Background: Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone. Clinical manifestations of Persistent chronic periodontitis may mimic varied clinical manifestations, including those of apical abscess and systemic involvement. Case report: This report presents the management of an intraoral sinus mimicking a chronic apical abscess in the mandibular anterior region associated with deep periodontal pockets in two male patients in their early thirties. With careful clinical and radiological examination and ruling out of endodontic and systemic involvement, the diagnosis of primary periodontal infection was made. Results: The treatment plan involved initially phase 1 therapy and correction of occlusal discrepancies. After 2 weeks of periodontal surgical intervention that included open flap debridement, both patients reported marked symptomatic improvement, with complete resolution of pain and swelling, and sinus with no recurrence at 3 and 6 months. Conclusions: This case report emphasized careful periodontal examination and diagnosis of primary periodontal infection with intraoral draining sinus mimicking endodontic involvement, which can prevent unnecessary endodontic therapy and tooth extraction.
Background: Cell proliferation is essential for tissue repair and immunomodulation in regenerative dentistry. Adipose-derived stromal vascular fraction (AD-SVF) is a promising autologous source for tissue engineering. Its exosomes (AD-SVF Exo), as cell-free products stable under ischemic conditions, represent an ethical and attractive modalityfor dental tissue regeneration and broader regenerative applications. Prior study indicates that AD-SVF Exo can enhance human dental pulp stem cell (hDPSC) migration and proliferation, particularly at low concentrations, but their detailed time-and dose-dependent proliferative effects remain unclear. This study aimed to investigate the time-and dose-dependent effects of low-concentration AD-SVF Exo on hDPSC proliferation in vitro. Methods: AD-SVF exosomes were isolated by size-exclusion chromatography and characterized by flow cytometry and nanoparticle tracking analysis, then applied to hDPSCs at multiple concentrations. Proliferation was evaluated using the Cell Counting Kit-8 assay. One-way ANOVA with LSD post hoc testing was performed (alpha= 0.05). Results: AD-SVF exosomes (mean size 103 +/- 24 nm) expressed CD9 and CD63. All tested concentrations significantly increased hDPSC proliferation versus control in a time-and dose-dependent pattern, with lower doses generally producing the most favorable responses. Conclusions: AD-SVF exosomes enhance hDPSC proliferation in a time-and dose-dependent manner, supporting their potential as a cell-free adjunct in regenerative dentistry.
Background: Missed root canals are common and can cause persistent periapical disease, making the assessment of their prevalence essential for improving diagnostic accuracy and treatment outcomes. This study aimed to investigate the prevalence of missed canals and evaluate their association with periapical lesions in root canal-treated teeth in the Makkah population. Methods: This retrospective cross-sectional study analysed 815 cone-beam computed tomography scans obtained from Umm Al-Qura University between 2019 and 2024. Missed canals and their association with periapical lesions were assessed by two independent observers. Statistical analysis was performed using the chi-square test. Results: Missed canals were detected in 21% of maxillary and 14.2% of mandibular root canal-treated teeth. A highly significant association was observed among maxillary teeth (p < 0.001), whereas no statistically significant association was found for mandibular teeth (p = 0.25). Periapical lesions were present in 77.9% of maxillary teeth and 69.2% of mandibular teeth with missed canals. Conclusions: Missed canals are common in root canal-treated teeth in the Makkah diverse population and are strongly associated with a high prevalence of periapical lesions. Meticulous canal detection and consideration of population-specific anatomical variations are essential to reduce missed canals, prevent periapical pathology, and enhance endodontic treatment outcomes.
Background: Tooth extraction is a common dental procedure often complicated by postoperative infections, with Staphylococcus aureus as a key opportunistic pathogen. Rising antibiotic resistance and side effects of conventional antiseptics like chlorhexidine highlight the need for natural alternatives. This study evaluated the antibacterial and antibiofilm potential of 96% ethanol extract from Ziziphus mauritiana leaves against S. aureus. Methods: The extract was prepared by maceration and tested in vitro using microdilution for minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against S. aureus ATCC 25923. Antibiofilm activity was assessed via crystal violet staining on mature biofilms, with confirmation byqPCR-based absolute quantification of bacterial load using S. aureus-specific 16S rRNA primers. Statistical analysis included Shapiro-Wilk, ANOVA, and Tukey HSD tests. Results: The extract showed MIC between 125-250 mg/mL and MBC at 250 mg/mL. Concentrations of 1000, 500, and 250 mg/mL inhibited >80% biofilm biomass, comparable to 0.2% chlorhexidine. qPCR confirmed significant bacterial load reduction at 1000 and 500 mg/mL. Conclusions: Z. mauritiana leaf extract demonstrates promising antibacterial and antibiofilm activity against S. aureus, supporting its potential as a natural agent for managing post-extraction infections, though further studies on clinical isolates, cytotoxicity, and formulations are warranted.
Background: Children's oral health can be influenced by various factors, including health behaviors, dietary patterns, and oral health knowledge. This study aimed to determine the correlation between oral health behaviors and oral health status in elementary school children. Methods: This cross-sectional study involved 182 elementary school children in Bontang, East Kalimantan, taken by convenience sampling. Health behavior data were acquired by 12-item questionnaires based on the WHO guideline. Examination of dental and oral health status was done by using the DMFT Index and OHI-S. Chi-square was used to determine the correlation between oral health behaviors and oral health status. Results: Majority of children had DMFT score index less than or equal to 8 (86.3%) and OHI-S score more than or equal to 1 (54.4%). There was a significant difference between age (p = 0.012) and the dental caries status of children. There was also a significant difference between of biscuits = 0.018) and the dental caries status of children. Conclusions: Elementary school children in Bontang, East Kalimantan, still have poor oral health behaviors. Education on the importance of daily toothbrushing, regular dental visits, healthy eating habits, and the use of fluoride-containing toothpaste still needs to be improved.
Background: This study aimed to evaluate canal transportation, centering ability, structure model index (SMI), surface area, and root canal volume changes in the mesial canals of mandibular first molars using micro-CT. Methods: Twenty-four mandibular first molars with two separate mesial canals and moderate curvature were included. Teeth were scanned using micro-CT before instrumentation and randomly divided into three groups (N = 8). Root canals were prepared using OneShape, OneCurve, and Rotate file systems, followed by post-instrumentation micro-CT scanning (10 & micro;m/pixel resolution). Changes in canal volume, surface area, transportation, centering ability, and SMI were analyzed at the apical, middle, and coronal thirds. Data were statistically evaluated (p < 0.05). Results: Canal transportation was significantly greater in the middle third compared to the apical and coronal regions. OneCurve (0.06 +/- 0.02) and OneShape (0.09 +/- 0.05) systems showed significantly higher transportation than the Rotate system (p < 0.05). No significant differences were observed among the groups in centering ability (p > 0.05), although the Rotate system demonstrated better centering ability. Additionally, the OneShape system resulted in greater increases in canal volume and SMI. Conclusions: While OneShape and OneCurve systems exhibited similar transportation, the Rotate system provided more favorable shaping outcomes. OneShape caused greater dentin removal and morphological changes.
Background: Oral squamous cell carcinoma (OSCC) is characterized by overexpression of the epidermal growth factor receptor (EGFR). Citral, eucalyptol, and caffeic acid phenethyl ester (CAPE), which are derived from Musa acuminata, have shown anticancer activity. This study evaluated the potential of citral, eucalyptol, and CAPE from Musa acuminata as anticancer agents for OSCC by targeting EGFR using an in silico approach. Methods: Potential biological activity was predicted using Prediction of Activity Spectra for Substances (PASS) Online. Molecular docking was conducted with AutoDock Vina, and BIOVIA Discovery Studio was used to analyze binding affinity, interaction types, and bond distances between the compounds and active-site residues of EGFR. Results: CAPE showed the strongest binding affinity (-8.6 kcal/mol), whereas citral and eucalyptol each showed a binding affinity of -5.4 kcal/mol. CAPE formed a conventional hydrogen bond with CYS775 at 2.65 & Aring; and hydrophobic interactions with PHE856, LEU777, and MET766, through pi-alkyl and pi-pi T-shaped interactions. These interaction distances were within the effective range of <3.5 & Aring;, indicating a stable ligand-protein complex. Conclusions: These in silico findings suggest that CAPE derived from Musa acuminata is a promising anticancer candidate for OSCC through its interaction with EGFR.
Background: This study aimed to evaluate variations in maxillary and sinus morphology and their correlations with skeletal malocclusion patterns using CBCT. Methods: This retrospective study analyzed CBCT records of 70 subjects aged 17-40 years, divided into three groups: Skeletal Class I (N = 25), Class II (N = 25), and Class III (N = 20). Five maxillary skeletal and four sinus parameters were assessed. Intergroup comparisons were performed using one-way analysis of variance (ANOVA) followed by Tukey's post hoc test. Correlations were evaluated using Pearson's correlation test. Intra-observer reliabilitywas assessed by re-measuring 8 randomly selected CBCT scans after a two-week interval, and intraclass correlation coefficients (ICCs) were calculated to confirm measurement consistency. Results: Significant intergroup differences were found in ANS-PNS, Cd-A, and Zm-Zm, with skeletal Class III subjects showing consistently reduced values. Maxillary sinus dimensions did not differ significantly among groups. Skeletal Class III subjects demonstrated stronger correlations between sinus and skeletal parameters compared to Class I and II. Conclusions: Although maxillary sinus dimensions did not differ significantly among skeletal classes, notable correlations with maxillary skeletal morphology, especially in Class III malocclusion, were observed. These findings may have relevance for diagnostic assessment and treatment planning in orthodontic and surgical cases.
Background: Accurate radiographic diagnosis requires images obtained with proper technique. Artifacts are unwanted irregularities or densities not produced by the primary X-ray beam and may obscure anatomical details in radiographic images. This retrospective study aimed to evaluate the performance of ChatGPT, Claude AI, and intern dental students in detecting artifacts in panoramic radiographs (PRs). Methods: Between January and December 2024, panoramic radiographs of 40 patients containing 74 artifacts (motion, mispositioning, airway/soft tissue, and foreign body/metal artifacts) were retrospectively evaluated. The artifact detection performance of ChatGPT-4.0, Claude AI 3.5 Sonnet, and intern dental students was subsequently evaluated and compared with the radiologist-defined gold standard. Results: Dental students demonstrated higher overall accuracy than both AI models in detecting artifacts on PRs. Among the LLMs, Claude AI showed higher accuracy than ChatGPT in detecting motion artifacts (65.0% vs 42.5%), foreign body/metal artifacts (90.0% vs 62.5%), and patient mispositioning (85.0% vs 67.5%), whereas ChatGPT performed better in identifying airway/soft tissue artifacts (87.5% vs 65.0%). Conclusions: ChatGPT and Claude AI demonstrated lower performance than dental students in detecting artifacts in panoramic radiographs. These findings suggest that human evaluation remains essential in radiographic interpretation, and further development of LLMs is needed for reliable clinical application.
Background: Orthodontic treatment increases the risk of bacterial plaque accumulation; therefore, oral hygiene education is essential to prevent complications, but its impact is usually limited when it is not reinforced with effective tools. This study aims to evaluate an audiovisual educational tool with reinforcement messages, compared with a verbal explanation about the proper use of the orthodontic oral hygiene kit. Methods: This was a randomized controlled trial that included 62 patients randomly assigned to an intervention group: 31 patients who received an educational video plus three reinforcement messages via WhatsApp, and a control group: 31 patients who received a verbal explanation about orthodontic hygiene. Initial measurement of the O'Leary plaque index was performed, and the measurement was repeated 6 months later. Results: The intervention group showed a mean reduction of 31.16 points, compared to 7.67 points in the control group, with a mean difference between groups of 23.49 points (95% CI: 19.84 to 27.14; p < 0.001). Conclusions: The audiovisual educational tool with reinforcement messages was significantly more effective than the verbal explanation in improving oral hygiene in orthodontic patients.
Objectives: The gonial angle could be one of the contributing factors for the continuous bone resorption in edentulous persons. This study aimed to examine the association between the gonial angle and RRR in edentulous patients receiving mandibular implant-supported overdenture (ISOD) and to compare different gonial angle measuring techniques. Methods: Twenty-three individuals with opposing mandibular ISOD and maxillary full dentures were recruited. The proportional area index was used to calculate the posterior RRR. Orthopantomographs (OPGs) pre-and four years post-implant insertion were compared. Comparison of the gonial angle measurements was made on 5 patients using four measurement methods: (i) Two different vertical line tracing points on OPG (exterior border points and mid-condylar points), (ii) Measurement on a 3D model using a goniometer, (iii) Lateral cephalometric view of CBCT using Mimics software. Results: The posterior RRR showed no correlation with the gonial angle (r < 0.3, p > 0.05). Between the two OPG measurement techniques, there was no discernible difference (p = 0.185), and there is a strong association between both OPG measuring techniques and CBCT readings (R-2 = 0.927, 0.829). The manual measurement on the CBCT showed a modest correlation with models produced by 3D printing (R-2 = 0.098). Conclusion: The mandibular gonial angle did not correlate with posterior mandibular RRR.
Objective: Mouthwash is widely used to maintain oral health by reducing the prevalence of pathogenic microbiomes. Nonetheless, chlorhexidine, a common active ingredient, is associated with side effects including teeth staining, mucosal peeling, mouth and tongue numbness. This has prompted interest in natural alternatives. This study aimed to identify the cytotoxicity and anti-inflammatory properties of 1'S-1'-acetoxychavicol acetate (ACA) isolated from Alpinia conchigera rhizome against human primary gingival fibroblast and keratinocyte (HPGF and HPGK). Methods: Cytotoxicity of ACA (1.57 mg/mL) against HPGF and HPGK was assessed using the MTT assay. Meanwhile, the anti-inflammatory property of ACA was analyzed based on the concentration of interleukin-6 (IL-6) and lactate dehydrogenase (LDH) synthesized by HPGF and HPGK in response to injury stimulation by lipopolysaccharide (LPS). Results: Treatment with ACA was non-cytotoxic to HPGF and HPGK, with cell viability maintained above 80% after 24 hours. In addition, ACA showed anti-inflammatory activity by reducing the concentration of IL-6 and LDH produced by HPGF and HPGK in response to LPS, reflecting the ACA possibly protecting the cells from inflammation. Conclusion: ACA isolated from A. conchigera rhizome demonstrated non-cytotoxic and anti-inflammatory properties in oral epithelial cells, suggesting its potential to be incorporated in the mouthwash.
Objectives: The misalignment of teeth and/or jaws caused by abnormalities in the dynamic process of craniofacial growth and development is known as malocclusion. Over half of children and adolescents worldwide experience some form of malocclusion. Orthodontic treatment is the process of adjusting the position of teeth and jaws to achieve optimal occlusion. In recent decades, there has been a global surge in the need for orthodontic treatment among adults. This study aims to evaluate the factors affecting interest in orthodontic treatment among adults in Jakarta. Methods: This cross-sectional study was conducted from October to December 2023. A total of 196 adults were retrieved by purposive sampling from public places located in Jakarta. Self-administered questionnaire was used to collect data on demographic characteristics, knowledge regarding orthodontic treatment, self-perception, psychosocial, and oral disorder factors. Logistic regression analysis was carried out with a level of significance less than 0.05. Results: Majority of respondents had a good level of knowledge regarding orthodontic treatment (63.3%) and were interested in undergoing orthodontic treatment (85.7%). There was a significant association between other opinions about respondents' dental arrangement and interest in orthodontic treatment (p = 0.018; 95% CI = 0.135-0.826). Self-perception factors, oral disorder factors, and demographic characteristics were not significant in predicting interest in orthodontic treatment. Conclusion: For adults in Jakarta, other people's opinion about respondents' dental arrangements is the only psychosocial factor correlated with interest in orthodontic treatment. The importance of orthodontic care still needs to be improved for adults in Jakarta.
Objective: Bruxism has been described as a parafunction associated with a multifactorial etiology, but primarily as a psychological factor. This study determined the prevalence of bruxism among dental students and explored the potential contributing factors. Methods: A cross-sectional self-administered questionnaire survey was conducted among dental students across various academic years. The prevalence of bruxism (awake and during sleep) was assessed along with stress levels, lifestyle factors, and demographic variables. Statistical analyses were performed using the chi-square test and multivariate logistic regression. Results: The prevalence of bruxism was significantly associated with stress and academic workload. Most participants exhibited moderate to severe stress. Of these, most reported symptoms of bruxism. However, formal diagnoses and treatment-seeking behaviors were low. Conclusions: Bruxism is prevalent among dental students and may be associated with academic stress. Implementing preventive strategies, such as stress management programs and awareness campaigns, could help reduce its impact.
Objectives: This study aimed to evaluate the proximity of upper posterior tooth roots to adjacent sinus borders using cone-beam computed tomography (CBCT) in a Turkish subpopulation and to assess dental students' competence in identifying this anatomical relationship. Methods: CBCT scans of 171 patients were analyzed. The vertical relationship between premolars and molar roots, and the maxillary sinus (MS) border was categorized into four types (Type 0-3). Interrater agreement between three final-year dental students and an experienced radiologist was measured. Results: Type 0 was the most frequent classification, except for first molars, where Type 2 and Type 3 predominated. MS-root distances were significantly greater in men for specific teeth. Interrater agreement between the radiologist and each student was substantial. Conclusion: The relationship between the MS and posterior teeth varies by tooth type, gender, and age. Second molars most frequently lie closest to the MS, increasing the likelihood of sinus-related complications. Dental students demonstrated substantial diagnostic agreement with the radiologist, highlighting the value of structured radiographic education. These findings underscore the need for thorough radiographic assessment to minimize procedural risks in clinical practice.
Objective: Selecting and arranging acrylic resin teeth for dentures is essential to achieve a natural appearance; however, limited understanding and older adults' aesthetic expectations may result in inconsistencies and increased patient visits. This study aimed to explore the methods and factors dental students prefer when selecting artificial teeth for dentures for older adults. Method: A validated questionnaire, including consent, demographics, and six domains of the methods with related factors for selecting acrylic teeth, was distributed to dental students of the Universiti Teknologi MARA (UiTM). The participants responded using a five-point Likert scale and closed-ended questions. Result: 161 dental students participated in the study (115 females, 71.4% and 46 males, 28.6%), divided into no-experience (n = 80, 49.7%) and experienced (n = 81, 50.3%) in treating older denture patients. Both groups preferred the visual shade selection method, with no-experience students' mean score is 3.88 +/- 1.03 and experienced students' score is 4.11 +/- 0.77 (p > 0.05). The digital shade selection method was the least preferred by no-experience students (2.98 +/- 1.28) and experienced students (2.51 +/- 1.33) (p < 0.05). The factors most influencing the selection were experience, light source, and characteristics of the tooth. Conclusions: Dental students preferred the visual shade selection method for choosing acrylic teeth in denture fabrication for older adults and were influenced by experience, light source, and natural tooth characteristics.
Objective: Pulpitis is an inflammatory condition of the dental pulp. The inflammatory status can be accurately assessed by histological examination. Biomarkers, such as matrix metalloproteinases (MMPs), are effective indicators of inflammation severity. Among these, matrix metalloproteinase-9 (MMP-9) has emerged as a key mediator of inflammatory processes associated with pulpitis. However, its clinical application as a biomarker remains limited owing to challenges in its extraction. This study aimed to evaluate the effectiveness of MMP-9 extracted from the dentinal fluid as a biomarker for pulpitis. Methods: Dentinal fluid was collected using the blunt tip of a sterile paper point, following clean excavation of the cavities. The paper point was placed in a sterile tube containing phosphate-buffered saline (PBS) and stored at-20 degrees C. MMP-9 levels were analyzed using enzyme-linked immunosorbent assay (ELISA). Results: MMP-9 was detected in three of four patients diagnosed with irreversible pulpitis. Kruskal-Wallis test revealed a statistically significant difference in MMP-9 levels in the irreversible pulpitis group (p < 0.05). Conclusion: MMP-9 in dentinal fluid is a potential biomarker for irreversible pulpitis. However, further research is required to validate their diagnostic utility in clinical practice.
Patients who report to the dental outpatient department following maxillofacial trauma often exhibit suboptimal oral hygiene, which is frequently attributed to challenges in sustaining oral care stemming from pain and restricted mouth opening after the injury. This case report aims to provide an individualized protocol of oral care and pain management for patients with maxillofacial trauma. Case report: A treatment protocol combining the Tailored Brushing Method (TBM), a personalized approach for at-home oral hygiene, and photobiomodulation using lowlevel laser was performed on a 24-year-old patient with maxillofacial trauma and poor oral hygiene. Results: The TBM is successful in achieving good patient adherence to at-home oral hygiene protocols. The results showed that the application of low-level laser soon after the trauma helped in pain control and augmented the patient's compliance with the necessary procedures. This application was also shown to be effective in healing intraoral soft tissues. Conclusion: This case report highlights the TBM's success in improving patient compliance and the effect of photobiomodulation in managing pain and enhancing the healing of soft tissues. In the precision periodontics era, this personalized oral care approach will offer significant therapeutic advantages in the management of patients with maxillofacial trauma.
Objectives: The human amniotic membrane (HAM) is a promising scaffold for oral applications due to its antimicrobial properties, which help protect against bacterial degradation. However, evidence of its activity against oral bacteria remains limited. Thus, this study aimed to evaluate the antibacterial activity of the HAM against selected Gram-positive oral bacteria, namely, Streptococcus mutans (S. mutans), Streptococcus sobrinus (S. sobrinus), and Enterococcus faecalis (E. faecalis). Methods: HAM in 1 cm2-pieces was inoculated with bacterial suspensions and incubated at 37 degrees C in 5% carbon dioxide (CO2) for 48 hours to evaluate its inhibition activity. Tetracycline-30 and 0.2% Chlorhexidine served as the positive controls, while phosphate-buffered saline (PBS) was used as the negative control. Swabs from the inhibition zone were re-cultured on Mueller-Hinton agar to test for the bacteriostatic and bactericidal effects of the HAM. Results: HAM inhibited the growth of S. mutans and S. sobrinus but showed no activity against E. faecalis. It also exhibited bactericidal effects against both the Streptococcus species. A statistical analysis revealed a significantly smaller inhibition zone for the HAM compared with the positive controls, while there was no significant difference compared to the PBS. Conclusion: The human amniotic membrane (HAM) demonstrated antibacterial and bactericidal activity against the selected Streptococcus species, but not E. faecalis. The antibacterial properties of HAM against other oral pathogens require further studies to explore its potential as an oral scaffold.
Objective: Musculoskeletal disorders (MSDs) are common workplace hazards in dentistry resulting from poor ergonomics and static postures, which lead to back, neck, and upper limb (shoulder, elbow, wrist, and hand) problems among dentists, resulting in harm to their health, productivity, and career. This study aimed to assess the frequency of MSDs, risk factors related to MSDs, and awareness of ergonomics among clinicians. Methods: Data were collected from 400 dental professionals, including house officers, postgraduate trainees, general dentists, and teachers/consultants, each with at least 12 months of practice. Data were collected using a structured, closed-ended questionnaire. Before data collection, ethical approval was obtained from the Institutional Review Board of the Karachi Medical and Dental College (ESRC/KMDC/069/2023). Results: It was found that only 12.8% of respondents (n = 49, all postgraduate trainees) regularly adjusted their chairs to an ergonomic position. Maintaining posture for > 40 min (p = 0.025), uncomfortable stools (p = 0.034), repeated motions for more than two hours (p = 0.003), maintained non-neutral postures for > 2 h (p = 0.002), and repetitive wrist flexion or extension (p = 0.014) were all significant risk factors. Conclusion: There is a need to incorporate ergonomics and posturedontics into undergraduate and continuing education curricula to minimize the risk of developing MSDs and to support sustainable careers.
