOR maxillary attachment groups. Inclusion criteria included adequate maxillary bone volume and quality, suitable inter-arch space, acceptable systemic health and absence of parafunctional habits or conditions affecting osseointegration. DATA ANALYSIS:Retention was measured using a digital force gauge at R0, one month after prosthesis delivery, and at 12 and 24 months. Vertical and horizontal marginal bone loss were assessed using standardised periapical radiographs and digital software. Between- and within-group comparisons were performed using t tests with Bonferroni correction. RESULTS:Telescopic attachments showed significantly greater retention than LOCATOR attachments at all time points. Telescopic retention decreased from 28.59 N to 15.63 N over 24 months, while LOCATOR retention increased slightly at 12 months before decreasing to 9.44 N. Marginal bone loss was significantly greater in the telescopic group at 12 and 24 months. One implant failed in the telescopic group. CONCLUSIONS:Telescopic attachments provided greater retention, whereas LOCATOR attachments were associated with less marginal bone loss. Both systems remained within accepted implant success thresholds over two years.
A COMMENTARY ON:Lawson ARJ, et al. Somatic mutation and selection at the population scale. Nature. 2025;647(8089):411-420. https://doi.org/10.1038/s41586-025-09584-w . DESIGN:A cross-sectional observational cohort study using advanced genomic sequencing to map somatic mutations and clonal selection in normal human tissues at the population level1. PARTICIPANTS:The authors used targeted NanoSeq, a duplex sequencing method achieving exceptionally low error rates (fewer than five errors per billion base pairs). The technique was applied to targeted capture of a 239-gene panel (0.9 Mb) in 1042 non-invasive buccal swab samples (median donor age 68 years, 79% female, 37% smokers) and 371 blood samples from the TwinsUK registry. DATA ANALYSIS:Mutation calling required strict duplex consensus filters. Gene-level selection was quantified using dNdScv, while site-level dN/dS analyses were used to identify recurrent hotspots and selected sites. Mutational signatures were deconvolved with sigfit, and multivariate mixed-effects regression modelled associations with age, smoking (pack-years), alcohol (drink-years), missing teeth, and other covariates. RESULTS:In the oral epithelium, single nucleotide variants (SNVs) accumulated at 18.0 per cell per year and indels (insertions or deletions in the genome) at 2.0 per cell per year. Across all 1,042 participants, the authors detected 341,682 somatic mutations, including approximately 62,000 estimated driver mutations across 46 positively selected genes (e.g., NOTCH1 mutant cells reaching approximately 10% by ages 65-85 years, TP53 ~ 3%). Nine genes showed negative selection. Two dominant mutational signatures emerged: a clock-like signature A (resembling SBS1 and SBS5) and an alcohol associated signature B (resembling SBS16). The authors reported that smoking and alcohol were associated with higher mutation burdens, and that some effects on clonal selection were inferred from regression analyses; missing teeth (a marker of poor oral health) were independently associated with higher overall driver density. Driver frequencies for NOTCH1 were similar in normal epithelium and head and neck squamous cell carcinoma (HNSCC), whereas TP53 was enriched in cancer. CONCLUSIONS:The authors concluded that optimised NanoSeq enables population-scale mutational epidemiology in polyclonal tissues, revealing an extraordinarily rich landscape of positive and negative selection in normal oral epithelium. Environmental exposures shape mutagenesis and may also influence clonal selection, supporting a plausible mechanistic link between smoking, alcohol, and oral cancer risk.
A COMMENTARY ON:Pereira Santos RM, Ottaviani G, Di Lenarda R, Biasotto M, Rupel K. MRONJ Risk Related to Dental Implants in Osteoporosis Treated with Denosumab: A Systematic Review. Oral Dis. 2026 Jan 8. https://doi.org/10.1111/odi.70181 . DATA SOURCES:A literature search using a combination of MeSH terms and specific keywords like osteoporosis, dental implants, jaws, osteoradionecrosis, MRONJ, Denosumab, and Bisphosphonates was conducted using Boolean operators in PubMed and Scopus, until October 2025, following PRISMA guidelines and a predefined PICO framework. STUDY SELECTION:Randomized clinical trials, retrospective studies, and case series (reporting a minimum of 4 patients) were included according to the following research question: "What will be the impact of dental implant in osteoporotic patients undergoing treatment with DEN on MRONJ development, considering both implant surgery-triggered osteonecrosis (ISTO) and implant presence-triggered osteonecrosis (IPTO). Only human studies published in English and evaluating osteoporotic patients treated with antiresorptive therapy (ART), including Bisphosphonates (BP's) and/ or Denosumab (DEN), and dental implants were considered eligible. DATA EXTRACTION AND SYNTHESIS:Relevant data, such as type of ART, dose and duration of therapy, timing of implant placement to differentiate between implant surgery-triggered osteonecrosis (ISTO) and implant presence-triggered osteonecrosis (IPTO), and stage of MRONJ, were extracted independently by two reviewers. The quality assessment of included studies was reported using appropriate tools according to the study design. RESULTS:Ten studies met the inclusion criteria, comprising one randomized controlled trial, two retrospective studies, one case-control study, and six case series, involving a total of 1823 implants placed in 8220 patients. Most patients were postmenopausal females (mean age = 71.45 years). Four studies reported implants placed prior to initiation of ART, whereas three studies analysed the implants positioned after therapy initiation. Implants were identified as a trigger for MRONJ in 8 studies, with 24 implants associated with MRONJ. Patients developed MRONJ after receiving several doses of DEN (two to nine); however, data related to dose and duration of monotherapy or after transitioning from BP's were inconclusive. The risk of bias ranged from moderate to high. Large variations in the study design, dose, and duration of ART, type of therapy (DEN alone or following transition from BP's), and follow-up periods produced highly heterogeneous data, restricting comparability. CONCLUSIONS:Current evidence suggests that MRONJ related to dental implants in osteoporotic patients treated with DEN is uncommon but clinically relevant, particularly in patients with prior bisphosphonate exposure or peri-implant inflammation. Most of the studies reported MRONJ associated with implants already in position, followed by antiresorptive therapy (IPTO). However, the results should be interpreted with caution, as there is a lack of homogeneous evidence regarding the impact of ART, especially Denosumab monotherapy, on the risk of MRONJ and implant failure in osteoporotic individuals. Well-designed prospective studies with standardized reporting of implant timing, antiresorptive exposure, and peri-implant conditions are needed to help in evidence-based clinical decision-making.
A COMMENTARY ON:Casas K, DiPede L, Toema S, Ogwo C. Assessing Teledentistry versus In-Person Examinations to Detect Dental Caries: A Systematic Review and Meta-analysis. JDR Clinical & Translational Research. 2025;11(1):4-15. https://doi.org/10.1177/23800844251320974 DESIGN: A systematic review and meta-analysis focusing on the diagnostic accuracy of teledentistry compared to in-person examinations for detecting dental caries in primary and permanent dentition. The authors conducted a search in PubMed and CINAHL via EBSCOhost and followed the PRISMA-DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy) guidelines. STUDY SELECTION:Comparative studies, including randomized and non-randomized clinical trials, that used DMFT/S or ICDAS indices and reported sensitivity and specificity as diagnostic parameters were considered eligible. Only studies published in English between January 2013 and December 2021 were included. Studies that did not meet these criteria were excluded. DATA ANALYSIS:QUADAS-2 and JBI checklists were used for risk of bias and critical appraisal. A DerSimonian-Laird random-effects approach was applied to conduct the univariate meta-analysis. Forest plots were generated for included studies, and sensitivity, specificity, diagnostic odds ratio (DOR), and confidence intervals were calculated. Heterogeneity was assessed using Cochran's Q and Higgins's I² to evaluate the variation across studies and the consistency of the results. RESULTS:Twelve studies reported sensitivity of 45.6-88.3% and specificity of 55.2-98.3% for teledentistry in caries detection. Accuracy ranged from 70% to 96%, and PPV/NPV were 79-92% and 48-97%, respectively. Heterogeneity was low (I² = 24%), and the DerSimonian-Laird random-effects model estimated a diagnostic odds ratio of 35.14, indicating high diagnostic performance. CONCLUSIONS:Teledentistry can be considered a method comparable to in-person examinations for diagnosing dental caries.
AIM:To evaluate whether systematic reviews (SRs) with or without meta-analysis or network meta-analysis focusing on non- and micro-invasive treatment of caries lesions in children and adolescents adhere to the PRISMA reporting guidelines and the PRISMA checklist and their extensions for Abstracts and Network Meta-analysis (NMA). MATERIAL AND METHODS:We conducted a comprehensive literature search up to 1st of September 2025 in the following databases: PubMed/MEDLINE, Scopus, Web of Science, and EMBASE. Gray literature was assessed through ProQuest and Epistemonikos, with no language or publication date restrictions. We included SRs focused on non- and micro-invasive caries treatment and excluded study protocols of SRs and SRs focused on special populations. Two independent reviewers extracted data from the included systematic reviews and assessed the adherence to PRISMA and its extensions as a reporting guideline. RESULTS:We retrieved 1221 publications; after duplicate removal and eligibility process, 45 studies were considered for further data extraction and 36 SRs for the assessment of the adherence to the PRISMA checklists. Two independent reviewers assessed the adherence to the PRISMA checklist, and the mean overall adherence was 70.8%. Thirty-six SRs (80%) reported following PRISMA. The PRISMA item with the lowest adherence was protocol pre-registration (n = 2; 12.5%). In contrast, the SRs reported following the PRISMA-NMA extension showed higher adherence to the checklist items. CONCLUSIONS:Despite the authors' declaration of adhering to PRISMA, several reporting items were not fully addressed in the systematic reviews on non- and micro-invasive caries treatments. Incomplete or inconsistent reporting limits clinicians' ability to interpret the sources of discordant findings across reviews and constrains the application of evidence-based judgments in pediatric caries management. Given the overall low reporting quality, not only is further improvement in these SRs essential, but some recommended management strategies should also be interpreted and implemented with caution until more robust and transparently reported evidence becomes available.
Supervised toothbrushing programmes (STPs) are widely implemented to improve children's oral health, yet it remains unclear which behaviour change techniques (BCTs) they use and whether these support children's toothbrushing at home. This rapid review addresses this evidence gap to inform programme design and evaluation. AIM(S):To conduct a rapid review of behaviour change techniques (BCTs) used in supervised toothbrushing programmes (STP1qs) and assess whether they support children's at-home toothbrushing. METHODS:A rapid review (Feb-Mar, updated Jul 2025) across PubMed, MEDLINE, Scopus and PsycINFO. Inclusion criteria focused on primary studies on children ≤12 years, STPs with any link to home brushing. Behaviour change techniques (BCTs), the active ingredients in changing behaviours, identified in included studies were code according Behaviour Change Taxonomy (BCTv1). BCTs were also mapped to COM-B mode of behaviour change and the Theoretical Domains Framework. There was no formal quality appraisal. RESULTS:From 187 records, 153 were screened, 16 full texts assessed, and 4 studies included (randomised controlled trials, mixed-methods, single-case). A range of BCTs was identified: instruction/demonstration, behavioural practice, prompts/cues, social support, environmental restructuring; incentives/rewards appeared in some trials. Only one study explicitly used the COM-B. Evidence for effects on home brushing was limited and largely parent-reported (e.g., greater enthusiasm, longer brushing, transfer of songs/charts), with no robust quantitative measures of home routines. CONCLUSION(S):Based on this rapid review, a number of STPs reliably embedded BCTs strengthening children's capability and opportunity to brush with the possibility of a "spill over" effect to home brushing behaviour. However, evidence that STB is associated with sustained at-home brushing remains weak and poorly theorised. Future evaluations should pre-specify mechanisms, measure home brushing with validated tools, and test which BCT combinations most effectively bridge school-to-home behaviour.
A COMMENTARY ON:Seijas Naya, F. Bernabeu Mira, J., C. Pérez Jardón, et al. "Influence of Abutment Shape on Implant Marginal Bone Remodeling: A Double-Blind, Randomized 24-Month Clinical Study." Clinical Oral Implants Research 1-11; https://doi.org/10.1111/clr.70085 DESIGN: A 24-month follow-up of a split-mouth randomised clinical trial with two parallel experimental groups: straight aesthetic antirotational abutments (Nueva Galimplant, Sarria, Spain) and concave antirotational abutments (Nueva Galimplant, Sarria, Spain). This continuation study, with 24-month post-loading data, re-analysed the 8 week post-placement and 6 month post-loading data, from the original study1. The primary outcome defined in the protocol was stability, measured as Implant Stability Quotient (ISQ), and secondary outcomes were Marginal Bone Loss (MBL), and Probing Depth (PD). CASE SELECTION:30 partially dentate patients (n = 80 implants) who required at least two posterior implants to be restored with single-unit crowns, were recruited at a secondary care academic department. Adults over 20 years old, who smoked less than 5 cigarettes per day, were at least 6 months post-extraction with healed bone able to accommodate 4 mm diameter and 10 mm length implants, without hard or soft tissue augmentation, were considered. Implants were placed transmucosally 4 mm from the future gingival margin, 1 mm below the alveolar crest, utilising 2 mm or 3 mm height abutments. Healing caps were removed at 8 weeks and outcomes measured, the implants were then loaded with crowns and outcomes measured again at 6- and 24-months post-loading. DATA ANALYSIS:A per-protocol analysis was done using independent-sample t-tests for dichotomous variables and paired-sample t-tests for intra-group bone level changes. Mixed linear regression models were used to assess the impact of abutment type and height on MBL, with individual variations weighted based on implant count per patient. Generalised Additive Models were also constructed. RESULTS:There was no statistical difference in stability, measured through ISQ, between groups at 24 months. There was no statistical difference in PD, bleeding and plaque scores either. At 8 weeks post placement, prior to loading, there was a statistically significant (p = 0.002) difference in MBL: straight abutments had an average of 0.54 mm (95% confidence interval 0.35 to 0.73) and concave abutments of 0.18 mm (95% confidence interval 0.05 to 0.31). A linear mixed-effects regression model was used to evaluate changes in marginal bone levels. Overall, implants restored with concave abutments showed significantly less MBL than those with straight abutments. The model also indicated that this difference appeared early after loading and remained consistent over the follow-up period. In addition, greater abutment height was associated with reduced MBL, suggesting a protective effect of increased abutment height independent of abutment type. Two implants 'failed' and one abutment fractured. Of the 12 implants excluded from the analysis, two had abutment fractures and four crown fractures, the rest were lost to follow-up. CONCLUSIONS:Concave abutments in this cohort had the same MBL at 24 months compared to straight abutments and had no effect on implant stability (ISQ) or periodontal indices such as, bleeding on probing, and PD. At 8 weeks there was a small disparity, less than 0.5 mm difference in MBL, but this appears to be clinically insignificant regarding the final 24-month MBL value.
