Aim This randomized parallel arm single blinded trial, evaluated the clinical efficacies of de epithelialized free gingival graft (DFGG) and volume stable collagen matrix (VCMX) enriched with injectable platelet-rich fibrin (i-PRF) along with coronally advanced flap (CAF) for the treatment of recession defects. The objectives were to assess and compare changes in recession depth (RD) and root coverage percentage (RC) between the groups. Materials and methods Forty-five systemically healthy individuals presenting Cairo's RT1/RT2 recession defects in the maxilla were treated either with control (CAF + DFGG, n = 23) or test intervention (CAF + i-PRF + VCMX, n = 22). Parameters such as recession depth (RD) and keratinized tissue width (KTW) were measured at baseline, 6 and 12 months. Mean and complete root coverage percentages (MRC and CRC) were calculated. Results From baseline to 12 months, a statistically significant reduction in mean RD was observed in both the treatment groups (p < 0.001). At 12 months, the control group demonstrated a MRC of 90.21 ± 28.93% and CRC of 89.13 ± 29.99% and the test group showed a MRC of 81.62 ± 32.03% with CRC of 72.73 ± 45.58%. Intergroup analysis revealed no statistically significant differences in the measured clinical parameters at 6 and 12 months (p > 0.05). Conclusion Within the limits of this study, volume-stable xenogeneic collagen matrix enriched with i-PRF resulted in similar outcomes to those achieved with de-epithelialized free gingival graft in the treatment of maxillary gingival recession defects.
Background Periodontitis is a widespread inflammatory disease marked by progressive loss of the periodontal ligament and alveolar bone, often leading to tooth loss. Its complex etiology involves dental plaque, the immune response, behavior, and systemic factors such as diabetes. While traditional diagnostic tools such as probing depth, clinical attachment loss, and radiographs are useful, they often miss the heterogeneity of disease progression. Conventional assessments evaluate clinical and radiographic data separately, missing key patterns and interactions. Recent advances in artificial intelligence, especially graph neural networks (GNNs), model the oral cavity as a network of teeth as nodes and relationships as edges. This approach provides a more comprehensive and biologically relevant understanding of periodontal disease. Methods We developed GraphCROC, a dual-stream model that separately encodes 11 node-level clinical features and five edge-level bone loss metrics, integrating them via a cross-correlation module. The model was trained on data from 90 patients using a clinically weighted reconstruction loss and evaluated against VAE, GCN, and DEC baselines. Results GraphCROC outperformed all baselines in reconstruction (MAE = 0.402, R2 = 0.607) and predicted CAL with the lowest RMSE (0.369). Unsupervised clustering revealed three biologically meaningful disease patterns. Dimensionality reduction revealed clear gradients that represent inflammation and structural loss. Conclusion GraphCROC successfully reconstructs clinical data, identifies disease subtypes, and supports personalized diagnosis by connecting individual risk factors to spatial bone loss. This graph-based model demonstrates potential for AI-driven periodontal risk assessment and treatment planning.
Objectives To compare gingival depigmentation achieved with microneedling and topical ascorbic acid (MN + AA) versus the conventional scalpel technique, along with evaluation of repigmentation and patient-reported outcomes (PROMs). Gingival thickness (GT) and dermal-gingival pigmentation associations were also explored. Methods Twenty-six participants with maxillary physiologic gingival hyperpigmentation were randomized (1:1) to scalpel or MN + AA using an automated microneedling pen. Gingival pigmentation was assessed clinically (Dummett-Gupta Oral Pigmentation Index [DOPI], Gingival Pigmentation Index [GPI]); photographically (Pigmented Surface Area [PSA], Lightness [L]), and using a melanin meter (Gingival Melanin Meter Score, GMMS) at baseline, 1, 3, and 6 months. Primary outcome was change in DOPI at 1 month. Gingival Thickness (GT) and Dermal Melanin Meter Scores (DMMS) were recorded. Results Twenty-three participants completed the study. The scalpel group showed greater reduction in DOPI, GPI, PSA, GMMS, and a greater increase in L at 1 month (P < 0.05). Incomplete depigmentation was observed at some gingival sites with MN + AA. Repigmentation occurred in both groups; DOPI and GMMS were significantly lower in scalpel group at 3 months, with the difference in DOPI persisting at 6 months. Pain, itching, and discomfort scores were modestly higher in the scalpel group, with significant for discomfort on day 3. Color improvement and satisfaction scores were high in both groups. GT increased significantly in the MN + AA at 6 months. DMMS and GMMS were not correlated at any timepoint. Conclusion Both treatments significantly reduced gingival pigmentation at 1 month, with the scalpel technique showing lower pigmentation intensity at 6 months. Both treatments were well tolerated with favorable PROMs. Clinical trial registration number CTRI/2024/05/066602 (ctri.nic.in)
Objective The present study aimed to evaluate the antibacterial and antibiofilm efficacy of eugenol against clinical isolates of Enterococcus faecalis obtained from persistent root canal infections and to investigate its potential interactions with virulence-associated target proteins using network pharmacology and molecular docking approaches. Methods Clinical isolates of E. faecalis were recovered from infected root canal samples and identified using standard microbiological methods. Antibacterial activity of 2% and 4% eugenol was assessed using the agar disc diffusion assay, with further determination of MIC and MBC values using microbroth dilution method. Antibiofilm activity was evaluated using an ex vivo dentinal root canal biofilm model followed by CFU analysis. Potential molecular targets of eugenol were identified further using standard computational tools. Results 4% eugenol exhibited the largest zone of inhibition (23.4 ± 1.4 mm) with the MIC and MBC values at 0.04 mg/mL and 0.4 mg/mL, respectively. In the ex vivo biofilm model, 4% eugenol significantly reduced bacterial colony counts and demonstrated antibiofilm activity comparable to 2% CHX. Network pharmacology analysis identified five potential target proteins, namely pyrG, thyA, accD, tgt, and mtnN and the molecular docking demonstrated favorable binding interactions between eugenol and the selected targets. Conclusion Eugenol demonstrated significant antibacterial and antibiofilm activity against E. faecalis and the computational analyses suggesting the potential interactions with virulence-associated proteins involved in important metabolic pathways. These findings indicate the potential of eugenol as a plant-derived antimicrobial candidate for endodontic applications; however, further in vivo and toxicity studies are required before clinical application.
Objectives:To compare the agreement and concordance between ICDAS and UniViSS caries detection systems among toddlers and preschoolers. Methods:This cross-sectional study included 281 children aged 2-6 years at a tertiary care hospital in South India. All primary molars were examined using both systems and converted to binary format (caries present vs. sound) for comparison, as full ordinal-scale comparison was not feasible given their non-equivalent scoring dimensions. Agreement was assessed using Cohen's Kappa coefficient; sensitivity, specificity, PPV, NPV, and likelihood ratios were calculated with ICDAS as the reference comparator. As ICDAS is a visual index rather than a histological gold standard, all parameters reflect inter-method concordance, not true diagnostic accuracy. Results:The mean age was 5.01 years (SD = 1.07), with 52.7% females. Cohen's Kappa values ranged from 0.886 to 0.983, indicating almost perfect agreement. Against ICDAS as comparator, UniViSS showed inter-method sensitivity of 0.88-1.00, specificity of 0.96-0.99, PPV of 0.88-0.97, and NPV of 0.94-1.00; these values represent agreement with ICDAS and not true diagnostic accuracy. Overall concordance ranged from 95% to 99%. Conclusion:UniViSS demonstrated almost perfect inter-method concordance with ICDAS for binary caries detection in primary molars of toddlers and preschoolers. UniViSS may serve as a practical clinical alternative to ICDAS for binary caries screening; however, findings should be interpreted in the context of the high-prevalence study population, and histological validation remains a priority.
Objective Areca nut chewing is a major risk factor for oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC), yet the molecular mechanisms underlying its carcinogenic effects remain incompletely integrated. This systematic review aimed to synthesize in vitro evidence on the molecular effects of areca nut extract and areca nut–derived alkaloids in human oral cancer cells. Methods This systematic review followed PRISMA 2020. PubMed, ScienceDirect, and Scopus were searched from inception to the final search date. Eligible studies used human oral squamous cell carcinoma cell lines or primary oral cancer cells exposed to areca nut extract or related compounds. Outcomes involving inflammation, proliferation, oxidative stress, oncogenic signaling, and tumor-suppressor regulation were qualitatively synthesized because of methodological heterogeneity. Results Twenty studies met the inclusion criteria. Areca nut–derived compounds were associated with increased pro-inflammatory mediators, including IL-1β, IL-6, IL-8, COX-2, and PGE2. They also altered cell proliferation and cell-cycle control, with increased proliferative markers and suppression of key checkpoint regulators. Oxidative stress was characterized by elevated intracellular and mitochondrial reactive oxygen species, oxidative DNA damage, lipid peroxidation, and impaired antioxidant defenses. Oncogenic and stress-responsive pathways, including NOTCH1, Akt, and Nrf2/HO-1, were activated, whereas p53, p27, SIRT1, and AP-1 transcription factors were downregulated. Findings for p21 were contradictory across studies. Conclusions In vitro evidence indicates that areca nut constituents induce coordinated inflammatory, proliferative, oxidative, and signaling alterations that support their carcinogenic role in human oral cancer cells.
Background:Dentin hypersensitivity (DH) is a prevalent clinical condition characterized by short, sharp pain arising from exposed dentin in response to thermal, tactile, osmotic, or chemical stimuli. Conventional desensitizing agents often provide temporary relief, with inconsistent long-term effectiveness, prompting growing interest in advanced treatment modalities. Objective:To systematically evaluate and compare the efficacy of advanced treatment modalities with conventional or placebo interventions in reducing dentin hypersensitivity in adults. Methods:This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (Registration ID: CRD420250651753). Electronic searches were performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, with the date of final search being 30 September 2025. Randomized controlled trials involving adults with clinically diagnosed dentin hypersensitivity affecting permanent teeth were included. Advanced interventions such as laser therapy, photobiomodulation, bioactive glass, nano-hydroxyapatite, CPP-ACP, iontophoresis, Resin and varnish systems, were assessed. The primary outcome was reduction in hypersensitivity measured using validated pain assessment scales. Risk of bias was evaluated using the Cochrane RoB 2.0 tool, and quantitative synthesis was performed using a RevMan 5.4. software. Results:Thirty-one randomized controlled trials were included in the qualitative synthesis, and twenty-five studies were eligible for meta-analysis. Advanced treatment modalities demonstrated a statistically significant reduction in dentin hypersensitivity compared with conventional or placebo controls (pooled SMD = -1.02; 95% CI: -1.32 to -0.73; p < 0.001). Laser-based therapies showed the greatest effectiveness, followed by nano-hydroxyapatite and bioactive glass agents. Moderate heterogeneity was observed across studies. Conclusion:Advanced treatment modalities are more effective than conventional desensitizing agents in managing dentin hypersensitivity. Laser therapy provides the most consistent and sustained relief, supporting its clinical use, while further standardized long-term trials are recommended.
Background Children with congenital heart disease (CHD) are at high risk for infective endocarditis (IE), with poor oral health being a key portal for bacteraemia. Data holistically integrating clinical status, salivary defence mechanisms, and parental behaviors in this vulnerable population are scarce. Aim To compare the oral health status, salivary parameters, Streptococcus mutans levels, and parental knowledge-attitude-practice (KAP) between children with CHD at risk for IE and healthy controls. Materials and methods This cross-sectional comparative study enrolled 65 children with IE-risk CHD and 65 age- and sex-matched healthy controls (aged 3-12 years). Assessments included the DMFT/deft and Simplified Oral Hygiene Index (OHI-S). Unstimulated saliva was analyzed for flow rate, pH, buffering capacity, viscosity, osmolality, and secretory IgA. S. mutans was quantified via culture. Parental KAP was evaluated using a validated questionnaire. Results The CHD group had significantly higher mean DMFT (4.2 ± 2.1 vs. 1.8 ± 1.5; p < 0.001) and OHI-S scores (2.5 ± 0.7 vs. 1.2 ± 0.5; p < 0.001). They exhibited compromised salivary function (reduced flow, pH, buffering, sIgA; p < 0.05) and elevated pathogenic markers (viscosity, osmolality, S. mutans counts >105 CFU/mL; p < 0.001). Parental KAP scores were significantly lower in the CHD group (p < 0.001). Regression analysis identified CHD status (β = 2.1, p < 0.001), low salivary flow (β = −0.8, p = 0.002), high S. mutans (β = 0.5, p = 0.01), and poor parental practice (β = −0.3, p = 0.03) as key predictors of caries severity. Conclusion Children with CHD exhibit a deleterious triad of severe caries, dysfunctional salivary defences, and inadequate parental preventive practices. These findings mandate the integration of point-of-care oral screening and structured parent education into routine cardiac follow-up to mitigate IE risk.
Introduction:Saliva reflects both oral and systemic health. Monitoring salivary pH and glucose using tongue cleaner-based biosensors may provide a simple non-invasive method for routine salivary assessment. Objective:To develop and preliminarily evaluate separate tongue cleaner-based biosensors for salivary pH and glucose detection in healthy individuals and those with oral disease. Materials and methods:Separate pH and glucose biosensors were fabricated on tongue cleaner platforms. The pH biosensor used an anthocyanin-chitosan-pullulan membrane, while the glucose biosensor incorporated glucose oxidase-functionalized carbon graphite and silver/silver chloride electrodes. Eighty participants aged 18-65 years were included: 40 with dental caries or periodontitis and 40 healthy controls. The glucose sensor was calibrated using glucose standards and validated against the GOD-POD assay. Results:Salivary pH was significantly lower in the study group than controls (6.71 ± 0.41 vs 7.44 ± 0.22; p < 0.001). Glucose resistance values were significantly higher in the study group (39.03 ± 15.54 kΩ vs 10.24 ± 1.13 kΩ; p < 0.001), indicating elevated salivary glucose levels. Very large effect sizes were observed for pH, glucose resistance, and glucose levels. Potentiometric measurements strongly correlated with the GOD-POD assay (r = 0.96; p < 0.001). Conclusion:The developed tongue cleaner-based biosensors demonstrated measurable differences in salivary pH and glucose between healthy individuals and those with oral disease. These low-cost, non-invasive biosensors show potential for salivary assessment, although further large-scale validation is required.
Purpose This study evaluated changes in patient-reported functional, aesthetic, and psychosocial outcomes before and after orthognathic surgery and assessed overall satisfaction among patients treated in the Eastern Province of Saudi Arabia. Methods A retrospective cross-sectional study was conducted among 100 patients who underwent orthognathic surgery at Dammam Medical Complex, Saudi Arabia. Data were collected through structured telephone interviews using a questionnaire adapted from previously published instruments and translated into Arabic. Paired multi-category outcomes were analyzed using the Stuart-Maxwell test, paired binary outcomes using the McNemar test, and p ≤ 0.05 was considered statistically significant. Results The sample included 53 females and 47 males, with a mean age of 29.4 ± 5.9 years. Most participants (70%) expected improvement in both aesthetics and chewing function. Overall, 65% reported postoperative improvement in both domains. Significant favorable changes were observed in chewing ability, nasal breathing, facial profile, frontal facial appearance, and smile (all p < 0.001). Self-confidence increased from 50% to 87% (p < 0.001), and 95% said they would recommend surgery to others. Conclusion Orthognathic surgery was associated with high patient-reported satisfaction and favorable functional, aesthetic, and psychosocial outcomes in this sample from the Eastern Province.
Purpose:To evaluate salivary telomere length as a potential non-invasive exploratory biomarker for early molecular alterations associated with oral leukoplakia and oral squamous cell carcinoma. Methods:Forty-five participants were initially recruited: 15 healthy controls, 15 leukoplakia cases, and 15 oral squamous cell carcinoma (OSCC) cases. Two milliliters of unstimulated saliva was collected, and genomic DNA was isolated using the QIAamp DNA Mini Kit (Qiagen, Hilden, Germany). Relative telomere length (RTL) was assessed using quantitative real-time PCR via the comparative 2 - Δ Δ C t method. Given the non-normal distribution of RTL values (Shapiro-Wilk p < 0.001 in all groups), group variations were evaluated using the non-parametric Kruskal-Wallis test, with Bonferroni-corrected Mann-Whitney U tests for pairwise comparisons. Results:The mean relative telomere length (RTL) ratios 2 - Δ Δ C t were 0.41 ± 1.00 for healthy controls, 0.48 ± 0.80 for leukoplakia, and 0.61 ± 0.87 for OSCC. The Kruskal-Wallis test confirmed no significant difference in RTL ranks across the cohorts (H(2) = 2.68, p = 0.261), and Bonferroni-corrected post hoc Mann-Whitney U comparisons showed no significant pairwise differences between any two groups (all p > 0.35), revealing a highly variable, non-significant upward trend in salivary relative telomere length from health to malignancy. Conclusion:Salivary telomere length exhibits substantial inter-individual variability and a non-significant increasing trend from healthy controls to oral leukoplakia and OSCC. These preliminary findings suggest that relative telomere length may not be a reliable standalone biomarker in its current form and warrants further validation in larger, longitudinal studies.
Objectives Dynamic navigation systems are increasingly used in endodontics to improve accuracy, particularly in complex cases. However, their effectiveness in routine procedures such as gutta-percha removal remains unexplored. This study compared the accuracy and efficiency of Dynamic Navigation System (DNS) versus the conventional freehand technique in gutta-percha retrieval. Materials and methods Single-rooted mandibular first premolar teeth obturated with injectable thermoplasticized gutta-percha were used in this study. Tooth samples were mounted on a 3-dimensional (3D) printed mandibular cast. Pre-operative and post-operative Cone Beam Computed Tomography were performed. The samples (n = 56) were randomly divided into two groups (I: DNS; II: conventional technique). All procedures for both groups were performed by a single clinician who had been trained in DNS. Accuracy and efficiency were assessed by evaluating coronal and apical deviation, angular deflection, procedural time, and the extent of gutta-percha removal. Results The data were analysed using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, N.Y., USA). The Kolmogorov-Smirnov test was used to assess the normality of the data, and it was determined that all parameters were normally distributed. The mean and standard deviation were calculated as the descriptive statistics. An Independent t-test was employed to analyze intergroup comparisons of all parameters. The statistical significance level was determined at p < 0.05. The conventional group showed less coronal and apical deviation compared to the DNS group (p = 0.000). The conventional group exhibited less angular deflection than DNS group (p = 0.005). The conventional group required less procedural time than the DNS group (p = 0.010). Conclusion The conventional free-hand technique significantly improved the operator's accuracy and efficiency compared with DNS for the retrieval of injectable gutta-percha.
Extrusion of endodontic sealers into the maxillary sinus is an uncommon but clinically significant complication, particularly when biologically active zinc oxide-eugenol-based materials are involved. Their persistence within the sinus may impair mucociliary clearance and sustain chronic inflammation. This report describes a 25-year-old woman with persistent unilateral maxillary pain following root canal treatment and subsequent extraction of the involved tooth. Cone-beam computed tomography revealed a well-defined radiopaque foreign body within the maxillary sinus associated with mucosal thickening. Conservative therapy failed to relieve symptoms, and surgical removal was performed using a Caldwell-Luc approach. Histopathological examination demonstrated septate fungal hyphae with acute-angle branching consistent with Aspergillus species in association with a foreign body reaction and chronic inflammatory changes. Complete symptom resolution was achieved and maintained at one-year follow-up. This case highlights the diagnostic value of CBCT in post-treatment persistent pain, the biological behaviour of extruded Endomethasone within the sinus, and the need for early surgical intervention in symptomatic patients. Preventive strategies based on preoperative anatomical assessment and controlled obturation are also discussed. This case defines a transition from odontogenic to biomaterial-induced sinonasal disease and proposes CBCT-based criteria for early surgical intervention.
Aim: To evaluate the marginal fit and internal adaptation of graphene-reinforced CAD-CAM crowns compared with prefabricated zirconia crowns, and to assess the influence of thermocycling on their mechanical and optical properties. Materials and methods: In this in vitro comparative study, typodont mandibular second primary molars were prepared using a standardized protocol and allocated into two groups: graphene-reinforced CAD-CAM (G-CAM) crowns and prefabricated zirconia crowns. Marginal fit was assessed using a stereomicroscope at 40× magnification, and internal adaptation was evaluated using a silicone replica technique combined with three-dimensional digital analysis. For fracture resistance, crowns were tested under pre- and post-thermocycling conditions using a universal testing machine. Disc specimens were prepared separately for surface roughness, microhardness, and color stability; within each parameter, the same specimens were evaluated before and after thermocycling. Artificial aging was performed using 5000 thermocycles (5°C-55°C). Statistical analysis included Shapiro–Wilk and Levene's tests, independent and paired t-tests, and two-way ANOVA (P < 0.05). Results: G-CAM crowns showed significantly lower marginal discrepancy and internal gap values than zirconia crowns (P ≤ 0.002). Fracture resistance was higher in G-CAM crowns before and after thermocycling, with a significant reduction observed in both groups (P < 0.05). Surface roughness, microhardness, and color stability were unaffected by thermocycling (P > 0.05), with ΔE values within clinically acceptable limits. Conclusion: Under in vitro conditions, G-CAM crowns demonstrated superior marginal fit, internal adaptation, and fracture resistance compared with zirconia crowns. Thermocycling had minimal effect on surface and optical properties, though clinical studies are needed to confirm long-term performance.
Background: The mechanical behavior and shaping performance of heat-treated nickel–titanium (NiTi) rotary instruments are influenced by temperature-dependent phase transformation. Aim: This study evaluated cryo-instrumentation technique, in which NiTi instruments are used under controlled cryogenic conditions, and assessed its effect on cyclic fatigue resistance, cutting efficiency, and canal centering ability of HyFlex CM instruments. Materials and methods: Thirty-six samples were randomly allocated into two groups. In the cryo-instrumentation group, HyFlex CM instruments were surface-cooled with Endo-Frost® and used under intracanal cryogenic conditions at 2°C. In the body-temperature group, instruments were used at 37°C without surface cooling. Cyclic fatigue resistance was assessed using standardized artificial canals, and the number of cycles to fracture was calculated. Cutting efficiency was evaluated by measuring dentin reduction on pre- and post-instrumentation cone-beam computed tomography scans. Canal centering ability was assessed using standardized two-dimensional image superimposition at the coronal, middle, and apical thirds. Intergroup comparisons were performed with statistical significance set at p < 0.05. Results: Instruments used under cryogenic conditions demonstrated significantly greater cyclic fatigue resistance than those used at body temperature (p < 0.001). Cutting efficiency did not differ significantly between the groups at any canal level (p > 0.05). Canal centering ability was significantly improved in the cryo-instrumentation group at the middle and apical thirds (p < 0.05), whereas no significant difference was observed at the coronal third. Conclusion: The proposed cryo-instrumentation technique may enhance cyclic fatigue resistance and canal centering ability of HyFlex CM instruments without compromising cutting efficiency.
Background:Secondary alveolar bone grafting (SABG) places bone in the alveolar cleft, crucial for managing cleft lip and palate. SABG restores ridge continuity, aids tooth eruption, and stabilizes the maxilla. Autogenous iliac crest grafting is the standard treatment option. However, varied evidence on donor-site morbidity, graft resorption, and outcomes prompts exploring alternative grafts and adjuncts. Objective:To systematically map and critically synthesize randomized controlled trial (RCT) evidence on graft materials, adjunctive biologics, and outcome assessment strategies in SABG, and to identify methodological gaps that limit translational decision-making. Methods:A comprehensive search was performed across PubMed, Scopus, Web of Science, and Embase for RCTs published in the last decade that evaluated graft materials and biologic adjuncts in SABG. Data on graft materials, adjunctive biologics, surgical strategies, outcome assessment methods, and clinical outcomes were extracted and synthesized narratively. Results:Of 408 records identified, 27 RCTs met the eligibility criteria. Most studies used autogenous iliac crest grafting. Adjunctive strategies included platelet concentrates, cell-based therapies, barrier membranes, graft substitutes, and tissue-engineered constructs. Some studies reported improvements in early healing, intraoperative handling, or bone density. Radiographic assessments were primarily CT and CBCT-based. Outcome measures and reporting approaches varied across studies. Most studies reported short-term outcomes, with limited long-term follow-up data available. Conclusions:Across the 27 RCTs, autogenous iliac crest bone remained the main graft and comparator, with no adjunct or alternative showing consistent superiority in bone volume, density, or resorption. Adjunct benefits were context-dependent, while heterogeneity in outcomes, imaging, and follow-up limited cross-study comparability.
Introduction:Odontogenic orofacial infections involve a broad microbial spectrum, with the rise of multidrug-resistant organisms complicating management. ESKAPE pathogens, known for their ability to evade standard antimicrobial therapies, are increasingly implicated in severe infections. However, their prevalence and resistance patterns in odontogenic orofacial space infections remain insufficiently reported. This study aimed to identify the occurrence of ESKAPE pathogens in such infections and assess their antimicrobial susceptibility to guide effective treatment. Methodology:Between August 2019 and June 2022, 132 patients with oral and maxillofacial infections were prospectively enrolled. Pus samples collected using sterile swabs were cultured following standard protocols. Bacterial identification and susceptibility testing were performed using the VITEK 2-Compact system. Results:Twenty-nine samples (21.97%) yielded at least one ESKAPE pathogen, with Enterobacter species being the most common isolate (34.48%). High resistance rates were seen to amoxicillin-clavulanic acid (62.07%), cefuroxime (62.5%) and trimethoprim-sulfamethoxazole (68.42%). Linezolid, ertapenem, and clindamycin demonstrated the highest susceptibility (100%), followed by imipenem (86.96%, p ≤ 0.05). Acinetobacter baumannii demonstrated complete resistance to all tested antibiotics. Conclusion:ESKAPE pathogens represent a significant proportion of odontogenic orofacial infections and exhibit considerable resistance to commonly used antibiotics. These findings reinforce the necessity of culture-based therapy and highlight imipenem as a potential option for resistant cases. Strengthened antibiotic stewardship and continued surveillance are essential to manage the growing threat of multidrug-resistant organisms in maxillofacial infections.
Background:Bilateral sagittal split osteotomy (BSSO) is widely used for mandibular advancement in patients with skeletal Class 2 malocclusion; however, long-term postoperative stability remains an important clinical concern. Purpose:To evaluate long-term skeletal, dentoalveolar, and soft tissue stability following mandibular advancement with BSSO and rigid fixation. Methods:A retrospective cohort study was conducted in 32 patients undergoing mandibular advancement with BSSO and rigid fixation. Cephalometric measurements were obtained at four time points: preoperative, immediate postoperative, 12 months, and long-term follow-up (>3 years). Changes were analyzed using the Wilcoxon signed-rank test. Results:The mean mandibular advancement was 5.42 ± 1.71 mm. Immediately after surgery, significant skeletal correction was achieved, with increased SNB and decreased ANB (both p < 0.001), accompanied by significant improvements in occlusal and soft tissue profile measurements. Most skeletal and occlusal parameters remained stable during the first postoperative year and throughout long-term follow-up, with no statistically significant changes observed between one year and the final evaluation. Soft tissue remodeling continued during follow-up, whereas overall skeletal and dental stability was maintained. Conclusion:Bilateral sagittal split osteotomy with rigid fixation effectively corrected skeletal Class 2 malocclusion and demonstrated favorable long-term skeletal, dental, and soft tissue stability.
