AimTo evaluate the quantification of Enterococcus faecalis using quantitative polymerase chain reaction (qPCR) and culture techniques following different root canal irrigation protocols in refractory endodontic cases.Materials and methodsFifty refractory endodontic cases were randomly allocated into five experimental groups according to the irrigant and activation method used: Group I, saline irrigation; Group II, 5.25% sodium hypochlorite with Passive ultrasonic irrigation; Group III, 5.25% sodium hypochlorite with EndoActivator; Group IV, 2% chlorhexidine with Passive ultrasonic irrigation; and Group V, 2% chlorhexidine with EndoActivator. Microbiological samples were collected before and after disinfection using sterile paper points. Quantification of Enterococcus faecalis was performed using conventional culture techniques and qPCR. Data were analyzed using one-way ANOVA, post hoc Tukey test, and paired t-tests (P < 0.05).ResultsPost-treatment bacterial counts were significantly lower in all experimental groups than in the saline control (P < 0.001). Group II (NaOCl with Passive ultrasonic irrigation) showed the greatest reduction, with mean post-treatment counts of 1.73 × 10⁵ CFU/mL by culture and a mean log CFU of 3.56 by qPCR, compared with 408 × 10⁵ CFU/mL and 26.54 log CFU, respectively, in the saline control. Both culture and qPCR demonstrated significant reductions in E. faecalis following all active irrigation protocols, with Group II consistently showing the greatest reduction across both detection methods.Conclusion5.25% NaOCl activated by Passive ultrasonic irrigation achieved the greatest reduction in E. faecalis across both culture and qPCR assessments.Clinical significancePassive ultrasonic activation of sodium hypochlorite may enhance root canal disinfection by significantly reducing Enterococcus faecalis, a microorganism commonly associated with persistent endodontic infections. The use of qPCR provides a sensitive method for evaluating the antimicrobial efficacy of endodontic irrigation protocols.
ObjectiveThe aim of this paper is to investigate clear aligner therapy (CAT) practice patterns among Turkish orthodontists and compare them with Iranian specialist orthodontists.MethodsA web-based cross-sectional survey of Turkish specialist orthodontists assessed CAT use, adjuncts, training, case selection by malocclusion and age, monitoring and retention protocols, and perceived advantages/disadvantages. Findings were compared with a previously published survey of 142 Iranian orthodontists.ResultsA total of 178 Turkish orthodontists participated (7.5% response rate; 71 males, 107 females). Most were aged 30–39 years (53.9%), had 11–20 years of experience (42.1%), and worked in private practice (62.9%). CAT use was reported by 96.1% of Turkish orthodontists versus 69.0% of Iranian orthodontists. More Turkish orthodontists initiated >50 new CAT cases annually (33.1% vs. 7.7%), while fewer reported <10 cases/year (18.0% vs. 35.9%). CAT use was significantly higher in Turkey across all age groups (P < 0.001). Preferences were similar for mild crowding, spacing, and anterior cross-bite. Turkish orthodontists more frequently used CAT for complex cases, including mild/moderate open bite and severe crowding (P < 0.05). CAT was preferred more for limited extraction and space-opening cases than orthognathic surgery cases. Iranian orthodontists more commonly used local manufacturers (49.3% vs. 15.7%) and in-office aligner production (19% vs. 9%). Perceptions regarding CAT advantages and limitations were largely similar between groups.ConclusionAmong respondents, CAT was more widely integrated into orthodontic practice in Turkey, with broader self-reported clinical indications and more positive clinician perceptions than in Iran. Iranian orthodontists relied more on locally manufactured and in-office aligners.
Down Syndrome (DS) involves widespread systemic issues, including a near-universal development of early-onset Alzheimer's Disease, driven by factors beyond Amyloid Precursor Protein (APP) over-expression, such as chronic neuroinflammation and endosomal dysfunction. High prevalence of periodontitis in this population acts as a significant source of peripheral inflammation that may accelerate this cognitive decline, necessitating further study into the bidirectional, pro-inflammatory links between systemic health and neurodegeneration in DS. This review analyzes the common pathophysiological pathways linking periodontitis and AD development within the DS population, evaluating how oral dysbiosis acts as a systemic driver of neurodegeneration. We synthesized current molecular, microbiological, and clinical evidence evaluating the bidirectional relationships between trisomy 21-induced immune dysfunction, severe periodontitis, and accelerated cognitive decline. Individuals with DS exhibit a heightened susceptibility to aggressive, early-onset periodontitis starting as early as age six. This chronic oral dysbiosis facilitates microbial translocation, allowing periodontal pathogens (e.g., Porphyromonas gingivalis) and their virulence factors to cross the blood-brain barrier via circulatory or trigeminal routes. In the central nervous system, these pathogens encounter microglial populations already genetically primed by trisomy 21. This induces an exacerbated M1 microglial phenotype response, triggering sustained neuroinflammation, defensive over-deposition of Amyloid-β (Aβ) plaques, and upregulation of GSK-3β, which accelerates Tau protein hyperphosphorylation. While bidirectional links are strongly indicated, current literature lacks robust longitudinal studies connecting periodontal, microbiological, and cognitive data to establish definitive causality. Early clinical intervention and management of gum disease present a critical therapeutic window to delay the onset and slow the progression of AD in this vulnerable population.
ObjectiveRecent outbreaks of respiratory infectious diseases, transmitted via aerosols, have placed dental healthcare workers at high risk. Traditional dental education, based on student–teacher–patient interactions, faces unprecedented challenges across all stages. From admissions to classroom teaching, laboratory instruction, clinical training, and final examinations, every aspect of dental education is undergoing significant challenges and is in urgent need of change.MethodsThis narrative review with content analysis synthesized literature on the impact of respiratory infections on dental education. We systematically searched PubMed, Web of Science, and CNKI (2020–2026) using relevant keywords. Two reviewers independently screened and selected studies. Data were thematically analyzed into five core domains: classroom teaching, laboratory teaching, clinical teaching, student admissions/assessment, and licensing examinations.ResultsIn classroom teaching, online platforms and AI-augmented PBL/CBL were rapidly adopted, yet persistent issues included network instability, limited interaction, digital inequities, and heavy reliance on student self-discipline. In laboratory teaching, AR/VR and iLab-X enabled remote training, but were constrained by high costs, poor haptic realism, inability to replicate patient emotions, and equipment dependence. In clinical teaching, enhanced infection controls—including PPE, rubber dams, and HEPA filtration—were implemented, though bio-aerosol risks, reduced patient flow, and limited clinical exposure remained. In admissions, online exams with dual-camera proctoring, open-ended questions, AI-generated items, and virtual OSCEs were adopted, while challenges persisted in cheating prevention, subjective scoring, validity, and privacy. Licensing examinations remained in-person with strict protection; VSP showed promise but lacked robust evidence and incurred high costs. Overall, technological innovations enabled educational continuity, yet significant infrastructure gaps, inequities, and unresolved validity issues persist across all domains.ConclusionChina's dental education rapidly adapted to respiratory epidemics through online teaching, simulation, and enhanced infection control, yet persistent challenges remain in digital equity, cost, validity, and infrastructure. These innovations are important primarily because they directly influence student learning outcomes—including knowledge acquisition, clinical reasoning, and skill retention—while also shaping curriculum design. Future preparedness requires sustained investment, faculty development, equitable access, and rigorous longitudinal research to validate skill transfer to clinical practice, ensuring that technological advances ultimately translate into measurable improvements in student competency and patient safety.
Supportive periodontal care is essential for maintaining periodontal stability after active therapy, yet adherence to periodontal maintenance remains difficult. Once bleeding, halitosis or other presenting concerns improve, some patients may interpret the disease as resolved and the maintenance visit as “just a clean.” This Perspective uses the intention–behaviour gap to examine behavioural, financial and health-literacy barriers to continued supportive care. It then considers a narrower, testable hypothesis: artificial intelligence (AI) might assist clinicians in organising clinician-verified periodontal information and presenting it through personalised visual summaries or prompts. Evidence that AI improves periodontal recall attendance is currently sparse; most dental AI research concerns image interpretation or classification, and the only directly relevant periodontal adherence study is proof-of-concept. Proposed risk projections are therefore presented as a distant research concept rather than a clinically validated tool. AI should not replace clinical judgement, and any future system would require validation, transparent uncertainty, consent, governance, equity safeguards and comparison with simpler non-AI interventions.
BackgroundUllrich congenital muscular dystrophy (UCMD) is a rare inherited myopathy caused by mutations in the COL6 gene and is frequently associated with multisystem complications affecting the respiratory and skeletal systems, which may increase airway and anesthetic risks during dental treatment.Case reportThis report describes a 4-year-old girl with UCMD who presented with pain in the left lower molar. After a comprehensive multidisciplinary evaluation by the Department of Stomatology, Anesthesiology, and Pediatrics, the patient was classified as ASA III and underwent dental treatment under total intravenous anesthesia, with tracheal intubation performed under fiberoptic bronchoscopic guidance. The procedures included pulpotomy, tooth extraction, resin restoration, placement of preformed metal crowns, and topical fluoride application. The perioperative course was uneventful and no respiratory, airway, or anesthesia-related adverse events were observed. The patient was followed up continuously for 6 to 12 months after dental treatment.ConclusionThis report delineates the multidisciplinary perioperative management of comprehensive dental treatment in a 4-year-old patient with UCMD, thereby providing a clinical reference for oral healthcare in individuals with this rare disorder.
BackgroundChewing difficulty is associated with poorer physical and mental health. Objective measurement of chewing function is currently limited to methods that require specialist lab equipment (for example lab-based manipulation or comminution tests). A remote method for estimating chewing-related metrics would support the development of accessible and scalable means of detecting and monitoring chewing-related health issues.MethodThis paper details initial work on developing a novel smartphone-based, image-analysis algorithm to estimate particle-size metrics from photographs of masticated raw carrot deposited in a Petri dish. A two-stage image-processing pipeline was developed, comprising geometric calibration and particle segmentation, enabling estimation of particle-size metrics from smartphone photographs. The algorithm was implemented both as a Python script and as a graphical user interface (GUI), the latter allowing semi-automated per-image adjustment of calibration and segmentation parameters with visual feedback. The script and graphical user interface (GUI) are publicly available: osf.io/kgx9fResultsPerformance was evaluated on artificially generated test images to benchmark the algorithm against ground-truth data with known sizes, while also assessing data-collection processes, usability and key challenges. On the more realistic synthetic-particle images, which include overlapping particles of varying size, the algorithm produced a cumulative area error of 20.6% and a mean per-particle relative error of 21.1% (median 14.8%; mean absolute error 1.02 mm2), with the largest errors occurring for the smallest and most overlapped particles. These synthetic-particle figures reflect performance on successfully matched particles; end-to-end performance including undetected particles would be lower. On simpler geometric-shape images, total-area relative error was lower, at 3.10% for the large-shape set, 3.00% for the small-shape set, and 3.12% across all shapes.ConclusionThe algorithm demonstrates quantifiable analytical performance in estimating chewing-related particle-size metrics from smartphone images, supporting its potential use as a foundation for future remote measurement of chewing function. However, the method is not yet clinically validated. In its current form, the method achieves its best performance through a semi-automated, GUI-based workflow, which introduces a subjective element but provides a practical way to handle heterogeneous image conditions and inform future automation.
Curcumin, the active polyphenol in turmeric (Curcuma longa), is well-known for its anti-inflammatory, antioxidant, and antimicrobial properties, making it a promising therapeutic agent for a range of diseases, including neuroinflammatory conditions and periodontal disease. Periodontitis, a prevalent oral disease, is associated with chronic inflammation and bacterial infection. Curcumin has demonstrated antibacterial effects against periodontal pathogens such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia when applied locally as a sub-gingival gel in conjunction with scaling and root planning (SRP). Furthermore, curcumin's ability to produce reactive oxygen species (ROS) under visible light exposure enhances its effects through photodynamic therapy (PDT) and potentiates its antibacterial and anti-inflammatory actions. Curcumin demonstrates promising potential as an adjunctive therapy for periodontitis, indicating that it may serve as a valuable adjuvant strategy for improving periodontal management. Nonetheless, additional well-designed clinical and translational studies are warranted to confirm these benefits.
IntroductionSkeletal anterior open bite (AOB) often requires orthognathic surgery. This study compared the clinical and perioperative outcomes of computer-guided and conventional plan-transfer workflows following virtual surgical planning.MethodsEighteen adults with skeletal AOB underwent virtual surgical planning and were subsequently randomized to computer-guided transfer of the established surgical plan using CAD/CAM guides (n = 9) or conventional model-surgery transfer using articulator-mounted casts and occlusal wafers (n = 9). Outcomes included intraoperative handling, operative time, blood loss, complications, healing, and AOB correction.ResultsMean operative time was 6.0 ± 0.5 h versus 6.5 ± 0.6 h (p = 0.08), and blood loss was 450 ± 60 versus 520 ± 80 mL (p = 0.12) for the computer-guided and conventional groups, respectively. Intraoperative handling was perceived as easier with computer guidance, although this assessment was subjective. No major intraoperative complications occurred. Mean postoperative AOB was 1.33 ± 0.50 mm in both groups (p = 1.00).ConclusionNo statistically significant between-group differences were detected in operative time, blood loss, or postoperative AOB. Computer-guided plan transfer was perceived to facilitate intraoperative handling, although this assessment was subjective. Given the small sample size and limited statistical power, the absence of statistically significant differences should not be interpreted as evidence of equivalence between the workflows. Larger adequately powered studies are warranted.
BackgroundPreterm birth (<37 weeks of gestation) occurs during critical stages of odontogenesis and is associated with developmental defects in dental hard tissues. Enamel hypoplasia, enamel hypomineralization, and structural dentin alterations may compromise esthetics, function, and long-term oral health outcomes. However, the nature and extent of these defects and their underlying mechanisms have not been comprehensively investigated.ObjectiveTo map and evaluate the available evidence regarding developmental defects of enamel and dentin in individuals born preterm, identify proposed pathophysiological mechanisms, and highlight the gaps in the current literature.MethodsThis scoping review was conducted in accordance with the Arksey and O'Malley framework, incorporating methodological refinements proposed by Levac et al., and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A structured search of PubMed, Scopus, and Web of Science was performed for studies published until July 2026. Studies evaluating enamel and/or dentin outcomes in individuals born preterm (<37 weeks of gestation) were eligible for inclusion.ResultsFourteen studies, including cross-sectional, cohort, case-control, longitudinal, and histological investigations, met the eligibility criteria. Enamel hypoplasia and hypomineralization were the most frequently reported defects, with greater prevalence and severity observed among individuals with lower gestational age and birth weight. Dentin alterations, including reduced mineralisation, altered hardness, and structural irregularities, were reported in only three of the included studies. Although these findings suggest an association with prematurity, the limited evidence base means that they should be regarded as preliminary and hypothesis-generating rather than conclusive. Proposed mechanisms include perinatal hypoxia, nutritional deficiencies, systemic inflammation, and neonatal intensive care–related interventions, such as endotracheal intubation and prolonged assisted ventilation. The available evidence is characterised by methodological heterogeneity, variations in diagnostic criteria, and a paucity of longitudinal studies.ConclusionCurrent evidence suggests that preterm birth is associated with developmental defects in both enamel and dentin. Nevertheless, significant knowledge gaps remain, particularly regarding dentin-specific pathologies, long-term outcomes, and underlying biological mechanisms. Future research should prioritise standardised diagnostic approaches and well-designed longitudinal studies to strengthen the evidence base and inform preventive and therapeutic strategies for this condition.
PurposeThis systematic review aimed to evaluate the effect of neuromuscular re-education, oral motor exercises, or biofeedback compared to standard post-insertion care on objective masticatory function and patient-reported outcomes in completely edentulous adults receiving new conventional complete dentures.MethodsA pre-piloted search protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses – Protocol guidelines (PRSIMA-P) and registered in PROSPERO (CRD420251186130). A comprehensive electronic search was conducted across various databases. The selected studies were further evaluated using the Cochrane ROB 2 tool for randomized controlled trials (RCTs) and the ROBINS-I V2 tool for non-randomized studies.ResultsThe initial search yielded 1,517 records from which a final set of 3 articles (2 RCTs and 1 clinical trial) were included. Quality assessment indicated that one RCT had “some concerns,” one RCT was “high risk,” and the clinical trial was at “critical risk” of bias. A sensitivity analysis suggested that excluding the higher-risk studies did not alter the overall positive direction of the findings. The findings of the included studies indicated that oral motor exercises and biofeedback significantly improved the functional adaptation as well as patient satisfaction.ConclusionThe presented evidence suggests that active neuromuscular training is a cost-effective and feasible intervention to improve the functional adaptation to conventional complete dentures. Further high-quality research is recommended to substantiate these findings and to develop a protocol advocating for oral motor exercises and biofeedback to be included as a part of post-insertion instructions for conventional complete dentures.Systematic Review RegistrationPROSPERO(CRD420251186130).
IntroductionDental caries remains a global public health issue influenced by multiple family, psychosocial, and socioeconomic factors, including parental oral health literacy and parenting practices. However, the associations between parental oral health literacy, parental stress, parenting practices, and children's dental caries experience are still not fully understood. Therefore, this cross-sectional study evaluated the associations of parental oral health literacy, parental stress, parenting practices, and socioeconomic status with children's dental caries experience assessed during dental care.MethodsA cross-sectional study involved children aged 4 to 12 attending the Pediatric Dentistry Clinic at the School of Dentistry, Federal University of Alfenas. Children underwent dental prophylaxis and a clinical examination to assess caries using the dmft/DMFT index. Parents’ oral health literacy was measured with the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), parental stress with the Parental Stress Scale (PSS), and family bonding with the Parenting Practices Inventory (PPI). Statistical analysis was performed using the Kruskal-Walli's test and Poisson regression, with a significance level of 5%.ResultsAmong 134 parent–child dyads, children were mostly male (52.2%; n = 70; mean age: 7.64 ± 2.21 years), and parents/guardians were predominantly female (88.1%; n = 118; age: 29–40 years). Higher parental oral health literacy, more positive parenting practices, older parental age, and older child age were associated with lower dmft/DMFT values, whereas lower family income was associated with higher dmft/DMFT values.ConclusionHigher parental oral health literacy was associated with lower DMFT/dmft values in children. Parenting practices, socioeconomic status, parental age, and child age were also associated with children's dental caries experience.
BackgroundThe objective of this systematic review and meta-analysis was to determine the prevalence of the second mesiobuccal (MB2) canal in permanent maxillary molars within the South American population, evaluated exclusively through cone-beam computed tomography (CBCT).MethodsFollowing the PRISMA guidelines, an electronic search was conducted across PubMed, Scopus, Web of Science, Embase, SciELO, LILACS, and gray literature until May 2026. Observational studies published from 1990 onwards were included. A meta-analysis of proportions was executed using a random-effects model. The risk of bias was assessed with the JBI tool, and the certainty of evidence using the GRADE framework.ResultsA total of 23 observational studies were included. The pooled overall prevalence of the MB2 canal was 59% (95% CI: 53%–66%). In the tooth-specific analysis, prevalence reached 66% in first molars and 41% in second molars. Significant sexual dimorphism was evident in second molars, where males presented a 35% higher probability of possessing the canal (OR = 1.35). The GRADE analysis indicated a High certainty for the overall and first molar prevalences, and Moderate for second molars.ConclusionsThe MB2 canal is a highly prevalent anatomical variation in South America, constituting the anatomical norm in first molars. The clinical use of CBCT is crucial for its diagnostic prediction and successful management.Systematic Review RegistrationDOI: 10.17605/OSF.IO/KRG4Z.
Population ageing is increasing the complexity of oral health care and creating new expectations for undergraduate dental education. Elder adults increasingly present with multimorbidity, frailty, polypharmacy, functional dependency, cognitive decline, and social vulnerability, all of which require dental graduates to move beyond procedural competence toward integrated, person-centred, and collaborative care. However, the literature continues to show substantial variability and underdevelopment in undergraduate gerodontology teaching, with inconsistent curricular structure, limited standardization, and insufficient attention to authentic clinical performance. Recent work in dental education also suggests that Entrustable Professional Activities (EPAs) may provide a practical bridge between competency frameworks and workplace-relevant assessment, yet their use in geriatric oral health education remains limited. This article presents a curriculum innovation framework for longitudinal integration of geriatric oral health in undergraduate dental education, informed by competency-based education, contextualized EPAs, constructive alignment, spiral curriculum design, interprofessional education, and programmatic assessment. On this basis, six context-sensitive geriatric oral health EPAs are proposed, together with a longitudinal curriculum model, suggested pedagogical approaches, and an assessment framework. Rather than being restricted to a single institutional curriculum, the model is intended as a flexible reform framework that can be adapted across diverse undergraduate BDS programs. EPA-informed curricular reform offers a theory-informed and practically relevant approach for making geriatric oral health teaching more explicit, longitudinal, interprofessional, and assessable in undergraduate dental education.
The oral cavity represents a highly complex biochemical ecosystem in which host tissues, saliva, microbial communities, and environmental factors interact dynamically to maintain health or promote disease. This narrative review examines a comprehensive overview of the biochemical processes occurring within the oral cavity and examines their implications for oral health and disease. Key aspects discussed include the biochemical composition and functions of saliva, the metabolic activity of the oral microbiota, biofilm formation, and the molecular mechanisms underlying major oral diseases such as dental caries, periodontal disease, and oral mucosal disorders. Particular emphasis is placed on the role of biochemical homeostasis, microbial dysbiosis, inflammation, and oxidative stress in disease pathogenesis. Although substantial progress has been made in characterizing these mechanisms, current evidence remains largely derived from in vitro or reductionist models that do not fully replicate the complexity of the oral environment. In addition, inter-individual variability and host-microbial interactions are still incompletely understood, limiting full translational application. This review also discusses the emerging role of salivary biomarkers as non-invasive diagnostic and prognostic tools, as well as potential therapeutic strategies targeting biochemical pathways. By critically integrating current evidence, this work highlights both advances and remaining gaps in oral biochemistry, emphasizing its relevance for the development of more precise preventive, diagnostic, and personalized approaches in oral healthcare.
Objective:To evaluate the environmental impact and sustainability-related practices of clear aligner therapy (CAT), focusing on environmental impact, economic implications, waste management, recycling practices, manufacturing processes, and aligner materials. It further explores the alignment of clear aligner practices with Sustainable Development Goals (SDG's) 3,9,12 and 13. Methodology:A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The review was guided by the Population-Concept-Context (PCC) framework. A comprehensive literature search was performed across five electronic databases (PubMed Central, Google Scholar, Scopus, Web of Science, and EBSCOhost) for studies published between January 2014 and December 2024. Studies evaluating the environmental sustainability of clear aligner therapy, including materials, manufacturing processes, waste management, recycling practices, and carbon emissions, were included. Results:Thirteen studies met the inclusion criteria. The evidence indicates that clear aligner therapy contributes to plastic waste, microplastic generation, and greenhouse gas emissions throughout its life cycle. The included studies reported biodegradable materials, direct three-dimensional (3D) printing technologies (SDG-9), recycling initiatives (SDG 12), and circular economy approaches as potential strategies to reduce environmental impacts (SDG 3 & 13). However, the implementation of these strategies remains constrained by limited recycling infrastructure, economic considerations, and insufficient high-quality evidence. Conclusion:Available evidence suggests that innovations in material selection, circular economy approaches, optimized manufacturing processes, and enhanced recycling programs may reduce the environmental burden associated with clear aligner therapy. Nevertheless, further high-quality environmental assessment studies are required to support the development of more sustainable orthodontic practices aligned with SDGs 3, 9, 12, and 13.
IntroductionPrior work has largely focused on landmark-localization error and runtime; whether AI-derived parameter-level measurements differ systematically from those obtained by manual cephalometric analysis remains unclear.ObjectiveTo compare parameter-level cephalometric measurements obtained using AI systems with manual reference methods through a systematic review and meta-analysis; secondarily, to narratively summarize any reported diagnostic metrics (κ/ICC, sensitivity/specificity, AUC) without pooling.MethodsSix databases (PubMed, Scopus, Web of Science, IEEE Xplore, EBSCO, and SciELO) were searched with no time restriction (inception to 20 September 2025) and no language limits; citation chasing was performed (Google Scholar). Eligible studies directly compared AI-based and manual cephalometric tracings. Random-effects meta-analyses were conducted only for parameter-level cephalometric measurements (primary outcomes), using standardized mean differences (Hedges’ g) with 95% confidence intervals (CIs). Statistical heterogeneity was quantified using the I2 statistic. Sensitivity/specificity/AUC were not meta-analyzed due to heterogeneous thresholds and ≤3 studies per metric; no bivariate or HSROC model was applied. Risk of bias was assessed with QUADAS-2 and certainty with GRADE. Legacy rule/knowledge-based reports were summarized narratively and not pooled. Registration: OSF (DOI: 10.17605/OSF.IO/WKMVD).ResultsTwenty-two studies published between 2020 and 2025 were included. AI showed small and generally non-significant differences compared with manual methods across most evaluated parameters, although the certainty of evidence was low to moderate and heterogeneity was considerable for several outcomes. A statistically significant but small advantage was observed for the ANB angle (g = 0.28; 95% CI: 0.03–0.53; p = 0.03), with uncertain clinical relevance. Complementary legacy studies were described narratively and excluded from pooling. GRADE certainty ranged from low to moderate.ConclusionsAI-assisted cephalometric analysis produces parameter-level measurements comparable to manual tracings for most evaluated parameters; a small statistical difference for ANB was observed without clear clinical relevance. However, the certainty of evidence is limited by heterogeneity, publication bias, and lack of multicenter validation. AI may complement cephalometric workflows and save time, but it requires expert supervision and does not replace comprehensive orthodontic diagnosis or treatment planning. Funding/COI: As declared in the manuscript.Systematic Review Registrationhttps://doi.org/10.17605/OSF.IO/WKMVD.
IntroductionEstablishing a durable seal between enamel and fissure sealant materials is critical for the long-term prevention of occlusal caries, particularly in anatomically complex pits and fissures. This in vitro study evaluated the effects of chemical pretreatment with a papain-based gel and mechanical pretreatment with air abrasion on the microleakage, sealant penetration, and shear bond strength of two pit and fissure sealant materials.MethodsA total of 120 sound human premolars were randomly allocated according to sealant type, resin-based sealant (RBS) or resin-modified glass ionomer cement (RMGIC), and pretreatment protocol: no pretreatment, enzymatic papain-based gel, or air abrasion. Following sealant application and thermocycling, microleakage was evaluated by dye penetration under a stereomicroscope. Sealant penetration was measured in relation to fissure morphology using ImageJ software, and shear bond strength was evaluated using a universal testing machine.ResultsRBS showed significantly lower microleakage than RMGIC, indicating better sealing ability. Papain-based gel pretreatment significantly reduced microleakage in the RBS group without affecting sealant penetration or shear bond strength; however, no comparable improvement was observed in the RMGIC group. In contrast, air abrasion pretreatment did not produce a significant improvement in any of the evaluated outcomes. Fissure morphology significantly influenced sealant penetration, with wider fissure patterns demonstrating greater penetration.DiscussionThese findings indicate that fissure sealant performance is primarily influenced by material properties and fissure morphology, while the benefit of enamel pretreatment appears to be material-dependent.
BackgroundPeople with any form of dry mouth may have problems with eating, swallowing, speaking, taste perception, wearing dentures, and maintaining good oral health. Subsequently, it can have a major impact on the quality of life through its effects on the qualitative and quantitative parameters of nutrition. Nevertheless, little is known about the effects of different foods and nutrients on salivation and orofacial sicca symptoms. Despite this, the literature on the relationship between xerostomia (x), hyposalivation (h), Sjögren disease (SD), and nutrition is relatively sparse.ObjectiveThe authors aimed to evaluate the dietary habits of middle-aged patients with newly diagnosed dry mouth and/or SD compared with healthy controls.MethodsA total of 128 participants (10 men and 118 women; mean age: 53 ± 13 years) enrolled in the study. A 35-question questionnaire containing a “computer-assisted personal interview”-type exploratory survey was used to record body mass index (BMI), possible food allergies, harmful habits, used sources of health-related information, and nutritional habits such as frequency and types of daily meals, for example, fruit, vegetable, meat, vitamin, and trace element consumption. Subjective sicca symptoms (xerostomia, xerophthalmia) were also assessed by guided questions, while the unstimulated whole saliva (UWS) flow rate was determined by the spitting method to confirm hyposalivation. SD was diagnosed based on the 2016 ACR-EULAR diagnostic criteria. Participants were divided into four groups: healthy controls (c), xerostomia (x), hyposalivation (h), and SD. Patients' data were compared with those of healthy controls.ResultsThe mean BMI of the participants did not show a significant difference from the normal BMI, although it was slightly elevated in all four patient groups (c: 24.7; x: 25.4; h: 26.2; SD: 25.2). The smoking percentage was high in the SD group: 49% vs. 18% in the c group (p = 0.01), while it was 0 in both the x and h groups. The percentage of food allergy and/or intolerance (lactose, milk protein or gluten, floating, and bloating) was increased among all patients compared with healthy controls: 50% of patients with xerostomia and 44% and 68% with those with hyposalivation compared with only 16% of healthy controls (p < 0.05, p < 0.05, p < 0.00001, respectively). Similarly, liquid consumption was between 1.9 and 2.2 L/day in all groups, and the interviewed participants preferred water ( approximately 78%) and diary milk products (more than 80%). Significantly less patients with xerostomia consumed alcohol (2.6 vs. 18%, p < 0.05) and vegetable milk regularly (2.6 vs. 18%, p < 0.05) compared with healthy controls; alcohol consumption was also low in the h (4.7%) and SD (6.4%) group of patients. There was no significant difference in the intake of different vitamins and trace elements between any patient group and the c group, except that of vitamin D3, which was consumed in a significantly higher frequency by the x group of patients (p < 0.05). Extra sugar, processed food, snack, extra salt consumption, and grain and wheat types of preference were at similar levels in all the examined groups. It was observed that all four groups favored apple among all fruits, while patients with dry mouth did not prefer sour fruits like berries (hyposalivation p < 0.05) and citrus fruits (x and h; p < 0.05 and p < 0.05) or irritating agents like onions (h; p < 0.05), as these foods might deteriorate both the dryness feeling and the burning mucosal symptoms. Potato was less preferred by the other groups compared with the healthy control group and might cause swallowing problems in patients of the x group (p < 0.05). Nevertheless, rice and tomato-paprika consumption was increased in the h group (p < 0.05, p < 0.05). With regard to meat types, poultry (50%–88%), pork (40%–58%), and seafood (33%–50%) were the most popular, but possibly because of its less fat content, the x and SD group of patients consumed less poultry compared with the c group of patients (50 and 52% vs. 80%; p < 0.001, p < 0.05, respectively. It should also be noted that people today prefer the internet as a source for obtaining any diet or health awareness information (64%–92%) and less frequently consult their physicians or specialists (0%–6%). No significant differences were found between the patient and control groups in terms of oil and fat consumption; vegetable oils (82%–100%) and butter (22%–25%) were the most popular between the groups.ConclusionsAs a primary outcome of this study, the nutrition of patients with dry mouth and/or SD generally does not differ from the diet of healthy persons, and it is determined by local traditions and availability. The number of daily meals and the pattern of fluid consumption do not vary significantly because of sicca symptoms or SD. A higher incidence of food allergy was reported in patients with dry mouth and/or SD. Affected patients tend to prefer easily swallowable, non-irritant, softer (rice), or high-water content foods such as tomato and paprika, or cold cuts. Patients with dry mouth and/or SD need conscious dietary advice from their family practitioners, dentists, or specialists to alleviate their symptoms, while trustworthy websites and social media may serve as important sources of health information.
