Objective: To evaluate whether adherence to the Mediterranean Diet (MD) is associated with a lower prevalence of oral and systemic diseases and to investigate the relationship between MD adherence and oral health parameters, including dental caries, periodontal disease, salivary flow, and salivary pH, in a multicenter population of adults. Materials and methods: We enrolled 232 patients, recorded their medical histories, and assessed their adherence to the MD using the “Mediterranean Diet Adherence Screener” questionnaire. We also randomly performed an intraoral examination on 43 patients from the adherence group and 30 patients from the non-adherence group. Results: We found a statistically significant difference in the prevalence of systemic conditions, such as cancer (p = 0.045) and cardiovascular disease (p = 0.02), between patients adhering to the MD and those who did not. Additionally, stimulated pH (p = 0.019), periodontal disease stage (p = 0.009), decayed, missing, and filled teeth (p = 0.048), and stimulated sialometry (p = 0.002) were also correlated with MD adherence. Conclusions: This study found that adherence to the MD acts as a protective factor against both oral and systemic diseases. An associative relationship exists between certain oral and systemic diseases and adherence to the MD.
Objective: The interplay between periodontitis (PD) and rheumatoid arthritis (RA) is well recognized, with aging being a central risk factor for both. However, the shared aging-related molecular mechanisms remain unclear. We aimed to identify common aging-related hub genes linking PD and RA and elucidate their underlying functional mechanisms. Material and methods: PD and RA gene expression profiles were obtained from Gene Expression Omnibus database. Crosstalk genes were identified via differential expression analysis and intersected with aging-related genes from GeneCards. Functional enrichment (GO/KEGG) was performed. Hub genes were screened using protein–protein interaction network analysis and two machine learning algorithms and validated with external datasets. Diagnostic performance was evaluated by nomogram and receiver operating characteristic analysis. Immune cell infiltration was analyzed using CIBERSORT. Results: We identified 191 aging-related crosstalk genes, enriched in immune-inflammatory pathways. Five hub genes (RAC2, CSF2RB, IL2RG, ENTPD1, and IL10RA) were confirmed, showing significant overexpression in PD and RA tissues with excellent diagnostic value. Immune infiltration revealed coordinated dysregulation of plasma cells and γδ T cells in both diseases. Conclusions: This study reveals shared aging-related genes, pathways, and immune cell dysregulation between PD and RA, elucidating how aging exacerbates both diseases through immune-inflammatory mechanisms. These findings provide a theoretical basis for novel biomarkers and therapies.
Aims: Early detection and intervention are crucial for effective management of periodontitis. Our study aims to identify diagnostic biomarkers for periodontitis by integrating single-cell RNA sequencing analysis, Mendelian randomization, and experimental validation. Methods: Gene Expression Omnibus (GEO) dataset GSE164241 was downloaded to analyze the cellular compositions and intercellular communications in periodontitis. GEO datasets GSE10334, GSE16134, GSE23586, and GSE106090 were downloaded, and differential expression genes (DEGs) and functional enrichment were analyzed, followed by investigation of endothelial-fibroblast signaling pathways. Molecular subtypes were defined based on myeloid and fibroblast markers, and their immune characteristics were analyzed. A diagnostic model was built using 106 algorithm combinations from 11 machine learning methods (Lasso, Ridge, Enet, Stepglm, SVM, glmBoost, LDA, RandomForest, GBM, XGBoost, and NaiveBayes) to screen reliable biomarkers. Key genes were identified using Mendelian randomization and validated via reverse transcription and quantitative polymerase chain reaction (RT-qPCR). Results: This study identified four novel periodontitis subtypes using consensus clustering based on myeloid cell and fibroblast markers: fibroblast-dominant, myeloid-dominant, fibroblast/myeloid quiescent, and fibroblast/myeloid mixed. These four subtypes exhibited unique biological patterns, potentially leading to different disease progression. Patients in the fibroblast/myeloid mixed and myeloid-dominant groups, in particular, may have a stronger inflammatory microenvironment. In addition, we found that IGFBP4, IL1B, LAPTM5, PSAP, and SRGN were closely related to the occurrence and development of periodontitis through random forest (RF) analysis and Mendelian randomization. RT-qPCR validation in gingival tissues from 13 stage III/IV periodontitis patients and healthy controls confirmed significant differences in the expression of IGFBP4, IL1B, and LAPTM5 (p < 0.001). Conclusion: Our findings suggest that IGFBP4, IL1B, and LAPTM5 could be potential biomarkers for periodontitis, paving the way for future research on its pathogenesis, diagnosis, and treatment.
Objective: This retrospective study aimed to investigate the frequency, causes, and temporal distribution of orthodontic emergencies at the Department of Orthodontics, University of Oslo. Methods: All appointments coded as emergencies from 2015 to 2022 were reviewed and manually screened. Emergencies were classified into three categories: (1) during active treatment, (2) during retention, and (3) miscellaneous. A negative binomial generalized linear regression model was used to assess annual and monthly variations. Chi-square tests for independence were applied to analyze relationships between age group and year, gender and year, and reason for emergency. The significance level was set at p < 0.05. Results: Out of 7206 records screened, 3592 met the inclusion criteria, involving 1657 patients – 685 males (41.3%) and 972 females (58.7%). The mean number of emergencies per patient was 2.2, with no significant year-to-year variation in gender distribution. The most common age groups were 10–14 years and over 20 years. Annual emergency numbers ranged from 313 in 2015 to 638 in 2022, with statistically significant variation. Monthly variation was also significant, with July consistently having the fewest emergencies (p < 0.001). Most emergencies occurred during active treatment (n = 2021), followed by the retention phase (n = 1353), and miscellaneous reasons (n = 218). The most frequent causes were issues related to full fixed appliances and fixed retainers. Conclusions: No consistent pattern of orthodontic emergencies was observed, indicating that operator experience, the stage of postgraduate training, and seasonal fluctuations are likely the key influencing factors
Objective: The aim of this cross-sectional study was to assess the root canal filling quality and the frequency of apical periodontitis (AP) in root-canal-filled teeth in a randomly selected adult non-patient population in Sweden. Materials and Methods: In 2023, 295 root-canal-filled teeth were identified in 126 adults in a cross-sectional study in Jönköping, Sweden. Periapical radiographs were assessed by two calibrated observers. The periapical status was scored according to the periapical index (PAI) and then dichotomized as either healthy (PAI 1–2) or diseased (PAI 3–5). The root canal filling quality was deemed as adequate/inadequate. An adequate root canal filling was considered to end 0.5–2 mm from the radiographic apex and to have no radiolucent voids. Results: Adequate root canal fillings were seen in 89 (30.2%) of the teeth. AP was present in 94 (31.9%) of the teeth, and of these, 72 (76.6%) had an inadequate root canal filling. Of the 122 root-canal-filled molars, 101 (82.8%) had inadequate root canal filling and 57 (46.7%) had AP. Conclusion: A large proportion of root-canal-filled teeth have inadequate root canal filling quality and AP, especially in molars. Both contributing factors and strategies for improvement require further study.
This study examined toothbrushing and its associated factors in children aged 1–4 years, using data from 306 mother-father-dyads and their 308 children participating in the FinnBrain Birth Cohort Study. Longitudinal multivariable regression analysis was conducted using the generalized estimating equation method to model the outcome, parent-reported brushing of a child’s teeth less than twice daily at the child’s age of 12, 24 and 48 months, controlling for the intraindividual correlation between repeated measurements using compound symmetry (correlation structure). The independent variables as time-varying covariates from 12 to 48 months were mother’s and father’s own toothbrushing, couple relationship satisfaction, number of positive life events of father, and fixed covariates were number of siblings, education level of mother and age of parents. Among the children, 50% had stable good and 16% stable poor toothbrushing habits from 1 to 4 years. Both parents’ less than twice daily brushing was strongly associated with less than twice daily brushing of a child’s teeth. The strength of the association between brushing mother’s own and the child’s teeth varied across time, whereas this association in fathers remained consistent. Early family-based intervention is crucial for promoting parents’ own brushing habits and thereby supporting children’s oral hygiene.
Objective: This narrative review aims to identify and evaluate the available scientific literature on digital technologies assisting clinicians in periodontal diagnosis and prognosis, including electronic dental record systems, mobile applications, consumer-engaging platforms, and image recognition technologies. Methods: A literature search was performed in PubMed/MEDLINE, supplemented by manual screening of reference lists. Literature management was supported by Covidence. Given the narrative nature of this review, studies were selected based on relevance to the review topics without application of a formal systematic screening protocol. Results: The reviewed literature demonstrates considerable progress in periodontal care supported by artificial intelligence (AI). Deep learning models, particularly convolutional neural networks, have shown diagnostic accuracy rates ranging from approximately 70–98% for periodontitis classification from dental radiographs, with some models achieving very high sensitivity for bone loss detection. Mobile health applications and gamification strategies have shown promise for improving oral hygiene behaviors and patient engagement. Conclusions: AI and digital technologies represent promising tools for periodontal care, offering the potential for enhanced diagnostic accuracy, streamlined clinical workflows, and improved patient engagement. However, significant challenges remain regarding standardization, validation in diverse populations, and integration into clinical practice. Future research should focus on conducting multicenter prospective trials, developing standardized reporting frameworks, and addressing algorithmic bias and data privacy concerns.
OBJECTIVE:To analyze the influencing factors of tooth retention within 5 years after root canal treatment (RCT) in patients with cracked teeth and chronic irreversible pulpitis, and to construct a nomogram model so as to provide a basis for the selection of clinical treatment regimen for such patients. METHODS:This retrospective case analysis included 295 patients (295 affected teeth) with cracked teeth complicated with chronic irreversible pulpitis who were treated from January 2017 to January 2020. Tooth retention within 5 years was taken as outcome event; independent-samples t test and chi-square test were applied for single factor comparison. Lasso was used to screen the variables. Binary logistic regression analysis was utilized to analyze the related factors. The nomogram model was constructed by the 'rms' package of R software. Receiver operating characteristic (ROC) curve was drawn to evaluate the discrimination degree of the model. Hosmer-Lemeshow (H-L) test was performed and the calibration curve was drawn to evaluate the calibration degree of the model. Decision curve analysis was conducted to evaluate the clinical practicability of the model. RESULTS:Successful and improved teeth were recorded as tooth survival. According to whether the teeth were retained within 5 years, the enrolled patients were categorized into survival group (265 cases) and non-survival group (30 cases), with the 5-year tooth survival rate of 89.9%. Multivariate analysis identified 2-3 RCT visits (Odds Ratio (OR) [95% Confidence Interval (CI)] = 0.15 [0.05, 0.50]), probing depth > 5 mm (OR [95% CI] = 2.99 [1.26, 7.09]), and crown restoration (OR [95% CI] = 0.28 [0.09, 0.83]) as independent predictors of 5-year tooth loss (p < 0.05). The nomogram was constructed based on multivariate results and the area under the ROC curve of the prediction model was 0.73 (0.62,0.84). H-L test revealed p = 0.682, and the calibration curve of the model had a high overlap degree with the ideal curve. The risk threshold ranged from 4 to 68%. The nomogram model line was located at the upper right of the None line and the All line. CONCLUSION:Multivariate analysis identified 2-3 RCT visits, probing depth > 5 mm, and crown restoration as independent predictors of 5-year tooth loss, and the nomogram constructed based on the above indicators has good practicability to predict tooth loss in patients. However, the sample size of our study was relatively limited, and the patient population was specific and may not be representative of the general population. Further external validation in a multi-center population is warranted.
Objective: Dental anxiety affects approximately 15% of adults worldwide and is associated with adverse oral health outcomes. The aim of this cross-sectional study was to describe oral health status and treatment needs among adults seeking dental anxiety treatment in general practice. Further, it evaluates the associations between oral health, treatment needs, age, sex, dental anxiety, and years of dental avoidance. Materials and Methods: This cross-sectional study included 88 adults with self-reported dental anxiety recruited from a rural Norwegian general dental clinic. Oral health was assessed using panoramic and intraoral radiographs combined with clinical examination. Treatment needs were evaluated according to Norwegian clinical guidelines by two dentists who reached consensus. Results: Mean age was 38.9 ± 12.2 years; 66% of the respondents were women and mean Modified Dental Anxiety Scale score was 21.0 ± 3.0. Mean decayed teeth were 5.9 ± 4.8 and missing teeth 2.5 ± 4.1. Overall, 93% of the respondents required restorative treatment, 38% endodontic treatment, and 47% extractions. Male sex and longer dental avoidance were significantly associated with poorer oral health (p < 0.05). Conclusions: Adults seeking dental anxiety treatment in general practice exhibit severe oral health problems comparable to those in specialist dental anxiety clinics, supporting the need for low-threshold anxiety interventions in general dental practice.
OBJECTIVE:To analyze national and regional differences in assessment of orthodontic treatment needs and timing for treatment between specialists in orthodontics in Denmark and Sweden. Additionally, to map the use of digital platforms in orthodontic referral processes. MATERIALS AND METHODS:A questionnaire comprising 20 items was developed to assess nine patient cases with different malocclusions and sent to nearly 500 board-certified orthodontic specialists in Denmark and Sweden. Each case was documented by clinical photos, line drawings of the head and face, and malocclusion descriptions. Before the start of the survey, the questionnaire was tested in both countries by eight experienced orthodontists. The survey was distributed between 06 November 2024 and 27 January 2025. Data were analyzed using chi-square tests with false discovery rate correction. RESULTS:Two hundred and nineteen responses were included. Both intra-regional and cross-national differences were found in treatment need assessments. Danish respondents showed greater agreement, while Swedish assessments varied more. Digital referral systems were more common in Sweden but linked to an increased tendency to select patient observation rather than making a definitive assessment of treatment need. In Denmark, high agreement (> 80%) was found for treatment need in six of nine cases. One patient case was generally deemed not eligible, while one case demonstrated high variability. Significant regional differences were noted in both treatment need and timing. In Sweden, strong agreement was observed for five cases. One case showed wide variation. Regional differences were significant for some cases, both in need and preferred treatment timing. CONCLUSIONS:Specialists in Orthodontics in Denmark showed more consistent assessments than those in Sweden, likely due to national guidelines. Digital referrals were common in Sweden but linked to more varied evaluations, especially in borderline cases.
OBJECTIVE:To develop and validate a risk prediction model for gingival embrasures after clear aligner therapy using multimodal oral data. METHODS:A retrospective study of 340 patients (December 2022-June 2025) was randomly divided into training (n = 238) and validation (n = 102) sets (7:3). Univariate analysis, multivariate logistic regression, and least absolute shrinkage and selection operator regression were applied to identify independent risk factors. Three machine learning models - random forest (RF), logistic regression, and support vector machine - were constructed based on seven core variables. Model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis, and Shapley Additive Explanations (SHAP) values for interpretability. RESULTS:No significant baseline differences existed between sets (p > 0.05). Seven indicators were identified (p < 0.05). Multivariate analysis confirmed percentage of bleeding on probing-positive sites, interproximal alveolar bone height, and relative movement of adjacent teeth at target site as independent risk factors, while gingival thickness, proximal contact area, interdental papilla height, and buccal/lingual bone plate thickness were protective factors (p < 0.05). The RF model performed best: training AUC = 0.849 (95% CI: 0.786-0.912), validation AUC = 0.815 (95% CI: 0.720-0.910), with good calibration and net benefit. SHAP analysis highlighted gingival thickness and interproximal alveolar bone height as key predictors. CONCLUSION:A risk prediction model for post-clear aligner gingival embrasures was successfully developed and validated using multimodal oral data, with RF as the optimal algorithm. The model exhibits good discrimination, calibration, and clinical utility, which can be used as an objective auxiliary tool for individualized risk prediction following clear aligner therapy and supplement traditional clinical empirical judgment.
OBJECTIVE:This in vitro study compared the efficacy, dentin loss, and outcomes of ultrasonic, Masserann, and Broken Tool Remover Pen (BTR-Pen) techniques for removing fractured endodontic instruments using cone-beam computed tomography (CBCT) analysis. MATERIALS AND METHODS:Ninety extracted single-rooted teeth were randomly allocated into three groups (n = 30). ProTaper F2 instruments were intentionally fractured in the middle third of each canal, creating 3-4 mm fragments. Removal was performed using ultrasonic tips, Masserann trephine burs, or the BTR-Pen loop system. CBCT scans quantified dentin loss. Success rates, removal times, and complications were analyzed using one-way analysis of variance, Tukey honestly significant difference, chi-square, and likelihood-ratio chi-square tests (p < 0.05). RESULTS:Ultrasonic removal showed the highest success rate (90.0%), followed by BTR-Pen (86.7%) and Masserann (70.0%). Pairwise likelihood-ratio chi-square analysis showed lower success for Masserann than ultrasonic removal (p = 0.049). Masserann caused significantly greater canal volume increase (4.50 ± 0.50 mm³) than ultrasonic (0.75 ± 0.30 mm³) and BTR-Pen (0.93 ± 0.40 mm³) techniques (p < 0.001). Ultrasonic removal required the shortest time (110.0 ± 35.0 s), followed by BTR-Pen (213.4 ± 40.0 s) and Masserann (240.0 ± 50.0 s). CONCLUSIONS:Ultrasonic and BTR-Pen techniques achieved high success with better dentin preservation than Masserann. When retrieval is indicated, techniques that maximize dentin preservation should be preferred to reduce the risk of root weakening and procedural complications.
OBJECTIVE:To investigate implant-supported prosthetic outcomes and influencing factors in alveolar bone atrophy. MATERIAL AND METHODS:One hundred and fifty patients with atrophy receiving implants (2021-2022) were followed for 2 years. Success (n = 97, 64.7%) and failure (n = 53, 35.3%) groups were compared using univariate analysis, followed by multivariate logistic regression to identify factors associated with overall failure and Cox regression to assess time to failure. RESULTS:Univariate analysis identified age, gender, smoking, implant length, and prosthesis type as significant (p < 0.05). Multivariate logistic regression showed short implant length (< 10 mm) as the sole independent risk factor for failure (OR = 4.418, p = 0.004); age ≥ 60 years (OR = 2.560, p = 0.094) and female gender (OR = 1.127, p = 0.807) were not significant. Multivariable Cox regression revealed age ≥ 60 years as a significant predictor of earlier failure (HR = 2.558, p = 0.010), while female gender and short implants were not (p > 0.05). Kaplan-Meier curves showed significant survival differences for age (p = 0.010), gender (p = 0.023), and implant length (p = 0.021). CONCLUSION:Short implant independently increases failure risk; age ≥ 60 years accelerates failure. Bone augmentation is preferred. Findings need validation.
Objective: To evaluate the association between obstructive sleep apnoea (OSA) and periodontitis and to assess the available evidence on the effects of continuous positive airway pressure (CPAP) therapy on periodontal status. Materials and methods: This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Comprehensive literature searches were performed in Cochrane, PubMed, Scopus, and Web of Science. Study selection and data extraction were carried out independently by two reviewers. A total of 20 original studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. Results: Fourteen of the 20 studies (70%) reported a significant association between OSA and periodontitis. However, only two studies fulfilled all methodological quality criteria, indicating an overall moderate to low quality of evidence. Data on the effects of CPAP therapy on periodontal outcomes were limited, and the available studies generally showed no significant impact. Conclusions: Current evidence supports an association between OSA and periodontitis, suggesting that OSA may contribute to periodontitis. Robust, well-designed studies with larger sample sizes and rigorous methodology are needed to clarify the nature of this relationship and to determine whether CPAP therapy influences periodontal health.
Objective: To examine determinants of oral health knowledge, perceived oral health status, perceived dental needs, and clinically assessed tooth decay among adults attending Katutura Hospital, Namibia. Material and methods: A cross-sectional hospital-based study was conducted among adults attending the dental clinic and general outpatient department. Of 660 invited participants, 639 were included in the final analysis (response rate 96.8%). Data were collected using structured questionnaires assessing socio-demographic characteristics, oral health knowledge, oral hygiene practices, perceived oral health status, and perceived dental needs. Clinical oral examinations were performed to assess tooth decay. Multivariable logistic regression analyses were conducted to identify factors independently associated with the outcomes. Results: Most participants (89.7%) demonstrated good oral health knowledge. Tertiary education was the only independent predictor of good oral health knowledge (adjusted odds ratio [AOR] = 2.47; 95% confidence interval [CI]: 1.54–3.97) and was associated with lower odds of tooth decay (AOR = 0.39; 95% CI: 0.27–0.57). Brushing twice or more daily was significantly associated with good self-rated oral health (AOR = 2.03; 95% CI: 1.45–2.84). Employment status was inversely associated with perceived dental needs (AOR = 0.71; 95% CI: 0.51–0.99). Conclusions: Education was the principal determinant of oral health knowledge and clinical tooth decay, while oral hygiene practices influenced perceived oral health. Strengthening oral health promotion and improving access to preventive services may reduce inequalities and unmet dental needs in Namibia.
Objective: To analyze the effects of cervical headgear (CHG) timing on costs and orthodontic outcome. Material and methods: Sixty-seven participants with Class II malocclusion were randomized into two groups. In the early group (EG, n = 33), CHG treatment began after the eruption of first upper molars. In the later-timed group (LG, n = 34), CHG treatment began nearly 2 years later. Orthodontic outcome was evaluated when CHG ended and at the end of follow-up using the Peer Assessment Rating (PAR) index and Little’s Irregularity Index (LII). Costs were calculated using medical records, estimated chairside times and average personnel and material costs. Results: The mean total costs including personnel and material costs during the follow-up were higher in the EG (€416) compared with the LG (€364) (p = 0.043). No statistically significant differences between the groups were found in the PAR and in the LII scores at the end of follow-up. The number of visits during CHG treatment was higher in the EG (13.3) compared with the LG (10.4) (p = 0.01). Conclusions: Earlier initiation of CHG treatment increased the personnel and material costs, number of appointments, and chairside time. Based on the PAR and in the LII scores, the orthodontic outcome of CHG treatment was equal regardless of the timing of the treatment. If orthodontic treatment during mixed-dentition stage is considered, it would be justified from an economic perspective to favor treatment during late mixed-dentition.
Objective: Saliva flow rate measurement (SFRM) is a prerequisite for accurate diagnosis of hyposalivation, but national data about the frequency of SFRM conducted in the Swedish population are lacking. The objective was to describe performed SFRMs in the population via registration in the Swedish dental financial system and compare with the earlier reported prevalence of hyposalivation. Material and Methods: A descriptive retrospective registry-based study was completed. Dental care registry data from 2008 to 2024 were investigated to determine the proportion of individuals > 25 years of age who had undergone SFRM. Results: During 2008–2024, 70,390 SFRMs were conducted in Sweden. SFRMs began to increase in 2013. SFRMs were performed more than twice as often for females than males. Measurements increased by age up to a peak at 65–69 years of age (1.7%) and decreased thereafter. The frequency of SFRM amounted to approximately 0.9% of the total Swedish population. Conclusions: The number of SFRMs performed in the Swedish population is low overall, with increased numbers in women and in older ages. The findings support that an increased use of SFRM to improve diagnosis of hyposalivation could be beneficial to understand more about the prevalence of hyposalivation and support for preventive caries treatment.
OBJECTIVE:To investigate whether baseline periodontal condition predicts reduced insulin sensitivity (RIS) over a follow-up period of about 15 years among participants with baseline euglycemia. MATERIAL AND METHODS:A subpopulation (n = 224) of the Oulu1935 cohort was studied. Periodontal condition was defined by the presence and number of sites with periodontal pockets (probing pocket depth ≥ 4 mm) or by the participant being edentulous. Insulin sensitivity was measured using the Quantitative Insulin Sensitivity Check Index, with the lowest tertile indicating RIS. Rate ratios (RRs) with 95% confidence intervals (CI) were estimated using Poisson regression models with a robust error variance. RESULTS:RIS was observed in 21.3% of the dentate participants without periodontal pockets, 32.8% of those with 1-6 sites with pockets, 33.3% of those with ≥ 7 sites with pockets, and 40.8% of the edentulous participants. Furthermore, adjusted RRs with 95% CIs (in parentheses) for the association of periodontal condition with RIS (reference: dentate participants without periodontal pockets) were 1.4 (0.8-2.6), 1.1 (0.6-2.1), and 1.4 (0.8-2.7), respectively. CONCLUSIONS:Poor periodontal condition and edentulousness predicted RIS. A healthy periodontium appears to support normal insulin function, but further studies are needed.
Objective: Congenital absence of mandibular second premolars occur in 2.91–3.22% of individuals, with nearly half of cases being bilateral. Interceptive hemisection of primary second molars promotes mesial drift but exposes the pulp for an extended period. This study investigates histopathological responses of pulp and associated mineralized tissues. Material and methods: Children aged 7–12 in Skaraborg region, Sweden, were screened for over-retained primary mandibular second molars as part of a single-center, blinded, prospective split-mouth randomized controlled clinical trial comparing hemisection with extraction. Mesial roots of 21 hemisected teeth were collected for histopathological analysis of inflammatory infiltrate, pulpal necrosis, fibrosis, and hard tissue formation. Results: Mean interval between distal and mesial root extraction was 11.54 ± 4.3 months. Histopathological analysis revealed no pulpal inflammation in 14% of specimens, acute/subacute inflammation in 38%, chronic inflammation in 48%, and necrosis in 24%. Reparative tertiary dentin with capping occurred in 48% and without capping in 33%. Necrotic mineralized tissue appeared in one specimen. Three patients reported symptoms during follow-up. Conclusion: Prolonged pulp exposure following hemisection induced tertiary dentinogenesis, maintaining pulp vitality for up to 17 months. Despite histological evidence of inflammation or necrosis, most cases remained asymptomatic, indicating remarkable regenerative capacity of primary pulp–dentin complex.
