Medicine and Pharmacology

Abstract: Background: Maxillary sinus floor elevation is a predictable procedure for implant re-habilitation in the posterior maxilla with reduced residual bone height. Schneiderian membrane perforation is the most frequent intraoperative complication during sinus lift surgery and may compromise graft stability and treatment outcomes. Stabilized collagen membrane techniques have been proposed to manage extensive perforations. Objective: To describe the management of a large Schneiderian membrane perforation (>10 mm) using a stabilized collagen membrane technique and to evaluate the clinical outcome. Case Description: A 67-year-old male patient (ASA I, non-smoker) with insufficient posterior maxillary bone height underwent lateral window sinus augmentation. During membrane elevation, a large perforation (>10 mm) occurred. A resorbable collagen membrane was adapted and stabilized to isolate the defect and create a contained compartment for graft placement. A xenograft was inserted, and an additional collagen membrane was used to cover the lateral window and stabilized with fixation pins. Pri-mary closure was achieved with tension-free sutures. Results: Healing was uneventful, without sinus pathology or postoperative complica-tions. Radiographic evaluation confirmed graft stability and adequate volume mainte-nance. Implant placement was successfully performed after 6 months, achieving satis-factory primary stability and favorable clinical outcomes after one year of loading. Conclusion: The stabilized collagen membrane technique allowed predictable man-agement of a large Schneiderian membrane perforation, enabling successful graft con-tainment and implant rehabilitation.

Abstract: Background/Objectives: Successful endodontic treatment depends on preserving sufficient radicular dentine during canal instrumentation to prevent complications such as perforations during cleaning and shaping. Mandibular first molars are particularly susceptible due to their complex root morphology and the presence of “danger zones,” especially within the mesial root. Data on dentine thicknesses for South African populations remain limited. Methods: This cross-sectional descriptive study evaluated micro-computed tomography scans of 77 mandibular first molars obtained from 45 Black South African individuals. A novel software program was used to generate orthogonal virtual sections along the entire root length adapting to its curved axis, enabling automated dentine thickness measurements at 0.1 mm intervals. Statistical analyses were performed to assess variations according to root surface, root level, sex, side, and age. Results: The mesial root consistently demonstrated thinner dentinal walls than the distal root, with the distal aspect of the mesial root representing the thinnest region. Progressive tapering of dentine thickness toward the apical third was observed in both roots. Buccal and lingual surfaces remained significantly thicker than mesial and distal surfaces in the coronal and middle thirds (p < 0.05). No statistically significant differences were identified between left and right molars, between sexes, or in relation to age. Conclusions: This study provides comprehensive three-dimensional baseline data on mandibular first molar dentine thickness in a Black South African sample to highlight clinically relevant areas of reduced dentine thickness. Thinner dentine thicknesses were reported in this study using micro-CT scans and a novel software program compared to the literature, emphasizing the need for increased clinical caution.

Abstract: Tooth loss and alveolar bone resorption caused by dental caries and periodontal disease remain major clinical chal-lenges that compromise oral function. Tissue engineering approaches based on biocompatible scaffolds have emerged as promising strategies for bone regeneration; however, the influence of fabrication methods on scaffold performance re-mains unclear. This study developed hydroxyapatite/poly(lactic-co-glycolic acid)/chitosan (HAp/PLGA/CS) scaffolds using freeze-drying and 3D-printing techniques and evaluated their physicochemical, biological, and biomechanical properties.Scaffold morphology, porosity, degradation behavior, and mechanical properties were characterized, while biocompatibility and osteogenic potential were assessed using human dental pulp stem cells (hDPSCs). Finite element analysis (FEA) using COMSOL Multiphysics® was performed to evaluate scaffold behavior under simulated dental implant loading conditions.Both fabrication methods produced biocompatible scaffolds that supported cell viability and early osteogenic responses. The 3D-printed scaffolds exhibited significantly higher cell viability than freeze-dried scaf-folds, reaching approximately 85% in the 50% infill group compared with 50% in the freeze-dried group. Microstructural analysis revealed interconnected hierarchical porosity, including macro, micro, and submicron scale pores. Although the 50% infill scaffold showed the highest cell viability, the 70% infill scaffold demonstrated the most favorable osteo-genic profile, with enhanced RUNX2 and OSX expression. Both scaffold types exhibited degradation profiles compatible with early bone regeneration. FEA simulations indicated that further mechanical optimization is required to improve load transfer and reduce deformation at the implant–scaffold interface. Overall, HAp/PLGA/CS scaffolds showed prom-ising potential for bone tissue engineering. Among the formulations evaluated, 3D-printed scaffolds provided superior architectural control and enhanced osteogenic performance, although additional mechanical refinement is needed before clinical translation.

Abstract: Background/Objectives: Malocclusion and delayed expressive language are managed as separate clinical problems, yet both may be two faces of a single stomatognathic dysfunctional syndrome. This cross-sectional study investigated whether neonatal feeding modality — breastfeeding, enteral feeding with non-nutritive oral stimulation, or total parenteral nutrition — predicts occlusal morphology and language acquisition in preterm children.Methods: We enrolled 40 preterm children (gestational age below 37 weeks; corrected age 36–42 months) from two follow-up programmes in Iași, Romania; 7 of 47 were excluded. Children were stratified: breastfed (Group A, n = 14), tube-fed with non-nutritive oral stimulation (Group B, n = 13), or parenterally fed (Group C, n = 13). Occlusal morphology was scored blind (κ = 0.91); language was assessed with the Communicative Development Inventories and a phonological checklist. Kruskal-Wallis tests with Dunn-Bonferroni post hoc comparisons, Spearman rank correlation, and multivariable regression adjusting for sex, residence, and socioeconomic status were used.Results: All three outcomes differed significantly by feeding group. Kruskal-Wallis tests: occlusion H(2) = 33.1, p < 0.001; language H(2) = 34.7, p < 0.001; age at first words H(2) = 35.3, p < 0.001. Median occlusion scores: 4.50 (A), 4.20 (B), 2.30 (C); median language scores: 8.40, 7.20, 3.50; median age at first words: 11, 15 and 24 months — a 13-month gap. All Dunn-Bonferroni pairwise contrasts were significant (p < 0.05). Occlusion and language scores were near-perfectly correlated (Spearman ρ = 0.986, p < 0.001). Malocclusion subtype distribution also differed significantly (χ²(6) = 19.1, p = 0.004).Conclusions: Breastfeeding was associated with the most favourable outcomes; parenteral nutrition without oral stimulation with the greatest delays. The near-perfect occlusion–language correlation supports combined stomatognathic screening as an early diagnostic tool and non-nutritive oral stimulation during tube feeding as a prophylactic priority.

Abstract: Background: Probiotic-based strategies for halitosis management are gaining increas-ing interest; however no clinical trial has evaluated the effects of Heyndrickxia coagulans on oral malodour. This study assessed whether chewing gum containing H. coagulans SNZ1969^® was associated with changes in oral volatile sulphur compounds (VSCs) and VSCs-associated dental-plaque taxa. Methods: Fifty-two healthy adults were randomized to receive either probiotic or placebo chewing gum (5 pieces daily) for four weeks. VSCs were quantified at baseline and at three subsequent time points (T₁–T₃) using OralChroma™. Dental plaque samples were analyzed by 16S rRNA gene profiling to assess microbial diversity and taxonomic composition. Results: Forty-four participants completed the study. Both groups showed declining VSCs concentrations over time. In probiotic group, H₂S levels significantly decreased from baseline to T₂ (p=0.008) and T₃ (p=0.031). Between-group differences did not reach statistical significance. Exploratory microbiome analyses identified nominal associations involving taxa plausibly linked to VSCs metabolism, with more consistent signals for H₂S than CH₃SH. Conclusions: Chewing gum containing H. coagulans SNZ1969^® was associated with a possible trend toward reduced H₂S levels and with exploratory microbiome shifts compatible with modulation of H₂S-associated oral taxa. However, given the exploratory nature of the analyses, these findings should be interpreted cautiously.

Abstract: Background/Objectives: Regenerative endodontic procedures have fundamentally changed the management of immature permanent teeth with pulpal necrosis by shifting the therapeutic focus from artificial apical barrier formation to biologically driven tissue regeneration. Unlike conventional apexification, revascularization aims to restore a functional intracanal environment that supports continued root maturation, dentinal wall thickening and apical closure. The present study describes the clinical application and long-term outcome of regenerative endodontic revascularization in a traumatically injured immature permanent maxillary central incisor. Methods: An 11-year-old patient presented with a traumatized immature permanent maxillary central incisor exhibiting pulpal necrosis and an open apex. Following clinical and radiographic assessment, a regenerative endodontic protocol was performed. Canal disinfection was achieved using 1.5% sodium hypochlorite irrigation and calcium hydroxide as the intracanal medicament. At the subsequent appointment, bleeding was intentionally induced beyond the apical foramen to establish an autologous blood clot scaffold. The canal was sealed coronally with a bioceramic material and restored with a definitive composite restoration. Clinical and radiographic follow-up, including cone-beam computed tomography, was performed over a three-year period. Results: Throughout the observation period, the treated tooth remained asymptomatic and functional, with no clinical or radiographic evidence of persistent apical pathology. Serial radiographs and CBCT examinations demonstrated progressive root maturation, increased dentinal wall thickness, continued root elongation and complete apical closure. Functional integrity and esthetic appearance were maintained during the entire follow-up period. Conclusions: This case demonstrates that regenerative endodontic revascularization is a predictable and biologically based treatment option for immature permanent teeth with pulpal necrosis following traumatic injury. When performed according to contemporary regenerative protocols, the procedure can facilitate continued root development and improve the long-term structural integrity of the tooth. Revascularization should be considered a valuable treatment option in appropriately selected immature permanent teeth, while long-term follow-up remains essential to evaluate healing and treatment stability.

Abstract: Background: Rising antimicrobial resistance among fungal and bacterial pathogens, including Candida spp., Staphylococcus aureus, and Enterococcus faecalis, necessitates alternative therapies. Riboflavin-mediated antimicrobial photodynamic therapy (aPDT) activated by blue light offers a broad-spectrum approach, but optimal parameters remain unclear. Objective: To define dose-dependent parameters for riboflavin 5′-phosphate aPDT using a 450 nm diode laser against Candida albicans, C. glabrata, C. krusei, S. aureus, and E. faecalis in vitro. Methods: Standard ATCC strains were exposed to 0.1% riboflavin 5′-phosphate and irradiated under systematically varied conditions: pre-irradiation incubation (1–30 min), photosensitizer volume (50–150 µL), irradiation time (10–120 s), and laser power (50–400 mW). Four groups were tested: L+P+ (photodynamic), L−P+ (pho-tosensitizer alone), L+P− (laser alone), and L−P− (control). Viable counts were quantified post-treatment. Results: Significant microbial reductions were observed only in L+P+ groups. Optimal conditions for Candida included 15 min incubation, 100 µL photosensitizer, and 60 s irradiation for C. albicans and C. krusei, 120 s for C. glabrata. Bacterial efficacy was primarily irradiation-time dependent, with maximal reductions at 120 s and 400 mW; S. aureus showed >46% reduction, E. faecalis less pronounced but consistent reductions. C. albicans was most susceptible among fungi (53.5%), followed by C. glabrata (37.9%) and C. krusei (35.9%). Conclusions: Riboflavin 5′-phosphate aPDT with 450 nm light exhibits reproducible, species-specific antimicrobial activity strictly dependent on the photodynamic mechanism and parameter optimization. While complete eradication was not achieved, this protocol shows translational potential for superficial fungal and Gram-positive bacterial infections. Further studies in biofilm and in vivo models are warranted.

Abstract: Background: Tooth auto-transplantation (TAT) is a surgical procedure in which a person’s own tooth is extracted and repositioned in the recipient site. The aim of the study is to evaluate the clinical outcomes, treatment strategies, and methodological characteristics, and to propose a preliminary management algorithm of TAT in patients with cleft lip and/or palate (CLP). Methods: A search of the literature was conducted in PubMed, Google Scholar, ClinicalKey, Web of Science, and Cochrane Library databases until 21 June 2026. The systematic review was written according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Risk-of -bias was assessed by the Joanna Briggs Institute (JBI) tool. Results: Five case series and three case reports were included, with four “low” and four “moderate” risk-of-bias ratings. They presented data about 23 patients and 27 TAT cases. The majority of patients (n=16) received secondary alveolar bone graft with iliac bone. The most common donor teeth were mandibular premolars (n=20). The most frequent recipient sites were the maxillary 2^nd premolar (n=9) and maxillary incisors (n=15). Twenty-six teeth (96.3%) survived, and one tooth (3.7%) was extracted. Conclusion: TAT appears to be a promising treatment option in carefully selected CLP patients; however, further high-quality studies are needed with the application of our proposed algorithm.

Abstract: Introduction: Temporomandibular joint ankylosis (TMJA) management have evolved from gap arthroplasty to total joint replacement (TJR). TMJ Re-ankylosis presents significant challenge in achieving long-term treatment success. This study evaluates the effectiveness of virtual surgical planning (VSP) guided stock TJR in TMJ re-ankylosis. Materials and method: 10 patients with TMJ re-ankylosis were screened according to inclusion and exclusion criteria. Preoperative virtual surgical planning and mock surgery was performed followed by TJR using Stock TMJ Replacement System. Result: This study showed statistically significant improvement in maximum interincisal opening (MIO) from 1.83mm to 37.83mm (p< 0.001), bite force from 0kg to 10.31kg (p< 0.001), masticatory efficiency, diet consistency post stock-TJR with a mean follow-up of 60months. Mandibular range of movements and quality of life improved markedly with minimal postoperative complications. VSP and mock surgery enhanced precision, reduced the intra-operative duration and complications. Conclusion: This study highlights the clinical success of dual validation protocol by integrating VSP guided stock-TJR in TMJ Re-ankylosis. Mock surgery verified digital precision with intraoperative flexibility, ensures optimal prosthesis fit, restored mandibular function, improvement in quality of life (QoL) and functional rehabilitation. With ongoing advancements, VSP guided stock-TJR protocol can be considered effective in TMJ re ankylosis.

Abstract: Background. Pulp necrosis in immature permanent teeth arrests root development, leaving an open apex, thin, divergent dentinal walls, and an unfavorable crown-to-root ratio that predisposes the tooth to fracture and complicate endodontic management. Apical barrier with hydraulic calcium silicate cements has become the first-line orthograde approach for these teeth when regenerative procedures are not indicated or feasible. Aim. This narrative review synthesizes the contemporary evidence on the complete clinical pathway of apical barrier in immature permanent teeth, with particular emphasis on the procedural determinants of plug formation, and critically appraises where the current evidence is robust and where it remains uncertain. Methods. Relevant English-language literature on root development, etiology of pulp necrosis in immature teeth, diagnosis, isolation, apical barrier methods, calcium silicate materials, and treatment outcomes was reviewed and narratively integrated, with attention to the explicit distinction between in vitro and clinical evidence. Key findings. The unreliability of sensibility testing complicates diagnosis in immature teeth; isolation is frequently challenging owing to traumatic crown loss, and successful treatment depends on adequate chemical disinfection, judicious minimal instrumentation, a well-condensed apical plug of at least 4–5 mm, and a definitive coronal seal that also addresses the weak cervical dentine. Calcium silicate cements—principally MTA, Biodentine, and pre-mixed bioceramic putties—achieve high clinical success, with material choice appearing less decisive than operator experience and the quality of the coronal restoration. Conclusions. Apical barrier placement with hydraulic calcium silicate cements is a predictable orthograde preservation approach for non-vital immature permanent teeth, particularly when regenerative endodontic procedures are not indicated, not feasible, or unlikely to yield a predictable clinical outcome. Well-designed randomized clinical trials with standardized reporting are required.

Abstract: Introduction: Root canal treatment (RCT) fear may affect treatment-seeking behavior, cooperation, and experience, yet it is often evaluated through overall anxiety scores. This study profiled RCT fear by severity and trigger content and examined associations with dental avoidance and negative experiences. Materials and Methods: In this single-center cross-sectional study, 247 adults scheduled for primary RCT completed a questionnaire; 28 incomplete or internally inconsistent questionnaires were excluded, leaving 219 participants. The questionnaire assessed dental attendance, postponement, previous RCT, fear triggers, and personal, social, and media-related negative experiences. Preoperative anxiety was measured using a 0-10 cm Visual Analog Scale for Anxiety (VAS-A). Fear-severity profiles were identified by hierarchical cluster analysis, and trigger-content profiles by latent class analysis among participants reporting RCT fear. Results: RCT-related fear was reported by 75.8%, and 21.9% had severe dental anxiety (VAS-A ≥ 7.0). Severe anxiety increased from 1.9% among participants reporting no trigger to 54.3% among those reporting three or more triggers. Hierarchical clustering identified low-fear (n = 120) and high-fear (n = 99) profiles. The high-fear profile was more frequent among women, irregular dental attenders, those who postponed visits, and those with a negative adult RCT experience. Latent class analysis identified needle-focused (n = 38) and procedural fear (n = 128) profiles. The procedural profile included more triggers, although VAS-A distributions were similar. Conclusions: RCT fear is heterogeneous in severity and content. Preoperative assessment should evaluate fear intensity, dominant triggers, and avoidance history to support individualized communication and anxiety management.

Abstract: Background/Objectives: Fibrous dysplasia (FD) is a benign fibro-osseous disorder charac-terized by the replacement of normal bone with fibrous tissue and immature woven bone, most commonly involving the craniofacial skeleton. It typically presents as an intraosse-ous lesion in children and young adults. Gingival presentation without prominent in-traosseous expansion is exceedingly rare. This report describes an unusual case of FD presenting predominantly as an exophytic gingival mass in the anterior maxilla of a mid-dle-aged patient. Methods: A middle-aged patient presented with a slowly enlarging gingival mass extend-ing from the right canine to the left central incisor region. After being lost to follow-up for approximately 4.5 years, the patient returned with increased swelling, pain, spacing of the anterior teeth, and functional impairment affecting mastication and speech. Clinical, ra-diographic, surgical, and histopathologic findings were evaluated. Surgical management included excision of the lesion, extraction of non-restorable teeth, and bone grafting under general anesthesia. Results: Radiographic examination demonstrated minimal osseous involvement without a clearly defined intraosseous expansile lesion. Histopathologic analysis revealed irregular curvilinear trabeculae of woven bone within a fibrous stroma containing bland spin-dle-cell proliferation, consistent with FD. At the six-month follow-up, the patient remained asymptomatic without complications and was undergoing prosthetic rehabilitation with plans for future implant placement. Conclusions: FD may rarely present as a predominantly gingival lesion with minimal ra-diographic evidence of bone involvement, posing a diagnostic challenge. Recognition of this atypical presentation is important to avoid misdiagnosis and to facilitate appropriate management through comprehensive clinicoradiologic and histopathologic correlation.

Abstract:

Background and Objectives: The aim of this study was to investigate the effects of local melatonin application on osseointegration of machined (MAC), resorbable blast material (RBM), and sandblasted and acid-etched (SLA) surface implants placed in rat tibiae, utilizing the reverse torque analysis. Materials and Methods: A total of 72 female Sprague-Dawley rats, weighing between 270 and 300 g, were included in the study. The rats were divided into six groups, and samples in which the implants were not properly placed were excluded from the study: control groups consisting of MAC-CNT (n = 12), RBM-CNT (n = 11), and SLA-CNT (n = 12), and local melatonin (MLT)-treated groups consisting of MAC-MLT (n = 12), RBM-MLT (n = 10), and SLA-MLT (n = 10). The implants were surgically placed into the tibiae of the rats under general anesthesia. Following a four-week experimental period, the biomechanical bone–implant connection level was evaluated using reverse torque analysis. Results: The lowest mean biomechanical bone–implant connection value was observed in the MAC-CNT group, whereas the highest value was recorded in the SLA-MLT group. Compared with the MAC-CNT group, all other groups demonstrated statistically significantly higher biomechanical connection values (p < 0.05). The SLA-MLT group showed significantly higher osseointegration levels than both the MAC-MLT and RBM-MLT groups (p < 0.05). In addition, the RBM-MLT group demonstrated significantly higher values compared with the MAC-MLT group (p < 0.05). Both MAC-MLT and SLA-MLT groups exhibited statistically significantly higher biomechanical bone-implant connection values compared to control groups (p < 0.05). Conclusions: Local melatonin application positively affected osseointegration in SLA and MAC surfaced implants. In contrast, local melatonin application did not provide any additional contribution to osseointegration in RBM surfaced implants.

Abstract: Background/Objectives: Prediction of mandibular growth rotation is important for orthodontic diagnosis and treatment planning, but conventional cephalometric methods are subjective and clinician-dependent. Deep learning may improve diagnostic consistency and efficiency. This study aimed to develop and evaluate a model for predicting mandibular growth rotation patterns from lateral cephalometric radiographs. Methods: A total of 800 untreated lateral cephalometric radiographs from individuals aged 9–20 years were retrospectively collected and classified as clockwise (n = 376) or counter-clockwise (n = 424) growth rotation patterns. The dataset was divided into training (80%) and validation (20%) sets. Three pre-trained convolutional neural network architectures (ResNet50, InceptionV3, and VGG16) were trained and compared. Image preprocessing included noise reduction, intensity normalization, and data augmentation. Model performance was evaluated using accuracy, precision, recall, F1-score, validation loss, and confusion matrix analysis. Results: VGG16 demonstrated the best performance, achieving the highest validation accuracy and lowest validation loss among the tested models. The model correctly predicted clockwise growth rotation with an accuracy of 84.57% and counter-clockwise growth rotation with an accuracy of 75.26%. Overall classification accuracy was 81.12%. Precision values were 0.85 and 0.73, recall values were 0.67 and 0.88, and F1-scores were 0.75 and 0.80 for counter-clockwise and clockwise growth patterns, respectively. Conclusions: The proposed VGG16-based model demonstrated promising accuracy in predicting mandibular growth rotation patterns from lateral cephalometric radiographs. Deep learning may serve as a valuable adjunct to orthodontic diagnosis and treatment planning, with further improvements possible through larger datasets and enhanced computational resources.

Abstract: Background: Periodontitis and type 2 diabetes (T2D) maintain a bidirectional pathophysiological relationship that impairs conventional periodontal treatment outcomes. Chitosan, a biopolymer derived from chitin, possesses well-documented antimicrobial, hemostatic, wound-healing, and osteo-inductive properties. Objective: We aimed to evaluate whether 1% chitosan gel delivered nightly via a custom occlusal guard, as an adjunct to full-mouth scaling and root planning (SRP), would improve periodontal clinical and radiographic outcomes in patients with T2DM and Stage I-II periodontitis compared to placebo. Methods: A double-blind, randomized, placebo-controlled, parallel-group clinical trial was conducted (n = 16; 8 per group) in adults aged 40-65 years with T2D and periodontitis. Following SRP, participants received either 1% chitosan gel or placebo nightly via a custom occlusal guard for 30 days. Primary outcomes included periodontal pocket depth (PPD), clinical attachment level (CAL), and radiographic bone level (RBL). Secondary outcomes were probing depth (PD), bleeding on probing (BOP), and Miller mobility grade. Statistical analysis employed the Wilcoxon signed-rank test (within-group) and Mann-Whitney U test (between-group); p < 0.05 was considered significant. Results: Groups were comparable at baseline. Within-group analysis at 30 days revealed significant reductions in PPD (4.2 +/- 1.1 to 3.4 +/- 1.1 mm; p = 0.019) and RBL (5.6 +/- 2.2 to 5.1 +/- 1.9 mm; p = 0.030) in the chitosan group, and a clinically meaningful trend in CAL (5.1 +/- 2.8 to 3.8 +/- 1.7 mm; p = 0.069). The placebo group showed significant BOP reduction (78.3 +/- 23.4 to 51.5 +/- 26.0%; p = 0.017), consistent with the known effect of mechanical debridement. No between-group differences reached significance in delta values. Conclusions: Adjunctive use of 1% chitosan gel via a custom occlusal guard as a delivery system produces clinically relevant improvements in PPD and RBL in T2D patients with periodontitis. The occlusal guard represents a novel, patient-administered, sustained-contact delivery platform for periodontal local therapy. Larger, long-term randomized trials with microbiological and glycemic endpoints are warranted.

Abstract: This study evaluated the biomechanical effects of abutment types, superstructure materials, prosthetic designs, and loading conditions in the implant-supported rehabilitation of three consecutive missing teeth in the mandibular posterior region using three-dimensional finite element analysis (FEA). Twenty FEA models were constructed, simulating two-implant (pontic, mesial, and distal cantilever) and three-implant (splinted and unsplinted) configurations using Multi-unit and Ti-base abutments, with monolithic zirconia and zirconia-supported feldspathic porcelain superstructures. Functional and parafunctional (bruxism) vertical and oblique loads were applied to analyze von Mises stresses in the components and principal stresses in the bone and superstructures. The results indicated that two-implant models generated higher stresses than three-implant models, and unsplinted/cantilever designs produced higher stresses than splinted/pontic designs. Ti-base abutments resulted in greater stress accumulation in the connection complex compared to Multi-unit systems. Under vertical and oblique parafunctional forces, stress on the abutments in distal cantilever models—and in unsplinted Ti-base designs under oblique parafunctional forces—exceeded the titanium yield strength (890 MPa). To optimize biomechanical stability, three-implant supported, splinted designs with Multi-unit abutments should be preferred. Avoiding distal cantilevers and unsplinted designs is critical for long-term clinical success in patients with bruxism to prevent plastic deformation.

Abstract: Background and Objectives: The aim of this preliminary study was to investigate the changes in upper airways space in patients undergoing bimaxillary surgery for facial dysmorphism. Orthognathic surgery alters maxillomandibular position and may influence upper airway morphology. Clarifying the direction and magnitude of these changes is clinically relevant because airway narrowing has been associated with obstructive sleep-disordered breathing, while enlargement may provide functional benefits. This preliminary study evaluated one-year changes in oropharyngeal airway volume and cross-sectional areas after bimaxillary orthognathic surgery and explored whether airway changes were associated with skeletal movements. Materials and Methods: A cohort of 17 patients was retrospectively analyzed using Cone beam computed tomography (CBCT) scans of the skull obtained preoperatively (PRE) and at 1 year follow up (POST). Skeletal landmarks were selected based on established criteria from the existing literature and the volumes of the oropharyngeal space were assessed using Newtom software (Cefla s.c. Bologna, Italy). Outcomes were airway volume (cm3), minimum cross-sectional area (mm2), and maximum cross-sectional area (mm2). Within-subject changes were computed as POST minus PRE. Paired comparisons were performed with the Wilcoxon signed-rank test (two-sided). Effect size was expressed as rank-biserial correlation, and 95% confidence intervals (CI) for the median change were estimated using non-parametric bootstrap on paired differences. Results: Median postoperative changes were positive for all outcomes: volume +2.19 cm3 (95% CI -5.17 to 5.84; p=0.332), minimum area +64.53 mm2 (95% CI -1.44 to 94.77; p=0.061), and maximum area +102.51 mm2 (95% CI -33.21 to 134.73; p=0.149). The largest effect size was observed for the minimum cross-sectional area (rank-biserial r=0.516), suggesting a more consistent improvement at the narrowest airway level. Discussion: This retrospective study evaluated changes in upper airway dimensions following bimaxillary orthognathic surgery. Oropharyngeal airway dimensions tended to increase after bimaxillary surgery at one-year follow-up; however, statistical uncertainty was attributable to small sample size and inter-individual variability. Conclusions: The findings support the importance of incorporating airway preservation into surgical planning, even in asymptomatic patients. Larger prospective studies with standardized acquisition protocols and stratification by surgical movement patterns are needed.

Abstract: Background and Objectives: Long-standing contact between oral mucosa and restorative materials may be associated with adaptive epithelial and stromal remodeling. This study evaluated non-dysplastic epithelial plasticity and cumulative remodeling burden in oral mucosa adjacent to different long-term restorative materials. Materials and Methods: This retrospective study included 150 formalin-fixed, paraffin-embedded oral mucosal specimens divided into five equal groups: control, dental amalgam, resin composite, ceramic, and metallic/metal–ceramic restorations (n = 30 each). Exposed cases had documented mucosal adjacency or repetitive contact with a dominant restorative material for at least 5 years. Histopathological parameters, CK19, Ki67, p53, and COX-2 expression were assessed. A Material-Associated Epithelial Remodeling Score (MAERS) was calculated, and intergroup, correlation, and age- and sex-adjusted regression analyses were performed. Results: Histopathological remodeling differed significantly among groups, with the highest inflammatory and epithelial remodeling burden in metallic/metal–ceramic and dental amalgam-associated mucosa. Ceramic specimens remained close to controls, while resin composite specimens showed an intermediate profile. CK19 redistribution, Ki67 expression, and COX-2 immunoreactivity showed a coordinated material-associated pattern, whereas p53 expression was less structured and showed no dominant strong diffuse overexpression. MAERS differed significantly among groups (p < 0.001), with the highest values in metallic/metal–ceramic and amalgam groups. Restorative material category remained independently associated with remodeling burden after adjustment for age and sex. Conclusions: Long-term mucosal adjacency to restorative materials is associated with distinct, non-dysplastic epithelial and stromal remodeling profiles, with the highest burden observed near metallic/metal–ceramic and dental amalgam restorations.

Abstract: Dentin derived from extracted human teeth has emerged as a promising autogenous biomaterial for bone regeneration. The growing interest in tooth-derived graft materials has also stimulated the development of tooth-banking concepts, in which extracted teeth are preserved for future regenerative applications. However, microbial contamination remains a potential concern, particularly when teeth are stored for prolonged periods before processing and clinical use. This in vitro study evaluated the microbiological status of dentin biomaterials prepared from human teeth stored under long-term refrigerated conditions and subsequently processed using three commercially available dentin-processing systems: BonMaker (BM), Tooth Transformer (TT), and Smart Dentin Grinder (SDG). A total of 72 extracted teeth collected between 2018 and 2025 were allocated to experimental groups and processed into 24 pooled dentin samples. Additionally, five freshly extracted teeth served as controls. Microbiological assessment was performed before and after processing using Schaedler Broth K3 culture media under aerobic and anaerobic conditions. Microorganisms isolated from positive cultures were identified using MALDI-TOF mass spectrometry. Baseline microbiological assessment detected bacterial contamination in 2 of 24 pooled dentin samples (8.3%) and in 4 of 5 control teeth (80.0%). The identified microorganisms included Staphylococcus epidermidis, Actinomyces viscosus, Streptococcus anginosus, Streptococcus mutans, and Staphylococcus hominis. No detectable microbial growth was observed in any sample following processing with BM, TT, or SDG, irrespective of storage duration, including teeth stored under refrigerated conditions for up to seven years. These findings suggest that the investigated dentin-processing protocols effectively eliminated microbiologically detectable contamination in dentin derived from long-term refrigerated human teeth. The results support the microbiological safety of dentin-derived biomaterials and provide preliminary microbiological evidence supporting the feasibility of future tooth-banking strategies. Further studies employing molecular microbiological techniques and larger sample sizes are required to confirm these findings.

Abstract: Background/Objectives: Glass-hybrid and high-viscosity glass-ionomer systems aim to improve conventional glass-ionomer performance. This in vitro study compared Vickers hardness and microleakage of a coated glass-hybrid system and a coated high-viscosity glass-ionomer system in thermocycled conservative Class II cavities in human maxillary first premolars. Methods: Thirty extracted maxillary first premolars were used in a paired within-tooth design. Two standardized conservative Class II cavities, one mesial and one distal, were prepared in each tooth, and each tooth received both systems: EQUIA Forte HT Fil with EQUIA Forte Coat and GC Gold Label IX EXTRA CAPSULE with GC G-Coat Plus. After restoration and thermocycling, Vickers hardness was measured on restoration cross-sections at occlusal and gingival locations. Microleakage was assessed on sectioned specimens using dye penetration measurements and ordinal infiltration scores. Results: EQUIA Forte HT showed a higher tooth-level mean Vickers hardness than Gold Label IX Extra after thermocycling (95.05 ± 6.58 HV vs. 91.33 ± 7.50 HV), with a mean paired difference of 3.72 HV (95% CI: 0.32 to 7.11; p = 0.033). In the location-dependent analysis, the effect of the restorative system was significant (p = 0.025), whereas testing location and the interaction were not significant. The microleakage index and the distributions of occlusal-wall and gingival-wall ordinal infiltration scores did not differ significantly between the two restorative systems. Conclusions: Under the conditions of this in vitro study, EQUIA Forte HT showed a slight tooth-level hardness advantage over Gold Label IX Extra after thermocycling. Neither system showed a statistically significant advantage in dye-based marginal sealing.