Objectives This study evaluated the anticariogenic effect and antibacterial activity of a titanium tetrafluoride (TiF4)/chitosan (Ch) toothpaste on enamel and dentin demineralization in an in vitro microcosm biofilm model. Methods Microcosm biofilm was produced from human saliva mixed with McBain saliva (0.2% sucrose) on bovine enamel and dentin for three days (5% CO2, 37°C). The treatments were applied as slurry (1 × 60 s/day): 1) TiF4/Ch (1400 ppm F⁻, 0.5% chitosan, 75% deacetylation, 500 mPas, pH 4.5); 2) TiF4 (1400 ppm F-, pH 4.5); 3) Ch (0.5% chitosan, 75% deacetylation, 500 mPas, pH 4.5); 4) Elmex® Caries Protection (GABA, Switzerland, 1450 ppm F- as AmF, pH 4.5, positive control); 5) placebo (pH 7.0, negative control); and 6) phosphate-buffered saline (PBS, pH 7.2). Colony-forming units (CFU) count was performed for total microorganisms, Lactobacillus spp., and Streptococcus mutans/S. sobrinus. Demineralization was measured by transverse microradiography (TMR). Data were compared using Kruskal-Wallis/Dunn test (p < 0.05). Results In enamel biofilm, TiF4/Ch significantly reduced Streptococcus mutans/S. sobrinus compared to placebo, whereas in dentin biofilm, this effect was observed only for TiF4 alone compared to both placebo and PBS. In enamel, TiF₄/Ch showed the lowest values of the integrated mineral loss (ΔZ) and lesion depth (LD), differing from Chitosan, Placebo and PBS groups. In dentin, similar performance was found for TiF4 and Elmex® on ΔZ, but not on LD (Elmex® was similar to placebo). No performance difference was observed between TiF4 and TiF4/Ch under this model. Conclusions In conclusion, toothpastes containing TiF4 were able to reduce enamel and dentin demineralization in an in vitro microcosm biofilm model. Clinical Relevance TiF₄/Ch toothpaste reduced enamel and dentin demineralization under the present in vitro model, supporting its anticaries potential.
Objectives To evaluate the predictive accuracy of single-factor, multi-factor, and machine learning-based caries risk assessment (CRA) methods in predicting caries risk among children and adults, updating the 2015 review. Data The review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, supplemented by relevant items adapted for prognostic accuracy reviews. Paired sensitivity and specificity data were extracted, and 2 × 2 contingency tables were reconstructed where necessary. Source PubMed, Web of Science, Cochrane Library, Embase, and Scopus were searched from February 2015 to July 2025. Study Selection Studies evaluating CRA methods with a minimum 1-year follow-up and sufficient data to reconstruct a 2 × 2 table were included. Of the 7,332 records identified, 30 studies met the inclusion criteria; 16 contributed to the meta-analysis. Results The full Cariogram in children demonstrated pooled sensitivity 72.10% and specificity 69.96%. Caries Management by Risk Assessment (CAMBRA) yielded a sensitivity of 67.65% and a specificity of 58.96% with substantial heterogeneity. The American Academy of Paediatric Dentistry (AAPD) CRA showed high sensitivity (95.56%) but very low specificity (5.12%), suggesting it may be more suitable for initial screening than for definitive risk stratification. Past caries experience demonstrated moderate predictive accuracy. Machine learning showed potential but lacked sufficient data for pooling. Conclusions CRA methods demonstrate moderate predictive accuracy, with substantial variability across populations, tools, and study designs. Clinical Significance CRA methods should be used alongside clinical judgement. Further prospective validation and incorporation of objective biomarkers may improve future caries risk prediction.
OBJECTIVES:To investigate Norwegian dentists' use of restorative materials and techniques for Class II restorations over a nine‑year period (2015-2024), following the national transition to non‑amalgam restorative dentistry. METHODS:A questionnaire survey was administered to dentists attending operative dentistry continuing‑education courses at 16 locations in Norway between 2015 and 2024. Participants recorded diagnostic information, restorative procedures and materials for Class II restorations during five working days. In total, 5056 restorations from 581 dentists were included. RESULTS:Resin-based composite was used in 94.4% of the restorations, with a strong preference for conventional composites over bulk‑fill versions. One‑third of the restorations involved multi‑material layering, most frequently with bulk‑fill flowable composites as base materials. The use of protective pulpal liners declined from 16% to 6% over time. Adoption of universal adhesives increased markedly from 10% in 2015 to 60% in 2024. Rubber dam isolation was used in 7% of the procedures, with most clinicians relying on cotton rolls or pads. CONCLUSIONS:Norwegian dentists have almost entirely transitioned to conventional composite materials for Class II restorations, with growing adoption of multi-material layering and universal adhesives. Use of pulpal liners declined substantially over the study period. CLINICAL SIGNIFICANCE:These findings provide a comprehensive overview of national restorative practices and highlight key trends relevant for clinical training, guideline preparation, and future research and development of restorative materials and techniques.
OBJECTIVE:To describe a technical proof-of-concept workflow using a patient-specific digital index as a physical intraoperative reference for positioning a porcine acellular dermal matrix and limited peripheral application of an n-butyl-2-cyanoacrylate-methacryloxy sulfolane surgical adhesive (Glubran 2; GEM Srl, Viareggio, Italy) to maintain the clinically selected matrix position during root coverage surgery. MATERIALS AND METHODS:Standardized photographs and an intraoral scan were used for virtual planning. A tooth-supported matrix-positioning index was designed and fabricated by vat photopolymerization and used as a physical reference for extraoral matrix trimming and intraoperative positioning. The fully hydrated matrix was adapted within the indexed boundaries and stabilized with discrete peripheral adhesive microdroplets while the central matrix-to-bed interface was kept free of adhesive. RESULTS:The index seated passively and provided a physical reference for the planned matrix boundaries. The matrix remained clinically stable during index removal, flap advancement, and suturing. Baseline and 1-year clinical measurements are reported for descriptive context; no quantitative index-transfer accuracy assessment was performed. CONCLUSIONS:This single-patient technical proof of concept showed that a patient-specific index could be used as an intraoperative reference for matrix positioning, with limited peripheral cyanoacrylate stabilization before flap closure. CLINICAL SIGNIFICANCE:A patient-specific index may provide a physical reference for planned matrix positioning, while limited peripheral cyanoacrylate may help maintain matrix stability before flap closure.
BACKGROUND:Early childhood caries (ECC) is preventable, and household secondhand smoke (HSHS) is a modifiable risk factor. However, evidence regarding critical early-life exposure windows and potential sex differences in the association remains limited. OBJECTIVE:To examine the associations between HSHS exposure from early fetal life to 24 months of age and ECC in preschool children, and to explore potential sex differences. METHODS:Data from 2,431 mother-child pairs in the Shanghai Maternal-Child Pairs Cohort were analyzed. HSHS exposure was self-reported during early and late pregnancy and at 2, 6, and 24 months of age. ECC was clinically diagnosed at 3-5 years of age. Group-based trajectory modeling identified HSHS exposure patterns, and Cox proportional hazards models estimated associations between HSHS exposure and ECC. RESULTS:Three distinct HSHS exposure trajectories were identified: Never Exposure (31.8%), Prenatal Decline-Postnatal Rebound (40.5%), and Persistently High Exposure (27.7%). Children in the latter two trajectories had a higher risk of ECC compared with those in the Never Exposure group (adjusted HR=1.23, 95% CI: 1.01-1.49; and adjusted HR=1.36, 95% CI: 1.12-1.66, respectively). Exposure at all assessed time points was associated with increased ECC risk, with the strongest associations observed during early pregnancy and at 24 months. Sex-stratified analyses showed significant associations among girls but not among boys. CONCLUSION:Early-life household secondhand smoke exposure was associated with an increased risk of early childhood caries in the overall study population, with significant associations observed among girls but not boys in sex-stratified analyses. CLINICAL SIGNIFICANCE:Assessment of household secondhand smoke exposure during early life may provide useful information for caries risk assessment and oral health counseling in preschool children.
OBJECTIVE:To develop a mixed reality (MR)-assisted, guide-free workflow for patient-specific implant (PSI)-based maxillary fixation and evaluate its positioning equivalence and procedural efficiency relative to conventional guide-assisted PSI fixation. METHODS:In this non-randomized cohort study, 28 patients undergoing Le Fort I osteotomy independently selected their preferred workflow after receiving detailed information on both approaches and were categorized according to the workflow received. MR navigation guided osteotomy lines and screw-hole positioning in the MR-assisted group, whereas conventional surgical guides were used in the guide-assisted group. Equivalence was assessed using two one-sided tests (TOST), with margins of ±0.5 mm for translational and ±1.0° for rotational outcomes. RESULTS:All 90% confidence intervals (CIs) for between-group differences in translational and rotational positioning errors were entirely within the prespecified equivalence margins, supporting statistical equivalence within these bounds. Small directional offsets were observed for A-X (mean difference, -0.206 mm), UL6-Y (0.168 mm; 90% CI, 0.070-0.267 mm), and yaw (0.159°; 90% CI, 0.017-0.302°), although all remained within the equivalence margins. Preoperative preparation time and mean Le Fort I segment time were reduced in the MR-assisted group, which also required fewer intraoperative adjustments (2.29 ± 1.49 vs. 4.29 ± 1.20; P = 0.0006). CONCLUSION:MR-assisted, guide-free PSI fixation showed positioning outcomes statistically equivalent to guide-assisted fixation within the prespecified margins and was associated with greater procedural efficiency. CLINICAL RELEVANCE:MR-assisted, guide-free PSI fixation may reduce reliance on surgical guides while maintaining between-workflow positioning differences within prespecified equivalence bounds.
Objectives To evaluate the three-dimensional bone regeneration achieved with digitally customized titanium meshes in patients presenting Cawood and Howell Class V defects, 8 months after surgery. Methods This retrospective clinical case series included 9 patients with severe alveolar ridge atrophy (Cawood and Howell Class V), who underwent guided bone regeneration using customized titanium meshes at 10 surgical sites (8 mandibular and 2 maxillary). Meshes were designed through a fully digital workflow based on cone-beam computed tomography (CBCT) data and manufactured using Direct Metal Laser Sintering (DMLS). This approach allowed accurate preoperative planning, optimal adaptation of the mesh, smooth and rounded margins, intrinsic stability, and reduced intraoperative time. Surgical procedures were performed with careful flap management to achieve tension-free primary closure. Clinical and histological outcomes were assessed at 8 months postoperatively. Results No cases of mesh exposure, infection, or graft failure were observed. The mean vertical bone gain was 5.18 ± 1.82 mm, while the mean horizontal bone gain was 7.27 ± 1.74 mm. The mean regenerated bone volume was 1.25 ± 0.67 cm³. Histological analysis revealed vital, well-vascularized bone in direct contact with residual graft material. Conclusions Within the limitations of this retrospective case series, customized titanium meshes were associated with measurable three-dimensional bone gain in Cawood and Howell Class V defects. These preliminary findings support the feasibility of this patient-specific digital approach and warrant further investigation in larger prospective studies with appropriate control groups.
Objective To investigate the oral health status, oral health-related behaviours (OHB), and oral microbiota between preschool children and their parents. Methods This cross-sectional study recruited 294 families. The caries and oral hygiene status of children and parents were assessed by calibrated dentists. Plaque samples collected from children with severe early childhood caries and their parents were analysed using 16S rRNA sequencing. OHB was collected via questionnaires. Bivariate analysis, Principal Coordinates Analysis, Binary Logistic Regression, Spearman’s rank correlation, and Pearson correlation were performed. Results Children’s caries status was correlated with fathers’ (rs=0.30, 95%CI:0.10-0.47, p=0.002, n=103 pairs) and mothers’ caries status (rs=0.29, 95% CI:0.16-0.41, p< 0.001, n=215 pairs). Higher odds of caries were observed among children whose fathers (OR = 4.67, 95%CI:1.74-12.49, p = 0.002) or mothers (OR = 2.63, 95% CI:1.30-5.33, p = 0.007) had caries. The proportion of children who established favourable OHB was higher among children whose fathers (p=0.002) or mothers (p<0.001) had favourable OHB. Children’s toothbrushing duration was correlated with fathers (rs =0.58,95% CI: 0.41-0.72, p<0.001, n=78 pairs) and mothers (rs=0.55,95% CI: 0.45-0.64, p<0.001, n=207 pairs), while snacking frequency was solely correlated with mothers (rs=0.45,95%CI:0.33-0.56, p<0.001). Likewise, the relative abundance of Porphyromonas gingivalis (rs = 0.45, 95% CI: 0.16, 0.68, adjusted p = 0.009) and Streptococcus sobrinus (rs = 0.42, 95% CI: 0.12, 0.65, adjusted p = 0.021) were correlated only in child-mother pairs. Conclusion Children’s caries status, OHB, and oral microbiota were associated with those of their parents. Exploring family-centered health promotion strategies is recommended. Clinical Significance Children’s caries status, establishment of favourable oral health-related behaviours, and oral microbial profiles were associated with those of their parents, particularly mothers. Early childhood caries management should focus not only on the child but also on parents. Enhancing parental engagement and family cohesion may contribute to better child health outcomes.
OBJECTIVES:Oral submucous fibrosis (OSF) is a chronic and progressive potentially malignant disorder with an increased risk of transformation to oral squamous cell carcinoma (OSCC). Some histopathological features of OSF may complicate adequate recognition of malignancy in OSF. This study aimed to develop a lightweight deep learning framework for classifying OSF-associated OSCC from OSF using whole-slide images (WSIs). METHODS:This retrospective study involved hematoxylin and eosin (H&E)-stained WSIs from 156 OSF and 94 OSF-OSCC, treated at the National Dental Hospital, Colombo, Sri Lanka. Data were allocated into training and test datasets according to an 80:20 split. A total of 4,966,521 image patches extracted from 200 WSIs were used to train and cross-validate a hybrid-operator multiple instance learning (MIL) model for classifying OSF and OSF-OSCC. The model was then tested preliminarily using 50 WSIs (20% unseen images) and 20 external photomicrographs. Discrimination, calibration, and net benefit of the model were evaluated. RESULTS:The framework achieved an AUC of 0.986 (95% CI: 0.953-1.000), an AUPRC of 0.977 (95% CI: 0.935-1.000), and a Brier score of 0.034 (95% CI: 0-0.084) on the internal test WSIs. Moreover, 19 out of the 20 external photomicrographs for preliminary external testing were correctly classified by the framework. On both datasets, The recall, specificity, precision, balanced accuracy, and negative predictive value of the MIL model in classifying OSF-OSCC and OSF were 100% (95% CI: 83.2-100%), 92% (95% CI: 80.8-97.8%), 83.3% (95% CI: 62.6-95.3%), 96% (95% CI: 82-98.9%), and 100% (95% CI: 92.3-100%) respectively. Additionally, the model had potential net benefit at all evaluated probability thresholds for classifying OSF and OSF-OSCC. CONCLUSION:A lightweight deep learning model demonstrated satisfactory performance in classifying OSF-associated OSCC and OSF at internal testing and preliminary external photomicrograph testing. CLINICAL SIGNIFICANCE:The deep learning model may serve as a diagnosis decision-support tool for classifying OSF and OSF-associated OSCC. The model may help flag suspicious cases for pathologist review following external WSI and prospective multicenter validation.
Objectives To evaluate the effect of intraarch connector design and build angle on the fabrication trueness and precision, and overall accuracy, of additively manufactured (AM) compared to subtractively manufactured (SM) frameworks in high-impact polymer composite (HIPC) for complete-arch implant-supported prostheses on four implants. Materials and Methods A typodont model with four implants and their multiunit abutments were digitized and an implant-supported complete-arch framework was designed. Three design files (no bar, horizontal bar, Y-shaped bar) were used to fabricate AM specimens using a glass-filler-reinforced composite resin in three different build angles (0°, 45°, 90°) (n=10). Ten SM frameworks fabricated from HIPC served as the control group. All frameworks were digitized and superimposed. Trueness and precision were evaluated in separate regions, as well as linear abutment and interimplant distance deviations. Marginal gaps were evaluated after seating the frameworks with one screw inserted in left posterior abutment. Data were statistically analyzed (α = 0.05) Results Both build angle and intraarch connector design significantly affected trueness, precision, linear deviations, and marginal gaps. Compared to the control group, test groups mostly showed similar or lower accuracy. No clear pattern among other test groups was observed. Marginal gaps differed significantly among groups (p<0.05), ranging from 50.2 µm at the right posterior abutment in the 0°-no-bar group to 573.7 µm at the left anterior abutment in the 90°-horizontal-bar group. 0° no-bar mostly showed the lowest surface deviation, lowest linear deviation, and least marginal gaps (p<0.05). Conclusions Within the limitations of this single-system in vitro study, AM complete-arch implant-supported interim fixed prostheses in a 0° no-bar configuration demonstrated accuracy comparable to SM HIPC. The marginal gaps found in some groups were beyond clinical acceptability. Printing such prostheses in 45° and 90° configurations using the tested printer, resin, and post-processing combination cannot be recommended. Clinical Significance The differences in marginal gaps found between the groups showed magnitudes beyond clinical acceptability and therefore additive manufacturing of complete-arch implant-supported interim fixed prostheses using build angles other than 0°and/or incorporating intraarch connectors should be approached with caution.
BACKGROUND:The association between sustained anterior head flexion during portable electronic device use and neuromuscular function remain poorly understood. This study aimed to investigate the relationship between TMD status, the HT operational classification, and the surface electromyographic activity of the masticatory muscles. METHODS:This cross-sectional study included 100 adults (63 F, 37 M; mean age 32.4 ± 11.3 years), equally distributed into four groups according to TMD status and HT classification. HT operational classification was defined by portable electronic device-use duration and an illustrated postural scale. Surface electromyography was recorded during clenching in the neutral head position and during 40°-60° anterior head flexion. POC TA, POC MM, Asymmetry Index, Activity Index, Torque Index, and Impact were analyzed. Main effects and interactions were assessed using Scheirer-Ray-Hare tests, and within-group changes using paired Wilcoxon tests. Statistical significance was set at p < 0.05. Multiple related comparisons were adjusted using the Benjamini-Hochberg false discovery rate procedure (FDR). RESULTS:TMD status was significantly associated with POC TA, POC MM, Asymmetry Index, and Torque Index in both positions (all pFDR ≤ 0.027). HT operational classification was significantly associated with Activity Index in both conditions (both pFDR < 0.001). Activity Index decreased during flexion in all groups (all pFDR ≤ 0.041), but the magnitude of change did not differ by TMD status, HT operational classification, or their interaction (all p ≥ 0.205). CONCLUSIONS:TMD status and HT operational classification showed distinct associations with the investigated sEMG parameters. Participants with TMD exhibited lower muscular symmetry and greater imbalance, whereas HT operational classification was associated primarily with differences in temporalis-masseter recruitment. Activity Index emerged as a potentially posture-sensitive parameter. However, TMD-related findings should be interpreted cautiously because the analyses were not adjusted for demographic differences. CLINICAL RELEVANCE:Activity Index may represent a potentially posture-sensitive sEMG parameter reflecting posture-associated differences in neuromuscular function; however, its clinical, diagnostic, and prognostic relevance remains to be established.
OBJECTIVES:To evaluate the influence of thickness and build orientation on the optical properties and relative translucency of an additively manufactured 3Y-TZP zirconia system and to compare its optical behavior with that of a subtractively manufactured 3Y-TZP zirconia system. MATERIALS AND METHODS:Zirconia discs were fabricated at five thicknesses (0.25-2.00 mm) and allocated to three groups: additively manufactured at 0º (AM0º), additively manufactured at 90º (AM90º), and subtractively manufactured (SM) (n = 9). Spectral reflectance was measured over white and black backgrounds. Kubelka-Munk scattering (S) and absorption (K), transmittance (T%), light reflectivity (RI), infinite optical thickness (χ∞), and albedo coefficient (a) were calculated. Relative translucency (RTP00) and translucency differences were determined according to translucency perceptibility and acceptability thresholds. RESULTS:Scattering was the dominant optical property governing light extinction in all groups (0.978 < a < 0.999). Scattering and absorption increased, whereas transmittance decreased, with increasing specimen thickness. The SM zirconia system showed lower scattering and higher transmittance than the AM zirconia system. RTP00 values were higher for SM zirconia than for AM 3Y-TZP zirconia at equivalent thicknesses. Translucency differences between SM and AM groups exceeded the translucency acceptability threshold, whereas differences between AM0º and AM90º remained below the perceptibility threshold. CONCLUSIONS:The additively manufactured 3Y-TZP zirconia system exhibited higher scattering and lower translucency than the subtractively manufactured 3Y-TZP zirconia system, whereas differences in translucency between build orientations remained below the perceptibility threshold. CLINICAL RELEVANCE:The additively manufactured 3Y-TZP zirconia system exhibited lower translucency than the subtractively manufactured 3Y-TZP zirconia system at equivalent thicknesses. These findings may be considered when selecting between the evaluated zirconia systems for esthetically demanding restorative situations.
OBJECTIVES:This meta-analysis compared hydraulic calcium silicate-based (HCSS) versus other types of root canal sealers regarding postoperative pain and treatment outcomes. DATA AND SOURCES:Five electronic databases were searched for randomized and non-randomized clinical studies from 1947 to 2026. Post-operative pain assessment was extracted as visual analogue scale scores (0-10). Treatment success and failure were recorded according to prespecified loose and strict radiographic criteria. For continuous and dichotomous outcomes, pooled effect estimates (e.g. standardized mean differences (SMD), odds ratios (OR)) with 95% confidence intervals (95%CI) were calculated using fixed- or random-effects models. STUDY SELECTION/RESULTS:Fifty-five articles were included, reporting on 53 cohorts comprising 5913 teeth at the end of the observation period. Forty studies investigated postoperative pain; 21 assessed treatment outcome using loose criteria and 14 strict criteria, with both reported in 12 studies. Sealer extrusion or resorption was documented for 25 cohorts. Patients treated with HCSS reported slightly lower postoperative pain scores after 6 hours (OR=-0.27, 95%CI:-0.51--0.04, moderate level of evidence), although this tendency was inconsistent over different postoperative intervals. For treatment success defined according to loose criteria, use of HCSS resulted in significantly fewer failures than other types of sealers (OR=0.70, 95%CI:0.50-0.99,high level of evidence), whereas no significant difference between sealer types was observed when strict criteria were applied (OR=0.89, 95%CI:0.67-1.19, high level of evidence). CONCLUSION:HCSS represent a clinically validated sealer group with no increased risk of elevated postoperative pain and can contribute to successful root canal treatment, with success rates comparable to those of other types of sealers. CLINICAL SIGNIFICANCE:Hydraulic calcium silicate-based root canal sealers were promoted for their biocompatibility and bioactivity. The results of clinical trials show that HCSS perform similar to other types of root canal sealers in terms of postoperative pain and treatment outcomes and display a well-investigated alternative to epoxy resin or zinc oxide eugenol sealers. REGISTRATION:PROSPERO database CRD420261365434.
Background Conventional caries indices, such as Decayed, Missing, and Filled Teeth (DMFT) and Decayed, Missing, and Filled Surfaces (DMFS), remain widely used. However, they do not adequately distinguish between lesion severity, restoration extent, and caries-related tooth loss, nor do they account for differences in the available tooth surfaces. This study aimed to develop a Severity-Adjusted Caries Index (SACI), an age-stratified and surface-normalized composite index designed as a structurally differentiated refinement of conventional cumulative caries-burden measures, and to evaluate its external known-groups validity. Methods This two-phase methodological cross-sectional study included a derivation cohort of 223 adults and an independent external validation cohort of 200 adults, including 100 participants with type 1 diabetes mellitus (T1D) and 100 controls without diabetes. The SACI integrates ICDAS-based caries lesion severity, restoration extent, and caries-related tooth loss within a surface-normalized framework. Age-specific weights were derived separately for participants aged <35 and ≥35 years using a deterministic exact constrained search against a composite optimization target incorporating CAMBRA-derived burden measures and conventional caries indices. External known-groups validation assessed the discriminatory performance against T1D status using ROC analysis, logistic regression, and pairwise DeLong comparisons. Results The SACI showed clear age-specific weighting patterns. In the derivation phase, the final age-specific models showed moderate correlations with the composite target (Pearson r=0.641 for <35 years and 0.638 for ≥35 years). Nested 5-fold cross-validation of the complete weight-selection procedure yielded pooled out-of-fold R² values of 0.345 and 0.315, respectively. In the validation cohort, SACI was significantly higher in participants with T1D than in controls (p<0.001) and showed the highest discriminatory performance among the evaluated indices (AUC=0.671), compared with DMFT (AUC=0.606) and DMFS (AUC=0.572). Conclusions SACI provided a more structurally differentiated and age-sensitive representation of cumulative caries burden than conventional unweighted indices and showed greater discrimination of T1D status in an independent adult cohort. These findings support SACI as a potential refinement of conventional caries-burden assessment rather than as a wholly distinct construct. Further validation against direct caries-related outcomes and in broader populations is warranted. Clinical Significance Conventional caries indices may not fully reflect the structural complexity of caries experience in adults because they treat lesions, restorations, and tooth loss as equivalent components. SACI provides a severity-weighted, age-sensitive, and surface-normalized refinement of cumulative caries-burden assessment by incorporating lesion severity, restoration extent, and caries-related tooth loss. It is intended to complement and refine, rather than replace, conventional indices such as DMFT and DMFS.
OBJECTIVES:To externally validate the generalizability of a cloud-based artificial intelligence (AI) software for automated anterior tooth segmentation in cone-beam computed tomography (CBCT) scans acquired with five CBCT systems and to identify factors associated with the need for manual refinement. METHODS:A total of 190 CBCT scans from five systems were analyzed. Automated segmentation was performed using Virtual Patient Creator (Relu, Leuven, Belgium). Two examiners evaluated 879 tooth segmentation maps, with refinements performed when necessary. Automated and refined segmentations were compared using voxel-wise, surface-based, and time-efficiency metrics. Factors associated with the need for refinement were assessed using mixed-effects logistic regression (α=5%). RESULTS:Automated segmentation was adequate in 90.1% of cases. Endodontic treatment (OR=4.43), orthodontic brackets (OR=3.74), and adjacent high-density artifacts (OR=7.88) were significantly associated with a higher need for refinement (p<0.05). Automated segmentations showed high performance across CBCT systems, with Intersection over Union (IoU) ranging from 0.92 to 0.95, Dice Similarity Coefficient (DSC) from 0.96 to 0.97, recall from 0.94 to 0.95, precision and accuracy above 0.97, Median Absolute Distance (MAD) below 0.07 mm, and Root Mean Squared Error (RMSE) below 0.10 mm. Automated segmentation was substantially faster than refined and manual segmentation. CONCLUSION:The cloud-based AI software showed high performance for anterior tooth segmentation across different CBCT systems, supporting its generalizability under the tested conditions. However, endodontic treatment, orthodontic brackets, and adjacent high-density artifacts increased the likelihood of refinement. CLINICAL SIGNIFICANCE:The reduced segmentation time and consistent performance across CBCT systems support the potential integration of cloud-based AI segmentation into digital dental workflows, especially for anterior teeth, where accurate morphology is clinically relevant.
OBJECTIVES:To identify, characterize, and synthesize the scientific evidence on single-shade resin composites used in direct restorations, encompassing product characteristics, study methodologies, and both clinical and laboratory outcomes. DATA:Clinical and in vitro studies investigating single-shade resin composites in direct restorations of permanent teeth were included. Performance was classified as satisfactory or unsatisfactory based on the original authors' reported conclusions. SOURCES:PubMed, Embase, Cochrane, Web of Science, and Google Scholar were searched up to December 2025 with no language restrictions, following PRISMA-ScR and JBI guidelines. The protocol was registered on the Open Science Framework (DOI: 10.17605/OSF.IO/DXE67). STUDY SELECTION:Of 194 identified records, 51 studies met the eligibility criteria: 41 in vitro and 10 clinical. Palfique Omnichroma (PO) appeared in 46 of 51 studies, with a 58% satisfactory rate in vitro. Essentia Universal achieved 100% satisfactory results. Clinical and laboratory findings diverged: instrumental color measurements tended to favor multi-shade composites, whereas clinical evaluations demonstrated satisfactory performance for single-shade materials. CONCLUSIONS:Single-shade resin composites appear to be promising restorative materials; however, evidence is limited and relies predominantly on short-term in vitro studies. The divergence between clinical and laboratory outcomes suggests that instrumentally detected color differences may not reach clinically relevant thresholds. Well-designed clinical trials with longer follow-up periods are needed. CLINICAL SIGNIFICANCE:Single-shade resin composites may simplify shade selection and reduce chairside time in direct restorations. While short-term clinical evidence shows satisfactory color matching comparable to multi-shade materials, clinicians should consider cavity depth and substrate shade when using these materials, particularly in esthetically demanding scenarios, until long-term clinical data become available.
OBJECTIVES:To develop and internally evaluate a YOLO-based model for fine-grained localization and classification of dental trauma subtypes. METHODS:This retrospective single-center study used a CBCT-dominant dataset of 1,256 annotated trauma instances (1,065 instances derived from sagittal CBCT images and 191 instances derived from periapical radiographs) to develop and internally evaluate a YOLO26x object detection model. Performance was assessed using average precision (AP), mAP@0.5, mAP@0.5:0.95, precision, recall, and inference speed. RESULTS:AP was 90.4% for complicated crown-root fracture, 88.2% for uncomplicated crown fracture, and 83.9% for root fracture, but 27.3% for alveolar fracture and 48.9% for uncomplicated crown-root fracture. Overall mAP@0.5, mAP@0.5:0.95, precision, and recall were 69.9%, 42.5%, 0.675, and 0.704, respectively; mean inference time was 3.3 ms per image. CONCLUSIONS:The YOLO26x model showed subtype-specific performance in fine-grained detection of dental trauma, with better performance for injuries with clearer radiographic boundaries and lower performance for alveolar fracture and uncomplicated crown-root fracture. These internal findings support preliminary feasibility and warrant multicenter validation with patient-level separation. CLINICAL SIGNIFICANCE:If validated in multicenter studies with patient-level separation, AI-assisted image analysis could support lesion localization and subtype recognition when clinically indicated imaging is available; it should complement, rather than replace, comprehensive clinical assessment.
OBJECTIVES:To evaluate implant survival and radiographic bone level outcomes after surgical treatment for peri-implantitis, and to identify factors associated with treatment outcomes. MATERIALS AND METHODS:This retrospective cohort study included patients who underwent surgical treatment for peri-implantitis at a university-affiliated hospital. between January 2000 and December 2024, with a minimum follow-up of 6 months. Patient-related variables, implant and prosthetic characteristics, surgical procedures, and follow-up records were collected. Radiographic measurements were used to assess changes in marginal bone levels. Implant survival and associated factors were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards regression models. In addition, a generalized linear mixed model (GLMM) was applied to identify factors associated with postoperative radiographic bone level changes. RESULTS:A total of 57 patients (91 implants) were included in the study. The median follow-up period was 33 months. The overall implant survival rate after surgical treatment was 75.8% (69/91), and the median survival time was 87.0 months, exceeding 7 years. Twenty-two implants were removed at a mean of 37.1 months after treatment. Among the 69 surviving implants, the mean changes in mesial and distal marginal bone levels during follow-up were -0.54 ± 2.01 mm and -0.57 ± 1.81 mm, respectively. Additionally, preoperative bone loss emerged as a predictor of implant survival (p = 0.001). Regenerative surgical therapy was associated with significantly more favorable radiographic bone level outcomes compared with non-regenerative surgical approaches (p = 0.049). CONCLUSIONS:Preoperative bone loss was identified as an independent prognostic factor for implant survival after peri-implantitis surgery. Regenerative surgical therapy was associated with more favorable radiographic bone level outcomes than non-regenerative approaches following peri-implantitis treatment. However, longer postoperative follow-up was associated with an increased risk of further bone loss, highlighting the challenges of long-term disease control. CLINICAL SIGNIFICANCE:Surgical therapy for peri-implantitis may provide acceptable mid- to long-term implant survival; however, maintaining long-term disease control remains challenging. Greater preoperative bone loss was associated with an increased risk of implant loss, highlighting the importance of early intervention and risk stratification. Regenerative procedures may improve radiographic bone level outcomes in selected cases.
