Background/Objectives: Rehabilitation of the severely atrophic edentulous jaw remains one of the most demanding challenges in oral and maxillofacial reconstruction, particularly when extensive bone augmentation is contraindicated, has previously failed, or is refused by the patient. Subperiosteal implants, first introduced in the 1940s and largely abandoned due to poor long-term performance, have re-emerged over the past decade as a viable alternative through the integration of cone-beam computed tomography (CBCT)-based virtual planning, computer-aided design/computer-aided manufacturing (CAD/CAM), and additive manufacturing. This review summarizes current evidence on the clinical outcomes, surgical workflow, and indications of customized, digitally designed subperiosteal implants. Materials and Methods: A structured literature search was performed in PubMed and Scopus, supplemented by manual searching, to identify publications relevant to the predefined clinical and conceptual scope of this narrative review. Search terms addressed subperiosteal implants, digital/CAD-CAM workflows, additive manufacturing, severe jaw atrophy, and clinical outcomes. Predefined selection criteria were applied to maintain consistency with the scope of the review, and the literature-selection process was documented using a descriptive flow diagram. Results: Sixty-two publications were retained as the core literature informing the narrative synthesis, comprising systematic reviews and meta-analyses, retrospective and multicenter clinical studies, case series, case reports, and biomechanical/technical investigations. The synthesized evidence indicates short-to-medium-term implant survival generally exceeding 90%, with soft-tissue exposure and dehiscence as the most frequently reported complications, and a decline in survival on longer follow-up. Digitally designed subperiosteal implants are increasingly reported for severely resorbed maxillae and mandibles, oncologic and post-traumatic defects, syndromic patients, and cases of failed conventional or zygomatic implant therapy. Conclusions: Digital workflows have renewed clinical interest in subperiosteal implants by enabling patient-specific design and digitally supported planning and manufacturing. However, the evidence base remains dominated by case reports and heterogeneous retrospective series, underscoring the need for prospective, standardized, long-term studies.
Background/Objectives: Painful temporomandibular disorders (TMDs) are multifactorial and biopsychosocial, yet identifying associated factors does not establish the function each factor occupies along an individual clinical trajectory. This conceptual hypothesis article aimed to propose a functional–temporal framework that distinguishes etiological role from biopsychosocial domain and incorporates individual adaptive capacity. Methods: The framework was developed from established TMD concepts and purposively selected prospective and longitudinal evidence relevant to first onset, post-onset course, repeated measurement, and person-by-exposure interaction. The article is not a systematic or scoping review. Results: Recognized influences are organized into three functional positions: predisposing, initiating, and perpetuating. These positions are not treated as intrinsic properties of variables; assignment depends on temporal ordering, context, measurement, phenotype, and the specified outcome. Adaptive capacity is proposed as a conceptual source of differential response and is distinguished from generic effect modification, which is one empirical strategy for testing the hypothesis. Existing longitudinal studies show that susceptibility, onset-related change, post-onset course, and exposure-by-person interactions can be measured, but no cohort has validated the complete framework. Falsifiable predictions and conservative wording rules are specified. Conclusions: The framework offers a temporally disciplined approach to etiological interpretation and patient communication without implying deterministic causation or treatment efficacy. Its current empirical basis is strongest for painful TMD, and densely measured inception cohorts are needed to test whether functional position and prespecified moderators add explanatory or predictive information.
Background/Objectives: Pregnancy and the postnatal period offer an opportunity to establish preventive oral health behaviors benefiting mothers and children. However, many pregnant women have limited knowledge of oral health and early childhood caries prevention. This study assessed oral health knowledge among pregnant and puerperal women attending a tertiary referral hospital in Spain and evaluated the effect of a brief educational intervention. Methods: A quasi-experimental pre–post study was conducted following TREND guidelines and registered at ClinicalTrials.gov (NCT07413393). Participants completed a questionnaire on demographics, oral health knowledge, attitudes, and educational background. They then received an educational intervention based solely on written educational materials, consisting of a brief explanation and a leaflet based on international paediatric dentistry guidelines. Knowledge changes among women completing follow-up were analyzed using the paired Student’s t-test and Wilcoxon signed-rank test. Results: Of 229 women completing the baseline assessment, 130 completed follow-up. Educational level was the main independent factor associated with higher baseline knowledge. Major gaps concerned maternal influence on early oral microbial colonization, recognized by only 38.86% of participants, and recognition of white spot lesions as the earliest sign of caries (10.77%). Overall knowledge improved significantly after the intervention (p = 0.018), particularly regarding nocturnal bottle feeding and caries (p = 0.0001) and timing of the first dental visit (p = 0.04). Conclusions: Pregnant and puerperal women showed important gaps in preventive oral health knowledge. A brief educational intervention improved overall knowledge, although deficiencies remained. Integrated multidisciplinary oral health education during prenatal care may improve maternal and child outcomes.
Background: Gingival metal tattoos caused by prosthodontic treatment present esthetic problems. To date, their removal has been unpredictable because of invasive surgical methods and the lack of reliable diagnostic tools. Objective: This study investigated the potential utility of optical coherence tomography (OCT) for the non-invasive assessment of metal tattoos and evaluated the minimally invasive removal using Er:YAG laser microsurgery. Methods: This study comprised an exploratory ex vivo proof-of-concept experiment using three gingival metal tattoo models and a clinical case series of three patients with gingival metal tattoos. Ex vivo models were created using porcine gingiva with artificially embedded metal fragments, which were analyzed through OCT and histological examination. In the clinical cases, three women with anterior gingival metal tattoos underwent OCT followed by Er:YAG laser microsurgery under microscopic guidance between 2012 and 2013. Results: Ex vivo experiments showed highly reflective OCT signals corresponding to the histological locations of metal fragments within the connective tissue. Clinically, OCT enabled visualization and localization of findings consistent with metal fragments and provided guidance for Er:YAG laser removal. All three patients showed uneventful healing without postoperative pain. Follow-up was available for 1.5 months in Case 1 and for up to 13 years in Cases 2 and 3, with favorable long-term clinical and esthetic outcomes observed in the latter two cases. Conclusions: OCT may facilitate non-invasive assessment and localization of gingival metal tattoos. When combined with Er:YAG laser microsurgery, it may provide a feasible and minimally invasive approach with favorable esthetic outcomes.
Background: Developmental enamel hypomineralisation is characterised by qualitative defects in enamel mineralisation that affect both primary and permanent dentitions. Proteomic studies have provided novel insights into the molecular mechanisms underlying these conditions; however, an updated critical appraisal integrating the available evidence across both Molar–Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) is needed. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception until 30 July 2026. Observational and laboratory studies examining proteomic changes in enamel, saliva, or other oral biological samples from individuals diagnosed with MIH or HSPM were included. Risk of bias was assessed using the revised Joanna Briggs Institute (JBI) tool and the Quality Assessment Tool for In Vitro Studies (QUIN). Results: Ten reports satisfied the inclusion criteria, representing nine independent primary datasets. Consistent findings included increased retention of serum-derived proteins, particularly albumin, alongside enrichment of protease inhibitors and inflammatory proteins within hypomineralised enamel. Additionally, alterations in proteins involved in enamel matrix processing and maturation, including matrix metalloproteinase-20 (MMP20) and kallikrein-related peptidase 4 (KLK4), were identified. Salivary analyses revealed quantitative differences in proteins involved in immune, inflammatory and mineralisation-related pathways. Both shared and distinct proteomic features were observed across hypomineralised enamel in the primary and permanent dentitions. Conclusions: Current evidence indicates recurrent proteomic alterations in developmental enamel hypomineralisation, particularly impaired enamel maturation, abnormal retention of serum-derived proteins, and alterations in inflammatory pathways. Further standardised proteomic studies are needed to validate these findings and assess their potential as biomarkers.
