Clinical, Cosmetic and Investigational Dentistry

Abdulkareem Alhumaidan,1 Khalid S Almulhim,2 Sukainah A Aldawood,3,4 Amr Bugshan,5 Esraa Alabdurubalnabi11Department of Preventive Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Restorative Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Private Practice, Alkhobar, Eastern Province, Saudi Arabia; 5Department of Biomedical Dental Science, college of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Abdulkareem Alhumaidan, Email aaalhumaidan@iau.edu.saAbstract: Management of a failing maxillary anterior tooth with extensive periapical pathology and loss of the buccal alveolar plate carries a significant esthetic and biological challenge, particularly in esthetically demanding patients. This report describes the interdisciplinary management of a compromised maxillary central incisor. Sequenced treatment plan included prophylactic root end resection, site reconstruction for future implant placement while preserving the tooth temporarily throughout the treatment period. After eight months of healing, digital implant planning was utilized to facilitate prosthetically driven immediate implant placement and immediate provisionalization. The provisional restoration was maintained for approximately 1 year before delivery of the definitive restoration. Clinical and radiographic findings at the two-year follow-up demonstrated stable peri-implant hard and soft tissues.Keywords: immediate implant placement, esthetic zone, alveolar ridge reconstruction, guided bone regeneration, digital implant planning

Basem H Al-Huthaifi,1– 3 Khalid Aldhorae,1,4 Baker M Abdullah,2 Arwa M Alhaj,5 Taghreed A Al-Kibsi,2 Thiyezen Abdullah Aldhelai,6 Randa MF Ibrahim,6 Emad M Shaamala,7 Shadha Daghshar,1 Yassmin Daghshar,1 Nadia E Al-Qadasy,1 Mohammed M Al Moaleem81Faculty of Dentistry, Ibn Al-Nafis University for Medical Sciences, Sana’a, Yemen; 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana’a University, Sana’a, Yemen; 3Orthodontic Department, Faculty of Dentistry, University of Sciences and Technology, Sana’a, Yemen; 4Department of Orthodontics, Faculty of Dentistry, Thamar University, Thamar, Yemen; 5Department of Preventive and Biomedical Sciences, College of Dentistry, University of Sciences and Technology, Sana’a, Yemen; 6Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, 52571, Saudi Arabia; 7Health Informatics Program, Department of Computer Science, Metropolitan College, Boston University, Boston, MA, USA; 8Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi ArabiaCorrespondence: Basem H Al-Huthaifi, Faculty of Dentistry, Ibn Al-Nafis University for Medical Sciences, Sana’a, Yemen, Email basemuthanna@gmail.comBackground: Early childhood caries (ECC) remains a significant public health concern, particularly in resource-limited settings. This study aimed to determine the prevalence of ECC and examine its associations with sociodemographic, feeding, and dietary factors among preschool children in Sana’a, Yemen.Methods: A preschool-based cross-sectional study was conducted among 360 children aged 36– 71 months recruited through stratified random sampling from preschools in Sana’a City. ECC was diagnosed using WHO 2013 criteria (dmft ≥ 1), with ICDAS used to identify non-cavitated lesions. Caregivers completed a structured questionnaire on sociodemographic characteristics, feeding practices, and dietary behaviors. Chi-square tests assessed unadjusted associations (p ≤ 0.05), and prevalence ratios (PR) with 95% confidence intervals (CI) were calculated for key exposures.Results: ECC prevalence was 17.5% (95% CI: 13.8– 21.8%), with the highest rate among 4-year-olds (25.0%). The sample was skewed toward 5-year-olds (n = 270, 75.0%), weighting prevalence estimates toward this group. Mean dmft was 0.42 (SD: 1.12); by age: 3 years, 0.13 (0.43); 4 years, 0.62 (1.25); 5 years, 0.43 (1.15); by sex: males, 0.40 (1.08); females, 0.44 (1.16). No significant associations were found with birth weight (p = 0.416) or maternal education (p = 0.991). Significant unadjusted associations included: bottle-feeding (30.3% vs 10.0% breastfeeding, p < 0.001); nighttime bottle-feeding (35.1% vs 9.6%, p < 0.001; PR = 3.64, 95% CI: 2.30– 5.75); and pacifier sweetening (43.5% vs 11.8%, p < 0.001; PR = 3.70, 95% CI: 1.65– 8.30). Consumption of grains and sugars showed the highest prevalence (40.9%, p < 0.001; PR = 4.34, 95% CI: 2.43– 7.75). Snacking frequency was also significantly associated with ECC (χ2 = 11.45, df = 4, p = 0.022).Conclusion: ECC prevalence in this Yemeni preschool population is within the lower range of regional estimates. Statistically significant unadjusted associations with modifiable feeding practices and dietary behaviors generate hypotheses for caregiver education interventions. Longitudinal and multivariable studies are needed to confirm these findings.Keywords: early childhood caries, cross-sectional study, prevalence, feeding practices, dietary habits, preschool children, Yemen

Bhanu Priya,1,&ast; Srikanth Gadicherla,2,&ast; Sruthi Menon Moothedath,3 Gauri Shahi,4 Pavithra Varchas,5 Thrishma Gauri Manipal,2 Anupam Singh,2 Aditi Kumar,3 Akanksha Tiwari,1 Sanhita Parasar,1 Tariq Mashood,1 Gowri Kamath,6 Mehul Saha,2 Kalyana Chakravarthy Pentapati,7 Komal Smriti11Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India; 2Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India; 3Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India; 4Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India; 5Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India; 6Department of Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Mangalore, India; 7Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India&ast;These authors contributed equally to this workCorrespondence: Komal Smriti, Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India, Email komal.smriti@manipal.edu Mehul Saha, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India, Email saha.mehul@manipal.eduIntroduction: Lingual nerve injury is a recognized complication of mandibular third molar extraction, with a reported incidence of 0.6– 2.0%. The lingual nerve’s superficial anatomical course adjacent to the lingual cortex makes it vulnerable to iatrogenic trauma, particularly in distoangular and vertical impactions. This study aimed to evaluate cone beam computed tomography (CBCT)-derived lingual cortical bone parameters and introduce the internal oblique ridge (IOR)–mylohyoid ridge (MR) interval as a radiographic safety corridor for the lingual nerve.Materials and Methods: This retrospective CBCT-based study included 48 subjects with vertical or distoangular mandibular third molar impactions. Buccal and lingual cortical thickness was measured at the cemento-enamel junction (CEJ), mid-root, and apical levels. Root morphology, lingual plate morphology, root-apex-to-lingual-cortex distance, buccolingual angulation, and the IOR–MR interval were also assessed. Independent samples t-tests compared parameters between impaction groups; statistical significance was set at p< 0.05.Results: Distoangular impactions demonstrated significantly thinner lingual cortical bone at the apical level compared to vertical impactions (p=0.03). No significant differences were observed in buccal cortical thickness or lingual cortical thickness at the CEJ and mid-root levels between groups. Mean distal bone thickness in both groups was significantly below the cadaveric reference of 3.01 mm (p< 0.001). The IOR–MR interval averaged 4.92 mm and 4.82 mm in vertical and distoangular groups respectively.Conclusion: Distoangular impactions demonstrate significantly thinner lingual cortical bone at the apical level, representing a measurable radiographic risk factor for lingual nerve injury during third molar extraction. The IOR–MR interval on preoperative CBCT provides a practical estimate of the lingual nerve’s course, supporting its integration into routine presurgical planning for higher-risk impaction patterns.Keywords: cone beam computed tomography, lingual nerve injury, mandibular third molar, lingual cortical plate, distoangular impaction, internal oblique ridge

Walid Al-JalladDepartment of Prosthodontics, Faculty of Dentistry, Arab American University, Jenin, PalestineCorrespondence: Walid Al-Jallad, Email walid.aljallad@aaup.eduBackground: Residual excess cement (REC) has been identified as an iatrogenic factor associated with peri-implant mucositis and peri-implantitis. The detection and removal of subgingival cement are considered clinically challenging, particularly in cases with deep margins.Objective: This narrative review aims to identify available clinical techniques used to minimize residual excess cement (REC) in cement-retained implant restorations, categorize these techniques according to pre-cementation, cementation, and post-cementation phases, and relate technique selection to clinical risk according to margin depth and clinical accessibility. Low risk (equigingival or ≤ 1 mm subgingival), moderate risk (1– 2 mm subgingival), and high risk (> 2 mm subgingival or poor access).Methods: An electronic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for English-language publications available through 28 February 2026 using seven complementary Boolean search combinations addressing residual/excess cement, peri-implant disease, cementation techniques, margin/abutment design, detection/removal, venting, and barrier techniques. The initial searches identified 929 records. After removal of 435 duplicates, the remaining 494 articles were screened for title and abstract,380 were excluded. 114 full text articles were assessed. Of these, 76 were excluded after full-text assessment and 38 publications were included in this narrative review. Due to heterogeneity in study designs and outcomes, findings were synthesized narratively rather than quantitatively.Results: Strategies were categorized into pre-cementation, cementation, and post-cementation. Low risk cases were managed with controlled cement volume, accessible margin designs and post cementation verification. Moderate- and high-risk cases favor custom margin design, radiopaque cement, extraoral cement-volume control, and selected barrier and/or venting measures. In high-risk cases,combining multiple techniques may be presented as an evidence informed option rather than validated protocols.Conclusion: Stage-based risk management offers clinicians an evidence-informed approach to technique selection. Margin depth and accessibility may be considered as a guide for selection of cementation strategies. In high-risk situations, combining multiple techniques may be reasonable, but specific combinations have not been prospectively validated and should not be regarded as definitive clinical protocols.Keywords: dental implants, dental prosthesis, implant-supported, dental cements, cementation, peri-implantitis, prosthesis retention, radiography, dental, CAD/CAM

Rusha Alyafi,1 Amal Jamjoom,1 Ady Azhari,1 Ziyad Alsefri,2 Osamah Ahmed Shendi,2 Razan AbedAlthaqafi,1 Mohammad Assaggaf,1 Yamna Alsahafi,3 Badr Othman,1 Shatha Bamashmous,1 Mohammad Alulaiyan,4 Arwa Badahdah,1 Arwa A Banjar,1 Mohammad Al Zahrani11Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 2Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 3Department of Periodontology, King Abdulaziz University Dental Hospital, Jeddah, 21589, Saudi Arabia; 4Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi ArabiaCorrespondence: Ady Azhari, Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia, Email aazhari1@kau.edu.saPurpose: Diabetes Mellitus (DM) represents a significant public health challenge globally, with a particularly high prevalence in Saudi Arabia. The rising incidence of DM has increased concerns about effective management strategies, especially in contexts involving surgical interventions such as dental extractions. Diabetic individuals frequently experience complications during postoperative healing, characterized by impaired tissue repair and increased susceptibility to infections. This study aimed to evaluate the effect of A-PRF on early post-extraction soft-tissue healing in patients with type 2 diabetes mellitus.Materials and Methods: A randomized, split-mouth clinical trial with participant and outcome-assessor blinding was conducted at King Abdulaziz University Dental Hospital. Eight patients with type 2 diabetes mellitus undergoing dental extractions contributed 31 extraction sockets/sites for site-level analysis. Sites were allocated to A-PRF treatment or control, and socket area was digitally measured at baseline, 1 week, and 3 weeks after extraction. Linear mixed-effects models were used to account for repeated measurements within sockets and clustering of sockets within patients. Fixed effects included treatment group, time, and group-by-time interaction. Marginal mean contrasts were used to estimate within-group changes from baseline and between-group differences, with false discovery rate adjustment applied where appropriate.Results: At baseline, mean socket area was similar between Control/No PRF and A-PRF sites. By 3 weeks, socket area decreased by − 17.10 mm2 in Control/No PRF sites and − 21.97 mm2 in A-PRF sites, with both reductions remaining statistically significant after FDR adjustment. However, between-group differences were not statistically significant at 1 week (− 3.82 mm2; 95% CI − 12.55 to 4.92; p=0.392) or 3 weeks (− 4.78 mm2; 95% CI − 13.51 to 3.96; p=0.284). The group-by-time interaction was also non-significant (p=0.532), and the average treatment effect was − 2.84 mm2 (95% CI − 10.30 to 4.62; p=0.456).Conclusion: A-PRF-treated sockets showed numerically greater reductions in residual socket area compared with control sites; however, the between-group differences were not statistically significant. These findings suggest that A-PRF may have a favorable healing trend in diabetic patients, but the results should be interpreted as preliminary and require confirmation in larger, adequately powered randomized trials.Keywords: wound repair, hyperglycemia, biologic therapy, postoperative complications, glycemic impact