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ورود به زیرشاخهجراحی دهان، فک و صورت
مقالهها، منابع و پژوهشهای تازه حوزه جراحی دهان، فک و صورت
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شواهد دندانپزشکی
PubMed2026
[THE ROLE OF SOCIAL HYGIENIC FACTORS AND SANITARY CULTURE OF POPULATION IN FORMATION OF STOMATOLOGICAL STATUS OF RURAL RESIDENTS OF THE REPUBLIC OF DAGESTAN].
The diseases of oral cavity belong to the most widespread non-communicable pathologies, significantly affecting quality of life and the economy. In Russia, the prevalence of dental caries and periodontal diseases remains high, especially in the rural population, where availability of stomatological care is limited. In the Republic of Dagestan, the situation is complicated by natural climatic, cultural and linguistic characteristics, that determine the necessity of local evaluation of factors of stomatological health.
PubMed2026
Defining Consensus-Based Components for Integrating Dietitians Into Primary Dental Care for Paediatric Populations: A Delphi Study.
BACKGROUND: Diet is a modifiable risk factor linking oral and systemic health, contributing to dental caries and weight-related outcomes (including underweight, overweight and obesity) in the paediatric population. However, dietary advice provided by dental professionals in primary dental care is often brief and sugar-focused, representing a missed opportunity to address shared risk factors. Integrating dietitians into primary dental care may support more holistic paediatric preventative care. OBJECTIVE: To develop expert consensus on the components required to integrate dietitians into primary dental care to address diet as a common risk factor in paediatric oral health and weight-related outcomes. METHODS: A three-round online Delphi study was conducted with dietitians and dental professionals, followed by patient and public involvement (PPI) consultation with caregivers and children and young people. Round 1 open-text responses were thematically analysed and synthesised into 158 statements. In Rounds 2 and 3, experts rated statements using a 7-point Likert scale. Consensus agreement was defined a priori as ≥ 70% agreement (ratings of 6 or 7) and < 15% disagreement (ratings of 1 or 2) across the panel and within both professional groups. Results were summarised using descriptive statistics. RESULTS: Thirty-six, twenty-eight, and twenty-five experts completed Delphi Rounds 1, 2 and 3, respectively. Round 1 generated 158 statements, of which 90 achieved full consensus agreement by Round 3. Full consensus agreement was reached on safeguards for discussing weight-related outcomes sensitively, referral criteria for oral-health dietary support, training and skill development, organisational structures for collaboration, communication pathways and role clarification. No single approach to identifying weight-related outcomes met the predefined agreement threshold and remained exploratory. CONCLUSION: This study identified consensus-based components for integrating dietitians into primary dental care, providing a practical foundation to inform the design and piloting of integrated dietetic-dental care models with potential to improve oral health and broader child health outcomes.
PubMed2026
Failure of Wide-Diameter Dental Implants (Predominantly 5.0 mm) Show Distinct Risk Profiles-A Large Cohort Study.
AIM: To evaluate survival rates and identify temporally distinct risk factors for early and late failure of wide-diameter dental implants (≥ 5.0 mm) in a large real-world cohort using landmark analysis. MATERIALS AND METHODS: This retrospective cohort study analyzed 12 041 wide-diameter implants (≥ 5.0 mm), predominantly 5.0 mm, placed in 9247 patients at a single center between January 2014 and December 2023. Implant survival was defined as the fixture remaining in situ without clinical loss or replacement at the same site. Failures were classified as early (≤ 1 year) or late (> 1 year). Kaplan-Meier survival curves and a multivariable Cox proportional hazards model clustered by patient were generated. Schoenfeld residuals revealed time-varying effects for penicillin allergy, implant length, and kidney disease, prompting a landmark analysis at 365 days with separate multivariable logistic regression models for early and late failure. RESULTS: Overall implant survival was 97.5%. Kaplan-Meier estimates were 98.1% (95% CI: 97.9%-98.4%) at 1 year, 97.8% (95% CI: 97.5%-98.0%) at 3 years, and 97.6% (95% CI: 97.4%-97.9%) at 5 years. Of 301 failures, 225 (74.8%) were early and 76 (25.2%) were late. In the Cox model, short implants (≤ 8 mm; HR = 1.94, 95% CI: 1.43-2.62, p < 0.001), maxillary placement (HR = 2.13 vs. mandible, p < 0.001), male sex (HR = 1.39, p = 0.010), penicillin allergy (HR = 1.66, p = 0.014), and older age (HR = 0.84 per SD, p = 0.008) independently predicted failure; smoking was borderline (HR = 1.33, p = 0.065). Landmark analysis showed that early failure was driven by penicillin allergy (OR = 2.26, p < 0.001), maxillary placement (OR = 2.42, p < 0.001), male sex (OR = 1.40, p = 0.016), and short length (OR = 1.70, p = 0.007), whereas late failure was driven by short length (OR = 3.19, p < 0.001) and kidney disease (OR = 6.11, p = 0.003). CONCLUSIONS: Wide-diameter implants achieve excellent long-term survival. Early and late failures arise from distinct mechanisms: perioperative, anatomical, and sex-related factors predominate early, while short implant length and renal disease predominate late. These findings support tailored perioperative protocols, individualized risk stratification, and targeted long-term surveillance.
PubMed2026
Impact of Thermal Cycling on Volumetric Stability of Endodontic Filling Materials.
OBJECTIVE: To evaluate the dimensional stability of root canal obturation materials under dynamic conditions by simulating ageing. MATERIALS AND METHODS: Forty extracted, single-rooted, human teeth were decoronated and randomly assigned to four experimental groups of 10 teeth each. Root canals were instrumented using the Reciproc R40 system and obturated using the single-cone technique in combination with one of four sealers: AH Plus, MTA Fillapex, TotalFill BC Sealer, or EndoREZ. All specimens underwent thermal cycling (9000 cycles between 5°C and 55°C) to simulate ageing. Each tooth was scanned using high-resolution micro-computed tomography (micro-CT) before and after thermal cycling. Volumetric changes of the filling materials were compared by analyzing the pre- and post-treatment scans in the apical 1 and 2-mm, and over the total canal volume. RESULTS: At the apical 1-mm region, AH Plus exhibited the greatest expansion ( 0.016 mm 3 $0.016\,{\mathrm{mm}}^{3}$ ). EndoREZ, MTA Fillapex, and TotalFill BC Sealer showed significantly lower expansion ( 0.008 , 0.003 , 0.001 mm 3 $0.008,0.003,0.001\,{\mathrm{mm}}^{3}$ ) than AH Plus. In the apical 2-mm region, only TotalFill BC Sealer expanded significantly less than AH Plus, with a difference of 0.03 mm3. CONCLUSION: Thermal cycling induced measurable expansion in all tested endodontic sealers, with the most pronounced effects observed in the apical region. AH Plus exhibited significantly greater expansion than the other materials. Controlled apical expansion may be clinically beneficial by improving sealer adaptation to dentinal walls and enhancing apical sealing without generating detrimental radial stresses. These findings underscore the clinical relevance of long-term volumetric stability under thermally dynamic conditions and suggest that sealer selection may influence the durability of the apical seal.
PubMed2026
Influence of Air Polishing and Ultrasonics on Veneer Margins in Vitro: An Optical Coherence Tomography Pilot Study.
OBJECTIVE: In vitro evaluation of substance loss at the restoration margin of veneers was conducted as a function of prophylaxis procedures, air polishing, or ultrasonic instrumentation. MATERIALS AND METHODS: Forty-eight extracted premolars were restored with CAD/CAM materials after veneer preparation (t0): lithium disilicate, zirconia-reinforced lithium silicate ceramics, and resin-based composite. Five cycles of prophylaxis treatment (air polishing or ultrasonic scaling) and thermocycling (tE) were conducted. The substance loss of the luting material at the restoration margin was evaluated regarding width, depth, and the veneer inclination angle using optical coherence tomography and contour analysis. Group differences were determined using two-factor analysis of variance, Tukey tests, and linear regression models. RESULTS: Both prophylaxis procedures lead to substance loss at the restoration margin. The material choice had a significant effect on width and depth at the veneer margin (p < 0.002), this was not observed for the prophylaxis procedures (p ≥ 0.445). Air polishing resulted in the largest reduction in width and depth in zirconia-reinforced lithium silicate. A cross-group influence of inclination angle on substance loss was not detected. CONCLUSIONS: Both prophylactic procedures cause substance loss at the margins of the investigated CAD/CAM ceramic as well as composite veneers in the area of adhesive bonding. CLINICAL SIGNIFICANCE: The choice of luting and veneer material seems to have a more significant influence on the extent of substance loss than the type of instrumentation of the prophylaxis procedure.
PubMed2026
Influence of Implant Type on Clinical and Radiologic Outcomes: A Cross-Sectional Private Practice-Based Analysis.
OBJECTIVES: To compare tissue-level (TL) and bone-level X (BLX) implants regarding peri-implant bone level alterations, survival, and complication rates over a 3-years. MATERIALS AND METHODS: In this retrospective, non-interventional clinical study, patients that had received either TL or BLX implants (both: Straumann AG), with at least one clinical follow-up (minimum 6 months), were included. Bone-level alterations and bone peaks were evaluated at baseline (implant placement) and at follow-ups from dental radiographs. In addition, clinical follow-ups included the recording of the presence of keratinized mucosa and the registration of technical complications (e.g., chipping fractures). For statistics, descriptive analyses, t-tests, and a random-effects linear regression analysis were applied. RESULTS: A total of 146 implants (73 TL and 73 BLX) were included. TL implants showed a survival rate of 100%, whereas BLX implants showed a survival rate of 98% after 3 years. TL implants showed significant mesial bone gain (0.08 mm, p = 0.018) between 2- and 3-year follow-ups, with a notable difference (0.21 mm, p = 0.041) compared to BLX implants. At distal bone levels, TL implants showed initial bone loss (0.12 mm, p = 0.020) at 6 months but gained bone (0.07 mm, p < 0.001) between 2 and 3 years, whereas BLX implants showed significant distal bone loss (0.15 mm, p = 0.038) over 3 years. The number of complications was higher in BLX implants. BLX implants with a band of keratinized mucosa > 2 mm showed smaller bone level alterations. CONCLUSIONS: Both TL and BLX implants performed similarly in terms of clinical and radiological outcomes. However, at the mesial aspect, bone level alterations in TL implants were smaller than in BLX implants, and complications were less frequent. Keratinized mucosa seems especially beneficial in BLX implants. As implant selection was based on clinical indication, the two groups differed in baseline characteristics, and this should be considered when interpreting the between-group comparisons.
PubMed2026
Influence of Metal Artifact Reduction Algorithms on the Detection of Inferior Alveolar Canal Perforations by Zirconia Implants in CBCT Images.
INTRODUCTION: This study aims to evaluate the efficacy of a metal artifact reduction (MAR) algorithm in detecting contact between zirconia implants and inferior alveolar canal. MATERIALS AND METHODS: Twelve zirconia implants were placed in dry human mandibles using surgical guides, in two conditions: 1 mm above and within the canal. cone beam computed tomography (CBCT) was acquired with the MAR algorithm turned off and on. Three observers indicated whether canal damage was present using a 5-point Likert scale: 1. Definitely no contact, 2. Probably no contact, 3. Uncertain, 4. Probably contact, and 5. Definitely contact. Sensitivity and specificity were calculated and the ROC curve was used to compare the two conditions (α = 0.05). RESULTS: The area under curve (AUC) was higher in MAR On condition for all observers; however, the differences in AUC between the On and Off MAR states were not statistically significant (p > 0.05): for observer 1, AUC increased from 0.9916 (Off) to 1.0 (On); for Observer 2, it increased from 0.7666 to 0.8833; and for Observer 3, it increased from 0.95 to 1.0. Observers 1 and 3 displayed 100% sensitivity and specificity regardless of MAR activation, while for Observer 2, diagnostic sensitivity increased from 66.7% to 83.3% with MAR activation, while specificity remained constant at 80% in both conditions. CONCLUSION: For the detection of contact of the zirconia implants with the IAC, activating the MAR algorithm slightly increased the diagnostic performance metrics of CBCT images, but the differences were not statistically significant. CLINICAL RELEVANCE: Activating the MAR algorithm did not produce a statistically significant improvement in detecting contact between zirconia implants and the inferior alveolar canal.
PubMed2026
Initial Cytotoxicity of Additively and Subtractively Manufactured Resin-Based Materials for Interim Fixed Dental Prostheses: An In Vitro Study.
OBJECTIVES: To compare the initial cytotoxic response of additively manufactured (AM) and subtractively manufactured (SM) resin-based materials for interim fixed dental prostheses (FDPs) under indirect and direct in vitro exposure conditions. MATERIAL AND METHODS: A total of 216 standardized resin discs were fabricated from AM resins (Group P, n = 108) and SM polymethyl methacrylate (PMMA)-based resins (Group M, n = 108). L929 mouse fibroblasts were used as the biological model, with a negative control group (Group C, n = 36). After 24 h of cell attachment, cell viability was assessed after 72 h under two conditions: indirect exposure to resin eluates and direct contact with resin discs. Viability was quantified by crystal violet staining. Data were analyzed using Kruskal-Wallis tests followed by Dunn's pairwise post hoc comparisons (α = 0.05). RESULTS: In the indirect assay, Group M showed 87% cell survival relative to the control, whereas Group P showed 65%; in the direct assay, values were 89% and 48%, respectively. Significant differences were observed among pooled groups in both assays (p < 0.001). Based on ISO 10993-5 thresholds, Group P was classified as slightly cytotoxic in the indirect assay and moderately cytotoxic in the direct assay, whereas Group M remained within the non-cytotoxic to slightly cytotoxic range. Group P showed significantly lower cell viability than Group M in both assays (adjusted p < 0.001), while no statistically significant differences were detected within each manufacturing category (adjusted p > 0.05). CONCLUSIONS: At 72 h, the tested AM resins showed significantly lower cell viability than the tested SM PMMA-based resins under the present in vitro conditions. CLINICAL SIGNIFICANCE: The lower cell viability observed for the tested 3D-printed interim materials under short-term in vitro conditions highlights the need for caution when extrapolating 72-h cell-viability findings to clinical performance and supports further standardized long-term in vitro and in vivo investigations.
PubMed2026
Long-Term Incidence of Peri-Implant Conditions: 25-Year Results of The Bernese Prospective Cohort Study.
OBJECTIVE: To assess 25-year implant survival, success rates, peri-implant conditions, and variables influencing peri-implant mucositis (PM), peri-implantitis (PI), and loss of osseointegration. METHODS: Partially edentulous patients rehabilitated with tissue-level implant-supported prostheses were evaluated. Calibrated examiners performed clinical and radiographic assessments, and potential variables for PM and PI were analyzed at the final follow-up. RESULTS: At the 10- and 25-year follow-ups, 303 and 159 patients with 511 and 252 implants, respectively, were included. Implant failure (IF) was 1.2% at 10 years and 6.0% at 25 years, with implant survival rates of 98.8% and 94.0%, respectively (p < 0.001). Implant success rates ranged from 97.0% at 10 years to 90.8% at 25 years (p < 0.001). IF due to loss of osseointegration increased from 0.6% to 3.6% at the implant level and from 1.0% to 2.5% at the patient level, and were located only in premolar or molar sites. At implant level, peri-implant health (PH) was 14.4% at 10 and 25 years (p = 1.00), while PM decreased from 82.1% to 76.5% (p = 0.08), and PI increased from 3.5% to 9.1% (p = 0.001). At patient level, PH remained stable between 10 and 25 years, ranging from 10.0% to 10.3% (p = 0.94), while PM decreased from 80.0% to 71.6% (p = 0.06), and PI increased from 10.0% to 18.1% (p = 0.01). In the multivariate analysis, history of periodontitis (OR = 3.87) and facial mucosal thickness (OR = 0.42) were associated with PM, whereas facial mucosal thickness was associated with PI (OR = 0.02). CONCLUSIONS: After 25 years, implant survival and success exceeded 90%. Loss of osseointegration accounted for approximately 60% of IF. While PI and IF increased over time, PM decreased but remained prevalent.
PubMed2026
Osteoimmunomodulatory Effects of Zirconia-Modified Titanium: Promoting Macrophage Activation and Osteoblast Mineralization at the Dental Implant Interface.
OBJECTIVE: Immune cells are the first to interact with implant surfaces, yet their contribution to osseointegration is often underestimated. Understanding how titanium-based and zirconia-enriched surface properties regulate macrophage polarization is essential for designing regenerative biomaterials. This study evaluates how these physicochemical characteristics modulate macrophage behavior and how macrophage-derived signals affect osteoblast mineralization, a key determinant of successful clinical outcomes. MATERIAL AND METHODS: Human monocytes were differentiated into pro-inflammatory (M1) or anti-inflammatory (M2) macrophages on hydrophobic and hydrophilic titanium (P, SLA/modSLA) or zirconia-enriched titanium (R/modR) surfaces. Macrophage polarization was assessed by Real Time-PCR, fluorescent immunoassays, and Luminex analysis of pro-/anti-inflammatory cytokines and bone-related markers. Conditioned media from M1/M2 macrophages cultured on each surface were used to culture human osteoblast-like cells, and their differentiation and mineralization were evaluated by gene expression analysis and Alizarin Red staining. RESULTS: The obtained results indicate that surface chemical composition, rather than hydrophilicity, is the main driver of early macrophage phenotype modulation. Zirconia incorporation induced effects comparable to titanium on macrophage activation while increasing transcription of pro- and anti-inflammatory genes. Moreover, zirconia enhanced M1 activation and the release of angiogenic and osteogenic mediators, including VEGF and OPN. Although seemingly contradictory, these effects contribute to an immune microenvironment favorable to bone formation by promoting a balanced macrophage response. Consistently, zirconia-enriched surfaces enhanced osteoblastic differentiation and mineralization, regardless of hydrophilic differences compared with conventional titanium surfaces. CONCLUSION: Our findings indicate that zirconia-supplemented titanium alloys may provide a useful model to elucidate the concept of osseointegration as an osteoimmune process rather than a conventional bone healing response. The data emphasize the critical role of early M1 macrophage activity controlling the release of specific cytokines, supporting the hypothesis that the use of titanium/zirconia alloys may provide an osteoiummunomodulatory advantage that may contrast peri-implant bone loss.
PubMed2026
Peri-Implant Tissue Stability Following Guided Bone Regeneration With Bioceramic: A Multicenter One-Year Cohort Study.
OBJECTIVES: This multicenter prospective cohort study follows a 1-year period after a previously published randomized controlled trial, comparing the radiographic and clinical outcomes of implants placed with simultaneous guided bone regeneration (GBR) using bioceramic (BC) versus xenograft (BO). MATERIALS AND METHODS: Patients from the previous trial were recalled 1 year after crown delivery. The follow-up data focused on the buccal bone stability evaluated by CBCT and implant survival rate, Probing Depth (PD), Bleeding on Probing (BOP), Plaque Index (PI), and patient satisfaction through Oral Health Impact Profile-5 (OHIP-5). RESULTS: Out of 150 enrolled patients in a previous trial, a total of 97 patients completed the 1-year follow-up: 44 in the BC group and 53 in the BO group. The implant survival rate was 100% in both groups. Change in horizontal buccal bone thickness (△HBBT) at 1 year post-crown delivery versus immediately post-surgery was -0.28 ± 0.10 mm for the BC group and -0.91 ± 0.09 mm (mean ± standard error) for the BO group, with the BC group exhibiting less bone resorption along the implant than the BO group (p = 0.0000). No significant differences were observed in PI, BOP, or PD. Patient satisfaction remained high in both groups. CONCLUSIONS: GBR with bioceramic demonstrated stable radiographical bone on the buccal side of the implant 1 year after crown delivery.
PubMed2026
Self-Reported Penicillin Allergy, Alternative Antibiotics, and Implant Outcomes: A Retrospective Study.
INTRODUCTION: The effects of self-reported penicillin allergy and alternative antibiotic regimens on implant outcomes remain poorly investigated. Therefore, the aim of this study was to evaluate the association between self-reported penicillin allergy and the use of alternative antibiotics with post-implant placement surgical complications, early implant failure, and preloading crestal bone loss (PLCBL). METHODS: This retrospective cohort study examined dental records of patients who received at least one dental implant. Patients who reported a penicillin allergy were identified as the exposed group, whereas patients without a reported penicillin allergy were selected as unexposed in a 1:2 exposed-to-unexposed ratio. Relevant patient- and implant-related factors were recorded. Implants were evaluated for postsurgical complications, PLCBL, and early failure. Data were analyzed using bivariate analyzes and mixed-effects regression models. RESULTS: A total of 179 subjects and 374 implants were evaluated. Early implant failure and surgical complications occurred in 6.1% and 8.0% of implants, respectively, while PLCBL was observed in 32.5% of implants. A higher prevalence of surgical complications and implant failure was observed among patients who reported a penicillin allergy compared with those without a reported allergy (p < 0.05). Implants prescribed azithromycin showed a higher prevalence of surgical complications, and those prescribed azithromycin or clindamycin had higher early failure rates compared with penicillin (p < 0.05). Regression analyzes showed that self-reported penicillin allergy was not independently associated with surgical complications, PLCBL, or early implant failure (p > 0.05). In exploratory multivariable analyzes, azithromycin and other alternative antibiotics were associated with higher odds of surgical complications compared with penicillin (p < 0.05). No significant associations were found between antibiotic type and PLCBL or early implant failure (p > 0.05). CONCLUSION: Self-reported penicillin allergy was not independently associated with early implant outcomes in this cohort. Certain alternative antibiotics were associated with a higher prevalence of early surgical complications, warranting further investigation in larger studies.
PubMed2026
Transcrestal Sinus Floor Elevation Using Dental Implant Robot and Osseodensification Drills: A Preliminary Case Series.
OBJECTIVE: This study aims to evaluate the application of an autonomous dental implant robot combined with osseodensification drills for transcrestal maxillary sinus floor elevation (ADIR-OD-TSFE) and simultaneous implant placement. The following parameters, such as maxillary sinus elevation volume (MSV), maxillary sinus elevation area (MSA), membrane elevation height (MEH), implant protrusion length (IPL), implant placement accuracy, intraoperative Schneiderian membrane perforation rate, and operative time, were evaluated. In addition, the force feedback characteristics associated with different maxillary sinus floor morphologies were preliminarily investigated. MATERIALS AND METHODS: This study enrolled patients treated at the Stomatological Hospital of Chongqing Medical University between January and November 2024, with a residual bone height (RBH) of 4.00-8.00 mm, who underwent simultaneous implant placement using ADIR-OD-TSFE. Postoperative CBCT scans were imported into the design software to evaluate implant placement accuracy. The software's AI segmentation function was used to calculate the sinus floor augmentation outcome immediately after surgery (P1) and at 6 months postoperatively (P2). Force feedback characteristics were analyzed for two sinus floor morphologies (flat and sloped). The total operative time for osteotomy, sinus floor elevation, and implant placement performed with robotic assistance was recorded; the surgeon's learning curve was plotted, and the intraoperative complications were documented. RESULTS: A total of 18 implants were placed, with 9 in flat sinus floors and 9 in sloped sinus floors. The mean preoperative RBH was 5.92 ± 1.01 mm. Schneiderian membrane perforation occurred in 1 case (5.6%). The mean surgery time was 25.5 ± 9.8 min, and the surgeon's learning curve plateaued as case numbers increased. The coronal global deviation (CG), apical global deviation (AG), and angular deviation (AD) were 0.69 ± 0.36, 0.76 ± 0.41, and 1.64° ± 0.91°, respectively. The maxillary sinus floor elevation volume was 351.54 ± 151.74 mm3 immediately after surgery (P1) and 253.68 ± 160.60 mm3 at 6 months postoperatively (P2). Force feedback analysis showed that the breakthrough force was higher in flat sinus floors (Ff0) than in sloped sinus floors (Fs0), with a mean difference of 6.86 N, a 95% CI of 0.82 to 12.90 N, and a large effect size (Hedges' g = 1.08). CONCLUSION: The ADIR-OD-TSFE technique is effective for sinus floor elevation and implant placement, with the learning curve improving as the surgeon's experience increases. It demonstrates high implant placement accuracy and maintains relatively stable bone augmentation outcomes at 6 months postoperatively. Flat sinus floors require significantly higher breakthrough forces compared to sloped sinus floors. Overall, the ADIR-OD-TSFE system proves to be a safe and clinically reliable approach.
PubMed2026
Understanding Oral Hygiene and Periodontal Health in Space Using a Bedrest Analog Model for Weightlessness (NASA Sensorimotor Countermeasures Study).
AIMS: To investigate longitudinal alterations in oral hygiene, gingival inflammation, and salivary secretion during a 60-day head-down tilt bed rest (HDTBR) protocol as a validated ground-based analog of microgravity. MATERIALS AND METHODS: Twenty-four healthy volunteers participated in a 60-day, 6° HDTBR study conducted under strictly controlled conditions. Oral health assessment safety measures were performed at baseline, mid-head-down tilt (HDT), end-HDT, and post-recovery. RESULTS: Plaque accumulation and gingival inflammation increased, with increases from baseline to end-HDT in the Quigley-Hein Plaque Index (1.8 ± 0.4 to 2.3 ± 0.4; p < 0.01), Gingival Index (0.8 ± 0.4 to 1.2 ± 0.2; p < 0.001), and bleeding on probing (BoP) (18.4 ± 11.6% to 35.1 ± 16.6%; p < 0.001). BoP partially recovered post-HDT, while QHI and GI remained elevated compared with baseline. Periodontal Screening Index scores shifted toward higher grades during HDT without evidence of destructive periodontal breakdown. The unstimulated salivary flow rate remained unchanged throughout. CONCLUSIONS: Prolonged gravitational unloading induces a plaque-driven deterioration of gingival health in systemically healthy individuals, likely related to impaired mechanical plaque control and microcirculatory changes rather than salivary dysfunction. Gingival tissues appear to be sensitive biomarkers of adaptation to unloading conditions, supporting the need for optimized oral hygiene and adjunctive preventive strategies during future long-duration space missions. TRIAL REGISTRATION: German Clinical Trial Registry (DRKS00033882, registration date 03-15-2024, https://www.drks.de/search/de/trial/DRKS00033882/details).
PubMed2026
Understanding the Workflows in Dynamic and Robotic Computer-Assisted Implant Surgery.
Computer-assisted implant surgery (CAIS) represents a comprehensive digital workflow integrating prosthetically driven planning with various execution modalities. Among these, dynamic (d-CAIS) and robotic (r-CAIS) systems constitute two distinct yet interrelated approaches, sharing core technological principles as well as operative differences. This white paper aims to provide a structured overview of the fundamental concepts and workflows underpinning d- and r-CAIS, focusing on their shared components, procedural steps, and system-specific characteristics. Both approaches rely on accurate digital treatment planning, spatial positioning systems, registration protocols, and real-time feedback mechanisms to guide implant placement. However, while d-CAIS enables operator-controlled freehand execution under real-time navigation, r-CAIS introduces robotic assistance or task autonomy, integrating mechanical actuation into the surgical workflow. Rather than providing exhaustive technical instructions, this work aims to establish a conceptual framework to support clinicians in understanding and evaluating emerging CAIS technologies and their role in contemporary implant dentistry. Furthermore, it discusses current advantages, limitations, and challenges related to clinical implementation, cost, and training requirements.
PubMed2026
A novel composite hyaluronic acid/chitosan/polyvinyl alcohol ternary hydrogel scaffold for periodontal regeneration: an experimental study.
BACKGROUND: Furcation defects are considered among the most challenging periodontal lesions to regenerate given the complexity of the periodontal apparatus, inaccessibility and the limited blood supply to the area. The aim of the current study was to create and characterize a novel ternary hydrogel composed of hyaluronic acid (HA), chitosan (CS) and polyvinyl alcohol (PVA) and to evaluate its potentials in periodontal regeneration of furcation defects in dogs. MATERIALS AND METHODS: A composite hydrogel scaffold composed of hyaluronic acid, chitosan and polyvinyl alcohol was successfully prepared and characterized in terms of SEM, swelling and mechanical behaviors, FTIR analysis as well as biocompatibility assay and direct cell-scaffold interactions. In an in vivo study, thirty-two critical size class II furcation defects were created in eight mongrel dogs and randomly allocated to group I, hydrogel group and group II, negative control group. Histological analysis and histomorphometric evaluation of percentage of newly formed bone area were used to evaluate the regenerative potential of the novel hydrogel after one and three months, postoperatively. RESULTS: The prepared hydrogel was cytocompatible, had proper degradation rate, water uptake and mechanical strength as well as ease of handling clinically. Histologic results of the hydrogel group revealed superior bone, periodontal ligament and cementum formation compared to the negative control group at both time points. The hydrogel group showed a statistically significant increase in the percentage of newly formed bone surface area compared to the negative control group. CONCLUSIONS: The novel ternary hydrogel prepared using hyaluronic acid, chitosan and polyvinyl alcohol showed adequate cytocompatibility and mechanical properties. The in vivo results support that the novel scaffold might be effective for periodontal regeneration in furcation defects in dogs.
PubMed2026
An innovative device for scooting impacted third molars away from the inferior alveolar nerve.
OBJECTIVE: Impacted mandibular third molars pose significant clinical challenges, often leading to complications such as pericoronitis, adjacent tooth caries, and inferior alveolar nerve (IAN) injury during extraction. This study evaluates the effectiveness of the Kyola Distraction System, an innovative approach designed to gradually move impacted third molars away from the IAN, reducing surgical risks. METHODS: A retrospective analysis of 100 cases was conducted at Changhua Christian Hospital. Patients underwent Kyola Distraction, which combines coronectomy with orthodontic traction using an elastic-based anchorage system. The movement of the third molar relative to the inferior alveolar canal was assessed through panoramic radiographs. The study analyzed the distraction period, scooting distance, and potential nerve complications. RESULTS: Among 100 patients (57 male, 43 female, aged 18-60 years), 32 cases involved single-root third molars, and 68 cases had double-rooted teeth. The average distraction period was 61.3 days for single-root cases and 61.1 days for double-root cases. The estimated scooting distance was 1.38 mm for the mesial root and 1.59 mm for the distal root in double-root cases, while single-root molars moved an average of 1.42 mm. No cases of nerve damage were reported. CONCLUSION: The Kyola Distraction System presents a safe and effective alternative to conventional odontectomy for impacted mandibular third molars. By reducing the risk of IAN injury, minimizing postoperative complications, and promoting bone regeneration, this approach offers a promising advancement in third molar management. Further studies are recommended to evaluate its long-term clinical outcomes.
PubMed2026
Clinical and radiographic evaluation of local application of insulin versus hyaluronic acid using resorbable collagen sponge in management of periodontal intra-bony defects: a pilot randomized controlled clinical trial.
OBJECTIVES: We aimed to evaluate the clinical and radiographic effectiveness of locally applied insulin versus hyaluronic acid (HA), each combined with absorbable collagen sponge (ACS), using the single flap approach (SFA) in the management of periodontal intra-bony defects. MATERIALS AND METHODS: 21 periodontitis patients with intra-bony defects were randomly assigned to 3 groups: group I (SFA + insulin + ACS; n = 7), group II (SFA + HA + ACS; n = 7), and group III (SFA + ACS; n = 7). Primary outcome was clinical attachment level (CAL), assessed at baseline and 6 months postoperatively; secondary outcomes included probing pocket depth (PPD), measured at baseline and 6 months; postoperative pain, using visual analogue scale (VAS) at 24 and 48 h; and radiographic parameters, including radiographic linear defect depth (RLDD) and bone density, assessed at baseline and 6 months. RESULTS: PPD and CAL improved significantly over time in all groups (P < 0.001), with no intergroup differences. VAS scores were significantly lower in the insulin and HA groups than in controls at 24 h (P = 0.004) and 48 h (P = 0.007), with the lowest scores in the insulin group (P = 0.008). RLDD decreased significantly in all groups (P < 0.001), with a greater reduction in HA + ACS compared to insulin and controls at 6 months (P = 0.027). Bone density increased significantly over time in insulin + ACS (P < 0.001) and HA + ACS (P = 0.022), with no change in the ACS group (P = 0.860), with non-significant intergroup differences. CONCLUSION: In the management of periodontal intrabony defects, SFA with both insulin and HA soaked in collagen sponge showed favorable clinical and radiographic improvements. CLINICAL RELEVANCE: Local insulin may represent a promising, simple, and cost-effective biomaterial in periodontal treatment; however, more studies are needed. CLINICAL TRIAL REGISTRATION: NCT05746676.
PubMed2026
Comparison between flowable and flowable bulk-fill composites in the manufacture of attachments for orthodontic aligners: a split-mouth randomized clinical trial.
INTRODUCTION: Orthodontic aligner attachments are crucial for enhancing dental movements that aligners alone cannot achieve. With recent advancements in design and materials, treatment precision and efficacy are improving. This study aimed to compare conventional and bulk-fill flowable composites in fabricating orthodontic attachments to determine their loss rate and clinical outcomes. METHODS: This split-mouth randomized clinical trial enrolled 50 participants (21 men and 29 women; mean age 37.86 ± 6.90 years), who were allocated to two treatment sequences (25 participants per group). In Group 1, the right side received 3 M Filtek Supreme Flowable and the left side received 3 M Filtek Bulk Fill Flowable; in Group 2, the allocation was reversed. This design allowed an intra-individual comparison between materials. RESULTS: After 140 days of follow-up, 150 of 800 attachments had been lost and rebonded, corresponding to an overall failure rate of 18.75%. No statistically significant differences were found between materials when evaluating individual teeth, contralateral teeth, or time to failure. Cox regression showed no significant difference between groups (HR = 0.84; 95% CI, 0.60-1.16; p = 0.293). CONCLUSION: Flowable and flowable bulk-fill composites showed similar clinical performance and attachment survival. REGISTRATION: This clinical trial was registered under UTN U1111-1303-5576 at the Brazilian Registry of Clinical Trials (ReBEC).
PubMed2026
Gingival crevicular fluid asprosin, adropin, and irisin hormone levels in the different periodontal status.
OBJECTIVES: This study aimed to evaluate asprosin, adropin, and irisin levels in gingival crevicular fluid (GCF) across different periodontal conditions and to analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A total of 122 systemically healthy participants (25-60 years) were divided into four groups: healthy periodontium (n = 30), gingivitis (n = 30), Stage I-II periodontitis (n = 32), and Stage III-IV periodontitis (n = 30). Clinical parameters recorded included probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI). GCF samples were collected, and asprosin, adropin, and irisin levels were measured by ELISA. Statistical analyses included ANOVA/Kruskal-Wallis with post hoc tests, Pearson correlations, and receiver operating characteristic (ROC) analysis. RESULTS: Asprosin levels were significantly higher in Stage III-IV periodontitis compared with other groups (p < 0.05). Adropin and irisin levels were higher in the healthy group, although not statistically significant. Asprosin correlated positively with PI, PD, CAL, and BOP, while irisin correlated negatively with PI. ROC analysis indicated that asprosin had diagnostic potential for distinguishing between advanced periodontitis and other conditions. CONCLUSIONS: Elevated GCF asprosin levels were found to be associated with periodontitis severity, whereas adropin and irisin were related to periodontal health. More research is needed to understand the role of irisin, asprosin, and adropin in periodontal pathogenesis. CLINICAL RELEVANCE: This study provides novel insights into the potential role of asprosin, adropin, and irisin as biomarkers of periodontal status. Elevated GCF asprosin levels were associated with advanced periodontitis, reflecting the inflammatory burden of the disease. Conversely, higher levels of adropin and irisin were associated with better periodontal health, suggesting protective or homeostatic functions. These findings indicate that GCF asprosin, adropin, and irisin levels may serve as promising adjunctive diagnostic indicators for distinguishing between periodontal health and disease. Future longitudinal studies are needed to validate their prognostic value and to clarify their mechanistic involvement in periodontal pathogenesis.
PubMed2026
Inferior alveolar nerve dissection/repositioning during SSRO in hemimandibular hyperplasia: cases report and literature review.
PURPOSE: Inferior alveolar nerve (IAN) dissection and repositioning is critical for preventing iatrogenic IAN injury during combined mandibular border resection and sagittal split ramus osteotomy (SSRO) in patients with severe hemimandibular hyperplasia (HH). Traditional IAN repositioning includes two-stage and concurrent one-stage procedures. This study introduces a modified one-stage technique and compares the respective advantages and disadvantages of these three surgical protocols. METHODS: Four patients with HH were enrolled and treated with three different surgical protocols: one two-stage procedure, one conventional one-stage procedure, and two modified one-stage procedures. The modified technique features a vertical osteotomy placed 5 mm anterior to the mental foramen to protect the anterior loop of the IAN. RESULTS: All patients achieved satisfactory facial symmetry and aesthetic improvement postoperatively. Neurosensory assessment at 6-month follow-up confirmed complete recovery of lower lip sensation without persistent numbness. Compared with the two-stage and conventional one-stage approaches, the modified technique effectively preserved the IAN anterior loop, simplified surgical procedures, and minimized bony defects by maintaining buccal cortical bone integrity. CONCLUSION: The modified one-stage approach is a simplified and effective technique that provides reliable neuroprotection for the anterior loop of the IAN while minimizing bony defects during SSRO in HH patients. Given the limited sample size of this case series, further large-sample and long-term studies are required to fully validate tits efficacy, long-term stability, and complication profile.
PubMed2026
Maxillary anterior retraction with clear aligner: a retrospective comparative cohort study of efficiency between periodontally healthy and stable periodontitis patients.
OBJECTIVE: This retrospective comparative cohort study aimed to evaluate the efficiency of maxillary anterior tooth retraction using clear aligners in patients with stable periodontitis compared to periodontally healthy individuals, addressing clinical concerns regarding the efficacy of aligner therapy in this population. METHODS: This retrospective study included 33 patients with stable periodontitis (SP) and 33 periodontally healthy (PH) individuals who underwent clear aligner treatment. Pre-treatment virtual setups and post-treatment actual models were superimposed in three dimensions using Geomagic Wrap 2021 software. Anterior tooth retraction efficiency was calculated as (actual tooth movement / predicted tooth movement) × 100%. Univariate analyses were performed, followed by multivariable analyses using Generalized Estimating Equations (GEE) to identify predictors influencing efficiency. RESULTS: No significant difference was detected in maxillary anterior retraction efficiency between the two groups (SP: 56.6%, PH: 52.0%, P = 0.245). However, the factors influencing efficiency differed significantly. In the SP group, efficiency was significantly correlated with treatment design parameters, including the number of aligner steps, amount of predicted tooth movement and auxiliary traction. In contrast, efficiency in the PH group was mainly associated with patient-related physiological factors, such as age and tooth type. CONCLUSION: Within the limitations of this retrospective study (crown-level measurement), anterior tooth retraction efficiency with clear aligners did not differ significantly between patients with stable periodontitis and periodontally healthy individuals under strict periodontal maintenance. Clinical planning should be individualized: precise biomechanical design is essential for patients with stable periodontitis, whereas physiological factors warrant greater consideration in periodontally healthy patients. These findings support the feasibility of clear aligner therapy in well-maintained periodontitis patients and highlight the need for differentiated treatment planning.
PubMed2026
Photobiomodulation for primary wound healing and patient-reported outcomes after esthetic crown lengthening surgery: A pilot randomized clinical trial.
To evaluate the efficacy of photobiomodulation (PBM) on primary wound healing and patient-centered outcomes following esthetic clinical crown lengthening with osteotomy over a three-month follow-up period. Twenty-seven systemically healthy patients presenting < 10% bleeding on probing and altered passive eruption were enrolled in a split-mouth, triple-blind, randomized controlled clinical trial. Each patient underwent esthetic crown lengthening surgery in two hemi-arches: a control group (CG), treated with surgery alone, and a test group (TG), treated with surgery followed by PBM (660 nm, 100 mW, 30 J, 5 min, sweeping motion). Laser irradiation was performed immediately after surgery and on postoperative days 4, 7, 11, and 14. Clinical assessments were conducted at baseline and at 4, 7, 11, 14, 45 days, and three months postoperatively. Outcomes included bleeding on probing, probing depth, gingival phenotype, width of keratinized mucosa, wound healing assessed by the modified Landry Healing Index, postoperative pain measured by a numerical visual scale, oral health-related quality of life (OHIP-14), patient satisfaction, and esthetic outcomes assessed by the Pink Esthetic Score. Statistical analyses were performed with a significance level set at p < 0.05. All patients completed the study and remained periodontally healthy throughout the follow-up period. No statistically significant intergroup differences were observed for wound healing, postoperative pain, or professional esthetic outcomes at any evaluation time point (p > 0.05). However, esthetic crown lengthening surgery resulted in significant improvements in patient satisfaction and oral health-related quality of life from baseline to three months of follow-up (p < 0.001). Photobiomodulation did not enhance primary wound healing or reduce postoperative pain following esthetic clinical crown lengthening with osteotomy. Nevertheless, the surgical procedure significantly improved patient satisfaction and quality of life over a three-month follow-up period.
PubMed2026
Subgingival air polishing (glycine powder) versus minocycline hydrochloride: efficacy in residual periodontal pockets following endoscope-assisted scaling and root planing.
AIMS: To evaluate the effects of subgingival air polishing (glycine powder) or minocycline hydrochloride on periodontal parameters and inflammatory levels in residual periodontal pockets following periodontal endoscope-assisted scaling and root planing. METHODS: This single-center, randomized controlled trial (RCT) enrolled 80 patients with periodontitis(Stage II-IV, Grade A-C), who were randomly assigned at the patient level to four groups: scaling and root planing alone (SRP group), endoscope-assisted SRP (E-SRP group), endoscope-assisted SRP plus minocycline hydrochloride (E-SRP + M group), or endoscope-assisted SRP plus subgingival air polishing (E-SRP + AP group). The primary outcome was mean reduction in probing depth (PD) at 6 months post-intervention in residual pockets (PD ≥ 4 mm at baseline). Periodontal parameters, including probing depth (PD), bleeding index (BI), and clinical attachment loss (CAL), were assessed at 6 weeks, 3 months, and 6 months post-intervention. Inflammatory factors [levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP)] and Porphyromonas gingivalis (P. gingivalis) abundance were quantified at 1, 2, 3, 4, 6 weeks, 3 months, and 6 months post-intervention. Linear mixed-effects models (LMM) with Bonferroni correction for multiple comparisons were used for longitudinal continuous outcomes, and exact P-values, effect sizes (Cohen's d), and 95% confidence intervals (95% CI) were reported. RESULT: Levels of P. gingivalis, IL-6, TNF-α, and CRP in deep periodontal pockets showed a slight increase following endoscope-assisted SRP. However, these levels, as well as the bacterial load, remained significantly lower than those in the SRP-alone group. Additionally, periodontal indices demonstrated greater improvement in the endoscope-assisted group compared to the SRP-alone group at the 6-week follow-up. Comparison between the combination therapy groups (endoscope-assisted SRP plus either minocycline hydrochloride or subgingival air polishing) and the endoscope-assisted SRP-alone group revealed that the combination therapies were superior in reducing both bacterial load and inflammatory factor levels within the first 4 weeks. This superior efficacy extended to periodontal indices after 6 weeks. No significant difference was observed between the two combination therapy groups at any time point. A ≥1 mm reduction in PD was defined as a clinically significant improvement (per 2022 EFP guidelines), with 89.2% of sites in combination therapy groups achieving this at 6 months, vs. 71.7% in the E-SRP group and 55.2% in the SRP group. CONCLUSIONS: Combining E-SRP with glycine air polishing or local minocycline improved periodontal conditions, suppressed early biofilm and inflammation, and promoted healing of deep residual pockets. Both treatments produced equivalent outcomes at all follow-up time points, with stage-specific therapeutic effects observed among patients at different periodontal stages. The 4-week early adjunct approach is practicable in clinical settings and aligns with 2022 EFP guidelines. Based on the present results, glycine air polishing is a reasonable option for Stage II patients, while local minocycline may be better suited for advanced periodontitis. This study provides preliminary data to support early adjunct therapy following E-SRP. The choice of adjunctive therapy should be tailored to individual patient characteristics (e.g., antibiotic sensitivity, periodontitis stage/grade).
PubMed2026
Influence of Scan Body Geometry, Implant Angulation, and Interimplant Distance on the Accuracy of Maxillary Full-Arch Digital Implant Scans: An In Vitro Study.
BACKGROUND This study compared the accuracy of different scan body geometries under different implant angulation and interimplant distance conditions. Evidence regarding full-arch digital implant scanning under these conditions remains limited. MATERIAL AND METHODS In this in vitro study, 5 implants were placed in maxillary edentulous plaster models representing 3 implant systems (Bioinfinity, Meisinger, and Mode). The reference implant was positioned perpendicular to the ridge crest at the midline. Implant angulations (5° and 10°) and interimplant distances (5 mm and 10 mm) were standardized. Scan bodies were attached to the master model, and each model was scanned 10 times using an intraoral scanner (TRIOS 5). Three-dimensional deviations were calculated. Data were analyzed using 1-way ANOVA and Tukey HSD tests (alpha=0.05). RESULTS No significant differences were observed among the groups at 5° angulation (P>0.05), whereas significant differences were detected at 10° angulation for implants 1 and 5 (P<0.01). Bioinfinity showed higher deviation values at implant 1, while Meisinger demonstrated higher deviations at implant 5. At a 10-mm interimplant distance (implants 1 and 2), significant differences were found among the groups (P<0.001), with Bioinfinity exhibiting lower deviation values. At a 5-mm distance, no significant difference was observed at implant 4 (P>0.05), whereas a significant difference was found at implant 5 (P<0.001), with the highest deviation in the Meisinger group. CONCLUSIONS Increased implant angulation and interimplant distance are associated with reduced accuracy and higher deviation values in digital full-arch scans. The influence of scan body geometry varies depending on implant position.
PubMed2026
A conceptual regeneration-maintenance decision aid for class II furcation involvement.
OBJECTIVE: To introduce a practical, evidence-based and prognosis-oriented conceptual decision aid for the management of Class II furcation involvement, integrating defect-specific regenerative potential with long-term maintenance feasibility. MATERIALS AND METHODS: A structured narrative review of the literature on Class II furcation involvement regeneration, prognostic factors, and long-term maintenance outcomes was conducted using PubMed, EBSCO, and Scopus databases. Variables with documented influence on regenerative outcomes or long-term tooth survival were extracted and grouped into two conceptual axes: a Morphological Regenerability Score, capturing defect anatomy, and a Maintenance Accessibility Score, capturing site-related and patient-related factors. Scoring ranges and thresholds were derived from the magnitude and consistency of reported effect sizes. RESULTS: The Morphological Regenerability Score integrates five defect-related variables (vertical furcation involvement component, root divergence at crestal bone, furcation entrance width, defect location and root trunk length) with modifiers for mobility, cervical enamel projections, exposed furcation entrance, and enamel pearls, spanning - 5 to 9 points. The Maintenance Accessibility Score integrates seven maintenance-related variables (plaque control, supportive periodontal treatment compliance, smoking, diabetes control, site/operator accessibility, endodontic status and tissue phenotype), spanning 0 to 13 points. Midpoint thresholds (MRS ≥ 5; MAS ≥ 7) define four clinical quadrants guiding case selection between regeneration, staged treatment strategy, non-surgical or resective approaches, and extraction. CONCLUSIONS: The proposed framework consolidates heterogeneous evidence on Class II furcation involvement prognosis and proposed treatment strategies into a single transparent decision aid. Prospective validation is required before routine clinical adoption. CLINICAL RELEVANCE: This framework supports evidence-based, individualised decision-making for Class II furcation involvement based on defect regenerability and long-term maintenance, and highlights modifiable risk factors that should be addressed before attempting regenerative surgery.
PubMed2026
Damage of irradiated teeth by ultrasonic scaling: an in vitro study.
PURPOSE: To test whether ultrasonic (US) scaling-induced hard-tissue surface loss on irradiated teeth depends on irradiation dose, type of scaler tip, angulation and orientation and tooth region. METHODS: In vitro study on 24 human molars irradiated with 0, 30, or 70 Gy. US scaling was robot-standardized (force 1 N, tips G6 and P20, angulation 15° and 45°, orientation back and lateral) with medium power and water spray. Surface loss was graded on intraoral scans by three blinded observers on a six-band ordinal 0-5 scale (increasing with loss depth) and analyzed with cumulative-logit ordinal mixed models for median and maximum depth. RESULTS: 30 Gy significantly increased the odds of deeper surface loss with the back orientation (median: β = 2.43, p = 0.039; max: β = 2.10, p = 0.022); no 70 Gy contrast reached significance, indicating a dose-threshold effect. The G6 tip increased the odds of deeper damage substantially more than P20 across both depth outcomes (all p < 0.001), and 45° angulation together with the back orientation further amplified peak damage. The root was more susceptible than the crown (β ≈ 2.95, p < 0.001). CONCLUSIONS: US instrumentation of irradiated teeth produced dose- and technique-dependent hard-tissue surface loss. Slim periodontal tips (P20) used at shallow angulation (15°) with a lateral orientation were associated with minimal surface loss across all doses and positions, whereas wider tip (G6) at 45° with the back orientation produced consistent measurable wear, amplified on the root and by prior irradiation.
PubMed2026
Influence of calcium hydroxide/nano-chitosan as intracanal medication on push-out bond strength of epoxy resin and bioceramic sealers: an ex-vivo study.
BACKGROUND: The present study aimed to evaluate the impact of intracanal medicaments-calcium hydroxide (CH) and calcium hydroxide/nano-chitosan (CH/NC)-on the push-out bond strength (POBS) of AH Plus (AHP) and NeoSEALER Flo (NSF). METHODS: Nano-chitosan (NC) characterization was done using transmission electron microscopy (TEM), dynamic light scattering (DLS) and zeta potential analysis. Sixty extracted maxillary central incisors were instrumented up to X5 (50/0.06). Based on intracanal medicament used, specimens were allocated into three groups (n = 20): Group I; no intracanal medicament (control), Group II; (CH), and Group III; (CH/NC). Intracanal medicaments were removed after one week of incubation. Each group was subdivided based on sealer used (n = 10): subgroup A (AHP) and subgroup B (NSF). Obturation was performed with cold lateral compaction. After one week of incubation, roots were sectioned and a universal testing machine was used to evaluate POBS. Three-way ANOVA and Chi-square tests were conducted at 0.05 significance level. RESULTS: TEM showed mostly spherical NC particles with diameters less than 50 nm. DLS analysis revealed a hydrodynamic Z-average diameter of 62.4 nm with a polydispersity index of 0.195. Zeta potential analysis demonstrated a positive surface charge of + 47.57 mV. The "medication" factor, "medication/sealer", "medication/root level" and "sealer/root level" interactions significantly affected POBS (P < 0.05). Neither "sealer" nor "root level" factors significantly affected POBS (P > 0.05). Pooled POBS data revealed that: IA and IB subgroups were significantly higher than IIA, IIB, IIIA and IIIB subgroups (P < 0.05). Regarding failure mode, tested subgroups showed no significant difference (P > 0.05). CONCLUSIONS: Under the conditions of this study, prior application of CH or CH/NC reduced POBS for both sealers compared with controls. The addition of NC to CH did not provide a statistically significant improvement in POBS compared to CH alone. Overall, AHP and NSF demonstrated comparable POBS to root canal dentin.
PubMed2026
Is inpatient monitoring necessary in pediatric patients with comorbidities following routine dental procedures? A retrospective analysis.
PURPOSE: Children and young adults with severe pre-existing conditions frequently require dental treatment under general anesthesia (GA) and are commonly scheduled for postoperative inpatient surveillance due to presumed elevated anesthetic or surgical risks. Although this approach prioritizes safety, it may contribute to prolonged or unnecessary hospitalization, increased healthcare costs, and potential psychological burden, particularly in patients with neurodevelopmental or congenital disorders. In light of the reportedly low incidence of severe complications following dental treatment under GA, this study aims to evaluate the necessity of routine inpatient admission in pediatric patients (< 18 years of age) with comorbidities and to assess the frequency and severity of perioperative complications. METHODS: All pediatric patients with pre-existing conditions who underwent planned inpatient surgical dental treatment under GA at the Department of Oral and Maxillofacial Surgery at Hannover Medical School between 2014 and 2025 were included. The indications for inpatient treatment, anesthesiological parameters such as the American Society of Anesthesiologists (ASA) classification, and severe perioperative complications (corresponding to grade ≥ 2 of the Clavien-Dindo classification) were analyzed. It was assessed whether the ASA classification or the type of pre-existing condition significantly influenced the occurrence of perioperative complications. RESULTS: A total of 199 patients were analyzed. Patients who underwent surgery were mainly categorized as ASA II (n = 80, 40.2%) and III (n = 102, 51.3%), and mostly presented with cardiovascular (n = 68, 34.2%) or hematological/oncological preconditions (n = 47, 23.6%). Perioperative complications occurred in 8 cases (4.2%); of those, 6 were intraoperative (3.1%), and 2 were postoperative (1.0%). The probability of perioperative complications did not correlate with ASA classification or pre-existing conditions (p [Fisher] = 0.166, and p [Fisher] = 0.571, respectively). Age significantly influenced the probability of complications (U = 451.00, p = 0.050), indicating that older patients were more likely to experience complications than younger patients. CONCLUSION: As postoperative complications occur very rarely, even in patients with pre-existing conditions, inpatient surveillance should warrant thoughtful consideration to liberate hospital capacities. Interdisciplinary pre-, intra-, and postoperative assessment of the need for inpatient surveillance should ensure patient safety and provide further insights into risk factors for peri- and especially postoperative complications. The authors recommend validating risk scores and algorithms for decision-making regarding inpatient surveillance.
PubMed2026
Comparative evaluation of root canal obturation techniques and sealers in Diabetic Dentin: An in-vitro push-out bond strength test.
This study evaluated the comparative performance of different root canal obturation approaches using different sealing materials on the push-out bond strength of dentin samples obtained from patients with diabetes mellitus (DM). Forty single-rooted mandibular premolars were instrumented using the Reciproc R40 system and randomly assigned to four groups (n = 10 teeth each): (1) cold lateral compaction with AH Plus, (2) warm vertical compaction with AH Plus, (3) hydraulic single-cone obturation with gutta-percha and Bioserra sealer, and (4) sealer-only technique using the Bioserra bioceramic sealer. After storage at 37°C and 100% humidity for one week, 1-mm slices were prepared from the coronal, middle, and apical thirds and subjected to push-out testing. Data were analyzed using ANOVA and Tukey's test (p < 0.05). Significant differences in push-out bond strength were observed among the obturation approaches using different sealer materials (p < 0.05). Bioceramic sealers exhibited higher bond strengths than epoxy resin-based sealers, particularly in the middle and apical thirds. Hydraulic single-cone and bioceramic sealer-only approaches outperformed conventional techniques (p < 0.001), whereas no significant difference was observed between cold lateral and warm vertical compaction techniques. Obturation approaches employing bioceramic sealers demonstrated superior bonding in diabetic dentin, suggesting potential advantages over conventional methods in the context of diabetic dentin.