Ankylosed primary molars are relatively common during the mixed dentition period; however, ankylosis does not always coincide with infraocclusion. This systematic review assessed the clinical evidence regarding ankylosis of primary molars, including its etiology, diagnosis, and management, and discussed whether infraocclusion is primarily caused by ankylosis or instead reflects a broader disturbance of tooth eruption. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across three databases (PubMed, Scopus, and Web of Science) on 25 April 2025 and updated on 3 July 2026. The risk of bias and methodological quality of the included studies were assessed using the Joanna Briggs Institute critical appraisal tools. Fourteen studies met the inclusion criteria. The person-level prevalence of infraoccluded primary molars, used as a surrogate for ankylosis, ranged from 1.3% to 24.8%. Histopathological and clinical studies indicated that not all infraoccluded primary molars exhibited evidence of ankylosis. Treatment strategies varied according to the severity of infraocclusion and the presence or absence of permanent successors. The available evidence remains limited and insufficient to determine the temporal and causal relationship between ankylosis and infraocclusion. Further epidemiological, histopathological, and treatment-related studies are needed.
The field of Orofacial Pain and Dysfunction (OPD) has evolved from a discipline centered on temporomandibular disorders (TMD) into a broad network of interconnected conditions. This letter highlights the biopsychosocial nature of TMD, its links with headache, bruxism, sleep disorders, and systemic health, and emphasizes the need for interdisciplinary collaboration. As OPD increasingly intersects with medicine, integrating dental and medical expertise becomes essential in education, research, and patient care.
Objectives:This systematic review and meta-analysis synthesised global prevalence, regimens, guideline adherence, and factors associated with antibiotic prescribing in dental implant surgery. Methods:MEDLINE, Scopus, and Web of Science were systematically searched from January 2010 to October 2025. Dentist surveys, patient-record studies, and register-based studies were included. Prevalence was pooled using random-effects meta-analysis with Freeman-Tukey transformation; regimen and appropriateness were narratively synthesised. Risk of bias and evidence certainty were assessed using JBI and GRADE tools. Results:Thirty-nine studies (7266 dentists; 137,207 patients) were included. Pooled prevalence of routine antibiotic prescribing was 61.3% (95% CI: 53.4-68.8%; I²=96.8%) with extreme heterogeneity (24.9-88.8%). Combined pre- and post-operative regimens predominated (52.6%), typically involving 5-7-day post-operative courses. Amoxicillin was the most frequent choice (50.9%). Prescribing increased with procedural complexity, reaching 97.3% for compromised cases. Guideline-concordant prescribing was low (1-28%), with a declining temporal trend. Overall evidence certainty was very low. Conclusions:Antibiotic prescribing for implant surgery varied widely but was often high, frequently exceeding evidence-based indications. Post-operative regimens predominated despite no demonstrated benefit over a single pre-operative dose. Reducing unnecessary antibiotic use in implant surgery may require procedure-specific international guidelines and targeted stewardship, though more robust evidence is needed to determine effective strategies.
Objectives:To determine if oxidative stress markers are consistently altered in TMD patients compared to healthy controls, by synthesizing evidence from blood, saliva, and synovial fluid analyses and assessing study quality. Methods:Following PRISMA guidelines, Medline/PubMed, Scopus, Web of Science, Google Scholar, Cochrane and Embase were systematically searched for English articles up to September 2025 using MeSH and free keywords. Human observational and clinical studies comparing biomarkers in TMD patients and healthy controls in blood, saliva, and synovial fluid were included. Risk of bias was assessed by using the Newcastle-Ottawa Scale (NOS). Results:Fourteen studies were included in the final analysis. Methodological quality was moderate to high (average NOS score 7.07 ± 1.07), with low risk-of-bias studies. Serum-based analyses most consistently showed higher oxidant markers (e.g., MDA) and reduced antioxidants (e.g., SOD) in TMD patients. Saliva results were the most varied. Conclusion:This 'compensatory-to-depletion' transition may represent a key biochemical indicator for disease staging. Evidence consistently links TMDs with oxidative stress imbalance across sample types, characterized by elevated oxidants (e.g., MDA) correlating with pain severity. Although heterogeneity limits causal inference, serum oxidative markers show diagnostic promise in early-stage/chronic pain states, with a biphasic antioxidant response reflecting progression. PROSPERO Reg:CRD420251186118.
Objectives:To map the knowledge structure of large language model (LLM) applications in the dental field (LADF) through a dual-database scientometric study that highlights trends, collaborations, hotspots, and future directions. Materials and methods:The Web of Science and Scopus were searched on August 1, 2025. LLM-related articles in dentistry were screened. After removing duplicates, 311 English articles and reviews were included in the study. Bibliometrix (v5.0) was used for characteristic and citation analyses. CiteSpace (v6.4.R1) was used for keyword analysis. Results:The number of publications surged from 24 (2023) to 182 (Jan-Aug 2025). Among all publications, 90% were original research articles. Two-thirds were open-access, funded mainly by governments. As for the collaboration network, author and institutional networks were fragmented. National-level collaboration was stronger. High-income countries dominated the LADF output. Keyword clustering revealed a hub-and-spoke structure that included three research frontiers: 1. broadening applications, 2. deepening clinical use, and 3. comparative evaluation, with accuracy and quality as central themes. Conclusions:LADF has expanded rapidly, but research remains fragmented. Shared datasets, stronger global collaboration, and the development of standardized evaluation metrics, particularly for diagnostic and question-answering proficiencies, are necessary to address the central themes of accuracy and quality.
Purpose Metadherin (MTDH) is frequently overexpressed across human malignancies, yet its roles in head and neck cancer (HNC) remain incompletely characterized. This systematic review evaluates the biological functions, molecular mechanisms, and clinical relevance of MTDH in HNC. Methods A systematic literature search was conducted across four electronic databases (PubMed, Embase, Scopus, and Web of Science) in accordance with PRISMA 2020 guidelines. Results Thirty-three studies met inclusion criteria. MTDH was consistently overexpressed across HNC subtypes and associated with advanced clinicopathological features and poor prognosis. Functional studies demonstrated that elevated MTDH promotes migration, invasion, metastasis, epithelial-mesenchymal transition (EMT), proliferation, angiogenesis, and chemoresistance. Mechanistically, MTDH activates NF-κB, PI3K/Akt, Wnt, and MAPK pathways and is post-transcriptionally regulated by nine miRNAs, with HNC-specific features including a CCL18-driven macrophage paracrine axis, MMP1-selective NF-κB effector activity, and a potential association with invasion front architecture as reflected by Worst Pattern of Invasion (WPOI). Clinically, MTDH modulates chemoresistance, ferroptosis-mediated radiosensitivity, and immune checkpoint expression. Conclusion This systematic review identifies MTDH as a multifaceted oncoprotein that plays a central role in HNC progression, metastasis, and therapeutic response, highlighting its potential as a prognostic biomarker and therapeutic target.
Fluoride has always been used as a gold standard in preventing early enamel caries, however due to its demerits, newer remineralising agents such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and bioactive glass (BAG) have been developed to either substitute or as an adjuvant to fluoride in managing white spot lesions (WSLs). A systematic search of five databases was conducted up to August 2025 following PRISMA guidelines. Eligible RCTs evaluated CPP-ACP or BAG in permanent teeth with WSLs or early enamel caries. Risk of bias was assessed using the Cochrane RoB-2 tool, and certainty of evidence with GRADE. Sixteen RCTs were included (3 BAG, 13 CPP-ACP). BAG showed greater remineralisation than fluoride and CPP-ACP in two studies. Five studies favored CPP-ACP over fluoride. Formulations containing CPP-ACP with fluoride showed slight advantages over CPP-ACP alone. Considerable heterogeneity in outcome measures and a high or unclear risk of bias was identified across most studies. Certainty of evidence was rated low to moderate. Both BAG and CPP-ACP demonstrate remineralising potential, with BAG particularly fluoride-containing formulations showing more consistent results. Current evidence remains insufficient to replace fluoride as the standard. High-quality multicentre RCTs with standardised outcomes are needed.
Background:Cell homing has emerged as a promising strategy in dental pulp regeneration using hydrogels, providing a minimally invasive and cell-free alternative. However, the lack of standardized models limits result comparability, biological interpretation and clinical translation. Objectives:This scoping review aimed to identify and classify the experimental strategies used to study cell homing with hydrogels in endodontics, and to provide recommendations to improve the physiological relevance and methodological clarity of future research. Methods:Two databases (PubMed and ScienceDirect) were searched for studies published in the past decade. Key variables extracted from each study included the modulated parameters, hydrogel type, targeted tissue, and whether cell homing was investigated. Results:From 2701 records identified, 2681 were screened and 32 articles were included. Among these, 72% evaluated cell homing using 3D migration models or acellular in vivo approaches. 19% of the studies explicitly reported to perform cell homing and assessed it experimentally, while 53% did not state this intention but assessed it through relevant experiments, revealing a discrepancy between declared intentions and methodological practices. Conclusion:Standardized methods are needed to clearly define and assess cell homing for dental pulp regeneration.
Background:Early detection of head and neck squamous cell carcinoma (HNSCC) remains challenging because tissue biopsy is invasive and unsuitable for repeated monitoring or large-scale screening. This study systematically evaluated the diagnostic accuracy of human papillomavirus (HPV) DNA detection in oral gargle and rinse samples for HNSCC. Methods:This meta-analysis followed PRISMA guidelines and included 10 studies with 1315 participants. Pooled sensitivity, specificity, summary receiver operating characteristic (SROC), and diagnostic odds ratios (DOR) were calculated using random-effects models. Comprehensive subgroup analyses were conducted to explore pre-analytical and analytical heterogeneity. Results:Pooled sensitivity and specificity were 0.68 (95% CI: 0.58-0.79) and 0.91 (95% CI: 0.88-0.95), respectively, with an AUC of 0.91. Higher pooled sensitivity was observed in subgroups using smaller collection volumes (≤10 mL), non-SPF10 PCR-based detection methods, and HPV16-specific targets, whereas specificity remained consistently high across subgroups. Fagan's nomogram showed that the test offers greater clinical value for ruling in than ruling out the disease. Conclusion:Oral HPV DNA testing via gargle and rinse samples shows high specificity but moderate, highly variable sensitivity. Therefore, it functions best as a non-invasive, supplementary tool for triage or monitoring, rather than as a standalone early detection or rule-out method for HNSCC.
Automated machine learning (AutoML) has emerged as a clinician-accessible approach to artificial intelligence by automating key stages of model development, including algorithm selection and hyperparameter optimization. This systematic review aimed to evaluate the application, performance, and translational relevance of AutoML in oral healthcare. Electronic searches of PubMed, Web of Science, Cochrane Library, and grey literature were conducted. Nineteen primary studies met the inclusion criteria. AutoML was applied across multiple dental specialties, including periodontology, orthodontics, pediatric dentistry, oral surgery, oral radiology, and public oral health, using heterogeneous data modalities such as radiographic images, clinical records, photographs, and omics data. Most studies reported strong performance on internal validation (e.g., cross-validation or validation splits) and/or independent hold-out test sets, particularly for imaging-based classification tasks, with several models achieving high accuracy and discrimination. However, external validation was uncommon, sample sizes were frequently limited, and substantial risk of bias was identified, particularly in analysis and participant selection. No study evaluated real-world clinical implementation or patient outcomes. Overall, AutoML shows promise in reducing technical barriers and supporting clinician-led artificial intelligence research in dentistry. Nevertheless, current evidence base remains exploratory, and rigorous external validation, standardized reporting, and prospective clinical evaluation are required before routine clinical adoption.
This systematic review assesses the necessity of in vivo models in determining whether these novel dual-biofunctional coating could induce osseointegration and exhibit antibacterial activity by providing a comprehensive biological response that in vitro models cannot replicate. This systematic review included in vivo studies involving intraoral implantation. A comprehensive search of original research published in English up to December 2024 was conducted across Medline, Scopus, and Web of Science. From the screened studies, 16 studies (1 clinical trial and 15 animal studies) met the inclusion criteria. The clinical trial involved 15 patients and reported 4-month outcomes. A large variance was observed among the protocol of animal studies, comprising five species (rats, rabbits, dogs, pigs, and goats). Six studies utilized peri-implantitis models to evaluate osseointegration outcomes under disease challenge. The reviewed studies highlighted various osseointegration-promoting components, such as inorganic compounds (e.g., calcium phosphate), peptides, and metal-based materials, as well as antimicrobial agents including metals, metal oxides, and polymers. By synthesizing in vivo findings, this review seeks to optimize dual-biofunctional coatings that simultaneously eradicate pathogenic bacteria and induce osseointegration within clinically relevant environments. Future work should aim to standardize in vivo protocols and new in vitro methods to reduce heterogeneity.
Objective Hypercementosis, characterized by excessive cementum deposition that distorts apical root morphology, poses specific anatomical challenges in endodontics; this systematic review aimed to synthesize its endodontic implications and to propose tailored treatment strategies for affected teeth. Methods A systematic search was conducted across PubMed, Scopus, EBSCO-DOSS, and Google Scholar following PRISMA guidelines. The SPIDER tool was used to refine inclusion criteria, focusing on studies involving human teeth affected by hypercementosis and its impact on endodontic treatment. Results Ten studies met the inclusion criteria: three experimental/descriptive and seven clinical studies. Hypercementosis was associated with anatomical challenges, complicating working length determination, canal negotiation, and obturation. Reported treatment approaches included orthograde treatment, surgical endodontics [including computer-aided-design-guided microsurgery], and the use of Cone Beam Computed Tomography for enhanced visualization of root morphology. Despite these interventions, treatment outcomes remained limited by persistent anatomical complexities. Conclusions Hypercementosis presents a significant challenge in endodontic treatment. A stepwise approach, ranging from clinical monitoring in asymptomatic cases to surgical interventions is recommended. The integration of advanced imaging technologies and individualized treatment planning is essential to improving therapeutic outcomes. Larger cohort studies with standardized diagnostic criteria are needed to better assess the prevalence of hypercementosis and its incidence on endodontic treatment.
The integration of LLMs in the healthcare sector offers significant potential for improving medical practice and patient care. They assist in medical diagnosis by analyzing patient symptoms and other relevant data. This systematic review proposes to assess the existing literature on the use of LLMs. The comprehensive review was conducted in PubMed, Web of Science, Google Scholar and Scopus databases using keywords related to LLMs for articles published in English language at all times. Data was extracted to determine the applications, evaluation criteria and outcomes of LLMs in dentistry. Of 1142 records, 38 studies fulfilled the inclusion criteria. Among all studies, ChatGPT-3.5 was the most frequently used LLM. Most of the studies addressed patient questions during or after dental treatment. Most studies asked open-ended questions, and the Likert scale was the most used evaluation scale. This systematic review has shown that LLMs can increase efficiency, improve patient care and diagnostic support in dentistry. However, due to the risk of incorrect and incomplete information, LLMs should be used as clinical decision support tools. To increase their effectiveness and reliability, they should be trained on rigorously validated and continuously updated data sets.
The DSPP gene regulates dentin mineralisation, and its pathogenic variants cause a spectrum of defects ranging from dentin dysplasia (DD-II) to dentinogenesis imperfecta (DGI-II/III). Clinical variability often confounds diagnosis. This systematic review of 48 publications (70 variants, 99 records) delineates quantitative genotype-phenotype correlations. Results revealed distinct molecular clustering: Exon 5 harboured 61 % of variants, predominantly frameshifts disrupting the repetitive dentin phosphoprotein (DPP) domain. In contrast, upstream regions (exons 2-4) contained mixed variant types affecting the signal peptide and dentin sialoprotein (DSP). Statistical analysis established a definitive severity gradient. Exon 5 frameshifts were significantly associated with the milder DD-II, characterised by thistle-shaped pulps and clinically normal permanent dentition. Conversely, upstream signal peptide, splice site, and missense variants (exons 2-3) were linked to the severe DGI-III, manifesting as 'shell teeth', rapid attrition, and pulp exposure requiring complex prosthodontic intervention. DGI-II displayed no specific genomic clustering, representing an intermediate phenotype. These findings provide complementary insights to historical classifications, highlighting a continuous spectrum of DSPP disorders where upstream defects cause severe failure, while downstream defects result in attenuated localised anomalies. Consequently, integrating DSPP genotyping into diagnostic workflows is essential to predict disease progression, refine molecular taxonomy beyond the Shields system, and guide personalised rehabilitation.
Postoperative pain after root canal treatment remains a frequent clinical problem despite advances in instruments and irrigants. This Bayesian systematic review and network meta-regression compared seven irrigation activation/agitation techniques-positive pressure, manual dynamic, sonic, ultrasonic, multisonic, negative-pressure and laser-activated irrigation-with respect to Day-1 postoperative pain. Electronic searches of PubMed, Cochrane Library, Scopus and Web of Science were conducted up to 10 December 2024; 57 trials (2595 patients) were included qualitatively and 31 contributed to the quantitative network. Pain scores were rescaled to a 0-10 scale and analysed as mean differences, with symptomatic status modelled as an ordinal covariate and treatment rankings summarised using SUCRA values. Laser-activated irrigation (LAI) produced the lowest Day-1 pain and showed a clinically important advantage over manual dynamic irrigation (MDI) exceeding the 1.0-point minimal clinically important difference, while also outperforming positive pressure and ultrasonic irrigation with smaller, statistically but not clinically important effects. Multisonic and negative-pressure irrigation also ranked favourably, whereas MDI consistently showed the highest pain scores and the lowest SUCRA values. Baseline symptomatic status was a strong effect modifier, with symptomatic teeth experiencing substantially higher pain irrespective of technique. Overall CINeMA confidence was low to very low for most contrasts, indicating that these findings should be interpreted cautiously and highlighting the need for larger, better-designed trials with standardised pain-assessment protocols.
Objectives:This systematic review assesses the diagnostic accuracy, feasibility, and clinical performance of artificial intelligence (AI)-based smartphone imaging tools for detecting dental caries. Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) guidelines, five databases: PubMed, Scopus, Web of Science, Embase, and Cochrane Library, were searched up to March 26, 2025. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251047689). Diagnostic accuracy and feasibility of AI-driven analysis of smartphone-based dental images for the detection of dental caries were assessed. Risk of bias and applicability were evaluated using QUADAS-2. Results:Fourteen studies met the inclusion criteria. AI models, particularly YOLO variants, DenseNet201, and MobileNetV3, demonstrated high diagnostic accuracy, especially for cavitated lesions, with some outperforming junior dentists. Enhanced YOLO models achieved up to 85.5 % mean average precision. Tools were generally user-friendly and suitable for community or at-home screening. However, sensitivity for early or non-cavitated lesions varied. Conclusion:AI-driven smartphone imaging shows promise as an accessible and reliable tool for caries detection, particularly in low-resource or remote settings. Further research is needed to improve early lesion detection, ensure clinical validation, and support equitable implementation.
Purpose Evaluate the bond strength performance of the different types of adhesive systems to the primary tooth enamel. Methods This study was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/YURB4). A two-stage literature search was conducted by two independent reviewers on PubMed, Embase, Web of Science, Scopus, and gray literature to identify in vitro studies evaluating the bond strength of different adhesive systems to primary tooth enamel. The risk of bias was evaluated with the QUIN tool. A Bayesian network meta-analysis was conducted to evaluate the bond strength at 24 h. Results The final sample was composed of 14 articles. The 2-bottle universal adhesive system with phosphoric acid etching (PAE) was statistically similar to the 3-step etch-and-rinse (E&R). In addition, self-etch and etch-and-rinse adhesives with the same number of steps had similar performances. In the ranking, 3-step E&R had the highest probability of being ranked the best adhesive, while 1-step self-etch without PAE had the lowest. All studies had a low risk of bias. Conclusion 2-bottle universal adhesive systems with PAE can probably provide similar bond strength to primary tooth enamel compared to 3-Step E&R. In addition, the similar performance of some of the tested adhesive systems indicates the possibility to reduce clinical steps.
Background:Temporomandibular disorders (TMD) are a heterogeneous group of conditions frequently associated with pain and functional impairment. Arthrocentesis has been proposed as a minimally invasive therapeutic option; however, its comparative effectiveness versus other treatments remains uncertain. Objective:To evaluate the effectiveness of arthrocentesis compared with other therapeutic modalities in patients with TMD, focusing on pain relief and mandibular functional outcomes. Methods:A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Randomized controlled trials comparing arthrocentesis with other therapeutic interventions for TMD were included. Comparator interventions included conservative therapies (e.g., occlusal splints, physiotherapy, and pharmacological treatment), intra-articular injections, arthroscopy, and alternative arthrocentesis-based protocols. Primary outcomes were pain intensity assessed by visual analogue scale (VAS) and mandibular functional outcomes, including maximum mouth opening (MMO), maximum incisal opening (MIO), masticatory efficiency, mandibular movements, and overall joint mobility. Pooled estimates were calculated using mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE approach. Results:Thirty-two randomized controlled trials were included in the quantitative synthesis. No statistically significant difference in pain reduction was observed between arthrocentesis and comparator interventions (MD = -0.25; 95% CI -1.09-0.59; p = 0.55), with very high heterogeneity (I² = 96%). No statistically significant differences were found for maximum incisal opening (MIO), mandibular movements, or overall joint mobility. Masticatory efficiency showed a small statistically significant improvement favoring arthrocentesis (SMD = 1.15; 95% CI 0.22-2.08), based on very low-certainty evidence. Overall, the certainty of evidence ranged from low to very low across outcomes, and heterogeneity was substantial in most analyses. Conclusions:Arthrocentesis may provide modest symptomatic improvement in selected patients with TMD; however, it does not demonstrate superiority over alternative therapeutic modalities for most functional outcomes. Given the substantial heterogeneity and low certainty of the available evidence, these findings should be interpreted cautiously. Further well-designed randomized controlled trials with standardized diagnostic criteria, clearly defined comparators, and longer follow-up are required to better define the role of arthrocentesis in the management of temporomandibular disorders. Clinical significance:Current evidence does not demonstrate clear superiority of arthrocentesis over alternative therapeutic modalities for pain reduction or functional improvement in temporomandibular disorders. While arthrocentesis may be considered as a minimally invasive approach in selected patients, particularly those who do not respond to conservative management, its clinical benefits remain uncertain due to substantial heterogeneity and low certainty of evidence. Therefore, arthrocentesis should be interpreted as a potential adjunctive option within a stepwise treatment strategy rather than as a definitive or superior intervention.
Single-cell RNA sequencing (scRNA-seq) has advanced the understanding of cellular heterogeneity and molecular dynamics in human dental tissues. This systematic review critically evaluated scRNA-seq studies exploring the cellular composition of human dental tissues, comparing in situ and cultured environments under both healthy and diseased conditions. Original research articles meeting the inclusion criteria were assessed for cell type identification, transcriptional profiles, analytical platforms, and other key biological insights by two independent authors. A total of fifteen studies that met the inclusion criteria revealed diverse cell populations, including mesenchymal stem cells (MSCs), immune cells, endothelial cells, and odontoblast-like cells, each exhibiting distinct transcriptional signatures in homeostasis, regeneration, and disease. Key findings included distinct MSC subpopulations, including THY1+, CD24+, FRZB+, and NOTCH3+/PDGFRB+, exhibiting unique differentiation potential, along with significant heterogeneity in odontoblast lineage. Moreover, carious dental pulp undergoes a fibrotic transcriptional shift (e.g., COL1A1, FN1, and TNC), whereas periodontitis exhibits increased expression of pro-inflammatory cytokines (IL-1β and TNFα) and diminished periodontal MSC regenerative capacity. This review underscores the contributions of scRNA-seq in providing unprecedented insights into the complexity and functional heterogeneity of dental tissues, offering a foundation for advancing targeted regenerative therapies and guiding future translational research in dental medicine.
