Denosumab is a humanized monoclonal antibody targeting receptor activator of nuclear factor-κB ligand(RANKL)and is commonly used in the treatment of osteoporosis and cancer-related bone metastases.However,the per-sistent use of denosumab has been associated with an increasing incidence of denosumab-related osteonecrosis of the jaw(DRONJ),particularly following tooth extraction.This expert consensus aims to develop clinical management guidelines for the perioperative period of tooth extraction in patients who are currently receiving or have previously received deno-sumab therapy.The consensus covers the definition,etiology,epidemiology,staging,and risk factors of DRONJ,focus-ing on preoperative assessment,risk-based prevention strategies,minimally invasive surgical techniques,and postopera-tive follow-up protocols.The core management strategy for DRONJ emphasizes individualized decision-making based on a comprehensive preoperative assessment of medication history,local infection,and systemic conditions.The main risk factors for DRONJ include high-dose and long-term denosumab therapy,preexisting oral infections,such as peri-odontitis and periapical periodontitis,and invasive dental procedures,including tooth extraction,diabetes,and concomi-tant use of glucocorticoids or antiangiogenic agents.Core preventive measures include strict perioperative oral care,risk assessment-based antibiotic prophylaxis,long-term drug holidays,which were developed by dentists and physicians prio-ritizing the primary disease,and minimally invasive surgical techniques for managing trauma,preserving local blood sup-ply,thoroughly removing infected tissues,and ensuring tight wound closure.This consensus highlights the importance of multidisciplinary collaboration between dental and clinical medicine experts in managing DRONJ.High-quality research is necessary to provide an evidence-based foundation for optimizing DRONJ prevention and treatment strategies.

Traumatic temporomandibular joint ankylosis (TTMJA), with its high recurrence rate post-surgery, lacks a unifying pathogenesis theory, hindering effective prevention. We propose a novel four-stage cascade hypothesis that highlights early lymphatic dysfunction-rather than hematoma organization-as a key early determinant of pathological repair. High-energy trauma releases free fibrocartilage fragments into the joint space, where they may act as 'osteogenic seeds'. Subsequent mechanical zonation of the joint into micromotion and stable zones then drives spatially distinct osteogenic pathways (endochondral and intramembranous ossification), explaining the histopathological heterogeneity of the ankylotic mass. This process culminates in piezoelectric-guided vascular fusion and osteoclast-suppressed consolidation, forming a complete bony bridge. Empirically testable in established models, this hypothesis delineates clear therapeutic windows: early intervention targeting lymphatic repair and debris clearance (<= 7 days), followed by mechanical modulation (7-21 days), and late osteoclast reactivation (>60 days). This framework reframes clinical management by advocating stage-specific interventions within defined therapeutic windows to shift from reactive surgery to mechanism-based prevention.

OBJECTIVE:To investigate the effects of different types of impacted mandibular third molar (IMTM) on lesions in situ and on adjacent tissues at different ages. METHODOLOGY:Cone Beam Computed Tomography (CBCT) images of 1007 IMTM cases were retrospectively analyzed. Associations between age, gender, impaction type, distal alveolar bone condition of mandibular second molar (MSM), IMTM-MSM contact status and occurrence of lesions on IMTM and its adjacent tissues were evaluated using Pearson's chi-squared test and Fisher's exact test. RESULTS:MSM distal alveolar bone defects showed the highest incidence among all IMTM-related lesions (79.2%), followed by MSM distal external root resorption (ERR) (25.5%) and MSM distal caries (10.4%). Mesioangular (96.2%, p<0.001) and horizontal (95.9%, p<0.001) IMTM were associated with more severe bone defects and the incidence increased with age. IMTM-MSM surface-to-surface contact was significantly associated with MSM distal caries severity (12.5%, p<0.001) and distal ERR (29.5%, p<0.001). Inflammatory resorption of MSM distal alveolar bone was significantly correlated with MSM distal caries (47.1%, p<0.001), ERR (36.5%, p<0.05), distal alveolar bone defects (100%, p<0.001), and IMTM caries (14.1%, p<0.05). Study design followed the STROBE guidelines. CONCLUSION:Mesioangular impaction, horizontal impaction, MSM-IMTM surface-to-surface contact, and MSM distal alveolar bone in a state of inflammatory resorption greatly affect lesions on IMTM and its surrounding tissues. These findings suggest the prophylactic extraction in young adults (18-25 years) with high-risk impactions, while recommending observation or cautious management for asymptomatic older patients without signs of inflammatory bone resorption.

Background The posterior molar canal (PMC) has been implicated as a potential source of bleeding during mandibular third molar surgery, yet its true incidence and anatomical characteristics remain controversial due to limitations of conventional imaging. This study aimed to evaluate the detection rates and morphological features of the PMC using four imaging modalities. Methods A total of 389 participants (766 mandibular sides) were enrolled and examined using cone‑beam computed tomography (CBCT), spiral CT, 3.0T magnetic resonance imaging (MRI), or contrast‑enhanced MRI. Detection rates were compared using Fisher–Freeman–Halton exact tests and binary logistic regression. Results The detection rate of the PMC increased significantly with improved soft‑tissue resolution: 32.37% for CBCT, 63.21% for spiral CT, 80.72% for contrast‑enhanced MRI, and 93.75% for 3.0T MRI (P < 0.001). High‑field MRI consistently revealed a three‑branch architecture comprising apical foramen, periodontal ligament, and retromolar branches. The main trunk of the PMC was observed even in patients with congenital absence of the mandibular third molar germ, indicating that the PMC is an inherent anatomical structure rather than a developmental variant. Conclusions The PMC is a consistent anatomical feature of the retromolar triangle that has been systematically underestimated by conventional CBCT. Reliance on CBCT alone may lead to underappreciation of surgical bleeding risks during third molar extraction when the canal runs adjacent to the surgical site. Preoperative recognition of this structure, particularly on high‑resolution MRI, is clinically relevant for anticipating and managing intraoperative bleeding.

The third molar is the most developmentally delayed of the permanent teeth and has the highest incidence of pericoronitis and odontogenic space infections. Impacted third molars significantly increase the risk of periodontitis, dental caries, and external root resorption of adjacent second molars. Third molars are associated with complex surgical procedures, and treatment decisions and clinical management of third molars in this context remain controversial. This expert consensus was generated by oral surgeons and related specialists, who synthesized the current evidence-based literature and contemporary clinical practices. This consensus addresses critical considerations: the developmental trajectory and impaction characteristics of third molars, clinical and radiographic examinations of third molars, classification of impacted third molars, adverse effects of impacted third molars on oral health, indications for extraction, preoperative preparation for impacted third molar removal, anesthetic choices for impacted third molar surgery, recommended surgical protocol for impacted third molar removal, application of implant materials in alveolar sockets, management of common severe complications in impacted third molar extraction, and functional utilization of impacted third molars. Based on a comprehensive expert deliberation, this consensus provides evidence-based clinical guidance and standardized protocols for dental practitioners in the context of third molar management and therapeutic decision-making.

To develop and internally–externally validate a multidomain machine-learning (ML) model for 2-year tooth loss in periodontitis patients using exclusively baseline predictors, and to quantify the incremental value of radiographic over clinical features. This multicenter retrospective cohort included 862 periodontitis patients (Stage I–IV) from three centers (2019–2024), of whom 718 were evaluable at a prespecified 24-month prediction horizon. Forty-one baseline predictors across six domains plus three a priori interaction terms were evaluated using seven ML algorithms with stratified 5-fold cross-validation, with all preprocessing (multiple imputation, standardization, feature engineering) performed within each training fold. Generalizability was assessed via leave-one-center-out (LOCO) internal–external and temporal validation. Incremental radiographic value was quantified through nested logistic regression with category-free NRI/IDI. Ensemble-level SHAP provided interpretability; DCA assessed clinical utility; Cox regression analyzed time to tooth loss. The 2-year event rate was 29.0

Inflammation-associated alveolar bone defects, such as periodontitis, remain a major clinical challenge, as persistent inflammatory microenvironments severely impair bone regeneration and tissue repair. The cathepsin family plays a significant role in inflammatory responses and the clinicopathological process of periodontitis. Studies have shown that the cathepsin K inhibitor, odanacatib (ODN), can repair inflammatory bone defects. However, its administration via oral or local delivery fails to maintain sustained drug concentrations within the periodontal pocket. Here, we report a gel sustained-release system that coordinates immunomodulation with osteogenic induction to overcome inflammation-impaired bone regeneration. We utilized the emulsification-solvent evaporation method to prepare ODN-loaded poly(lactic-co-glycolic acid) (PLGA) microspheres (ODN-MS). These microspheres were thoroughly mixed with gelatin methacryloyl (GelMA) to form a gel composite sustained-release system (ODN-MS-Gel). The ODN-MS-Gel prepared has excellent photopolymerization properties and can achieve sustained release of ODN for a long time, thus enabling local and targeted drug delivery within the periodontal pocket. In vitro, ODN-MS-Gel not only promoted the proliferation, adhesion, and migration of BMSCs but also induced macrophage polarization toward the M2 phenotype, demonstrating a significant ability to promote osteogenic differentiation under inflammatory conditions. Furthermore, this study also distinguished the differences between the two situations of continuous release and non-continuous release and revealed the potential role of macrophage immune regulation in conjunction with stem cell osteogenic differentiation. In vivo, ODN-MS-Gel gradually degraded over time, exhibiting excellent long-term biocompatibility. By using a rat periodontitis model, it was demonstrated that ODN-MS-Gel could reduce inflammatory expression in periodontal tissues under inflammatory conditions and repair the alveolar bone defect to 77% of its normal height. In conclusion, ODN-MS-Gel achieves anti-inflammatory and bone repair effects with a single drug, representing a promising biomaterial for treating inflammatory alveolar bone defects.

OBJECTIVES:The aim of this study is to investigate risk factors for external root resorption (ERR) of second molars (M2) associated with impacted third molars (M3), and to develop a prediction model that can offer dentists a reliable and efficient tool for predicting the likelihood of ERR. METHODS:A total of 798 patients with 2156 impacted third molars were collected from three centres between 1 December 2018 and 15 December 2018. ERR was identified by cone beam computed tomography examinations. The effects of different risk factors on the presence/absence of ERR and its severity were analysed using Chi-square or Fisher test. Multivariate logistic regressive analysis with stepwise variable selection methods was performed to identify factors which were significant predictors for ERR and its severity. Subsequently, a prediction model was developed, and the model performance was validated internally and externally. RESULTS:The overall incidence of ERR of second molars was 16.05%. The prediction model was established using six factors including position (upper/lower jaw), impact type, impact depth (PG: A-B-C), contact position, root number of M3, and age. In terms of internal validation, the prediction model demonstrated satisfactory performance, achieving an area under curve of 0.961 and a prediction accuracy of 0.907. As for external validation, the area under curve remained high at 0.953, with a prediction accuracy of 0.892. CONCLUSION:A risk prediction model for ERR was established in the present study. Position (upper or lower jaw), impact type, impact depth (PG: A-B-C), contact position, root number of M3, and age were identified as influencing variables which were significant predictors in the development of this predictive model. The prediction model showed great discrimination and calibration. CLINICAL RELEVANCE:This prediction model has the potential to aid dentists and patients in making clinical decisions regarding the necessity of M3 extraction.

Objective: Elucidate differences in key gene expression and cellular heterogeneity in alveolar bone between periodontitis (PD) and periapical periodontitis (PP) by analysing single-cell RNA sequencing data. Methods: Single-cell RNA sequencing datasets for PD (GSE171213) and PP (GSE181688) were obtained from the Gene Expression Omnibus and analysed. Differentially expressed genes were identified in comparisons of PD versus healthy controls (HC), PP versus HC, and PD versus PP. Functional enrichment analyses were performed to explore heterogeneity. Key genes related to angiogenesis (ARGs), inflammation (IRGs), and phagocytosis (PRGs) were identified and combined to form PD-specific and PP-specific key gene sets. The expression of these key genes was validated by quantitative real-time polymerase chain reaction. Cell types were annotated using SingleR, and key cell types were further analysed for their proportions, intercellular communication, and gene expression patterns. Hallmark pathway analysis and cell cycle/differentiation assessments were conducted to understand functional heterogeneity. Results: A total of 251 Differentially expressed genes associated with humoral immunity, B cell regulation, and leukocyte/lymphocyte activation were identified. Four PD-specific and 16 PP-specific key genes were found, and fibroblasts and macrophages were identified as the two key cell types. Fibroblast interactions were prominent, and cells in the G1 phase predominated. The key genes were highly expressed during early T cell and macrophage differentiation and during late fibroblast and plasma cell differentiation. Expression levels of these genes were highest in PP, intermediate in PD, and lowest in HC. Conclusion: This study identified four PD-specific and 16 PP-specific key genes, as well as two pivotal cell types in alveolar bone inflammatory diseases. Investigating the functional diversity of these cell types could enhance insights into the pathogenesis of these conditions. Clinical Relevance: The findings may guide clinical treatment strategies for alveolar bone involvement in PD and PP, and lay a theoretical foundation for exploring the underlying inflammatory mechanisms.

In May 2023, the Chinese Stomatological Association promulgated the group standard of "Clinical Practice Specifications for Permanent Tooth Extraction". These specifications were formulated after repeated discussions and revisions guided by relevant literature and the opinions of well-known experts in the field across the country. However, the content of the group standard is not elaborated and is limited to its writing form and requirements. As a consequence, medical workers might not easily understand and comprehend its content and knowledge points, which also limits its dissemination and wide use in primary medical units. This study aims to sort out and interpret the content of the 2023 edition of the "Clinical Practice Specification for Permanent Tooth Extraction" to help medical staff understand and apply it in clinical practice.

Bone grafting is a primary method for treating bone defects. Among various graft materials, xenogeneic bone substitutes are widely used in clinical practice due to their abundant sources, convenient processing and storage, and avoidance of secondary surgeries. With the advancement of domestic production and the limitations of imported products, an increasing number of bone filling or grafting substitute materials isentering clinical trials. Relevant experts have drafted this consensus to enhance the management of medical device clinical trials, protect the rights of participants, and ensure the scientific and effective execution of trials. It summarizes clinical experience in aspects, such as design principles, participant inclusion/exclusion criteria, observation periods, efficacy evaluation metrics, safety assessment indicators, and quality control, to provide guidance for professionals in the field.

The psychological symptoms of temporomandibular joint (TMJ) ankylosis were similar to that of depressive disorder, but there were no relevant evidences to confirm that the humans or animals with TMJ ankylosis had depressive disorder. The aim of this study was to investigate the association between TMJ ankylosis and depressive disorder in the rat model. Thirty 3-week-old male Sprague–Dawley (SD) rats were used in this study. The damage of TMJ complexes and narrowed joint space were performed in the unilateral TMJ of test group to induce TMJ bony ankylosis (experimental side). The other TMJ of test group underwent a sham operation (sham side). The TMJs of control group did not undergo any operations. At 8 weeks postoperatively, behavioral tests, body weight, passive maximum mouth opening (PMMO), and TMJ morphological features were evaluated, and the hippocampuses were analyzed using western blotting and immunocytochemistry. The data was compared between the test group and control group by independent t-test, between the experimental side and sham side by paired t-test. The correlations between PMMO/area of bony fusion and duration of immobility, sucrose preference, CB1 receptor protein, mean optical density of CB1 receptor protein, and the number of BrdU-positive cell were evaluated using linear regression analysis. The level of significance was 0.05. In the test group, the traumatic TMJ complexes with narrowed joint space developed TMJ bony ankylosis, the area of bony mass of experimental side (21.26 mm2) was larger than that of sham side (1.73 mm2) (p < 0.001). There were significant difference with the sucrose preference (test group: 0.36, control group: 0.76, p < 0.001), duration of immobility (test group: 127.36 s, control group: 59.41 s, p < 0.001), body weight (test group: 156.70 g, control group: 270.06 g, p < 0.001), PMMO (test group: 9.98 mm, control group: 28.79 mm, p < 0.001), CB1 receptor protein (test group: 41.00

This study aimed to investigate the molecular mechanisms of periodontitis and identify key immune-related biomarkers using machine learning and Mendelian randomization (MR). Differentially expressed gene (DEG) analysis was performed on periodontitis datasets GSE16134 and GSE10334 from the Gene Expression Omnibus (GEO) database, followed by weighted gene co-expression network analysis (WGCNA) to identify relevant gene modules. Various machine learning algorithms were utilized to construct predictive models, highlighting core genes, while MR assessed the causal relationships between these genes and periodontitis. Additionally, immune infiltration analysis and single-cell sequencing were employed to explore the roles of key genes in immunity and their expression across different cell types. The integration of machine learning, MR, and single-cell sequencing represents a novel approach that significantly enhances our understanding of the immune dynamics and gene interactions in periodontitis. The study identified 682 significant DEGs, with WGCNA revealing seven gene modules associated with periodontitis and 471 core candidate genes. Among the 113 machine learning algorithms tested, XGBoost was the most effective in identifying periodontitis samples, leading to the selection of 19 core genes. MR confirmed significant causal relationships between CD93, CD69, and CXCL6 and periodontitis. Further analysis showed that these genes were correlated with various immune cells and exhibited specific expression patterns in periodontitis tissues. The findings suggest that CD93, CD69, and CXCL6 are closely related to the progression of periodontitis, with MR confirming their causal links to the disease. These genes have potential applications in the diagnosis and treatment of periodontitis, offering new insights into the disease’s molecular mechanisms and providing valuable resources for precision medicine approaches in periodontitis management. Limitations of this study include the demographic and sample size constraints of the datasets, which may impact the generalizability of the findings. Future research is needed to validate these biomarkers in larger, diverse cohorts and to investigate their functional roles in the pathogenesis of periodontitis.

Objetivo: Investigar si los implantes de titanio impresos en 3D modificados con superficies de iones de magnesio y zinc pueden promover el cierre de tejidos blandos orales. Método: Se seleccionaron conejos grandes blancos de Nueva Zelanda como animales experimentales, y los dientes mandibulares izquierdo y derecho de cada animal se dividieron al azar en grupo experimental y grupo control, cada uno con 18 casos. Se extrajeron los primeros premolares bilaterales después de administrar anestesia general y se colocaron implantes en los grupos tratados con y sin modificación iónica de la superficie de magnesio/ zinc. Resultados: Bajo observación a simple vista, la combinación del material del implante y el tejido blando circundante en el grupo experimental fue significativamente mejor que en el grupo de control. La tinción de fluorescencia mostró que el valor de densidad de fluorescencia del grupo experimental fue significativamente mayor que el del grupo control (p < 0.05). Conclusiones: Los implantes de titanio impresos en 3D basados en la modificación iónica de la superficie de magnesio/zinc promueven el cierre de los tejidos blandos orales con resultados significativos.

Objectives The aim of the present study was to investigate the risk factors for external root resorption (ERR) of the second molars (M2) associated with impacted third molars (M3) and to develop a prediction model for clinical assessing the risk of ERR based on the individual characteristics of M3. Materials and methods A total of 798 patients with 2156 impacted third molars were collected from three centers between December 1, 2018 and December 15, 2018. ERR was identified by cone beam computed tomography (CBCT)examinations. The effects of different risk factors on the presence/absence of ERR and its severity were analyzed using Chi-Square or Fisher test. Multivariate logistic regressive analysis with stepwise variable selection methods was performed to identify factors which were significant predictors for ERR and its severity. Subsequently, a prediction model was developed, and the model performance was validated internally and externally. Results The overall incidence of ERR of second molars was found to be 16.05%. Risk factors of ERR included age, position (upper or lower jaw), impact depth, impact type, contact position, M2 situation in opposing jaw and root number of M3. The prediction model was established using six factors including position, impact type, impact depth (including PG:A-B-C and PG:I-II-III),contact position and root number of M2. In terms of internal validation, the model achieved an AUC of 0.959 and a prediction accuracy of 0.896 (95% CI, 0.867, 0.921). The Kappa value was 0.572, with a sensitivity of 0.956 and a specificity of 0.571. Additionally, for external validation, the model demonstrated an AUC of 0.975 and a prediction accuracy of 0.910 (95% CI, 0.870–0.941). The Kappa value was calculated as 0.653, with a sensitivity of 0.941 and a specificity of 0.732. Conclusion A risk prediction model for ERR was established in the present study. Position (upper or lower jaw), impact type, impact depth, contact position and root number of M2 were identified as influencing variables which were significant predictors in the development of this predictive model. The prediction model showed great discrimination and calibration. Clinical relevance: This prediction model has the potential to aid dentists and patients in making clinical decisions regarding the necessity of M3 extraction.

OBJECTIVE:The study aimed to investigate whether 3D-printed titanium implants modified with magnesium and zinc ion surfaces can promote oral soft-tissue closure. METHOD:New Zealand Great White rabbits were selected as experimental animals, and the left and right side mandibular teeth of each animal were randomly divided into an experimental group and control group, each with 18 cases, and the bilateral first premolar teeth were extracted after general anesthesia, and implants were implanted into the magnesium/zinc ionized surface-treated and the surface-untreated groups, respectively. RESULTS:Under naked-eye observation, the combination of implant material and surrounding soft tissue in the experimental group was significantly better than that in the control group; fluorescence staining showed that the fluorescence density value of the experimental group was significantly higher than that of the control group (p < 0.05). CONCLUSIONS:3D-printed titanium implants based on magnesium-zinc ion surface modification promote oral soft-tissue closure with significant results.

Background Delayed healing of diabetic cutaneous wounds is one of the most common complications of type 2 diabetes mellitus (T2DM), which can bring great distress to patients. In diabetic patients, macrophages accumulate around skin wounds and produce NLRP3 (NOD-, LRR-, and pyrin domain-containing protein 3) inflammasomes, which in turn undergo pyroptosis and produce inflammatory factors such as interleukin-1β that affect wound healing. Although our previous study revealed that apoptotic extracellular vesicles (ApoEVs) produced from mesenchymal stem cells (MSCs) improve cutaneous wound healing in normal C57BL/6 mice, whether ApoEVs can also improve diabetic wound healing remains unclear. Methods Umbilical cord mesenchymal stem cells (UCMSCs) were cultured in vitro and apoptosis was induced. ApoEVs were extracted and identified and used in a T2DM mouse cutaneous wound model to evaluate the efficacy. The inhibitory effect of ApoEVs on macrophage pyroptosis was verified in vivo and in vitro , and the level of oxidative stress in macrophages was assessed to explore the mechanism by which ApoEVs play a role. Results UCMSC-derived ApoEVs improved skin defect healing in T2DM mice. Moreover, UCMSC-derived ApoEVs inhibited macrophage pyroptosis in T2DM mice in vivo as well as in vitro under high-glucose culture conditions. In addition, we demonstrated that ApoEVs reduce oxidative stress levels, which is a possible mechanism by which they inhibit macrophage pyroptosis. Conclusions Our study confirmed that local application of UCMSC-derived ApoEVs improved cutaneous wound healing in T2DM mice. ApoEVs, as products of MSC apoptosis, can inhibit macrophage pyroptosis and regulate the death process by decreasing the level of oxidative stress.

PURPOSE:To verify the efficacy and safety of calcined cattle bone grafting material in filling alveolar bone defect after tooth extraction.METHODS:A randomized, bind, parallel, positive-control multicenter clinical trial was conducted. A total of 280 subjects were randomly assigned to either the experimental group (calcined cattle bone group) or control group (Bio-Oss group) equally. The main efficacy indicator was the imaging changes 24 weeks after material implantation. Secondary efficacy indicators were wound healing, rejection, bone metabolism, post-filling symptoms and signs of bone infection. The safety of material was assessed by the incidence of adverse events and serious adverse events. SAS 8.2 software package was used for statistical analysis.RESULTS:A total of 280 cases were included, of them 267 cases completed the study while 13 cases fell off. The effective rate of FAS(PPS) was 90.58%(97.46%) in the experimental group and 87.05% (95.04%) in the control group. The difference of effective rate between the experimental group and control group (95%CI) was 3.53% (-3.88%, 10.94%) of FAS, 2.42% (-2.38%, 7.22%) of PPS, and there was no significant difference between the two groups. The incision healing of the two groups was good, and the incidence of rejection, bone infection signs, post-filling symptoms and bone metabolic changes was very low. The incidence of adverse events was similar in the two groups, and no serious adverse events related to the study materials occurred.CONCLUSIONS:The efficacy of calcined cattle bone grafting material in filling alveolar bone defect after tooth extraction is not inferior to that of Bio-Oss, and it is safe and effective for alveolar bone defect repair.

The aim of the present study was to observe the abrasion of implant drills and postoperative reactions for the preparation of the interradicular immediate implant bed during the COVID-19 pandemic and beyond. Thirty-two implant drills were included in four groups: blank, improved surgery, traditional surgery, and control. In the improved surgery group, a dental handpiece with a surgical bur was used to decoronate the first molar and create a hole in the middle of the retained root complex, followed by the pilot drilling protocol through the hole. The remaining root complex was separated using a surgical bur and then extracted. Subsequently, the implant bed was prepared. Implant drills were used in the traditional surgery group to complete the decoronation, hole creation, and implant-drilling processes. The tooth remained intact until the implant bed was prepared. The surface roughness of the pilot drill was observed and measured. Surgery time, postoperative reactions (swelling, pain, and trismus), and fear of coronavirus disease 2019 scale (FCV-19S) were measured and recorded, respectively. Statistical analysis revealed significant difference with surface roughness among blank group (0.41 ± 0.05 μm), improved surgery group (0.37 ± 0.06 μm), traditional surgery group (0.16 ± 0.06 μm), and control group (0.26 ± 0.04 μm) (P < .001). Significant differences were revealed with surgery time between improved surgery group (5.63 ± 1.77 min) and traditional surgery group (33.63 ± 2.13 min) (P < .001). Swelling, pain, and trismus (improved group: r ≥ 0.864, P ≤ .006; traditional group: r ≥ 0.741, P ≤ .035) were positively correlated with the FCV-19S. This study proved that a new pilot drill could only be used once in traditional surgery but could be used regularly in improved surgery. Improved surgery was more effective, efficient, and economical than the traditional surgery. The higher FCV-19S, the more severe swelling, pain, and trismus.

The treatment of periodontitis can be very challenging due to its complex etiologies. A new pharmacologic strategy entitled "host-modulation therapy, " has been introduced to improve periodontal treatment outcomes. Supposedly, a multifunctional drug with the potential for bacterial infection prevention, host-response modulation and bone healing promotion would be a promising option for periodontitis therapy, but related studies remain substantially lacking. In this study, we successfully conjugated tetracycline with odanacatib (a selective inhibitor of cathepsin K) to construct a multifunctional drug (TC-ODN). We discovered that TC-ODN could promote macrophages polarizing toward anti-inflammatory phenotype and promote osteogenesis of PDLSCs under inflammatory microenvironment. In vivo, TC-ODN could be absorbed and distributed specifically to the bone after systemic administration, and accumulation of TC-ODN increased bone mineral density in ovariectomized rats. Importantly, periodontal administration of TC-ODN could successfully promote bone healing in periodontitis rats with alveolar bone loss. The findings in our study uncovered the excellent biocompatibility and multifunction of TC-ODN, including bone-targeted accumulation, immunoregulation, anti-inflammatory activity and promotion of bone healing, which might contribute to the clinical treatment of periodontitis.