Medicine and Pharmacology

Abstract:

Background: Abnormal occlusal loading may alter temporomandibular joint (TMJ) homeostasis and promote extracellular matrix remodelling. Matrix metalloproteinases (MMPs) are key regulators of extracellular matrix turnover, but the bilateral response of different TMJ fibrocartilaginous components to a sustained unilateral occlusal disturbance remains insufficiently characterised. Objective: To characterise MMP-2, MMP-3, and MMP-9 immunoreactivity in the glenoid cartilage, condylar cartilage, and articular disc of both temporomandibular joints following sustained unilateral occlusal alteration in rats. Methods: Twenty-five female Wistar rats were included in the experimental design. The study comprised a 4-week control group (n = 4), a 24-week control group (n = 9), and an experimental group (n = 12). In experimental animals, sustained unilateral occlusal alteration was created at 8 weeks of age by application of light-cured composite to the three right maxillary molars and maintained for 16 weeks. MMP-2, MMP-3, and MMP-9 were detected immunohistochemically in the glenoid cartilage, condylar cartilage, and articular disc of both TMJs. DAB immunostaining intensity was quantified by grayscale densitometry; lower grayscale values corresponded to stronger immunoreactivity. Results: Sustained unilateral occlusal alteration was associated with stronger MMP-2, MMP-3, and MMP-9 immunoreactivity in the glenoid cartilage, condylar cartilage, and articular disc relative to 24-week controls (P < 0.01 for the comparisons reported in the original analysis). The increase was bilateral but consistently greater in the TMJ ipsilateral to the occlusal alteration (P < 0.05 or P < 0.01, depending on marker and tissue). The original analysis also documented maturation-related differences for MMP-2 in glenoid cartilage and for MMP-9 in glenoid and condylar cartilage, whereas MMP-3 showed no significant age-related differences. Conclusions: Sustained unilateral occlusal alteration was associated with a bilateral but asymmetric increase in the MMP immunoreactivity profile of TMJ fibrocartilaginous tissues. The concordant involvement of MMP-2, MMP-3, and MMP-9 across the glenoid cartilage, condylar cartilage, and articular disc supports a broad alteration of matrix-remodelling proteins following altered occlusal loading. These findings refer to immunoreactivity and should not be interpreted as direct evidence of increased enzymatic activity or matrix proteolysis.

Abstract: Aim: To evaluate the effects of treatment using both conventional and 3D-printed Twin Block appliances for growth modification in Class II malocclusion.Background: Twin blocks are removable devices commonly used for treating Class II malocclusion. As functional appliances, they’re great for guiding craniofacial growth during a person’s developmental years. They work by harnessing nearby muscle forces to create changes in both the skeleton and teeth. Designed as a tooth- and tissue-borne appliance, the twin block makes the most of orthopedic forces. Since their introduction, they’ve become a popular orthodontic choice thanks to quick results, the ability to maintain normal oral functions, and comfort that supports long-term wear—boosting both motivation and compliance.Patients and methods: Pre-treatment (T1) and post-treatment (T2) lateral cephalograms of 10 patients treated with a conventional Twin Block appliance for class II malocclusion were compared to those of 10 patients treated with a 3D-printed Twin Block appliance for a 6-month follow-up period. Both groups were evaluated for dentoskeletal and soft tissue changes using various angular and linear geometric measurements, and differences between pre- and post-treatment were analyzed with a paired t-test.Results: The cephalometric analysis showed that the Twin Block appliance encouraged mandibular growth. Patients using it experienced a significant (p < 0.001) boost in mandibular length and lower facial height in both groups, with no significant differences between the two groups. All dental angular and linear measurements also changed notably from before to after treatment in each group. Similarly, there was improvement in the facial profile; thus, mean soft tissue measurements improved significantly over the treatment period, but there were no significant differences between the two groups Conclusion: Results of this study show that the Twin Block appliance is effective for treating Class II malocclusion, whether using a conventional or 3-D printed device. This effectiveness comes from the combined benefits of skeletal and dentoalveolar changes in both arches. Future research with larger sample sizes, 3D imaging, and long-term follow-ups could provide a clearer picture of how different functional appliances perform.

Abstract: Background/Objectives: Intraoral scanners (IOS) are increasingly integrated into dental curricula, yet evidence on how brief structured training affects novice students remains limited, particularly in resource-constrained settings. This pilot quasi-experimental study evaluated the effect of a structured IOS training program on the self-reported perceptions of undergraduate dental students with no prior IOS experience. Methods: Twenty first- and third-semester students at the School of Dentistry, Universidad de Especialidades Espíritu Santo (Ecuador), completed a 5-item Likert-type questionnaire (1–9 scale) before and after a training program comprising theoretical instruction and typodont-based practical sessions using a TRIOS 3 scanner (3Shape, Copenhagen, Denmark). Paired Student’s t-tests and Wilcoxon signed-rank tests were used to compare pre- and post-training scores, and effect sizes (Cohen’s d) were calculated for each dimension. Results: Significant improvements were observed in all five perception dimensions (all p < 0.001): familiarity (mean difference: +3.45; d = 1.74), comfort (+3.25; d = 1.91), confidence (+3.70; d = 2.06), perceived scan accuracy (+3.30; d = 1.61), and software competence (+3.55; d = 1.59). Conclusions: A brief, structured IOS training program produced large improvements in students’ self-reported perceptions. These findings support the early integration of IOS training into the dental curriculum. Future controlled studies should assess objective performance outcomes and long-term skill retention.

Abstract: Background: Post-curing may influence the fit and bonding performance of 3D-printed ceramic-filled resin restorations. This study evaluated the effects of post-curing protocols on marginal and internal fit and dentine microtensile bond strength (µTBS) of 3D-printed resin inlays. Methods: Seventy-six maxillary premolars received MOD inlay cavities and DLP-printed resin inlays and were allocated to post-curing protocols (n = 19): standard air (SP, control), glycerine-shielded (GP), microwave-assisted glycerine (MG; 800 W, 50 s), and autoclave-assisted thermal (AT; 121 °C, 58 min). Marginal and internal discrepancy were measured at 11 points using triple-scan superimposition. Microtensile bond strength (µTBS) was assessed per tooth. Results: Post-curing protocol significantly affected fit (F(3, 37.6) = 24.47, p < 0.001, η² = 0.494) and µTBS (F(3, 39.8) = 6.09, p = 0.002, η² = 0.195). GP showed the lowest discrepancy (77.09 ± 5.48 µm) and highest µTBS (21.58 ± 4.35 MPa), whereas MG showed the highest discrepancy (104.42 ± 13.57 µm) and lowest µTBS (15.04 ± 5.13 MPa). Adhesive failures were more frequent with MG than GP (68.4% vs. 0%; χ²(6) = 25.65, p < 0.001). Fit and bond strength were weakly correlated. Conclusions: Glycerine shielding improved fit and dentine bond strength, whereas microwave post-curing resulted in inferior performance.

Abstract: Osseointegration is strongly influenced by the physicochemical properties of implant surfaces, including topography, roughness, and biofunctionalization. This study investigated the effects of laser surface texturing and hydroxyapatite (HA) biofunctionalization on the viability, morphology, and inflammatory profile of human osteoblasts. Ti-6Al-4V discs were mechanically polished or laser-textured using an Nd laser to generate checkerboard patterns with spatial periodicities of 0.25 or 0.8 mm. Textured surfaces were subsequently coated with nanohydroxyapatite and sintered using either conventional furnace or CO₂ laser sintering. Immortalized human osteoblasts (hFOB 1.19) were cultured on the seven experimental surfaces for up to 14 days. Cell viability was assessed by a resazurin-based assay, while cell adhesion and morphology were evaluated by scanning electron microscopy. IL-1β, IL-8, and IL-10 secretion was quantified by ELISA. Smooth titanium exhibited higher osteoblast viability than textured surfaces, whereas the 0.25 mm pattern generally performed better than the 0.8 mm pattern. HA biofunctionalization consistently improved viability within both texture patterns, irrespective of the sintering method, while the sintering technique itself had no significant effect. The 0.8 mm pattern showed lower IL-1β secretion, whereas IL-10 remained largely unchanged. Within the limitations of this in vitro study, the 0.25 mm texture combined with HA biofunctionalization showed a more favorable cellular response than the 0.8 mm pattern. Further studies should characterize baseline surface roughness and investigate corrosion and microbiological responses.

Abstract: Aim: to evaluate how adding vancomycin to the xenograft in the infected socket affects bone preservation during immediate implant placement. Background: Proper dental implant placement is crucial for successful osseointegration, as the resultant tiny gaps between the implant and bone can affect implant stability. These gaps are better filled with xenografts, which are easy to handle, widely available, and provide an osteoconductive framework that supports better implant outcomes. It’s also important to prevent nearby infections, since the infected socket can damage both soft and hard tissues, raising the risk of peri-implantitis and further implant failure. Applying locally delivered antibiotics during placement can help protect and manage against early infections. Patients and methods: Twenty patients with mandibular extraction sockets participated in the study divided into two groups: 10 patients received a xenograft mixed with vancomycin (Group I), and 10 patients received a xenograft alone (Group II). Implant stability was assessed clinically at baseline and at 6 months only, while CBCT scans were used to monitor crestal bone loss and bone density at baseline, 6 months, and 9 months. Post-surgical complications were also monitored throughout the study period. Results: Group I showed a significant increase in stability over Group II over time, with less marginal bone loss. While baseline bone density was slightly higher in Group I, the difference became significant by 6 months and stayed that way at 9 months. Group II also improved; gains were consistently greater in Group I. Moreover, there is no significant difference between the studied groups regarding the incidence of complications such as infection, swelling, and edema. Conclusion: The results highlight the impact of local delivery of vancomycin plus xenograft (Group I) compared with xenograft alone (Group II), with a greatly promising effect on stability, bone density, and limiting marginal bone loss in dental implants. However, further well-designed studies with large sample sizes and adequate follow-up periods are necessary.

Abstract: Background/Objectives: Children who experience high levels of dental anxiety tend to exhibit poor cooperation during dental visits, which compromises treatment outcomes and leads to a vicious cycle with poor oral health and caries prevention outcomes. The purpose of this study is to analyze the prevalence of dental anxiety in a sample of clinical subjects in children and possible correlations with other factors, as well as the longitudinal nature of anxiety. Methods: This cross-sectional and longitudinal study was conducted on a sample of 150 children aged 12 to 18 years in the city of Zagreb and Zagreb County. The MDAS (Modified Dental Anxiety Scale) was used to collect data related to dental anxiety at three time intervals: before the procedure (T1), after the procedure (T2), and after a peri-od of 3 months (T3). Results: Significant differences between the MDAS before and after the procedure were found, suggesting that that dental anxiety decreased in most children (p< 0.001). The MDAS test results were 9.79 and 8.03 for the T1 and T2 periods, respective-ly, indicating mild anxiety. There are statistically significant differences between individ-ual time points T1, T2, and T3 (p< 0.001), and these differences are significant between T1 and T2 (p=0.045) and between T1 and T3 (p=0.012), while between T2 and T3, the differ-ences are not statistically significant (p=0.616). At T1, children mostly exhibited mild den-tal anxiety (55.3%), followed by moderate (41.3%) and severe dental anxiety (3.3%). At T2, children mostly exhibited mild dental anxiety (77.2%), followed by moderate anxiety (22.8%) and no severe dental anxiety. Financial influence on the use of dental services (p=0.014), the type of dental service/public/private/semi-private (p=0.021), and experience with the dentist (p=0.04) were statistically significant factors. The initial MDAS and cari-ogenic diet scores (p< 0.012) have a negative correlation with the change in the MDAS score; greater fear before the procedure (T1) is associated with a greater reduction in fear after the procedure (T2). A higher cariogenic diet score is associated with a greater reduc-tion in fear after the procedure (T2), while a shorter time since the last visit to the dentist shows negative correlations with the change in the MDAS score, indicating a greater re-duction in fear (p< 0.08). Conclusions: Most of the children in this study had mild to moderate anxiety, which de-creased after a visit to the dentist. Financial influence on the use of dental services, the type of dental service, and experience with the dentist can be associated with dental anxiety. Furthermore, a cariogenic diet and irregular dental check-ups may also be associated with higher dental anxiety. Better oral hygiene and oral status, higher socioeconomic status, and a low cariogenic diet could influence the dental anxiety levels in children.

Abstract: Background/Objectives: Panoramic radiography is the first-line examination before mandibular third molar extraction, but two-dimensional imaging may limit assessment of root proximity to the inferior alveolar canal. This study assessed panoramic risk signs for identifying root–inferior alveolar canal (IAC) contact, using cone-beam computed tomography (CBCT) as the reference standard, and evaluated a selective CBCT referral approach. Methods: This retrospective cross-sectional diagnostic study included 86 mandibular third molars from 62 patients. Four examiners with different clinical experience independently assessed panoramic radiographs for established risk signs. CBCT confirmed root–IAC contact and measured the minimum root–IAC distance. Interobserver agreement, regression analyses, ROC-based diagnostic performance and a selective CBCT indication rule were assessed. Results: Root darkening and cortical interruption were the most frequent signs. Agreement was generally low, although higher between the most experienced examiners. Cortical interruption was the only sign significantly associated with CBCT-confirmed root–IAC contact. Panoramic radiography underestimated the root–IAC distance. The selective rule would have recommended CBCT in 33/86 molars (38.4%) and identified 33/38 confirmed contacts (86.8%). Conclusions: Cortical interruption appears to be the most clinically relevant panoramic sign for selecting mandibular third molars requiring three-dimensional assessment. Structured criteria and senior review in borderline cases may support radiation justification and avoid routine CBCT use.

Abstract: Background: The aim of this in vitro study was to compare the cyclic fatigue resistance and fractured fragment length of three NiTi rotary systems of identical tip size and taper (25/.06). Nickel–titanium rotary instruments fracture unpredictably in curved canals, and no cyclic fatigue data have been published for either the Endo Magic All in One or the Denco Pro-Flexi system; this study provides the first independent fracture data for both, benchmarked against the established One Curve Mini.Methods: A total of 60 instruments (n = 20 per group) of One Curve Mini 25/.06, Denco Pro-Flexi 25/.06, and Endo Magic All in One 25/.06 were tested. Cyclic fatigue testing was performed in an artificial canal within a stainless-steel block (60° curvature angle, 5 mm radius of curvature, 1.5 mm internal diameter) in distilled water at 35 ± 1 °C. Instruments were rotated at 300 rpm until fracture. The number of cycles to failure (NCF) was calculated, fragment lengths were measured with a digital caliper, and cross-sectional geometry was evaluated by scanning electron microscopy (SEM). Data were analyzed using the Kruskal–Wallis and Dunn’s test (α = 0.05). Results: Significant differences were found among the groups for both NCF and fragment length (p < 0.001). The highest NCF was recorded for Endo Magic All in One (9165.50 ± 2049.58), followed by One Curve Mini (3007.50 ± 470.79) and Denco Pro-Flexi (2023.00 ± 1134.43); all pairwise comparisons were significant. Fragments in the Denco Pro-Flexi group were significantly longer (7.51 ± 1.05 mm). SEM revealed circular, triple-helix, and square cross-sections for Endo Magic All in One, One Curve Mini, and Denco Pro-Flexi, respectively. Conclusions: Instruments identical in tip size and taper differed up to 4.5-fold in cyclic fatigue resistance, so comparable fracture risk cannot be assumed from these specifications alone; fragment length data further indicate that the least resistant system also separates at a level that complicates retrieval. Cross-sectional geometry differed between the systems and offers a partial mechanical explanation; no metallurgical characterisation was performed, so the contribution of alloy behaviour was not established.

Abstract: Background: Implant-prosthetic rehabilitation of single-tooth edentulism often requires orthodontic reshaping of the potential implant-prosthetic space because its dimensions change due to the migration of adjacent teeth. In this context, it is very important to understand the force system generated by orthodontic arches in order to control tooth movement and to achieve, at the end of orthodontic treatment, the correct dimensions of the potential implant-prosthetic space for dental implant placement. Materials and Methods: The study was based on a set of 658 CBCT images from a 25-year-old female patient with maxillary and mandibular lateral edentulism. The images were processed using InVesalius and Geomagic software for the three-dimensional reconstruction of bone, dental, and periodontal ligament structures. Orthodontic components, including brackets, adhesive, and round-section nickel-titanium wires with a diameter of 0.012 inches, were modeled in SolidWorks. Based on virtual measurements of the wire geometry and using the relationships from the Theory of Elasticity and Strength of Materials, the elastic forces and reactions at the bracket components were calculated. Results: The study revealed an uneven distribution of forces along the orthodontic arches. For the upper arch, the elastic force values ranged from 0.044 to 0.383 N, and for the lower arch, from 0.050 to 0.308 N. The calculated reactions at the bracket components also varied depending on the orthodontic archwire geometry and the position of the support points. Conclusions: Three-dimensional modeling based on CBCT data, combined with classical methods of mechanics, allows for a personalized assessment of the force system in an orthodontic appliance. The results confirm the major influence of archwire geometry and bracket positioning on mechanical stresses and provide a basis for the biomechanical optimization of pre-implant orthodontic treatment.

Abstract: Background/objective: Minimally invasive dentistry advocates selective caries removal to preserve affected dentin, protect pulpal vitality, and maintain tooth structure. To compare selective caries removal using Brix3000® and polymer burs (PolyBur®) with conventional caries removal in deep dentinal lesions. Methods: Thirty extracted human molars with deep carious lesions were sectioned using a split-tooth design (n = 15). One half underwent selective caries removal with either Brix3000® or PolyBur®, while the corresponding half received conventional caries removal. Caries removal was completed according to predefined visual and tactile endpoints. Residual dentin thickness was assessed radiographically and stereomicroscopically. Operative time, residual infected dentin, and pulpal exposure were also evaluated. Statistical significance was set at p < 0.05. Results: Pulpal exposure occurred in one Brix3000® specimen, two PolyBur® specimens, and four corresponding controls, resulting in final sample sizes of 12 and 11 specimens, respectively. Both selective techniques preserved significantly more dentin than conventional caries removal. Radiographically, residual dentin thickness was greater with Brix3000® than with its corresponding control (p = 0.02), whereas the difference between PolyBur® and its control was not significant (0p = 0.06). No significant differences were found in residual infected dentin between Brix3000® and PolyBur®. Brix3000® preserved significantly more sound dentin but required the longest operative time (p < 0.001). Conclusions: Both selective caries removal techniques preserved more dentin than conventional caries removal. Brix3000® was the most conservative technique, preserving significantly more sound dentin than PolyBur®, although at the expense of longer operative times. These findings support selective caries removal as a minimally invasive approach for managing deep dentinal lesions.

Abstract: Background/Objectives: Photobiomodulation (PBM) has been proposed to regulate periodontal tissue remodeling, but its effects on osteoblastogenesis in periodontal ligament stem cells (PDLSCs) remain highly dependent on laser parameters. This study investigated whether irradiation with a 940-nm diode laser elicits a biphasic dose-response in proliferation and osteoblastic differentiation assays of human PDLSCs. Methods: Six human PDLSC lines were established and characterized using flow cytometry and multilineage differentiation assays. Cell proliferation was assessed after irradiation with fluences of 1, 2, 4, and 10 J/cm². Osteoblastogenesis was induced under suboptimal or complete osteogenic conditions and evaluated by Alizarin Red staining on day 21. The expression of osteogenic genes (RUNX2, BMP2, SPP1, TGFB1, COL1A1, ALPL, and BGLAP) was evaluated by qRT-PCR at different time points. Culture supernatants were analyzed for soluble osteogenic mediators. Results: The established PDLSC lines had an MSC-like phenotype, robust osteogenic potential, moderate chondrogenic potential, and weak or no adipogenic potential. Proliferation of PDLSCs was considerably increased by PBM at 2 J/cm² on day 7, whereas fluences of 4 and 10 J/cm² inhibited proliferation. Osteoblastic mineralization was increased at 2 J/cm² but was markedly reduced at 10 J/cm². Gene expression analysis confirmed this biphasic response under optimal culture conditions. Irradiation with 2 J/cm² upregulated all the analyzed genes, whereas 10 J/cm² downregulated RUNX2, BMP2, SPP1, COL1A1, and BGLAP. PBM at 2 J/cm² also increased production of soluble BMP-2, OPG, PDGF-BB, ALP, and Leptin in a time-dependent manner. Conclusions: PBM exerts a biphasic effect on human PDLSCs that critically depends on PBM fluency. A lower energy density of 2 J/cm² promotes proliferation and osteoblastogenesis, whereas higher energy densities, particularly 10 J/cm², are inhibitory.

Abstract: Background: The odontogenic keratocyst (OKC) is an aggressive intraosseous cyst with a high recurrence rate. Optimal surgical management remains debated, and independent predictors of recurrence require further analysis. The aim of this study is to evaluate surgical treatment outcomes for OKC across a spectrum of approaches and to identify clinical, demographic, and histopathological predictors of recurrence over long-term follow-up. Methods: A multicenter retrospective study was conducted. A total of 113 patients with histologically confirmed OKC treated between 2015 and 2025 were included. univariate and multivariate logistic regression analyses were performed to assess associations between clinical variables and recurrence. Results: First-stage recurrence occurred in 47/113 patients (41.6%). Histotype was the only independent predictor of recurrence, with 85% of parakeratinized and 15% of orthokeratinized cases. No recurrences were observed among 8 patients treated with excision combined with adjuvant therapy (cryotherapy or topical 5-fluorouracil), compared with 44.8% in the remaining cohort. Analyses for second- and third-stage recurrence did not identify significant predictors, likely due to limited event numbers. Conclusions: Parakeratinized histotype is the dominant predictor of OKC recurrence. Adjuvant therapy — particularly topical 5-fluorouracil or cryotherapy — was associated with absence of recurrence and should be considered in standard management. Long-term follow-up is essential.

Abstract: Objectives: To evaluate the effect of different healing abutment materials and 3D-printing orientations on microbial adhesion by comparing commercially available titanium abutments with customized composite resin and 3D-printed healing abutments. Materials and Methods: Fifty healing abutments were allocated into five groups (n=10); commercially available titanium (control), customized healing abutment resin composite CHA-Composite, and 3D-printed customized healing abutments printed on 0°, 45°, and 90° orientations; (CHA-3DP-0, CHA-3DP-45, CHA-3DP-90). Following sterilization, specimens were incubated with standardized suspensions of S. aureus and C. albicans for 24 h. Adherent microorganisms were quantified by colony-forming unit (CFU) analysis, and representative specimens were examined using scanning electron microscopy (SEM). Data were analyzed using one-way ANOVA with Tukey’s post hoc test (α = 0.05). Results: Significant differences in microbial adhesion were observed among the experimental groups for both C. albicans and S. aureus (P < 0.001). 3D-printed healing abutments at the 0° orientation demonstrated the lowest CFU counts for both microorganisms, significantly lower than all other groups (P < 0.001). In contrast, the 45° and particularly the 90° printing orientations exhibited significantly greater microbial adhesion. SEM findings corroborated the quantitative results, revealing reduced biofilm accumulation on 0°-3D-printed surfaces and more extensive biofilm formation on the 45° and 90° groups. Conclusions: Healing abutment material and 3D- printed abutments influence early microbial adhesion. The CHA-3DP-0 group showed the lowest S. aureus and C. albicans colonization, suggesting that optimized printing orientation may reduce biofilm formation. Further clinical and in vitro investigations are needed to confirm these findings.

Abstract: Background/Objectives: Hypertension is associated with sympathetic hyperactivity, abnormal bone metabolism, and enhanced bone resorption. Orthodontically induced inflammatory root resorption (OIRR) involves periodontal ligament inflammation, odontoclast induction, and resorption of cementum and dentin. This study investigated whether hypertension exacerbates OIRR and whether the selective β2-adrenergic receptor (β2-AR) antagonist butoxamine (BTX) suppresses these changes in spontaneously hypertensive rats (SHR). Methods: A 50-gf Ni-Ti closed-coil spring was placed between the maxillary incisors and left first molar in SHR and Wistar-Kyoto (WKY) rats for 21 days, beginning 7 days after BTX administration. Animals were assigned to WKY(control), WKY(BTX), SHR(control), and SHR(BTX) groups. Tooth movement distance, root length, and root volume were assessed by micro-computed tomography. Odontoclast number and surface, TNF-α expression, cementocyte number, empty lacunae ratio, and TUNEL-positive cells were evaluated histologically. Results: Compared with WKY(control), SHR(control) showed greater tooth movement, reduced root length and volume, increased odontoclast number and surface, a higher empty lacunae ratio, more TUNEL-positive cells, fewer cementocytes, and a higher TNF-α immunostaining score. These root resorption- and inflammation-related changes were significantly suppressed in SHR(BTX) compared with SHR(control). Conclusions: Hypertension-associated sympathetic hyperactivity may exacerbate OIRR by enhancing periodontal inflammation, odontoclast induction, and cementocyte damage. Blocking β2-AR signaling may therefore represent a potential strategy for controlling OIRR under hypertensive conditions.

Abstract: Introduction: Primordial odontogenic tumor (POT) is an exceptionally rare benign mixed odontogenic neoplasm recognized as a distinct entity in the 2017 World Health Organization classification of head and neck tumors. Owing to its rarity and overlapping clinicopathological features with other odontogenic lesions, establishing the diagnosis before definitive treatment remains challenging. Case Report: We report the case of a 2-year-old boy presenting with rapidly progressive swelling of the left maxilla associated with facial asymmetry and orbital displacement. Initial incisional biopsy performed at another institution suggested odontogenic myxoma. Computed tomography and magnetic resonance imaging demonstrated a large, well-defined expansile lesion occupying the left maxillary sinus with extensive bone thinning, cortical perforation and compression of the orbital contents. Because of the lesion extent, ocular involvement, and the presumed diagnosis, subtotal maxillectomy with immediate soft tissue reconstruction using an anterolateral thigh free flap was performed. Histopathological examination of the entire surgical specimen established the final diagnosis of primordial odontogenic tumor. At 24 months of follow-up, no evidence of recurrence was observed, and visual function remained normal. Conclusions: This case illustrates the diagnostic limitations of incisional biopsy in biphasic odontogenic tumors and highlights the importance of integrating clinical, radiological, and histopathological findings. Although POT generally demonstrates benign biological behavior, extensive lesions involving critical anatomical structures may require individualized surgical management.

Abstract: Background: With an increasing demand for aesthetic treatments, tooth bleaching is becoming a common procedure. Thus, a range of bleaching products are nowadays available at the market. As it is important to consider adverse effects on surrounding soft tissue, the paper aims at evaluating possible cytotoxic effects on fibroblasts in vitro. Respectively, commonly used gingiva barriers should also be critically examined regarding biocompability. Methods: Seven At-Home bleaching products (Opalescence 10/ 15/ 20, Perfect Bleach 10, Perfect Bleach 16, Viva Style 16 and White Strips), two In-Office products (Easy White Ready Kit and Opalescence Quick) and two gingiva barrier products (Easydam and Opaldam) were used for cytotoxic evaluation on primary human fibroblasts after 48h. Quantitative evaluation was performed using a cell counter for cell viability and qualitative evaluation was performed using cytotoxic grading based on morphological assessment according to ISO 10993-5. Results: There were no significant differences regarding viable cells between At-Home and In-Office bleaching products nor between gingiva barriers and the cell control. All In-Office bleaching products and three At-Home products (Opalescence 15 and 20 and Perfect Bleach 16) showed significant fewer viable cells than the cell control. Based on the qualitative assessment, the same bleaching products, except for Perfect Bleach 16, could be categorized as cytotoxic according to ISO 10993-5. Conclusions: Cytotoxic effects could be observed within At-Home and In-Office bleaching products by qualitative and/or quantitative means. Gingiva barriers showed no cytotoxic effects and their use as part of bleaching treatments seems to be beneficial for protecting the surrounding soft tissue.

Abstract: Background/Objectives: Artificial intelligence (AI) is entering clinical dentistry more quickly than the professional, ethical, and regulatory frameworks intended to govern it. Responsible implementation depends not only on diagnostic performance but on trust, professional autonomy, and clear accountability—dimensions rarely examined across the different stakeholder groups who shape dental care. This study assessed perceptions of trustworthy AI, distributed professional responsibility, and regulatory preparedness among dental and non-dental stakeholders in Romania. Methods: A multidisciplinary cross-sectional survey, reported in accordance with the CROSS guideline, was administered to dental professionals, legal professionals, forensic physicians, and other healthcare stakeholders. The instrument addressed AI literacy, governance and accountability, ethics and transparency, and clinical implementation. Responses were compared across professional groups using chi-square and Kruskal–Wallis tests with Benjamini–Hochberg or Holm correction, and the questionnaire structure was evaluated by exploratory and confirmatory factor analysis. Of 304 submissions, 287 were retained for analysis. Results: Agreement on ethical and governance safeguards was high (84–91%), including testing on diverse populations, independent auditing, and patient disclosure. Between-group differences concentrated in AI awareness, literacy, and education, and in governance and accountability, whereas ethics and transparency items showed broad consensus. Accountability was distributed across clinicians (77.4%), developers (49.5%), and healthcare institutions (28.3%), and only a minority reported AI Act awareness (32.8%) or AI-specific training (25.2%). Conclusions: Romanian stakeholders share strong normative expectations for trustworthy clinical AI but remain underprepared in regulatory and educational terms. Bridging this gap requires structured training, certification before clinical use, and governance frameworks that recognize responsibility as shared across the professionals and institutions involved.

Abstract: Objectives: The aim of this case report is to demonstrate that the Invisalign® clear aligner system is an effective and optimal therapeutic option for the treatment of Class II Subdi-vision malocclusion in adolescent patients. Methods: Z.E., a 13.3-year-old Caucasian female adolescent, presented with permanent dentition, Class II Subdivision malocclusion characterized by a Class II molar and canine relationship on the right side and a Class I molar and canine relationship on the left side, increased overjet and overbite, improper inclination of the upper incisors with diastemas, diastemas also present in the lower arch, and non-coincident midlines. The Invisalign® Comprehensive package was selected, and three sets of clear aligners were planned. The patient was instructed to wear the aligners full-time and to change every 7 days. At each follow-up appointment, scheduled every 4 weeks, a single operator assessed aligner fit, attachment positioning, and patient com-pliance. The treatment plan included expansion and restoration to achieve optimal upper and lower arch form, sequential distalization at 50% in the upper right quadrant, Class II elastics, and a “frog-staging” pattern for upper anterior retraction to achieve appropriate vestibular inclination (torque) of the upper incisors during the final phase. Results: Functional occlusion with Class I molar and canine relationships was achieved on both sides. Proper inclination of the upper and lower incisors was obtained. Good inter-cuspation and coincident midlines were observed at the end of treatment. Conclusions: In this case of Class II Subdivision malocclusion, effective esthetic and stable results were achieved using the Invisalign® clear aligner system.

Abstract: Background/Objectives: Implant impressions can present inaccuracies, affected by many factors, such as impression technique, impression material, parallelism or not among the implants. The use of a verification index can assess the accuracy of the mastercast, and can be used in order to adjust the inaccuracy of the mastercast. This article presents a novel technique for fabricating a verification index, followed by implant analog repositioning, which can be used in case of an impression inaccuracy. Case Presentation: A patient with moderate gag reflex received an implant. The impression of an implant and a prepared tooth was made. At the metal try-in an inaccuracy of the mastercast was found, attributed to the final impression. A technique was illustrated, describing a poly-methel methacrylate (PMMA) transfer index fabrication, as well as the implant analog repositioning in the removable die of the master cast. This method can skip the remaking of a new impression. The novelty in this technique is the repositioning of the implant analog in the removable die. Conclusions: This is a viable technique, which can replace the need for a new impression, and therefore skip one appointment. It is important for patients with moderate to severe gag reflex, since it can minimize the discomfort and stress for the patient and the dentist.