BACKGROUND:Clinical use of mineral trioxide aggregate (MTA) is often associated with several challenges, including a prolonged setting time, poor handling characteristics and compromised physical properties in the presence of tissue fluids. Mineral trioxide aggregate, when used as a perforation repair or root-end filling material, needs adequate strength to withstand the forces acting on it. Recently, several researchers have attempted to overcome these challenges through the use of various additives. OBJECTIVES:To evaluate the physical and antimicrobial properties of MTA reinforced with gold nanoparticles (AuNPs). MATERIAL AND METHODS:Sixteen customized putty molds (6 mm in height x 4 mm in diameter) were filled with the materials assigned to 2 groups: control group, MTA (n = 8); and experimental group, MTA + AuNPs (n = 8). Compressive strength (CS) was evaluated using a universal testing machine, while setting time was assessed using a flat-ended indenter. The antimicrobial properties of MTA and MTA + AuNPs were evaluated using the agar diffusion method against Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans. The data was statistically analyzed using an unpaired t-test. RESULTS:Compressive strength was significantly higher in the MTA + AuNPs group (115.75 ±2.22 MPa) than in the MTA group (55.00 ±5.35 MPa) (p < 0.001). The MTA + AuNPs group also demonstrated a significantly shorter setting time than the MTA group (48.05 min vs. 165.00 min, respectively). The unpaired t-test revealed a significantly greater antimicrobial activity against all tested microorganisms in the MTA + AuNPs group than in the MTA group (P. aeruginosa > E. coli > S. aureus > E. faecalis > C. albicans). CONCLUSIONS:Incorporation of AuNPs into MTA enhanced CS, shortened setting time and increased antimicrobial activity against the tested microorganisms.
A complex cavity is so named because it results from damage to the enamel-dentin complex, and such cavities can cause patients considerable difficulties in daily life. The reconstruction of damaged areas with synthetic restorative materials requires careful consideration of the unique functional properties of natural enamel and dentin, whose inherent characteristics remain superior to those of any synthetic restorative material currently available. The objective of this article was to organize the available information on indirect adhesive restorations for complex cavities, with particular emphasis on the factors and techniques that require consideration during clinical procedures.An electronic search was performed in MEDLINE/PubMed, the Web of Science and Google Scholar. The articles included in this study comprised randomized controlled trials (RCTs), clinical trials, clinical reports, reviews, and laboratory studies.The amount of the remaining natural tooth structure directly affects the longevity of the restored tooth. The remarkable properties of natural enamel and dentin have long been recognized, and bondable restorative materials have therefore been continuously developed with the aim of preserving these natural tissues and reinforcing the remaining tooth structure through effective adhesion. Even when a large portion of the tooth structure has been destroyed, conservative treatment can often still be performed, allowing the benefits of these advanced techniques to be achieved. All aspects of the procedure need to be considered, including material selection, cavity design and preparation, cavity and restoration surface preparation, and the cementation procedure. Additional techniques, including immediate dentin sealing (IDS) and the controversial deep margin elevation technique, are also addressed in this article.
Cancer therapies, including radiotherapy, chemotherapy and surgical interventions, are essential components of modern oncology, but are frequently associated with long-term, multifactorial oral complications that can impair patients' oral function and quality of life (QoL). This narrative review integrates current evidence, clinical guidelines and expert consensus to provide a comprehensive overview of contemporary approaches to oral management following cancer treatment.The aim of this review was to synthesize and critically evaluate current dental strategies for the comprehensive care of individuals after oncologic therapy, identify the most common oral complications, including oral mucositis (OM), xerostomia, dysgeusia, radiation-induced caries, oral candidiasis, osteoradionecrosis (ORN), and medication-related osteonecrosis of the jaw (MRONJ), and highlight the areas requiring further research.A literature search was conducted across PubMed, Wiley Online Library, the Web of Science, Google Scholar, and ScienceDirect from March to October 2025, focusing on clinical trials, reviews and international guidelines. Preventive measures, including remineralization protocols, rigorous oral hygiene practices and salivary stimulants, were emphasized as the crucial components of supportive care. The emerging therapeutic modalities, such as low-level laser therapy (LLLT) and novel pharmacological agents, were critically assessed with regard to their clinical effectiveness.Overall, the evidence emphasizes the need for an interdisciplinary, patient-centered approach involving oncologists, dental specialists and allied healthcare professionals to minimize morbidity and optimize clinical outcomes. Multidisciplinary dental care remains indispensable for preventing and managing oral complications, and improving the long-term QoL of cancer survivors.
Dental injuries frequently occur in children and adolescents. It is common for multiple types of injuries to affect the teeth and the surrounding tissues. Medical doctors often provide initial treatment; therefore, it is crucial for them to have the knowledge and skills necessary to provide first aid for traumatic dental injuries (TDIs).The present study aimed to analyze, synthesize, and evaluate the quality of the existing research on medical students' knowledge, skills and attitudes regarding the provision of first aid for dental injuries.The electronic medical databases Web of Science, PubMed, Wiley Online Library, Dentistry & Oral Sciences Source, and Scopus were searched. To identify additional publications, the reference lists of relevant articles were manually reviewed. The analysis included publications in English and Polish, including original research studies, such as randomized trials, cohort studies and cross-sectional surveys, while excluding case reports, reviews, commentaries, letters, and conference abstracts. The credibility of the studies was assessed using the Cochrane Collaboration's risk-of-bias tool. Due to substantial methodological and statistical heterogeneity, a meta-analysis was not possible; instead, a narrative synthesis was conducted to summarize the findings.The search identified 55 studies, of which 10 were included in the systematic review, involving a total of 2,424 medical students. All studies focused on tooth avulsion; 3 also addressed tooth fractures, and 1 discussed tooth luxation.The systematic review indicates that medical students often lack the knowledge and skills required to manage dental trauma in emergency situations, highlighting the need to include dental traumatology courses in medical education. Early training in the management of dental injuries should be implemented and integrated into first-aid training to improve preparedness for such situations.
Persistent inflammatory oral mucosal lesions characteristic of oral lichen planus (OLP) have attracted considerable attention due to their potential association with diabetes mellitus (DM). This systematic review aimed to synthesize evidence from different study designs, including cross-sectional and case-control studies, to clarify the complex relationship between OLP and DM. The study was conducted according to predefined objectives and eligibility criteria. Using the PECOS framework, the review evaluated the prevalence, risk factors and comorbidities associated with DM among individuals with clinically diagnosed OLP. A search strategy combining Medical Subject Heading (MeSH) terms and relevant keywords was applied across multiple databases. The findings demonstrated variability in the reported prevalence and clinical associations between type 2 DM (T2DM) and OLP. Some studies reported a strong correlation, whereas others yielded conflicting findings, potentially reflecting methodological differences. Cross-sectional studies generally demonstrated high methodological quality, supporting the reliability of findings. Case-control studies showed greater variability in methodological quality, with some areas requiring improvement. Quality assessment using the Newcastle-Ottawa Scale (NOS) indicated generally good methodological quality, although differences in selection and comparability were observed across studies. The risk-of-bias assessment identified potential sources of bias, emphasizing the need for cautious interpretation of the available evidence. This study underlines the importance of standardized management procedures, emphasizes individualized patient care and supports further research into the mechanisms underlying the association between OLP and DM.
BACKGROUND:Management goals for patients with temporomandibular disorders (TMDs) include reducing pain, improving function and resuming normal daily activities. OBJECTIVES:The present retrospective study compared the effectiveness and efficiency of 2 different gnathological treatment options - temporary bite-raising onlays (TBR) and stabilization splints (SS) - for the management of pain-related TMDs. MATERIAL AND METHODS:Medical records of 86 patients treated in the Department of Orthodontics of the Agostino Gemelli University Hospital IRCCS, Rome, Italy, were retrieved: 43 patients were treated with TBR; and 43 with SS. We included adult patients (aged 18-65 years) of both sexes, with a diagnosis of pain-related TMDs according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), treated with TBR or SS, with no systemic diseases or comorbidities, who provided written informed consent for the use of their clinical data. The outcomes assessed were the presence of pain and reduced mouth opening (<40 mm) at the end of treatment, the number of clinical check-ups and appliance adjustments, the overall treatment duration, self-reported patient discomfort, and the time frame within which patients experienced improvement. RESULTS:Temporary bite-raising onlays on molars achieved significantly higher pain recovery rates than SS in patients with pain-related TMDs (88.4% vs. 66.1%; p < 0.05). With regard to functional improvement in mouth opening, TBR and SS yielded comparable results, with no statistically significant difference between the groups (83.3% vs. 78.6%). Treatment with TBR was shorter than SS treatment, and required fewer clinical check-ups and repetitive occlusal adjustments. The initial self-reported discomfort was slightly more prevalent among TBR patients than among SS patients, while the initial improvement in pain symptomatology occurred earlier in the SS group. Overall, TBR was associated with a higher, although not statistically significant, prevalence of the initial self-reported discomfort, whereas SS was associated with statistically significantly earlier symptom relief. CONCLUSIONS:Despite the initial discomfort, TBR could be considered an effective and time-efficient treatment option for pain management in patients with pain-related TMDs.
BACKGROUND:Zirconia, or stabilized zirconium oxide (ZrO2), is a widely used dental ceramic for full-coverage crowns owing to its favorable biological and esthetic properties. Upon cooling after high-temperature sintering, zirconia undergoes a tetragonal-to-monoclinic phase transformation, which causes volume expansion and brittleness. Adhesive cementation (AC) is crucial for the clinical performance of zirconia restorations, enhancing their retention, marginal adaptation and fracture resistance, thereby contributing to their suitability for dental restorations. OBJECTIVES:The aim of the present study was to evaluate how different kinds of surface treatment affect the shear bond strength (SBS) of zirconia, to analyze the influence of various luting agents on the SBS of zirconia, and to investigate the effect of simulated aging through water storage on the SBS of zirconia. MATERIAL AND METHODS:An experimental study design was used to assess the impact of 2 luting agents (RelyX™ Unicem and Panavia™ F 2.0), different surface treatment methods (STMs) and variable water-storage durations (1day (1D), 1 month (1M) and 6 months (6M)) on the SBS of zirconia. RESULTS:The study revealed that RelyX consistently showed lower mean SBS values than Panavia across the different water-storage durations. For instance, in group 1 at 1D, the mean SBS for RelyX was 17.12 ±0.71 MPa as compared to 21.76 ±2.81 MPa for Panavia. ANOVA indicated significant differences in SBS between RelyX and Panavia in each group (group 1: F = 13.892; p < 0.000). Post-hoc tests confirmed significant differences in the mean SBS across the different aging durations. Overall, the findings provide comprehensive statistical evidence regarding the performance of the 2 dental luting agents under different surface treatment and aging conditions. CONCLUSIONS:RelyX consistently demonstrated lower mean SBS values than Panavia across the different water-storage durations, indicating differences in their bonding performance. Statistical analyses confirmed significant differences in SBS between the 2 luting agents.
BACKGROUND:Hypertension (HTN) is a prevalent condition affecting a significant proportion of the population. It requires careful management due to its potential systemic complications. While the overall effects of HTN are well documented, its specific impact on implant dentistry procedures, such as sinus augmentation, remains less clear. OBJECTIVES:The present study aimed to investigate the influence of HTN and antihypertensive medications on early implant failure (EIF) following sinus augmentation. MATERIAL AND METHODS:A retrospective cohort study was conducted at a tertiary referral center between 2013 and 2021. Data from 425 implants in 152 patients were analyzed. The primary outcome was EIF. Univariate and multivariable analyses were performed to identify potential risk factors. A p-value <0.05 was considered statistically significant. RESULTS:Hypertension did not significantly affect EIF. However, beta-blocker therapy was identified as an independent risk factor at both the patient and implant levels (OR (odds ratio) = 4.05; p = 0.018 and OR = 3.13; p = 0.045, respectively). A higher number of implants per patient and tobacco smoking were also associated with an increased risk of EIF (OR = 1.49; p = 0.039 and OR = 8.52; p < 0.001, respectively). Other antihypertensive medications were not significantly associated with EIF. CONCLUSIONS:Hypertension was not a significant risk factor for EIF following sinus augmentation. However, beta-blocker therapy was associated with an increased risk of failure, whereas other antihypertensive agents, including diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBs), were not significantly associated with EIF.
BACKGROUND:Research is required to characterize peri-implant strain distribution associated with different restorative designs. OBJECTIVES:This in vitro qualitative photoelastic stress analysis aimed to compare the influence of retention modality (screw-retained or cement-retained) on strain development around implants supporting different 3-unit posterior restorative designs. MATERIAL AND METHODS:Six prosthetic restorative designs were evaluated according to retention modality and prosthetic configuration: 3 single crowns, cement-retained and screw-retained (SC-c and SC-s, respectively); 3 splinted crowns (SP-c and SP-s); and simple 3-unit bridges (SB-c and SB-s). All prosthetic units were morphologically identical. A photoelastic resin block incorporating 3 implants was mounted on a loading device that applied vertical loads of 200 N simultaneously at 3 identical loading points on each restoration to simulate chewing, occlusal clenching and deglutition. Fringe lines were photographically recorded and qualitatively analyzed after placement of the restorations and during loading. RESULTS:Screw-retained restoration with splinted crowns (SP-s) was the only design to exhibit strain in the unloaded state following placement, representing preload strain. Loading-induced strains were observed in SC-c and SC-s, with lower strain levels for SC-c than for SC-s, and in SP-c and SP-s, with lower strain levels for SP-c than for SP-s. Both configurations also exhibited crestal strains. The simple bridge (SB) designs revealed purely axial strains, with no crestal strains, regardless of retention modality. CONCLUSIONS:Retention modality appears to influence peri-implant strain development in mesiodistal and occlusogingival dimensions for 3-unit single crown and splinted crown designs. Screw-retained 3-unit splinted prostheses may generate preload strains around the unloaded implant supporting the restoration. Simple 3-unit bridge designs demonstrated the most favorable strain pattern, regardless of the retention modality.
BACKGROUND:There are no studies in the Colombian population assessing the prevalence and severity of apical lesions (ALs), or the relationship between the frequency and quality of endodontic treatment (ET) obturation and the presence of ALs in patients with coronary atherosclerosis (CA). OBJECTIVES:The present study aimed to estimate the frequency of ALs and ET in Colombian patients with CA, and to identify a possible association between the frequency and severity of ALs and CA. MATERIAL AND METHODS:The study had a cross-sectional design. We included patients with the evidence of CA diagnosed by coronary angiography. The main outcome variables were the number of compromised coronary arteries and their degree of obstruction, as well as ET, including ALs and previously treated teeth (PTT). The periapical index (PAI) was assessed using periapical radiographs. RESULTS:A total of 1,394 teeth from 69 patients were evaluated (δ = 20.2 teeth/patient). The frequency of ALs and ET was 5.7% and 10.1%, respectively, considering all teeth evaluated, with a greater presence in the maxilla (50.6% and 51.4%, respectively). Apical lesions were most frequently observed in premolars and molars (35.4%), whereas ET was more frequent in molars (38.6%). Among teeth with ALs, PAI 3 was the most frequent score. Apical lesions were present in 40.0% of endodontically treated teeth; 79.2% of these teeth had inadequate obturation, of which 40 (39.2%) had ALs (p = 0.021). CONCLUSIONS:In patients with CA, a high incidence of ALs and ET was observed, with no evidence of an association between the frequency of ALs, the severity of coronary vessel occlusion, and the number of coronary arteries affected. More ALs were observed in teeth with inadequate ET. However, as we did not have a control group for comparison, these findings should be interpreted with caution.
BACKGROUND:Clear aligner treatment (CAT) may induce masticatory muscle tenderness and trigger temporomandibular disorders (TMD). Considering that CAT may interfere with the masticatory system, it is important to understand the relationship between CAT and occlusal changes. OBJECTIVES:This study aimed to analyze occlusal changes during CAT and assess the influence of postorthodontic occlusion on masticatory performance. A secondary objective was to determine whether the case complexity, the facial biotype and malocclusion were associated with occlusal alterations, masticatory performance, or the onset of TMD signs and symptoms during CAT. MATERIAL AND METHODS:Forty-two individuals who underwent and completed CAT were evaluated at 3 time points: before treatment (T0); at the end of treatment (T1); and 3 months after treatment, during which time clear aligners (CAs) were used only at night (T2). Temporomandibular disorders were assessed using Axis I of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) at T0, T1 and T2. Masticatory performance was evaluated at T1 and T2 using a two-colored chewing gum test and colorimetric analysis. Occlusal area and anterior and posterior occlusal contacts were evaluated digitally. Non-parametric statistical tests were used, with the significance level set at p < 0.05. RESULTS:The occlusal area decreased significantly from T0 to T1 (p = 0.016). At T1, normodivergent individuals had significantly more anterior contacts than hyperdivergent patients (p = 0.013). Masticatory performance increased with the number of posterior occlusal contacts (p < 0.05), and individuals with Class I molar relationship had more anterior contacts than Class II patients (p = 0.004). At T2, Class III individuals showed higher values than Class II patients (p = 0.011). CONCLUSIONS:The number of occlusal contacts and occlusal contact area decreased during treatment. Nighttime use of CAs slightly enhanced occlusal contact recovery. Complex cases presented more posterior contacts at T0; simple cases presented a greater occlusal area at the end of CAT. Class I individuals presented more anterior contacts at T0. These movements increased the anterior contacts in Class III molar cases at the end of treatment and 3 months later. No significant differences in masticatory performance were found according to the molar relationship, the facial biotype or the case complexity; no TMD signs and symptoms were found during or after CAT.
This systematic review evaluates the outcomes of different radiotherapeutic strategies in the management of head and neck cancers (HNCs), including curative-intent radiotherapy (RT), palliative stereotactic body radiotherapy (SBRT), multimodal approaches combining surgery and RT, and immunotherapy-based combinations.A structured literature search was conducted using 4 electronic databases - PubMed, BioMed Central (BMC), Scopus, and Ovid - to identify studies relevant to RT for head and neck squamous cell carcinoma (HNSCC), with a focus on the Quad Shot regimen and other hypofractionated approaches. The search strategy included keywords such as "palliative radiotherapy", "head and neck cancer", "Quad Shot", "hypofractionated RT", and "recurrent HNSCC", and was limited to studies published in English up to March 2025.Fourteen studies were included in this systematic review, comprising a total of 26,734 patients. Curative RT demonstrated favorable outcomes in large cohorts, particularly in terms of overall survival (OS) and local control (LC). Palliative SBRT regimens provided substantial symptomatic relief and disease control with minimal toxicity among elderly and inoperable patients.Multimodal treatment options yielded the most promising survival outcomes, particularly in patients with early-stage disease. Furthermore, the combination of immunotherapy and RT showed potential synergistic effects, improving both OS and progression-free survival (PFS).
BACKGROUND:The fundamental goals of traditional periodontal therapy have been the eradication of disease and the preservation of a healthy, functional dentition and its supporting tissues. However, in recent years, the emphasis has shifted increasingly toward esthetic outcomes, extending beyond dental prostheses and tooth color to encompass the soft tissues surrounding the dentition. OBJECTIVES:The main aim of this research was to compare the impact of the coronally advanced flap (CAF) in combination with concentrated growth factor (CGF) with that of CAF alone in the management of gingival recession. MATERIAL AND METHODS:This randomized controlled trial (RCT) included 90 patients with Miller's class I or class II gingival recession, who were categorized into 2 groups: CAF; and CAF with CGF. Follow-up assessments were conducted at 6 months, 1 year and 3 years. Periodontal clinical parameters, along with buccal recession depth (BRD) and the width of attached gingiva (AGW), were measured. Postoperative pain was assessed using a visual analog scale (VAS) 10 days after the intervention in both groups. Statistical analysis was performed using IBM SPSS Statistics for Windows, v. 23. RESULTS:The CAF+CGF group showed better results in terms of mean BRD, AGW and clinical attachment level (CAL), as well as reduced postoperative pain (p < 0.05). CONCLUSIONS:With a 3-year long-term follow-up, the present trial supports the additive effect of CGF in combination with CAF for maxillary gingival augmentation coronal to the recession.
BACKGROUND:Obesity is a chronic disease resulting from the interaction of genetic, environmental, socioeconomic, and behavioral factors, and is associated with the development of numerous comorbidities. Its prevalence is increasing worldwide, making obesity one of the most significant public health challenges. OBJECTIVES:The aim of the present study was to investigate the relationship between obesity and the cortisol levels and periodontal status in children. MATERIAL AND METHODS:Ninety eligible children aged 8-12 years were enrolled in the study and allocated into 3 groups: normal-weight; overweight; and obesity. After the parents completed a demographic questionnaire, the children underwent periodontal examinations and saliva collection. The salivary cortisol levels were measured using the ELISA method. Data were analyzed using ANOVA, Pearson's correlation test, the χ2 test, linear regression, and the Kruskal-Wallis test. RESULTS:The children's body mass index (BMI) was significantly associated with the salivary cortisol levels and the gingival index (GI), bleeding on probing (BoP) and periodontal probing depth (PPD) (p = 0.010, p < 0.001, p < 0.001, and p = 0.005, respectively). However, BMI was not significantly associated with father's education, mother's education, the parental smoking addiction status, total family income, the frequency of mouthwash use per week, toothbrushing frequency per day, or daily study duration (p = 0.599, p = 0.143, p = 0.480, p = 0.875, p = 0.884, p = 0.203, and p = 0.338, respectively). The salivary cortisol levels were also significantly associated with age and GI, BOP and PPD (p = 0.010, p = 0.001, p = 0.018, and p = 0.016, respectively). In the multivariable linear regression analysis, the salivary cortisol levels remained significantly associated with age (β = 0.276; p = 0.004), obesity (β = 0.269; p = 0.006), father's education level (β = 0.393; p < 0.001), and the parental smoking addiction status (β = 0.238; p = 0.026). CONCLUSIONS:The salivary cortisol levels and periodontal indices were higher in overweight and obese children. Therefore, encouraging children and adolescents to adopt a healthier lifestyle and achieve weight reduction may help reduce the salivary cortisol levels and improve periodontal health.
Insomnia symptoms reported in sleep bruxism may partly reflect circadian misalignment rather than insomnia disorder per se, highlighting the need to integrate chronobiological assessment into both bruxism research and clinical practice.
Emerging evidence suggests that viral integration into non-coding and genomically vulnerable regions may represent one of several mechanisms contributing to oncogenesis, warranting further investigation through long-read whole-genome sequencing (WGS).
BACKGROUND:Surgical injury triggers a stereotypical cascade of responses known as the systemic inflammatory response (SIR). To the best of our knowledge, the SIR following palatal graft harvesting has not been previously investigated. OBJECTIVES:The aim of the study was to examine the magnitude of the SIR following palatal graft harvesting in Wistar rats by assessing serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-18, peripheral white blood cell (WBC) counts (differential and absolute counts of lymphocytes, neutrophils, monocytes, eosinophils, and basophils); and anemia-related parameters (red blood cell (RBC) count, hemoglobin (Hgb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC)). MATERIAL AND METHODS:A total of 48 male Wistar rats were included in the study. A 4.2-mm palatal wound was created using a biopsy punch in the middle of the palate. Blood samples were collected before surgery and at 24, 48, 72, and 96 h postoperatively. Serum levels of TNF-α, IL-6 and IL-18 were measured using enzyme-linked immunosorbent assay (ELISA), and complete blood counts were analyzed with an automated blood cell counter on the day of sacrifice. RESULTS:TNF-α levels peaked on day 1, IL-18 on day 2, and IL-6 on day 3. All cytokine levels returned to baseline by day 4. A significant 40% decrease in WBC count was observed on day 1, primarily due to a 47% reduction in lymphocyte count despite a significant 50% increase in neutrophil count. Red blood cell count, Hgb and HCT decreased significantly by 25%, 23% and 23%, respectively, with the greatest reductions observed on days 1, 1 and 2. All values returned to baseline by day 4. CONCLUSIONS:The dynamics of SIR following palatal graft harvesting resemble those observed after other minor surgical procedures. The findings support the classification of periodontal and oral surgery as minor surgery. Changes in blood cell counts and cytokine levels may help identify situations requiring closer monitoring to promote optimal wound healing.
The efficacy of hyaluronic acid (HA) in the treatment of interdental papilla (IDP) deficiency is well documented. This systematic review sought to evaluate clinical studies reporting efficacy, safety, and health-related quality of life (HRQoL) data for HA used in the treatment of IDP deficiency. This review was conducted and reported in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. A comprehensive search of electronic databases was conducted for published randomized controlled trials (RCTs) from their inception until March 21, 2024. A total of 9 studies met the inclusion criteria. The sample sizes in the included RCTs ranged from 10 to 31 participants, with the mean patient age between 26.7 and 46.1 years, predominantly females. Of the 9 eligible studies, 6 assessed the use of HA alone, while 3 investigated the effects of HA in combination with other therapies. The most common outcome measures assessed black triangle dimensions (i.e., area, height or width) followed by probing depth (PD). Based on the limited published studies, this review suggests that HA treatment (whether alone or in combination) may offer therapeutic benefits for patients with IDP defects. However, none of the included studies assessed the safety of HA and its effect on HRQoL. There is a need for further research on the long-term efficacy and safety of HA treatment, and its influence on HRQoL.
BACKGROUND:Orthognathic and maxillofacial trauma surgeries are often challenged by postoperative instability resulting from persistent masticatory muscle forces acting on the repositioned bone segments. Botulinum toxin type A (BTX-A) has been proposed as an adjunctive intervention to transiently reduce these forces and enhance surgical stability. OBJECTIVES:The aim of this narrative review was to evaluate the adjunctive role of BTX-A in orthognathic and maxillofacial trauma surgery, with particular emphasis on its potential to reduce postoperative masticatory muscle forces, thereby enhancing skeletal stability and optimizing healing. The review summarizes the current evidence regarding target muscles, dosing strategies, timing of administration, effects on skeletal and occlusal outcomes, and potential impact on bone regeneration. In addition, it identifies limitations in the existing clinical protocols and highlights areas requiring further standardized, high-quality research. MATERIAL AND METHODS:A narrative review was conducted using the PubMed, Scopus, and Web of Science databases to identify experimental, clinical and case-based studies investigating the use of BTX-A in orthognathic surgery and maxillofacial trauma management. The reference lists of relevant articles were also manually screened to identify additional key mechanistic and translational evidence. RESULTS:Botulinum toxin type A injections into the masseter, temporalis and digastric muscles may reduce postoperative muscle tension, protect fixation hardware, and improve skeletal and occlusal stability. The available studies suggest a transient 20-40% reduction in bite force lasting approx. 3-4 months, corresponding to the critical period of bone healing. Experimental models also indicate a potential beneficial effect on bone regeneration. CONCLUSIONS:Botulinum toxin type A represents a minimally invasive and biologically plausible adjunct for enhancing outcomes in orthognathic and maxillofacial trauma surgery. However, standardized protocols regarding dosing, timing of administration, and safety have yet to be established. Well-designed controlled clinical trials are needed to define its optimal use, alongside ethical guidance addressing its off-label application and use in pediatric patients.
Cyst enucleation is a common procedure performed in oral and maxillofacial surgery to remove cystic lesions. Conventional surgical techniques have traditionally been used for this purpose. However, piezosurgery, a relatively new technology, has gained popularity in recent years. This systematic review aims to compare the efficacy, safety and clinical outcomes of piezosurgery and conventional surgery for cyst enucleation.A comprehensive literature search was conducted using electronic databases, including PubMed, EBSCOhost, Scopus, ProQuest, and ScienceDirect. Studies published from inception up to May 2023 were included. Randomized controlled trials (RCTs) comparing piezosurgery with conventional surgery for cyst enucleation were considered. The primary outcomes included surgical duration, intraoperative bleeding, postoperative complications, and healing outcomes. Secondary outcomes comprised postoperative pain, edema and recurrence. The quality of the included studies was assessed using the revised Cochrane risk of bias tool for RCTs (RoB 2.0).The initial search identified 160 relevant articles, of which 6 studies met the inclusion criteria. Piezosurgery was shown to have a longer operation time, but higher visibility and a similar ease of operation. Clinical outcomes showed less postoperative pain, swelling and trismus in the piezosurgery group.This systematic review suggests that piezosurgery is a promising alternative to conventional surgery for cyst enucleation, offering advantages in terms of reduced surgical duration, intraoperative bleeding, postoperative pain, and edema, as well as proven not to cause any recurrence. However, further well-designed RCTs with larger sample sizes are warranted to validate these findings and evaluate long-term outcomes.
