Objectives:Advanced glycation end products (AGEs) induce oxidative stress and cellular injury through excessive reactive oxygen species (ROS), contributing to aging- and diabetes-related degenerative conditions. Exosomes derived from stem cells from human exfoliated deciduous teeth (SHED) exhibit regenerative and cytoprotective properties. This study aimed to investigate the effects of SHED-derived exosomes on AGE-induced oxidative stress and cytotoxicity in neuronal cells. Materials and Methods:Exosomes were isolated from SHED-serum-free conditioned medium by differential ultracentrifugation and characterized using transmission electron microscopy, nanoparticle tracking analysis, and Western blotting for CD81, TSG101, and HSP70. Uptake of PKH26-labeled exosomes by SK-N-SH neuroblastoma cells was evaluated using confocal microscopy. AGEs were generated by incubating bovine serum albumin with glucose and confirmed by fluorescence analysis. Cell viability and intracellular ROS levels were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and 2',7'-dichlorodihydrofluorescein diacetate (DCHF-DA) assays, respectively. Proteomic analysis was performed to identify proteins associated with cytoprotective activity. Statistical Analysis:Data were presented as mean ± standard deviation from triplicate experiments. Statistical analysis was performed using one-way analysis of variance followed by appropriate post hoc tests. A p-value of < 0.05 was considered statistically significant. Results:SHED-derived exosomes exhibited a typical cup-shaped morphology with sizes ranging from 37 to 200 nm and expressed canonical exosomal markers. SK-N-SH cells efficiently internalized SHED-derived exosomes. AGE treatment induced dose-dependent cytotoxicity (IC50 = 5.24 mg/mL) and significantly increased intracellular ROS levels. Treatment with SHED-derived exosomes at 30 to 50 µg/mL significantly improved cell viability, whereas 20 µg/mL significantly reduced AGE-induced ROS accumulation (p < 0.05). Proteomic analysis identified proteins associated with oxidative stress response, cellular repair, and cell survival pathways. Conclusion:Exosomes derived from SHED attenuated AGE-induced oxidative stress and cytotoxicity in neuronal cells. These findings suggest the potential application of SHED-derived exosomes as a cell-free approach for oxidative stress-related cellular injury.
Objective:To move beyond simple prevalence reporting by applying an exploratory, transferable multi-method analytical framework to incidental findings on dental cone-beam computed tomography (CBCT). The framework combines multiple correspondence analysis (MCA), data-driven patient clustering, association rule mining, co-occurrence network analysis, and clinical burden quantification, and is intended to generate hypotheses for prospective validation. Materials and Methods:In this retrospective, cross-sectional, single-center study, 100 consecutive CBCT scans acquired for implant treatment planning were interpreted by a single board-certified oral and maxillofacial radiologist using a structured reporting template. Findings were classified into three investigator-defined clinical-action categories (I: intervention; II: monitoring/correlation; III: no action) and by anatomical domain. MCA (prevalence ≥5%) was followed by agglomerative clustering in MCA space; association rules were mined with the Apriori algorithm; a phi-coefficient co-occurrence network was built with Louvain community detection; and a weighted Clinical Burden Index (CBI) was computed per patient. Finding counts were modeled by Poisson regression, with sensitivity analyses for the prevalence threshold and CBI weights. This study is exploratory and hypothesis-generating. Results:Across 100 patients, 488 incidental findings (86 unique types) were identified (mean 4.9 ± 2.0; range 1-10), with Category I findings in 86% of patients. MCA yielded two dimensions explaining 43.9% of inertia. Clustering identified two exploratory phenotypes, "High-Burden Multimorbidity" (n = 23, mean 6.1 findings) and "Standard-Burden" (n = 77, mean 4.5; Kruskal-Wallis p = 0.001). Five association rules were found (top lift = 1.90, stable across thresholds), and a sparse, modular co-occurrence network bridged dental and nondental domains. Poisson regression identified Category I (incidence rate ratio [IRR] = 1.21, 95% confidence interval [CI]: 1.14-1.28) and Category III (IRR = 1.25, 95% CI: 1.16-1.34) counts as independent predictors of burden. Mean CBI was 10.3 ± 4.8; 18% of patients were high-burden, with tier assignment robust to weighting (Spearman ρ ≥ 0.90). An estimated 86% of patients would potentially require at least one specialist referral based on incidental findings alone. Conclusions:Applied to a retrospective single-center dataset, this exploratory analytical framework reveals patient phenotypes, clinically relevant co-occurrence patterns, and a potentially substantial specialist-referral burden that univariate prevalence reporting does not capture. These preliminary observations require prospective, multi-center external validation, and the framework may become a valuable tool for structured, data-driven CBCT interpretation.
Objective:This article compares skeletal movement after mandibular setback surgery using the NM (novel modification)-low Z plasty technique between patients treated with the surgery-first approach (SFA) and the conventional orthognathic surgery (COS) approach. Materials and Methods:This retrospective study included 42 skeletal class III patients (ANB < 0°) who underwent mandibular setback using the NM-low Z plasty technique between 2017 and 2022. Consecutive lateral cephalograms were obtained at three time points: preoperative (T0), immediate postoperative (T1), and 6 to 12 months postoperative (T2). Horizontal and vertical movements at the dentoalveolar point of the mandible were defined as primary outcomes. Data distribution was evaluated using the Shapiro-Wilk test and Q-Q plots. Within-group changes were analyzed with paired t-tests. Between-group comparisons were performed using Mann-Whitney U tests according to data distribution. Statistical significance was set at p < 0.05. Results:The mean mandibular setback was 9.34 mm in the COS group and 13.89 mm in the SFA group, respectively. Horizontal mandibular forward movement was 2.8 mm in COS (30%) and 2.06 mm in SFA (14.8%). Vertical movement at T2 showed upward movement of 1.68 and 2.8 mm, respectively. No statistically significant differences were found between groups for horizontal or vertical movement (p = 0.072). Changes in incisor inclination were also not significantly different between groups. Conclusion:Mandibular setback surgery using the NM-low Z plasty technique demonstrated comparable skeletal stability in both orthodontic-driven treatment protocols. The findings further suggest that postoperative mandibular positional changes in SFA were reflected as a consequence of planned orthodontically occlusal adaptation. Furthermore, vertical mandibular changes after surgery appeared to be primarily governed by postoperative orthodontic tooth movement rather than being attributable to the surgical technique itself.
Abstract:Alveolar ridge preservation (ARP) after tooth extraction depends on accurate three-dimensional bone assessment to optimize implant placement and prosthetic outcomes. Cone-beam computed tomography (CBCT) provides high-resolution volumetric imaging, yet manual interpretation remains operator-dependent and poorly standardized. Artificial intelligence (AI) may automate CBCT-based assessment, but its clinical role in ridge preservation remains insufficiently defined. This narrative review with structured thematic synthesis, reported in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA), examined AI applications in CBCT analysis relevant to ARP, explicitly distinguishing technical performance from clinical usefulness. A structured search of PubMed/MEDLINE, Web of Science, and Scopus (January 2026) identified English-language studies published between 2012 and 2026. Articles were appraised using adapted Joanna Briggs Institute (JBI) criteria and synthesized thematically. Thirty-three articles were retained: 17 AI-focused primary studies forming the core synthesis, seven conventional (non-AI) CBCT-based ARP or implant studies, and nine reviews providing background context. AI-driven segmentation of teeth and alveolar bone consistently achieved Dice similarity coefficients above 0.90 with markedly reduced processing times, and selected architectures generalized across CBCT devices and populations. Multimodal CBCT-intraoral-scan fusion enabled crown-root-bone visualization, while deep-learning image enhancement supported diagnostic quality at reduced radiation doses. However, these findings reflect technical (geometric) accuracy: no included study linked AI output to patient-centered ARP outcomes such as implant survival, aesthetics, complications, or need for re-augmentation. External validation on independent datasets was reported in only four AI studies, and reporting metrics were heterogeneous. Current evidence therefore supports the technical feasibility of AI-assisted CBCT analysis for ridge preservation and implant planning, but not yet its clinical effectiveness. Translation will require prospective multicenter studies with patient-centered endpoints, standardized reporting, cost-effectiveness evaluation, and clear regulatory pathways.
Objective:The aim of this study is to evaluate the time-dependent volumetric changes, push-out bond strength (POBS), and dentine adaptation of epoxy resin, silicone bioactive glass and calcium silicate root canal sealers over 60 days. Materials and methods:One hundred and twenty-five mandibular premolars were instrumented using ProTaper Next (size 40/06) and assigned to five groups (n = 25). Each canal was obturated using the matched single-cone technique with one of the following sealers: AH Plus Jet (AHP Jet), GuttaFlow Bioseal (GFB), CeraSeal (CS), Endosequence BC (ES BC), or AH Plus Bioceramic (AHP Bioceramic). In each group, 20 samples were subdivided into two subgroups (n = 10) to assess POBS (push-out test) and dentine adaptation (scanning electron microscopy) of the filling materials at 2 and 60 days post-obturation. Micro-computed tomography (Micro-CT) was used to evaluate sealer volumetric changes over 60 days (n = 5). Data analysis:Two-way ANOVA assessed the interaction between sealer type and post-obturation time on POBS. One-way ANOVA compared POBS and volumetric alterations among the sealers, while paired and independent t-tests evaluated differences within each sealer. Kruskal-Wallis and Mann-Whitney U tests were used to analyze interfacial adaptation. Results:For the POBS, AHP Jet, CS, and ES BC exhibited higher POBS values than GFB and AHP Bioceramic at 2 days post-obturation (p < 0.001). At the 60-day evaluation, CS and ES BC demonstrated higher POBS than the other sealers (p < 0.001), whereas GFB exhibited the lowest value. No significant difference in dentine adaptation was found among the sealers at either 2 days (p = 0.07) or 60 days (p = 0.08). After 60 days post-obturation, GFB, CS, ES BC, and AHP Bioceramic showed a significantly higher POBS (p < 0.001) and dentine adaptation (p < 0.05) than under the 2-day condition, whereas AHP Jet maintained consistent POBS (p = 0.87) and dentine adaptation (p = 0.76). Micro-CT revealed that silicone bioactive glass and bioceramic sealers expanded, whereas the epoxy resin sealer showed slight shrinkage after setting. Conclusion:CS and ES BC demonstrated the most stable long-term POBS, whereas all sealers illustrated favorable dentine adaptation. The volumetric expansion might relate to improvements in bond strength and dentine adaptation post-obturation in silicone bioactive glass and bioceramic sealers.
Objectives:The aims of this study were to provide a comprehensive evaluation of the dental status in pediatric patients with 22q11.2 deletion syndrome (22q11.2DS) and to analyze the associations between clinical dental findings, general medical conditions, and oral hygiene habits. Materials and Methods:The cross-sectional study included 20 children (10 girls, mean age 6.45 years) with a confirmed diagnosis of 22q11.2DS. Each child underwent a detailed dental examination, including caries (dmft/DMFT: decayed, missing, and filled teeth index for primary and permanent teeth), developmental defects of enamel (DDE), hypodontia, occlusal relationship disorder, and soft tissue findings assessment. Additionally, the functioning of the oral cavity, especially speech and swallowing patterns, was evaluated. Dental findings were correlated with medical history, oral hygiene habits, and laboratory results, with a specific focus on calcium-phosphate metabolism and immunological parameters. Statistical Analysis:Categorical variables were reported as counts and percentages, while continuous variables were presented as medians and interquartile ranges. Nonparametric methods, including Fisher's exact test and the Mann-Whitney U test, were used for group comparisons. Correlations were assessed using Pearson's (r) and Spearman's rank correlation coefficients. All tests were two-tailed with a significance level of α = 0.05. Results:DDE were identified in 13 (65%) children, of whom 6 (30%) were presented with only hypomineralization, 4 (20%) exhibited only hypoplasia, and 3 (15%) demonstrated both defects. Caries prevalence was 70%, with a mean dmft of 4.65 (standard deviation [SD] 5.05) and DMFT of 8.6 (SD 5.77). Occlusal relationship disorders were observed in 11 (55%) children and hypodontia in 3 (15%) children. Age was the most significant variable associated with caries experience (r = 0.73, p < 0.001), while dysmorphic features were the only significant factor for DDE (p = 0.022). No significant correlations were found between dental findings and laboratory parameters or oral hygiene habits. Conclusion:The most common dental manifestations of 22q11.2DS are DDE, dental caries, and oral dysfunctions. No direct correlation was found between oral health and immunological status or calcium-phosphorus metabolism. Caries is a significant problem and more dependent on age than on oral hygiene alone. Patients require early, comprehensive, and coordinated care from dentists, orthodontists, and speech-language pathologists.
Objectives:This study aimed to compare the cyclic abrasive wear behavior of an injectable composite and a preheated restorative composite when used as luting agents for indirect partial restorations, using a controlled in vitro model. A secondary objective was to evaluate the ability of an intraoral scanner (IOS) to detect wear progression in comparison with a non-contact profilometer (NCP). Materials and Methods:Twenty extracted human posterior teeth were prepared for standardized lithium disilicate onlays and randomly assigned to two groups (n = 10): luting with an injectable composite or with a preheated restorative composite. Specimens were subjected to three-body toothbrushing abrasion for up to 22,500 cycles. Using an IOS and a NCP, wear was measured at baseline and following each brushing interval. Mixed-effects models were used to analyze surface roughness and volumetric wear (α = 0.05). Results:Volumetric wear increased significantly with brushing cycles for both materials (p < 0.05), with no significant differences between the injectable and preheated composites (p > 0.05). Surface roughness was significantly higher for the preheated composite compared with the injectable composite at all evaluation points (p < 0.001). No significant differences were found between IOS and NCP volumetric wear measurements, although IOS data showed greater variability at higher wear levels. Conclusions:Injectable and preheated composites used as luting agents for indirect restorations showed similar resistance to abrasive wear under the conditions of this in vitro study. IOS-based wear assessment demonstrated agreement with NCP measurements, and injectable composites showed reduced surface roughness. Clinical Relevance:The present study contributes to the understanding of the wear behavior of contemporary composite materials used as luting agents and highlights the potential of IOSs as a noninvasive tool for monitoring wear over time.
The study investigates the influence of vitamin C-incorporated polycaprolactone (PCL-Vit C) membrane in scavenging reactive oxygen species (ROS) and enhancing angiogenic-osteogenic coupling in vitro.Human umbilical vein endothelial cells and human fetal osteoblast cells were co-cultured on PCL membrane alone and PCL-Vit C membranes under osteogenic conditions to mimic the bone microenvironment. Angiogenic-osteogenic crosstalk was visualized by confocal microscopy, using PECAM1 and connexin-43 antibodies. Cell viability was assessed by XTT assay and ROS generation measured by flow cytometry. Alkaline phosphatase (ALP) and vascular endothelial growth factor (VEGF) release were determined calorimetrically and by ELISA (enzyme-linked immunosorbent assay), respectively. ALP, Col1, RUNX-2, OC, VEGF messenger RNA (mRNA) expressions were determined by quantitative polymerase chain reaction. Col1, OC, BMP-7, HIF-α protein levels were assessed by western blotting. Activation of P38, P44, and JNK signaling was also analyzed.PCL-Vit C membrane co-cultures showed abundant expression of gap junction protein, Cx43, and significantly increased viability compared to PCL alone. ROS production significantly declined in co-cultures grown on PCL-Vit C membranes, with elevated levels of VEGF and ALP. Expression of ALP, Col 1, RUNX2, OC, and VEGF mRNA was significantly higher in PCL-Vit C membranes. PCL-Vit C co-cultures further demonstrated significantly lower HIF-α levels, increased Col 1, OC, and BMP-7 levels, and enhanced activation of phospho-p38/P38, phospho-p44/44, and phospho-pJNK/JNK.PCL-Vit C membranes supported angiogenic-osteogenic coupling, accompanied by changes in oxidative stress, intercellular communication, and osteogenesis through activating key signaling pathways.
Objectives:Artificial intelligence (AI) is increasingly used in esthetic dentistry; however, its accuracy in predicting post-prosthetic facial outcomes in edentulous patients remains unclear. This study aimed to evaluate the ability of AI models to simulate post-denture facial esthetics compared with actual clinical outcomes. Materials and Methods:A prospective within-subject observational study was conducted on 14 completely edentulous patients receiving new complete dentures. Standardized facial photographs were obtained pretreatment (T0) and posttreatment (T1). AI-generated images were produced from T0 photographs using Gemini (G-P) and FaceApp (FA-P). Outcomes included patient preference, expert esthetic evaluation, and quantitative facial anthropometric measurements. Statistical Analysis:Nonnormally distributed paired facial measurements were compared using the Wilcoxon signed-rank test. Differences among image types and expert panel scores were analyzed using the Friedman test (two-way analysis of variance by ranks), with post hoc Wilcoxon signed-rank tests where applicable. Participant preferences were assessed using the chi-square goodness-of-fit test. Statistical significance was set at p ≤0.05. Results:No significant differences were found in patient preferences (p = 0.247) and in expert evaluations between actual and AI-generated images (p = 0.316), with high inter-rater reliability (intraclass correlation coefficient >0.85). Anthropometric analysis revealed significant differences across most variables (p < 0.001) in oral commissure width, upper and lower lip height, and lower facial height. AI-generated images showed partial agreement but significant deviations in magnitude, particularly in FA-P, which were exaggerated. Bilateral comparison of commissure height showed no significant differences (p > 0.05), indicating preserved facial symmetry across all conditions. Conclusions:AI-generated simulations provide esthetically comparable representations to actual outcomes; however, they lack quantitative accuracy in reproducing facial anthropometric changes. While AI may serve as a useful adjunct for patient communication and visualization, it cannot replace clinically driven prosthodontic assessment.
Abstract:Odontogenic keratocyst (OKC) is a developmental odontogenic cyst with distinctive histopathological features and a recognized potential for recurrence. However, secondary inflammation may significantly alter or obscure its classical histopathological features, resulting in diagnostic overlap with inflammatory odontogenic cysts. A 40-year-old male patient presented with an incidentally detected, well-defined radiolucent lesion in the left posterior mandible associated with an impacted third molar. The lesion remained asymptomatic for approximately 11 years. Radiographic findings initially suggested a dentigerous cyst. Surgical management consisted of extraction of the impacted tooth followed by complete enucleation of the lesion. Histopathological examination revealed a non-keratinized stratified squamous epithelial lining with prominent inflammatory infiltrate and numerous cholesterol clefts. The cystic contents lacked typical keratinaceous material and appeared as a creamy cystic fluid. Despite the absence of classical keratinization, the diagnosis of inflammation-modified OKC was supported by preserved architectural features, including epithelial fragility and detachment, daughter (satellite) cysts or focal microcystic formations, odontogenic epithelial islands, and focal dystrophic calcification. Inflammatory modification may obscure the classical histopathological features of OKC and create significant diagnostic overlap with inflammatory odontogenic cysts. The absence or attenuation of keratinization does not exclude the diagnosis of OKC when preserved architectural clues remain identifiable within the cyst wall. Careful evaluation of preserved architectural features, combined with clinicopathologic correlation, is essential for accurate diagnosis, appropriate management, and structured long-term follow-up.
Abstract Radiation-induced second primary oral squamous cell carcinoma is a rare but recognized late complication of radiotherapy for nasopharyngeal carcinoma, typically presenting after a prolonged latency period within previously irradiated tissues. A 79-year-old woman developed a moderately differentiated squamous cell carcinoma involving the left edentulous mandibular gingiva and alveolar ridge 26 years after radiotherapy for nasopharyngeal carcinoma, with no history of tobacco or alcohol use. The patient had severe xerostomia and other chronic post-radiotherapy oral complications. Clinical examination revealed an irregular erythroleukoplakic lesion with ulceration, and histopathology confirmed the diagnosis. Surgical excision was performed without clinical or radiographic evidence of bone invasion, and additional radiotherapy was avoided because of the patient's prior head and neck radiotherapy and severe post-radiotherapy tissue changes. The patient remained disease-free after 15 months of follow-up. This case highlights a rare edentulous mandibular gingival/alveolar ridge presentation of radiation-induced second primary oral squamous cell carcinoma with an unusually long latency period. Persistent gingival or alveolar ridge lesions in previously irradiated tissues may be misinterpreted as traumatic, inflammatory, or post-radiotherapy changes; therefore, lifelong oral surveillance and early biopsy of suspicious lesions are essential in previously irradiated patients.
Objectives:This study aimed to compare the effects of storage conditions (vacuum-sealed vs. non-vacuum-sealed) and storage duration on zirconia surface wettability following airborne particle abrasion, based on the hypothesis that vacuum-sealed storage can mitigate time-dependent hydrophobic recovery. The influence of zirconia composition (3Y-TZP vs. 4Y-TZP) was also investigated. Materials and Methods:A total of 180 zirconia specimens were prepared from 3Y-TZP (VITA YZ HT) and 4Y-TZP (VITA YZ ST). After sintering, polishing, and airborne particle abrasion with 50 µm Al2O3, specimens were assigned to non-vacuum-sealed or vacuum-sealed storage. The non-vacuum-sealed groups were stored for 1 hour, 1 week, 2 weeks, 1 month, and 1.5 months (n = 10). Vacuum-sealed groups were stored for 1 week, 2 weeks, 1 month, and 1.5 months (n = 10) and compared with the non-vacuum-sealed 1-hour baseline group. Non-vacuum-sealed specimens were stored in sealed containers, whereas vacuum-sealed specimens were stored in vacuum-sealed pouches at room temperature. Contact angle measurements were performed using an optical contact angle measurement system with SCA20 software and a 10 µL deionized water droplet. Data normality and homogeneity were confirmed before applying two-way ANOVA and Tukey's post hoc test (α = 0.05). Results:In the non-vacuum-sealed condition, both zirconia types showed a marked increase in contact angle over time (3Y-TZP: 58.03 to 89.01 degrees; 4Y-TZP: 62.38 to 90.23 degrees). Material type (p < 0.001) and duration (p < 0.001) showed significant main effects, while their interaction was not significant (p = 0.122). Differences between materials were significant only at early time points. In contrast, vacuum-sealed specimens exhibited minimal changes in contact angle across all time intervals, and duration showed no significant effect (p = 0.110). Conclusion:Storage duration significantly affects zirconia surface wettability following airborne particle abrasion. Progressive hydrophobic recovery was observed in non-vacuum-sealed specimens, whereas vacuum-sealed specimens effectively preserved surface energy for up to 1.5 months. Vacuum-sealed zirconia represents a practical approach to maintaining zirconia surface wettability when immediate bonding cannot be performed.
Abstract:This systematic scoping review evaluates the current evidence regarding conventional acrylic- and thermoplastic-based materials, directly printed resins, and emerging materials used in orthodontic appliance fabrication. Particular emphasis was placed on material properties, biocompatibility, manufacturing considerations, aging behavior, clinical applications, and the integration of three-dimensional (3D) printing technologies into contemporary orthodontic workflows. Abstract:A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar from database inception through May 2026. Experimental studies, review articles, case reports, and relevant technical documents addressing orthodontic appliance fabrication, material performance, biocompatibility, or digital manufacturing technologies were considered for inclusion. Following screening and eligibility assessment, 45 studies were included in the qualitative synthesis. Abstract:The available evidence indicates that 3D printing technologies enable high levels of customization, digital workflow integration, and improved dimensional accuracy. However, material performance varied considerably among printable resins and conventional materials. Thermoplastic materials frequently demonstrated superior stiffness, transparency, color stability, and surface characteristics, whereas directly printed materials offered advantages in manufacturing flexibility and appliance customization. Current evidence generally supports the biocompatibility of contemporary printable resins, although residual monomer release, postprocessing protocols, and polymerization efficiency remain important considerations. Aging studies demonstrated material-dependent changes in mechanical behavior and optical properties, but long-term clinical evidence remains limited. Abstract:Digital manufacturing technologies are becoming increasingly integrated into orthodontic practice and have expanded applications in aligners, retainers, and customized orthodontic appliances. However, the evidence base remains dominated by laboratory investigations, with comparatively limited long-term clinical data. Further standardized experimental studies and prospective clinical investigations are needed to evaluate durability, biocompatibility, clinical effectiveness, and the potential role of emerging materials in orthodontic appliance manufacturing.
Objectives:This study aimed to evaluate the effects of relining material type and surface treatment protocol on shear bond strength within conventional heat-polymerized polymethyl methacrylate (PMMA), stereolithography (SLA), and digital light processing (DLP) denture bases. Materials and Methods:Denture base specimens were fabricated from conventional heat-polymerized PMMA (n = 96), SLA resin (n = 128), and DLP resin (n = 128), in accordance with ISO 9653:1998. The number of specimens differed because the conventional group included three relining material subgroups, whereas the SLA and DLP groups each included an additional subgroup relined with the corresponding three-dimensional (3D)-printed resin. Following 5,000 thermocycles, the specimens were assigned to one of four surface treatment groups: untreated control, air-particle abrasion, monomer treatment, or a combination treatment. Relining was carried out using auto-polymerizing PMMA (Unifast Trad Pink), PEMA (polyethyl methacrylate)-based materials (Kooliner, Tokuyama Rebase II), and the corresponding 3D-printed resin. Each subgroup consisted of eight specimens (n = 8). Shear bond strength was determined using a universal testing machine, and the failure modes were evaluated using a stereomicroscope. Statistical Analysis:Data were analyzed using two-way ANOVA (analysis of variance) and Tukey's post hoc test (α = 0.05). Results:Surface treatment, relining material, and their interaction significantly influenced shear bond strength in all groups (p < 0.05). Air-particle abrasion generally produced the highest bond strength, whereas the untreated control showed the lowest values. The highest values were observed with Unifast Trad Pink in the conventional group and with the corresponding printed resins in the SLA and DLP groups. Mixed failure predominated, and scanning electron microscopy showed greater surface alteration after air-particle abrasion and combination treatment compared with the untreated control. Conclusions:Air-particle abrasion generally produced the highest bond strength, particularly in 3D-printed denture base groups. The corresponding printed resins performed best in the SLA and DLP groups, whereas the PMMA-based relining material performed best in the conventional group.
Objective:Postoperative functional impairment, including reduced tongue strength and swallowing efficiency, is common following oral andmaxillofacial surgery. Prehabilitation strategies targeting oral function may enhance postoperative recovery; however, clinical evidence remains limited. This study aimed to evaluate the effect of a preoperative tongue and swallowing exercise program on early postoperative functional recovery in patients undergoing oral and maxillofacial surgery. Materials and Methods:This pilot-controlled rehabilitation study included eight adults undergoing oral and maxillofacial surgery, allocated to either standard postoperative rehabilitation alone or a 2-week preoperative tongue and swallowing exercise program followed by standard postoperative care. Maximum anterior (AMTS) and posterior tongue strength (PMTS) and swallowing-related quality of life assessed using the dysphagia handicap index (DHI) were measured preoperatively and at 4, 8, and 12 weeks postoperatively. Analyses focused on describing recovery trajectories and estimating changes over time to inform feasibility and effect size estimation. Results:Baseline characteristics were comparable between groups. Both groups demonstrated reductions in AMTS and PMTS at 4 weeks after surgery. Participants who performed preoperative exercises showed smaller early declines and a pattern of progressive recovery toward baseline tongue strength values over the 12-week follow-up, whereas recovery appeared more limited in the postoperative-only group. Changes in DHI scores suggested potential between-group differences in perceived swallowing impact at later postoperative time points. Conclusion:Preoperative tongue and swallowing prehabilitation may facilitate early postoperative functional recovery in oral and maxillofacial surgery patients. These findings support the potential role of targeted oral functional training as an adjunct to perioperative care. Further large-scale randomized studies are warranted.
Abstract:This systematic review aimed to evaluate the performance and clinical validation of artificial intelligence (AI) and rule-based methods for skeletal maturation assessment using cervical vertebral maturation (CVM) and hand-wrist radiography. The review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO. The PICOS framework guided selection of experimental, randomized controlled, and observational studies that applied AI to radiographic images of the cervical vertebrae or hand-wrist region. Eligible studies compared AI-derived classifications with expert assessments. Studies based on non-radiographic indicators, non-English publications, and investigations not involving AI methodologies were excluded. A systematic search was performed in PubMed, Scopus, EBSCOhost, and SpringerLink for articles published between 2015 and 2025. The methodological quality and risk of bias were evaluated using the QUADAS-2 tool. For CVM-based studies reporting sufficient quantitative data, a random-effects meta-analysis with restricted maximum likelihood (REML) estimation was performed using logit-transformed accuracy proportions. Heterogeneity was assessed using the Q statistic and the I 2 index. Studies based on hand-wrist radiography were excluded from the quantitative synthesis due to heterogeneity in outcome measures and the limited number of studies. Seven studies met the eligibility criteria, including five that used lateral cephalograms for CVM analysis and two that used hand-wrist radiographs for skeletal age estimation. CVM-based models demonstrated moderate to high diagnostic performance, with reported accuracy or agreement ranging from 60.4 to 82.8%, and kappa values reaching 0.985. These findings corresponded to a pooled accuracy of 80%. When compared with human observer assessments, several CVM-based models achieved comparable levels of agreement in selected studies. However, their performance remained variable across validation settings. Hand-wrist-based models showed consistently high agreement with human observers, with correlation coefficients up to r = 0.98 and mean absolute errors below 6 months, indicating stable reproducibility relative to expert readings. AI demonstrates promising potential for assisting skeletal maturation assessment, although accuracy varies across model architectures and validation settings. Current evidence supports the use of AI primarily as a diagnostic support tool, with further prospective multicenter studies required before routine clinical implementation. However, the current evidence remains limited due to the small number of studies and methodological heterogeneity.
Objectives:To evaluate the effect of low-temperature saline irrigation on postoperative clinical outcomes and salivary C-reactive protein (sCRP) levels after surgical removal of impacted mandibular third molars. Materials and Methods:This randomized, controlled, split-mouth clinical trial was conducted in 14 patients. The experimental side received saline irrigation at 0 to 4°C, whereas the control side received irrigation at room temperature (∼25°C). Postoperative pain, facial swelling, and trismus were assessed on postoperative days 1, 2, and 7. Unstimulated saliva was collected preoperatively and at 48 hours postoperatively for sCRP quantification. Statistical analysis:Between-side comparisons were performed using paired t-tests or Wilcoxon signed-rank tests as appropriate. Changes in sCRP (T2-T0) were analyzed within and between sides. The effect size for Wilcoxon tests was calculated as r = Z/√N. Results:Pain on postoperative day 1 was significantly lower on the low-temperature irrigation side than on the control side (p = 0.021). No significant between-side differences were observed for pain on days 2 and 7, or for facial swelling and trismus at any follow-up time point. sCRP levels increased significantly at 48 hours postoperatively on both sides (p = 0.001). However, the increase in sCRP was smaller on the low-temperature irrigation side compared with the control side (p = 0.048). Conclusions:Low-temperature saline irrigation may reduce early postoperative pain and attenuate the postoperative increase in sCRP, but did not demonstrate a beneficial effect on facial swelling or trismus in this study. Trial registration:ClinicalTrials.gov, NCT07243210.
Objective:Dental caries remains highly common among children, indicating a growing need for durable and biocompatible restorative materials. Glass ionomer cements (GICs) are amongst the most commonly used restorative materials because they provide fluoride release, chemical bonding, biocompatibility, and versatility in clinical applications. Materials and Methods:A finite element analysis was performed using a 3D micro-CT-derived model of a primary mandibular first molar. Six models were created, including Class I and Class II cavities restored with high- and low-viscosity GIC, plus two control models. Material properties were based on literature. A 100-N vertical load was applied, and von Mises stress and deformation were analyzed using ANSYS. The materials were assumed to be homogeneous, isotropic, and linearly elastic. Results:High-viscosity GIC showed lower stress than low-viscosity GIC in both cavity types. In Class I cavities, the stresses were 17.65 MPa versus 22.28 MPa, and in Class II cavities, 27.10 MPa versus 32.49 MPa. Class II cavities showed higher stress and deformation than Class I cavities. Unrestored models showed the highest stress values. Conclusion:Material stiffness and cavity design significantly affected stress distribution in primary molars. High-viscosity GIC demonstrated more favorable biomechanical behavior than low-viscosity GIC. Class II cavities generated higher stresses than Class I cavities under static loading.
Objective:To evaluate the diagnostic value of two soft tissue measurements (facial angle and angle of convexity) in predicting sagittal skeletal patterns using standardized lateral facial photographs. Materials and Methods:This cross-sectional study included 73 subjects aged 18 to 30 years who met inclusion criteria. Standardized lateral cephalograms and profile photographs were captured in natural head position (NHP). Anatomical landmarks were identified and utilized to derive angular measurements. All imaging and assessments followed a consistent protocol to evaluate sagittal skeletal relationship (specifically the angle of convexity and facial angle) using CorelDraw software for Windows. Statistical Analysis:Repeatability and reproducibility were assessed using intraclass correlation coefficients (ICCs) from NHP measurements on lateral photographs and cephalograms. Bivariate analyses examined associations between soft tissue predictors and their skeletal counterparts, with age and sex considered as confounders. Variables with p ≤0.25 were included in multivariable linear regression to predict skeletal angle of convexity and facial angle. Stepwise exclusion was applied for nonsignificant predictors (p > 0.05), and final relationships were represented using regression equations. Results:Reliability was excellent (Cronbach's α = 0.977; ICC = 0.933-0.977). Photographic angles significantly correlated with their cephalometric counterparts (p < 0.001). Regression analysis confirmed sex and photographic measurements as significant predictors for angle of convexity (R 2 = 0.371) and facial angle (R 2 = 0.545), with all model assumptions met. Conclusions:Photographic measurements of the angle of convexity and facial angle, alongside sex, were reliable predictors of skeletal morphology. Standardized profile photographs offer a valuable nonradiographic adjunct in sagittal assessment, especially in resource-limited settings where specialized imaging is unavailable. While not intended to replace cephalograms, these measurements serve as a viable screening tool. Further studies with larger, more diverse populations are warranted to expand applicability and refine predictive accuracy.
Objective:Clinical documentation is essential for patient safety, legal protection, and continuity of care. Nevertheless, record-keeping skills are usually overlooked by most undergraduate dental programs. This study investigated the outcomes of a structured educational intervention by auditing the outpatient case records documentation by dental interns at a public university of Saudi. Materials and Methods:A quasi-experimental single-group pre-post-test study was conducted among dental interns in the form of a baseline (July-September 2024) and a follow-up (October-December 2024) audit. The educational intervention consisted of a group presentation, one-on-one instruction, and monthly review sessions. Clinical records were assessed using a modified CRABEL scoring system. Completeness of patient data, medical and dental history, examination results, treatment planning, and authentication were evaluated in the documentation. Results:A total of 20 interns participated in the study, with an average of 367.8 clinical records reviewed each month. At the baseline audit (July-September, 2024), at least one essential component was missing from 78% of the records. Incomplete dental exams (46%), unsigned entries (42%), and missing medical histories (54%) were the most common deficiencies. At the re-audit, missing medical histories decreased to 16%, and unsigned entries decreased to 22%. A proportion of 53.4% of records had a baseline Crabel score below 70% (mean score = 56.31 ± 28.2). At the re-audit, the mean score increased to 85.47 ± 16.6. Records with a score ≥80% increased from a proportion of 21.6 to 84.6%, while those with a score <70% dropped to a proportion of 15.3%. Conclusion:Documentation quality and record-keeping by dental interns can be greatly enhanced by focused educational interventions. Undergraduate dental programs that incorporate frequent audits and targeted training are expected to assist students in developing lifelong habits of accurate and responsible clinical documentation.
