Medicine and Pharmacology

Abstract: Treatment with short implants is considered as predictable as conventional implants. Objective: This in silico experimental study aimed to determine the stress distribution in short zirconia dental implants using finite element analysis (FEA). Methods: Thirty-six implant-crown designs were modeled in ANSYS 2019 R2. Loading conditions included an oblique force of 150 N (30°, ISO 14801:2016), vertical forces of 300 N and 400 N, and a 32 Ncm screw tightening torque across Type I and Type III bone models using three implant diameters (4.1, 4.8, and 5.0 mm). Results: Under both oblique and vertical loads, zirconia generated lower bone deformation but higher overall stress concentrations than titanium. When stratified by bone density, zirconia concentrated higher peri-implant stress in low-density (Type III) bone. Discussion: In both loading scenarios, a progressive increase in implant diameter successfully and proportionally mitigated stress concentrations, which aligns with established biomechanical literature on titanium systems while matching findings from recent comparative studies showing elevated stress levels in zirconia structures. Conclusion: Stress concentrations are higher in zirconia than titanium, particularly in low-density bone; however, this biomechanical limitation can be effectively compensated for by increasing the implant diameter.

Abstract: Background/Objectives: Gingival enlargement is a very common problem, especially after orthodontic treatment. The aim of this study was to assess the healing process of gingival enlargement in adolescents with and without fixed orthodontic appliances following periodontal treatment and to evaluate the clinical response associated with laser-assisted gingival surgery. Methods: A total of 60 individuals participated in the study. Test Group 1 (T1- 20 individuals) consisted of individuals with gingival enlargement after orthodontic treatment who underwent Er,Cr:YSGG laser gingivectomy and gingivoplasty; Test Group 2 (T2- 20 individuals) consisted of individuals with gingival enlargement after orthodontic treatment who underwent gingivectomy and gingivoplasty with conventional hand instruments; and Control Group (K- 20 individuals) consisted of individuals with gingival enlargement without orthodontic treatment who underwent Er,Cr:YSGG laser gingivectomy and gingivoplasty. Patients with fixed orthodontic appliances constituted the test group. All participants were healthy, non-smokers, and 12–18 years of age, with gingival enlargement primarily affecting the labial surfaces of the anterior teeth. Clinical periodontal parameters, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and gingival overgrowth index (GOI), were evaluated at baseline and on days 1, 30, and 90 after treatment. Results: All groups demonstrated improvements in periodontal parameters during follow-up. The T1 and C groups showed a rapid postoperative reduction in BOP and a marked reduction in GOI compared with baseline. Differences between groups became less pronounced during subsequent follow-up, and several parameters were similar by day 30 and day 90. The clinical observations suggest that laser-assisted gingival surgery can be a useful treatment option for gingival enlargement in adolescents receiving fixed orthodontic treatment. Conclusions: The apparent advantages include effective tissue management, hemostasis, limited postoperative discomfort, and favorable early healing. The findings also emphasize that laser treatment should be considered an adjunct to, rather than a substitute for, meticulous plaque control and professional periodontal maintenance. Because the present study included a relatively small sample and had limitations in group comparability and follow-up duration, larger prospective studies with standardized treatment protocols are required to confirm the findings and establish the long-term periodontal benefits of laser therapy in orthodontic patients.

Abstract: Background. Evidence on the relationship among possible bruxism, self-reported TMD symptoms, and chronotype in dental students is limited. To explore the association among possible bruxism, self-reported temporomandibular disorder (TMD) symptom severity, and chronotype profiles within a population of dental students. Methods. A cross-sectional study was conducted among 258 dental students at the Uşak University Faculty of Dentistry in 2025. Possible awake and sleep bruxism were assessed using self-reported questions, self-reported TMD symptom severity was assessed through the Fonseca Anamnestic Index (FAI), and chronotype profile was determined via the Morningness–Eveningness Questionnaire (MEQ). Statistical analyses were performed using SPSS version 24.0, including chi-square tests and multivariable logistic regression to evaluate independent associations between chronotype, TMD symptom severity, and possible awake and sleep bruxism, with statistical significance set at α = 0.05. Results. Chi-square analyses revealed a statistically significant correlation (p = 0.005) between the chronotype profile and possible awake bruxism. A significant association was observed between possible awake and sleep bruxism and self-reported TMD symptom severity (p < 0.001). No significant association was found between chronotype profile and self-reported TMD symptom severity (p = 0.159). Results of the multivariable logistic regression indicated that chronotype was not independently associated with either possible awake or sleep bruxism after adjustment for potential confounders (p > 0.05). In contrast, self-reported TMD symptom severity showed a strong dose-response association with both conditions (p < 0.05). Conclusions. Self-reported TMD symptom severity was independently associated with both possible awake and sleep bruxism, whereas chronotype profile showed no independent association after adjustment for potential confounders. Considering dental students as a population exposed to irregular schedules, exploring the links between bruxism, self-reported TMD symptoms, and chronotype may provide insight into how biological rhythm-related factors intersect with oral health in dental education settings.

Abstract: Xenogeneic bone substitutes are widely used in dental regeneration, yet materials commonly described as collagen-containing or collagenated may differ fundamentally in their composition and biological behavior. This narrative review examines xenografts from the perspective of their manufacturing process, focusing on the distinction between preservation of native bone collagen and addition of exogenous collagen after depro-teinization. Thermal processing progressively removes the native organic matrix and carbonate components and, particularly at higher temperatures, increases mineral crystallinity and promotes the transformation of bone into a more ceramic-like scaffold. Such materials are highly osteoconductive but may exhibit very slow resorption and long-term particle persistence. Exogenous collagen can subsequently be incorporated into the processed mineral scaffold to improve cohesion, handling, and adaptation, but does not restore the original hierarchical mineral–collagen architecture. Conversely, chemical or enzymatic processing may preserve native collagen together with a less extensively transformed mineral phase. Available preclinical and clinical evidence suggests that some native-collagen-preserving xenografts may undergo greater biological turnover and progressive replacement than highly processed anorganic comparators, although differences in animal source, porosity, mineral structure, and manufacturing protocols preclude attributing these effects exclusively to collagen preservation. We therefore propose distinguishing native-collagen-preserving xenografts (NCP-XG) from exoge-nous-collagen-supplemented xenografts (ECS-XG). This processing-based framework may provide a more biologically meaningful interpretation of collagen-containing xenografts and highlights the need to select biomaterials according to the desired balance between scaffold persistence, dimensional stability, and biological replacement.

Abstract: Background/Objectives: Artificial intelligence (AI) tools for periodontal diagnosis are proliferating, yet little is known about what clinicians and patients in Central Asia expect from such systems. We elicited requirements for an AI-enabled periodontal decision-support system from three stakeholder groups in Kazakhstan and examined which patient-reported risk factors are associated with self-reported signs of periodontal disease. Methods: A cross-sectional online survey (July–September 2026) enrolled 33 dentists, 91 primary health care (PHC) physicians and medical specialists, and 455 patients with periodontal disease. Proportions were reported with Wilson 95% confidence intervals (CI); groups were compared with Fisher’s exact, χ², Mann–Whitney and Kruskal–Wallis tests with effect sizes; multivariable logistic regression identified factors associated with self-reported periodontal signs. Results: Dentists prioritised automation of history-taking (81.8%) and visual gingival assessment (72.7%), and named early gingivitis diagnosis as the stage where AI is most needed (69.7%). Only human-controlled autonomy levels were chosen; the most frequently cited barrier was the absence of a legal framework and liability insurance (60.6%), and dentists with >5 years of experience more often demanded mandatory verification or a prohibition of full autonomy (exact p = 0.045; Cramér’s V = 0.54). PHC physicians considered early gingivitis screening their most effective contribution (80.2%) but cited insufficient competence as the main barrier (53.8%). Self-reported periodontal signs were present in 49.0% of patients and were independently associated with high stress (adjusted odds ratio 2.11; 95% CI 1.14–3.89) and a positive family history (1.61; 1.02–2.55); six symptom items did not form a reliable scale (Cronbach’s α = 0.56). Conclusions: Stakeholders in Kazakhstan favour a low-autonomy, clinician-verified AI system focused on early gingivitis detection, interprofessional data sharing and clearly regulated accountability. These requirements provide an evidence base for the design and governance of periodontal AI in emerging health systems.

Abstract: Background: The aim of this study was to find out a combination between the endodontic treatment and the restorative procedure to be performed in one step. For that, the validity of a combined warm vertical condensation technique, an immediate washout of the bi-oceramic sealer (Bioceramic Immediate Wash Out, BIWO), and an immediate build-up (IBU) of the endodontically treated tooth was evaluated. Methods: One hundred ten single-root human teeth were selected. Then, the sample roots were divided into 3 Groups according to the used the endodontic sealer and the wash out technique: Group 1. CeraSeal root canal sealer with the continuous wave of condensation technique (CWC), BIWO and IBU; Group 2. Ceraseal with a week delayed BDWO (Bioceramic Delayed Wash Out, BDWO) and a delayed build-up (DBI); Group 3. Pulp Canal Sealer EWT (PCS) with the BIWO and IBU; Restorations were made with a fiber post or using a fiber re-inforced flowable resin composite. The samples were tested by push out and SEM ob-servation to evaluate the cleanliness of root canal walls. Also, apical leakage test was performed to evaluate if BIWO might negatively affect the apical seal. Results: Group 1 post scored the highest values (15.23 ± 4.2 MPa), followed closely by Group 1 composite (14.51 ± 3.1 MPa), and then Group 2 post (12.83 ± 3.1 MPa), and Group 2 composite (12.52 ± 2.1 MPa). The lowest values were recorded for Group 3 post (9.55±1.32) and Group 3 composite (9.12±1.67). Statistically significant differences were detected among these Groups (p > 0.05). Regarding the influence of sealer type, the groups obturated with BES (Group 1 and 2) demonstrated significantly higher bond strength values than those obturated with Pulp Canal Sealer (p < 0.05). From the SEM observation was evident that the BIWO technique obtained a better cleaned dentin surface from the smear layer. The apical leakage test did not show any differences among BIWO and BDWO, and BES and PCS. Conclusions: From the findings of this in vitro study, the following conclusions can be drawn: 1. The BIWO is more effective than BDWO. 2. The BIWO achieved clean dentinal wall surfaces, available for bonding. 3. The BIWO dos not affect the apical seal of the endodontic obturation.

Abstract: Background. Replacement of a maxillary lateral incisor is among the most demanding indications in implant dentistry. The site is typically narrow bucco-palatally, the buccal plate is frequently thin and largely bundle-bone dependent, and the aesthetic tolerance for ridge collapse is minimal. Immediate (Type 1) placement shortens treatment and preserves the soft-tissue architecture, but it does not prevent the remodelling of the buccal wall that follows extraction, and the osteotomy itself risks fenestration or loss of primary stability. Case presentation. A 60-year-old male smoker (about 20 cigarettes/day) with a history of stage IV periodontitis presented with an unrestorable, almost circumferential carious lesion of the maxillary left lateral incisor, already restored with a metal-ceramic crown (FDI 22). After atraumatic flapless extraction, the osteotomy was initiated on the palatal wall of the socket with a lance bur and a 2.2 mm pilot drill, and completed with a sequence of screw bone expanders instead of rotary drills. Expander position and axis were verified intraoperatively with a periapical radiograph and a CBCT scan before the osteotomy was finalized. An implant (“Newton”, Kalodon, 4.25 × 13 mm) was placed in a palatally shifted position with apical bone expansion of the nasal-floor cortex (part of the “supramaxillary arch buttress”, a nomenclature we have proposed), achieving an insertion torque exceeding 60 Ncm. The residual buccal gap was filled with a deproteinized bovine bone mineral xenograft to compensate for the expected resorption of the bundle bone, and a screw-retained provisional restoration was delivered the same day. Healing was uneventful. At three months the peri-implant mucosa was stable and well contoured, with no visible collapse of the buccal contour; the site was digitally scanned and a definitive screw-retained zirconia crown was delivered. Radiographically, the marginal bone level appeared stable at all controls. The patient was then followed for 12 months after crown delivery, with an uneventful course. Conclusions. In a narrow lateral incisor socket, combining “apical expansion” with immediate implant placement, buccal gap grafting and immediate provisionalization allowed a single-surgery, three-month rehabilitation with preserved mucosal architecture. Intraoperative three-dimensional verification of the expander before finalizing the osteotomy was decisive in confirming the implant axis in a site with minimal (bundle) buccal bone. The result was obtained in a heavy smoker with a history of severe periodontitis and should be confirmed with quantitative, longer-term data. Engaging the “supramaxillary arch buttress” of the splanchnocranium ensures the necessary stability.

Abstract: Background/Objectives: Bitewing (BW) radiographs are essential for detecting proximal caries but may cause discomfort and anxiety in children. Virtual reality (VR) distraction reduces procedural pain in several dental interventions, but its use during dental radiography has not been investigated. This study evaluated the effect of VR distraction on objective and subjective discomfort and pain during BW imaging in children aged 4–12 years. Methods: In this parallel-group randomized controlled clinical trial at King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia (ClinicalTrials.gov NCT07376941), 74 cooperative children were randomized 1:1 to VR distraction (n = 37) or no distraction (n = 37). Sessions were video recorded, and two calibrated examiners scored objective pain behavior with a modified Face, Legs, Activity, Cry, and Consolability (FLACC) scale (Face item excluded because the headset obscured facial expressions), the primary outcome. Immediately afterwards, children rated pain with the Arabic Wong–Baker FACES Pain Rating Scale and satisfaction on a 10-point Likert scale (secondary outcomes). Results: Groups were comparable at baseline. A modified FLACC score of zero was more frequent in the VR group (83.8% vs. 67.6%), but the difference was not significant (p = 0.267). More children in the VR group self-reported zero pain (91.9% vs. 70.3%; p = 0.044). Maximum satisfaction did not differ significantly (89.2% vs. 83.8%; p = 0.368). No adverse events were reported. Conclusions: VR distraction did not significantly reduce examiner-rated pain behavior, the primary outcome. The significant difference in self-reported pain, a secondary outcome without adjustment for multiplicity, should be regarded as exploratory. Adequately powered multicenter trials with blinded outcome assessment are needed.

Abstract: Multimodal large language models (MLLMs) have been used to support dental image interpretation, but performance may depend on prompt structure. We proposed Hierarchical Reasoning Gates (HRG), a prompt-level protocol organizing image interpretation into sequential stages with validation before progression. Forty anonymized panoramic radiographs of impacted mandibular molars were analyzed using three prompt architectures: P1, zero-shot natural language; P2, a five-step structured workflow followed by a final internal-validation checkpoint; and P3, HRG with 10 macro-stages and 35 procedural control blocks. Outputs were compared with expert radiology reference reports using five predefined variables. Mean Total Score was 3.52 ± 0.85, 3.58 ± 0.71, and 4.35 ± 0.74 for P1, P2, and P3, respectively; Full Accuracy was 10.0%, 5.0%, and 50.0%. Reports with errors in three or more variables occurred in 12.5%, 7.5%, and 0%, respectively. Only Apparent Anatomical Relationship differed significantly across prompts after Holm adjustment. Test–retest repeatability was high for several variables but lower for Apparent Anatomical Relationship in P3. HRG was associated with higher image-interpretation performance and fewer complex error patterns, although higher performance did not uniformly translate into greater repeatability. These findings support gated prompt design for controlling dependent steps in MLLM-based image analysis, while clinical use still requires expert supervision.

Abstract: Purpose: Maxillofacial metastases from prostate cancer are accounts for 9–11% of metastatic jaw lesions. Optimal imaging for suspected maxillofacial metastases remains undefined. Conventional imaging often lacks sensitivity for early disease, while PET/CT may be limited due to physiologic tracer uptake in adjacent salivary glands. With increasing use of PET/CT in advanced prostate cancer, its diagnostic performance in the mandibular region requires further evaluation. Methods: We conducted a single-institution paired retrospective study using the prospectively maintained Mayo Clinic Advanced Prostate Cancer Registry. Patients with clinically confirmed mandibular metastases who underwent molecular PET/CT ([⁶⁸Ga]Ga-PSMA-11 or [¹¹C]choline) and conventional imaging (CT or MRI) within 1 month were included. All studies were blindly reviewed by a board-certified radiologist specialized in nuclear medicine. Detection rates, anatomic distribution, and quantitative imaging parameters were assessed. paired detection rates were compared using a one-sided exact McNemar test, with a two-sided exact test performed as a sensitivity analysis. Results: Eighteen patients with clinically confirmed mandibular metastases underwent 36 paired imaging evaluations (18 molecular PET/CT and 18 conventional studies). Median age was 70.5 years (IQR, 60–77), and median Gleason score was 8 (IQR, 7–9). At detection of mandibular metastasis, 56% of our cohort had hormone-sensitive and 44% had castration-resistant disease. Molecular PET/CT detected mandibular involvement in 18/18 patients (100%; 95% CI, 81–100%) versus 13/18 (72.2%; 95% CI, 47–90%) with conventional imaging. All five discordant cases were detected by molecular PET/CT but not conventional imaging, with no discordant cases favoring conventional imaging (one-sided exact McNemar p = 0.031; two-sided p = 0.063). Mandibular involvement was predominantly unilateral (94.4%), most commonly involving the body (50%), followed by the ramus (28%) and condyle (17%). Median SUVmax was 6.3 (IQR, 4.4–16.9) for PSMA PET/CT and 4.3 (IQR, 3.8–8.5) for choline PET/CT; median lesion volume was 5.0 mL (IQR, 1.1–11.3). Conclusions: Molecular PET/CT identified all clinically confirmed mandibular prostate cancer metastases in this paired cohort, including five cases not detected by conventional imaging. Despite physiologic tracer uptake in adjacent salivary structures, mandibular metastatic disease remained detectable on molecular imaging. These findings suggest that molecular PET/CT may provide complementary value when mandibular metastasis is suspected, particularly when conventional imaging is negative or equivocal.

Abstract: Background/Objectives: Mandibular fractures frequently require restoration of occlusion, stabilization of bone fragments, and maintenance of intermaxillary relationships during healing. Conventional Erich arch bars remain a widely used method of maxillomandibular fixation (MMF), but are associated with prolonged operative time, mucosal trauma, plaque accumulation, needle-stick risk, and reduced comfort. Bone-supported intermaxillary fixation (IMF) screws have been introduced as an alternative, yet screw-related complications continue to limit their universal adoption. This narrative review synthesizes the clinical, morphological, biomechanical, technical, and practical rationale for a proposed method of mandibular fracture stabilization using self-tapping titanium orthodontic screws, with heads placed intraorally in the alveolar process of the maxilla and mandible, connected by elastic intermaxillary traction. Methods: A narrative literature review was undertaken across five thematic domains: mandibular fracture management, Erich arch bars, intermaxillary fixation screws, orthodontic miniscrews, and the biomechanics of elastic maxillomandibular fixation. The proposed technique was appraised against these existing fixation concepts and their documented clinical limitations. Results: Screw-based intermaxillary fixation can shorten operative time and avoid extensive circumdental wiring relative to conventional arch bars, with a potential but meta-analytically mixed hygiene benefit. Elastic traction between screws near a fracture line is not new: it was first described as "Elastic Internal Traction" in 2004, and a more recent precedent combines IMF screws with orthodontic elastic chains; the present proposal extends this lineage using orthodontic titanium screws with a provisional, not yet anatomically validated interradicular placement scheme (approximately 8 mm from the gingival margin, at least one tooth from the fracture edge), connected by elastic rings. Biomechanically, elastic intermaxillary traction is proposed to distribute force between the maxilla and mandible, but this has not been tested for this specific combination. Conclusions: Orthodontic screw-assisted intermaxillary fixation represents a promising, minimally invasive intraoral strategy for selected mandibular fractures, with potential advantages including reduced intraoral bulk, improved hygiene access, and controlled fragment stabilization. Prospective clinical trials, CBCT-based anatomical safety studies, and dedicated biomechanical analyses are required before broad clinical use.

Abstract: Connective tissue grafts (CTGs) remain a vital component in periodontal and pe-ri-implant plastic surgery; however, their harvesting creates a second surgical wound at the palatal donor site. This narrative review critically synthesizes the evidence on com-plications, technical pitfalls, and strategies for reducing donor-site morbidity following the harvesting of subepithelial connective tissue grafts and de-epithelialized gingival grafts. Subepithelial harvesting techniques support primary wound closure but require adequate residual flap thickness and careful dissection. In contrast, harvesting de-epithelialized gingival graft creates an open wound that demands effective hemostasis and protection; however, this approach provides greater control over graft dimensions and composition. No single harvesting technique or adjunctive intervention is universally superior. In addition to the harvesting technique and the resulting wound configuration, donor-site morbidity is determined by interactions among patient-related medical factors, palatal anatomy, graft dimensions and composition, and performance of the surgery. Pain and bleeding are the most frequently assessed early outcomes, whereas wound dehiscence, necrosis, infection, persistent sensory disturbances, and symptomatic scarring remain insufficiently quantified. The risk of postoperative morbidity and complications may be reduced through careful medical and anatomical assessment, the use of the minimum effective graft dimensions, atraumatic tissue handling, preservation of adequately vascularized residual tissues, effective hemostasis with appropriate wound protection, and easy-to-follow postoperative instructions for patients. Standardized endpoints, outcome measures, assessment intervals, and CTG-specific risk-assessment tools are needed to improve the comparability of evidence and guide clinical decision-making.

Abstract: Background: Secondary caries or caries around restorations or sealants is a common reason for replacement of restorations. However, distinguishing true secondary caries from restoration-related defects remains clinically difficult and may lead to overtreatment and unnecessary removal of healthy tooth structure. Objectives: This scoping review aimed to map how diagnostic strategies for secondary caries are used and how these findings are translated into treatment decisions, while identifying diagnostic thresholds and informing an evidence-based decision framework. Methods: Searches were performed in seven electronic databases, gray literature sources, and guideline repositories without restrictions on language or publication year. Evidence addressing diagnostic strategies for secondary caries, as well as relevant guidelines and consensus documents, were included. Data were organized descriptively, and the methodological quality of primary studies was critically evaluated. Results: Forty-eight documents were included (34 original studies and 14 guidelines or consensus statements). Visual–tactile examination, commonly combined with bitewings, was the most frequently reported detection approach. Adjunctive methods, including fluorescence-based devices, optical imaging, and artificial intelligence, were investigated as complementary detection tools, with heterogeneous performance across study designs. Treatment decisions were primarily driven by lesion activity and suspected dentine involvement rather than marginal appearance alone. Explicit diagnostic thresholds were rarely predefined, and substantial variability was observed in how diagnostic findings informed treatment decisions. Conclusions: The evidence supports visual–tactile assessment complemented by bitewings as first-line approaches within a diagnostic strategy for secondary caries evaluation. However, heterogeneity in diagnostic thresholds and treatment decision criteria limits comparability across studies and may contribute to inconsistent clinical management. Greater standardization in reporting diagnostic strategies and decision frameworks is needed to support evidence-based and conservative care. Clinical significance: This review provides an evidence-informed clinical framework based on visual–tactile and radiographic assessment for secondary caries around restorations. By integrating detection methods, lesion interpretation, and commonly reported clinical thresholds, the framework illustrates how findings from routine assessment are translated into treatment strategies. The findings indicate that treatment decisions are more consistently guided by lesion activity and dentine involvement than by restoration defects alone, supporting a more conservative approach under diagnostic uncertainty and highlighting the need for greater standardization in clinical criteria.

Abstract: Background/Objectives: To determine the prevalence, severity, and tooth-type distribution of nonsyndromic permanent tooth agenesis among children attending a university pediatric dental clinic in Turkey. Methods: Records and diagnostic radiographs of 7,109 children aged 6-15 years who attended Karadeniz Technical University between January 2019 and January 2021 were evaluated retrospectively. Children with syndromic or generalized developmental conditions and radiographs of insufficient quality were excluded. Agenesis was diagnosed when a permanent tooth germ was absent radiographically and extraction or acquired loss was not indicated; third molars were excluded. Prevalence, severity, and tooth-type distribution were summarized descriptively with Wilson 95% confidence intervals (CIs). Results: Permanent tooth agenesis was identified in 546 children (7.68%; 95% CI: 7.08-8.32), including 288 girls and 258 boys. Overall, 1,150 permanent teeth were absent. One or two teeth were missing in 439 children (80.4%), three to five in 78 (14.3%), and six or more in 29 (5.3%). Mandibular second premolars were most frequently absent (32.7%), followed by maxillary lateral incisors (26.1%) and maxillary second premolars (17.9%). Conclusions: Permanent tooth agenesis affected approximately one in thirteen children in this clinic-based sample. Most affected children had one or two missing teeth, with agenesis concentrated in second premolars and maxillary lateral incisors.

Abstract: Background/Objectives: Preschool teachers can reinforce oral health practices, but the persistence of educational messages requires evaluation. This study assessed changes in knowledge, beliefs and self-reported practices between 3 and 12 months after school-based education. Methods: Education reached 240 teachers in 63 schools in Trabzon, Turkey. Questionnaires were completed by 222 teachers at 3 months and 152 at 12 months. Paired analyses included the 152 teachers assessed at both follow-ups. Responses were compared using McNemar tests. No matched pre-education assessment or concurrent control group was available. Results: The paired cohort represented 63.3% of trained teachers. Endorsement of fluoride-containing products for caries prevention decreased from 63.8% to 40.1%, recognition of enamel strengthening from 82.9% to 66.4%, and identification of first-tooth eruption as the time to begin cleaning from 92.8% to 75.7% (all p < 0.001). Recognition that avulsed primary teeth should not be replanted decreased from 83.6% to 70.4% (p < 0.001), whereas endorsement of immediate permanent-tooth replantation changed little (91.4% versus 89.5%; p = 0.508). Twice-daily brushing decreased from 82.9% to 73.0% (p = 0.001). Tests were exploratory and unadjusted for multiple comparisons. Conclusions: Several preventive messages were less frequently endorsed at 12 months. Follow-up identifies priorities for updated content and refresher education concerning fluoride, early oral care and primary-tooth avulsion. These observations do not establish initial educational effectiveness or clinical benefit in children.

Abstract: Periodontitis is an inflammation-driven disease caused by dysbiosis, in which excessive host proteolytic activity contributes to connective tissue destruction and alveolar bone loss. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are key regulators of extracellular matrix turnover and potential molecular targets of photobiomodulation (PBM). This review summarizes the available clinical evidence on the effects of adjunctive PBM on MMP/TIMP-associated biomarkers in periodontitis. Nine clinical publications published between 2005 and 2023 were identified, together with one relevant systematic review. The included studies used PBM-compatible protocols or mixed laser studies with a PBM-related arm. There was considerable heterogeneity in irradiation parameters, treatment schedules, comparator therapies, follow-up period, and biomarker assessment. The most studied marker was MMP-8, showing a reduction after periodontal therapy, independent of PBM. Some studies reported a greater PBM-associated reduction, whereas others observed clinical improvement without changes in MMP-8 or related cytokines. Data supporting MMP-1, MMP-9, MMP-13, TIMP-1 and MMP/TIMP ratios were sparse and heterogeneous. Changes in biomarker production did not always correlate with clinical improvements in probing depth, clinical attachment level, gingival inflammation, bleeding indices, and early wound healing. In conclusion, PBM may influence MMP-related responses during periodontal healing, but a definite effect beyond conventional periodontal therapy has not been established. Future randomized trials should employ well-defined non-thermal PBM parameters, the same background treatment, quantitative evaluation of active MMPs and TIMPs, and standardized long-term clinical and biochemical follow-up.

Abstract: Background: Commercial flavoured dairy products contain milk-derived minerals and proteins that may protect enamel, but they may also contain acids capable of promoting erosion. This study investigated the effects of repeated exposure to six flavoured dairy products on primary tooth enamel in vitro. Methods: A total of 108 non-carious primary molars were allocated to independent analytical sets: 56 intact teeth for weight analysis (n = 7/group), 28 teeth sectioned to obtain 56 enamel specimens for Vickers microhardness testing (n = 7/group), and 24 intact teeth for micro-CT analysis (n = 3/group). Six dairy products, cola and artificial saliva constituted eight experimental groups. Specimens were exposed for 5 min twice daily for six months. Weight and microhardness were assessed at baseline and after 1, 3 and 6 months; apparent mineral density was assessed at baseline and after 6 months. Results: At six months, mean weight decreased by 10.5%-14.0% in the dairy-product groups and by 20.6% in the cola group, compared with 0.8% in the artificial-saliva group. Mean microhardness decreased by 60.2%-68.3% in the dairy-product groups and by 60.6% in the cola group, whereas the artificial-saliva group showed a 17.1% increase. Significant time and time-by-group effects were observed for weight and microhardness (p < 0.001). No significant within-group or between-group differences were detected by micro-CT (p > 0.05). Conclusions: Repeated exposure to the tested flavoured dairy products produced measurable reductions in whole-tooth weight and enamel surface microhardness under the experimental conditions. The exploratory micro-CT analysis did not detect statistically significant changes in apparent mineral density. Adequately powered in situ and clinical studies are required before these findings can inform dietary recommendations.

Abstract: Periodontal disease (PD) is a multi-factorial condition that may lead to tissue destruction and tooth loss. Multirooted teeth are at high risk due to the furcation space where roots diverge, and new regenerative therapies are needed to support complete repair of furcation defects. This study assessed safety and preliminary efficacy of an injectable piezoelectric-based hydrogel (Ambrilux Dental Gel) in a canine model of ligature-induced PD. Animals were randomized to study treatment (n=3) (two applications 28 days apart) or control (n=3). Laboratory results were normal throughout the study. Radiographs demonstrated notable increase in furcation bone density in all animals in the study treatment group by 28 days after the first treatment, with continued increase following the second treatment. The control group showed continued loss of bone or minimal regeneration. Quantitative CT showed treated animals had greater furcation bone mineral density, bone volume and bone volume to tissue volume ratio compared to control. This study provides the first direct evidence that a degradable, piezo-based hydrogel is efficacious for treatment of PD in large animals, serving as a foundation for future studies. The ability of Ambrilux to promote bone growth in tooth furcations suggests it represents a safe and novel approach to PD.

Abstract: Background/Objectives: The aim of this study was to compare the outcomes of pulpotomy done in primary molars under different treatment settings, namely: Basic Behavior Guidance (BBG), Oral Sedation (OS) and General Anesthesia (GA). Methods: In this is retrospective study, dental records of 79 pediatric dental patients treated in university dental hospital between March 2019 to January 2022 were reviewed. Data collected include: (1) age at the time of receiving the treatment, (2) age at the recall visit, (3) gender, and (4) type of clinical setting when providing the dental treatment (BBG, OS, or GA). A total of 154 primary molars received pulpotomy procedure. Recall visits include clinical and radiographic examination. Results: Clinically, six teeth in the BBG group exfoliated. SSC was lost in all groups, but no significant difference was found (P= 0.236). For the percussion and palpation responses, no significant differences were found between the three groups (p= 0.245 and 0.395 respectively). Radiographic findings showed no significant difference between the three groups when roots and pulp canals and bone resorption were examined (p= 0.313 and 0.193 respectively). Signiant differences were found when dentinal bridge formation was assessed (p=0.003). When the quality of the pulpotomy, success of the SSC, and the success of the pulpotomy were compared, no significant differences were found (P>0.05). Conclusions: No significant differences were found between the three groups when the pulpotomy outcomes were assessed. This retrospective study highlights the effect of treatment settings. Future prospective study is recommended.

Abstract: Background: Although toothbrushing is widely recognized as a cornerstone of caries prevention, oral hygiene has traditionally been assessed using self-reported frequency or categorical plaque indices. Evidence regarding the relationship between objectively quantified brushing efficacy and cumulative caries severity remains limited. This study evaluated the association between a quantitative brushing efficacy index and dental caries severity among schoolchildren. Methods: A cross-sectional analytical study was conducted among 200 schoolchildren examined during a community dental campaign in 2025. Caries was assessed using Decayed, Missing, Filled Teeth indices following Word Health Organization criteria. Severe caries was defined as Decayed, Missing, Filled Teeth ≥5. Oral hygiene was measured using a brushing efficacy index, expressed as the percentage of biofilm removed after supervised brushing. Associations were evaluated using chi-square tests and logistic regression models adjusted for age and sex. Results: Caries prevalence was 95.5%, with a mean Decayed, Missing, Filled Teeth of 4.99 ± 2.96. Severe caries was observed in 49% of participants. No statistically significant differences were found across tertiles of brushing efficacy (χ² (2) =2.18; p=0.336). In regression analysis, each 10% increase in brushing efficacy was not significantly associated with severe caries (adjusted OR=0.92; 95% CI: 0.81–1.03; p=0.154), although a protective trend was observed. Conclusions: This population exhibited an extremely high burden of dental caries. Quantitative brushing efficacy showed a non-significant protective trend, suggesting that in high-risk contexts, caries severity is influenced by multifactorial determinants beyond isolated oral hygiene performance.