Journal Of Dentistry[JOURNAL]
Sun
200 papers
Association of Toothbrushing, Dental Flossing, and Interdental Brushing with Stroke Risk.
Park S, Kim DE, Park SJ … +6 more , Song J, Kim HJ, Lee SK, Shin HY, Cho HJ, Park SM
J Dent · 2026 Jul · PMID 42401333 · Publisher ↗
OBJECTIVES: Stroke is the second leading cause of death globally. While daily toothbrushing is widely promoted for oral hygiene, the preventive impact of adjunctive oral hygiene practices, such as dental flossing and int...
OBJECTIVES: Stroke is the second leading cause of death globally. While daily toothbrushing is widely promoted for oral hygiene, the preventive impact of adjunctive oral hygiene practices, such as dental flossing and interdental brushing, on stroke risk remains unclear. This study aimed to investigate the association between comprehensive oral hygiene behaviors and the risk of stroke. METHODS: We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance Service-Health Screening cohort. A total of 98,866 adults aged ≥40 years who underwent both general and oral health examinations during 2009-2010 were included. Participants were followed from January 2011 to December 2019. Individuals with pre-existing cardiovascular disease, death before baseline, or missing data were excluded. Oral hygiene behaviors, including daily toothbrushing frequency and weekly use of dental floss and interdental brushes, were self-reported. The primary outcome was incident stroke requiring hospitalization for ≥2 days and was classified as total, ischemic, or hemorrhagic stroke according to diagnostic codes. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: During follow-up, participants with favorable oral hygiene behaviors showed a lower risk of stroke compared with those with poor oral hygiene practices. In multivariable-adjusted analyses, individuals who brushed their teeth at least twice daily and regularly used dental floss and interdental brushes had a 23% lower risk of ischemic stroke (adjusted hazard ratio [aHR] 0.77, 95% CI 0.63-0.94). A significant dose-response relationship was observed across categories of oral hygiene behaviors. CONCLUSIONS: Frequent toothbrushing combined with regular use of dental floss and interdental brushes was associated with a reduced risk of ischemic stroke. These findings suggest that comprehensive oral hygiene practices may provide additional benefits for stroke prevention. CLINICAL SIGNIFICANCE: Comprehensive oral hygiene behaviors, including regular toothbrushing, dental flossing, and interdental brushing, may contribute to stroke prevention beyond conventional vascular risk factor management. Promoting adjunctive oral hygiene practices could represent a simple, accessible, and population-based strategy for reducing ischemic stroke risk in middle-aged and older adults.
Cervical critical dentin in non-carious cervical lesions: relationship with remaining dentin thickness and implications for restorative decision-making.
de Abreu NMR, Dantas NV, Cunha D' Assunção FL … +2 more , Loguercio AD, de Sousa FB
J Dent · 2026 Jul · PMID 42401332 · Publisher ↗
OBJECTIVES: To define the critical cervical dentin region (CCD), an anatomical region extending from the cervical enamel limit to the occlusal limit of tertiary dentin, in non-carious cervical lesions (NCCLs), to test it...
OBJECTIVES: To define the critical cervical dentin region (CCD), an anatomical region extending from the cervical enamel limit to the occlusal limit of tertiary dentin, in non-carious cervical lesions (NCCLs), to test its association with dentin thickness, and to evaluate the diagnostic performance of CCD- and depth-based predictors for detecting critical remaining dentin thickness (RDT ≤ 1.0 mm; a criterion for placement of restoration). MATERIALS AND METHODS: A total of 139 natural NCCLs from extracted human premolars were analyzed using micro-computed tomography. Lesion depth, lesion height, depth/height ratio, CCD height, and RDT were measured using standardized cross-sectional images. Linear regression assessed the association between lesion depth and RDT. Risk ratios assessed the associations of CCD with the RDT and lesion depth. Diagnostic performance for detecting critical RDT was tested using restoration predictors (maximum lesion depth, probing lesion depth, and CCD involvement), including morphology-guided sensitivity analyses of diagnostic performance. RESULTS: Each 1-mm increase in lesion depth reduced RDT by 0.637 mm. The CCD showed the highest occurrence of the lowest RDT, critical RDT, and lesion depth. CCD inner-half involvement and probing depth ≥ 1.5 mm predictors showed good performance when lesion height ≤ 2.5 mm, otherwise diagnostic performance varied across tomographic profiles. CONCLUSIONS: The CCD concentrated the lowest RDT. RDT can be detected with probing lesion depth or CCD involvement when height ≤ 2.5 mm, otherwise a tomography would be required. CLINICAL SIGNIFICANCE: Restorative need decision can be made using probing depth cutoff 1.5 mm when height ≤ 2.5 mm.
Periodontal and Prosthodontic Outcomes of Zirconia Single Crowns and FPDs with Biologically Oriented Preparation Technique: 10-Year Prospective Study.
Serra-Pastor B, Loi I, Fons-Badal C … +4 more , García-Selva M, Peláez-Rico J, Zubizarreta-Macho A, Agustín-Panadero R
J Dent · 2026 Jul · PMID 42401331 · Publisher ↗
OBJECTIVES: The purpose of this prospective clinical study was to evaluate the 10-year performance of zirconia single crowns and fixed partial dentures placed on teeth prepared with the BOPT, assessing periodontal and pr...
OBJECTIVES: The purpose of this prospective clinical study was to evaluate the 10-year performance of zirconia single crowns and fixed partial dentures placed on teeth prepared with the BOPT, assessing periodontal and prosthodontic parameters. MATERIALS AND METHODS: The sample (33 patients) was divided into 2 groups: 39 abutment teeth supporting single crowns and 52 abutment teeth supporting fixed partial dentures. A control group consisting of untreated antagonist teeth was included. Periodontal parameters were gingival margin stability, gingival index, plaque index, and probing depth; all were recorded annually. Additional parameters such as gingival thickness, biological and mechanical complications, and patient satisfaction were also analyzed. RESULTS: After 10 years, 94.9% of single crowns and 90.4% of fixed partial dentures exhibited no gingival recession. The mean gingival index was 0.5 for single crowns and 0.69 for fixed partial dentures. The mean plaque index remained below 1 in both groups. Probing depth was less than 3 mm in 94% to 97% of the sample. Gingival thickness increased by 0.44 mm in the single-crown group and by 0.49 mm in the fixed partial dentures group. Low rates of biological and mechanical complications were observed in both groups. CONCLUSIONS: Within the limitations of this 10-year prospective study, zirconia restorations fabricated with the BOPT demonstrated favorable periodontal health and clinical stability, with no significant differences between restoration types. CLINICAL SIGNIFICANCE: This study indicates that the biologically oriented preparation technique (BOPT) is a reliable option for zirconia single crowns and fixed partial dentures. BOPT was associated with stable gingival margins, increased buccal gingival thickness, low complication rates, and favorable periodontal health, supporting its use when long-term soft tissue stability and esthetic integration are desired.
Pre-clinical evaluation of the anticaries effect of an experimental Malva sylvestris extract mouthwash using a cariogenic model in situ.
Braga AS, Figueira LGT, Kim RR … +3 more , Vertuan M, Esteves-Oliveira M, Magalhães AC
J Dent · 2026 Jul · PMID 42398621 · Publisher ↗
OBJECTIVE: The aim of this study was to evaluate the antimicrobial and anticariogenic potential of Malva sylvestris extract on enamel and dentin in situ. METHODS: A double-blind crossover in situ study was conducted with...
OBJECTIVE: The aim of this study was to evaluate the antimicrobial and anticariogenic potential of Malva sylvestris extract on enamel and dentin in situ. METHODS: A double-blind crossover in situ study was conducted with 12 participants wearing palatal appliances containing two bovine enamel and two dentin specimens per 3 phases, a total of 72 enamel and dentin specimens. Biofilm formation and daily sucrose exposure were allowed. Treatments were applied twice daily in three phases: Malva sylvestris (2.5%, MS); fluoride (225 ppm, F); and placebo (P). After seven days, biofilm was collected from the bovine specimens for analysis of Lactobacillus spp. and mutans streptococci by Colony Forming Unit counts (CFU log₁₀/mL). Dental demineralization of the bovine specimens was assessed by transverse microradiography (TMR). RESULTS: MS did not reduce Lactobacillus spp. counts (CFU log₁₀/mL: enamel 6.63±0.81; dentin 6.68±0.92) compared to P (6.63±0.70; 6.62±0.51). F also did not differ (6.29±0.75; 6.32±0.41; ANOVA/Tukey,p>0.38). Mutans streptococci data were inconclusive. In enamel, both MS (2320.8±768.2 %vol·µm; 101.6±27.0 µm) and F (1777.3±733.3 %vol·µm; 95.8±23.5 µm) significantly reduced mineral loss and lesion depth compared to P (3517.2±1119.9 %vol·µm; 138.6±19.5 µm; ANOVA/Tukey,p≤0.0003). In dentin, MS significantly reduced mineral loss (322.5 [250-580] %vol·µm) and lesion depth (30.1 [15-42.2] µm) compared to P (880 [580-1705]; 58.3 [32.2-88.6] µm; Kruskal-Wallis/Dunn,p≤0.001), while F (587.5 [305-720]; 25.2 [16.5-38.8] µm) did not differ significantly (p>0.05). CONCLUSIONS: Malva sylvestris extract had no antimicrobial effect on Lactobacillus spp. counts, but significantly reduced enamel and dentin demineralization, showing anticaries effect comparable to fluoride. CLINICAL RELEVANCE: Malva sylvestris has demonstrated promising biological activity. This study investigates the antimicrobial efficacy of Malva sylvestris against cariogenic microorganisms in situ. Our findings provide relevant evidence that M. sylvestris exert significant anticaries effects using an in situ model.
Five-Year Outcomes of Zirconia and Fiber-Reinforced Composite Cantilever Inlay-Retained Fixed Dental Prostheses with Different Retainer Designs: A Randomized Controlled Clinical Trial.
Kasem AT, Tribst JPM, Abo-Madina M … +1 more , Al-Zordk W
J Dent · 2026 Jul · PMID 42392351 · Publisher ↗
OBJECTIVE: To evaluate and compare the clinical performance of three retainer designs of cantilever inlay-retained fixed dental prostheses (IR-FDPs) fabricated from zirconia and fiber-reinforced composite over 60 months....
OBJECTIVE: To evaluate and compare the clinical performance of three retainer designs of cantilever inlay-retained fixed dental prostheses (IR-FDPs) fabricated from zirconia and fiber-reinforced composite over 60 months. METHODS: This prospective randomized controlled clinical trial included 47 patients with 60 IR-FDPs requiring replacement of mandibular second premolars. Patients were randomly allocated into three groups according to retainer design: inlay ring (IR), lingual coverage (LC), and occlusal coverage (OC) (n = 20 each). Each group was further subdivided based on material into zirconia (Z) and fiber-reinforced composite (FRC) (n = 10). Randomization was performed using a computer-generated sequence with allocation concealment via sealed opaque envelopes. All restorations were adhesively bonded following standardized preparation protocols. Clinical and radiographic evaluations were conducted over 60 months using modified FDI criteria. Monte Carlo tests were used to compare qualitative data between groups as appropriate. Cochran's Q test was used to compare more than 2 follow-up readings for qualitative data. RESULTS: No statistically significant differences were observed among the groups (P > 0.05) in clinical performance, with satisfactory esthetic, functional, and biological outcomes according to modified FDI criteria. Five failures requiring replacement were recorded, including two zirconia connector fractures, two debonding-related failures, and one irreversible framework deformation. In addition, six complications were observed, including debonding, plastic deformation, veneering composite delamination, minor veneering chipping, and two cases of secondary caries, all of which were successfully managed without replacement. Zirconia failures tended to occur as connector fractures or loss of retention, whereas FRC restorations showed predominantly repairable complications with occasional progressive deformation. The overall survival rate was 91.7%, while the success rate was 81.7%. CONCLUSION: Within the limitations of this randomized controlled clinical trial, zirconia and fiber-reinforced composite cantilever IR-FDPs demonstrated favorable 5-year clinical performance with high survival rates. Apparent differences in failure behavior between materials should be considered exploratory and interpreted cautiously because of the limited number of observed failures. CLINICAL SIGNIFICANCE: Cantilever IR-FDPs with different retainer configurations, including the inlay ring design, provide reliable, conservative, and long-term treatment options for posterior tooth replacement.
ACCURACY OF 2D FACIAL PROFILE PHOTOGRAPHS UNDER ROUTINE CLINICAL CONDITIONS COMPARED WITH 3D IMAGING.
Opacic J, Kanavakis G, Halazonetis D … +1 more , Gkantidis N
J Dent · 2026 Jul · PMID 42392350 · Publisher ↗
AIM: To assess the accuracy of facial soft-tissue profile lines derived from two-dimensional (2D) photographs acquired under routine clinical conditions, using three-dimensional (3D) facial photographs as the reference s...
AIM: To assess the accuracy of facial soft-tissue profile lines derived from two-dimensional (2D) photographs acquired under routine clinical conditions, using three-dimensional (3D) facial photographs as the reference standard. MATERIALS AND METHODS: This study analysed pre-existing 2D and 3D facial photographs of 160 orthodontic patients. True facial profile lines were generated from 3D photographs using an automated midsagittal plane based on best-fit superimposition of mirrored surface models. Corresponding profile lines were traced on 2D photographs. Fixed landmarks and sliding semilandmarks were placed on predefined profile curves, and configurations were analysed using geometric morphometrics. Pairwise Procrustes superimposition was performed, and Procrustes distances quantified discrepancies between 2D- and 3D-derived profiles. The effects of age and sex were evaluated. RESULTS: Significant differences were found between 2D-derived and 3D reference profiles (P < 0.001). The median discrepancy was 0.75 mm (IQR 0.79 mm; range 0.01-9.36 mm), with the largest differences in the lip region. Although mean discrepancies were small, variability at the individual level was considerable. Differences exceeding ±1 mm and ±2 mm occurred in 35.2% and 8.2% of measurements, respectively. Errors were greater in males and younger subjects, with no significant interaction. CONCLUSIONS: 2D photographs show statistically significant and clinically relevant discrepancies compared with 3D-based profiles. While average errors are small, individual variability should be considered when precise assessment is required. CLINICAL SIGNIFICANCE: Routine 2D facial photographs may be insufficient for accurate individual-level soft-tissue profile assessment. Clinicians should be cautious when using them for diagnosis or treatment planning where precision is critical.
Adhesion of resin composites to 3D-printed dental resins: A study on the effect of surface conditioning methods and repair materials.
Beher L, Tonin BSH, Özcan M … +1 more , Dascanio R
J Dent · 2026 Jul · PMID 42385840 · Publisher ↗
PURPOSE: To evaluate the adhesion of 3D-printed dental resins according to surface conditioning protocol, repair material, and aging condition. METHODS: Disc-shaped specimens (10mm × 2mm) were fabricated from a 3D-printe...
PURPOSE: To evaluate the adhesion of 3D-printed dental resins according to surface conditioning protocol, repair material, and aging condition. METHODS: Disc-shaped specimens (10mm × 2mm) were fabricated from a 3D-printed resin for definitive restorations (Crowntec, Saremco Dental AG). The study design included 36 groups (n=10): 9 surface treatments, 2 repair materials (flowable composite or 3D-printed resin), and 2 aging conditions (before/after thermocycling). Repairs were performed using a hydrophobic adhesive resin (Heliobond). SBS was measured using a universal testing machine, and failure modes were analyzed under stereomicroscopy. Data were analyzed using three-way ANOVA and Tukey's post hoc tests (α = 0.05). RESULTS: Surface treatment (p < 0.001) and repair material (p < 0.001) significantly influenced SBS, whereas aging showed no significant effect (p = 0.539). Tribochemical silica coating + primer and aluminum oxide air abrasion + primer yielded the highest SBS values (>25 MPa), particularly for 3D-printed resin repair (up to 31.27 ± 4.75 MPa). Minimal surface conditioning protocols resulted in significantly lower SBS values (<12 MPa). Failure mode analysis showed predominantly mixed/cohesive failures in high-SBS groups and adhesive failures in low-SBS groups. CONCLUSIONS: Repair performance of 3D-printed resin was mainly influenced by surface conditioning. Mechanical surface treatment combined with primer showed the most promising bonding performance, whereas minimal conditioning protocols resulted in lower adhesion values. Thermocycling did not significantly affect SBS under the tested conditions. CLINICAL SIGNIFICANCE: Reliable repair of 3D-printed dental resins depends on adequate surface conditioning prior to adhesive procedures.
DGADS: A Graph-based Agentic Decision Support System for Precision Dental Question Answering.
Xiong YT, Chen YX, Sun YN … +3 more , Lu AJ, Tang W, Liu C
J Dent · 2026 Jul · PMID 42385839 · Publisher ↗
OBJECTIVES: Large language models (LLMs) have significant potential for dental applications, but their inherent tendency to hallucinate remains a major challenge. This study aims to develop and evaluate a graph-based age...
OBJECTIVES: Large language models (LLMs) have significant potential for dental applications, but their inherent tendency to hallucinate remains a major challenge. This study aims to develop and evaluate a graph-based agentic decision support system for dental question answering. METHODS: We developed a Dental Graph-based Agentic Decision Support System (DGADS) to support precision dental question answering. DGADS comprised three core modules: a knowledge graph builder, a graph-based RAG module, and an agentic RAG module. DGADS transformed a large volume of dental textual knowledge into a knowledge graph, termed DentalKG, and established a graph-based retrieval augmented generation system. DGADS was evaluated on three benchmarks against state-of-the-art LLMs and chunk-based RAG approaches, including internal multiple-choice questions, external multiple-choice questions, and open-ended questions. RESULTS: DentalKG comprised 130,735 entities and 236,935 triples constructed and evaluated between 15 October 2025 and 1 May 2026. DGADS leveraged knowledge from DentalKG to outperform baseline models, achieving absolute accuracy improvements of 0.04 (95% CI: 0.03, 0.06) on 500 internal questions and 0.05 (95% CI: 0.04, 0.07) on 260 external questions. In addition, DGADS improved performance on open-ended questions, with mean scores increasing up to 0.78 points on a 5-point scale. DGADS was able to automatically assess the sufficiency of information retrieved from DentalKG and retrieve relevant data from external information sources. CONCLUSIONS: DGADS has the potential to become a useful research-oriented tool for supporting dental question answering, with the promise of improving the precision and efficiency of broader clinical applications. CLINICAL SIGNIFICANCE: DGADS supports precise dental question answering by grounding LLMs' outputs in a dental knowledge graph and retrieving external evidence when needed. By reducing hallucinations and providing traceable rationale in benchmark-based evaluations, it may help clinicians access reliable information more efficiently in the future.
Preventive Effects of a Strontium‑Containing Nano Bioactive Glass Hydrogel Against Enamel Caries: An In Vitro Study.
Yin IX, Ma VR, Chu CH
J Dent · 2026 Jul · PMID 42385838 · Publisher ↗
OBJECTIVE: To evaluate the antibiofilm and remineralising effects of a functionalised chitosan/nano-strontium phosphosilicate hydrogel (fCS/nSPS) on enamel caries. METHODS: Human enamel blocks were treated with fCS/nSPS...
OBJECTIVE: To evaluate the antibiofilm and remineralising effects of a functionalised chitosan/nano-strontium phosphosilicate hydrogel (fCS/nSPS) on enamel caries. METHODS: Human enamel blocks were treated with fCS/nSPS and incubated with Streptococcus mutans, Actinomyces naeslundii, and Lactobacillus acidophilus. Biofilm morphology, viability, and bacterial surface charge were assessed using scanning electron microscopy (SEM), colony-forming unit (CFU) counting, and a cytochrome C binding assay, respectively. After a cariogenic challenge, surface morphology, crystal characteristics, lesion depth, elastic modulus, and nanohardness were evaluated by SEM, X-ray diffraction (XRD), micro-computed tomography, and nanoindentation. Silver diamine fluoride (SDF) and deionised water served as positive and negative controls. RESULTS: Dense bacterial biofilms formed on water-treated enamel, whereas only sparse biofilm growth was observed on fCS/nSPS- and SDF-treated surfaces. Biofilm viability and bacterial surface charge in the fCS/nSPS and SDF groups were significantly lower than in the water group. A mineral-rich surface layer covered fCS/nSPS- and SDF-treated enamel, while enamel prisms remained exposed on water-treated enamel. XRD revealed stronger crystalline apatite on fCS/nSPS- and SDF-treated enamel, in contrast to poorly crystalline apatite on water-treated enamel. Lesion depths in fCS/nSPS- and SDF-treated enamel were significantly shallower than in water-treated enamel. The elastic modulus and nanohardness of fCS/nSPS- and SDF-treated enamel were significantly higher than those of water-treated enamel. CONCLUSION: The fCS/nSPS hydrogel effectively inhibits cariogenic biofilms and promotes remineralisation of artificial enamel caries lesions in vitro. CLINICAL SIGNIFICANCE: This antibacterial and mineralising nanocomposite hydrogel shows promising potential as a minimally invasive preventive treatment for early enamel caries, particularly in high-caries-risk patients.
Does robotic surgery offer the highest accuracy for delayed implant placement in single-tooth spaces? A network meta-analysis of randomized clinical trials.
Mahardawi B, Jiaranuchart S, Tajmiri G … +2 more , Mattheos N, Pimkhaokham A
J Dent · 2026 Jul · PMID 42385837 · Publisher ↗
OBJECTIVE: The aim of this network meta-analysis was to collectively synthesize the evidence on computer-assisted implant surgery (CAIS), with its static, dynamic, and robotic types, for delayed implant placement in sing...
OBJECTIVE: The aim of this network meta-analysis was to collectively synthesize the evidence on computer-assisted implant surgery (CAIS), with its static, dynamic, and robotic types, for delayed implant placement in single-tooth spaces, in order to explore whether robotic surgery provides comparable accuracy to other implant placement techniques, based on homogenous data from studies with the same design and population. MATERIALS AND METHODS: Literature search was performed in Scopus, MEDLINE/PubMed, and Cochrane library, screening for randomized clinical trials, in which delayed implant placement was performed in single-tooth spaces, reporting information on at least one aspect of platform, apex, and angle deviation. A frequentist network meta-analysis was performed. RESULTS: Eleven studies were included. All CAIS methods demonstrated significantly less deviation compared with freehand implant placement. Robotic CAIS ranked the highest among all techniques and showed significantly less apex deviation than static CAIS (MD= -0.42, 95% CI -0.71; -0.13), as well as lower angle deviation compared with both static and dynamic surgery (MD= -1.65, 95% CI -2.89; -0.40, and MD= -1.26, 95% CI -2.39; -0.13, respectively). The certainty of evidence in the outcomes of the meta-analysis ranged from very low to moderate. CONCLUSION: Robotic surgery provides high accuracy for delayed implant placement in single-tooth edentulous sites, superior to other CAIS methods. Nevertheless, the low number of studies available and limited evidence necessitate further exploration of its overall performance, in order to validate these conclusions. CLINICAL SIGNIFICANCE: This study offers strong insight into the performance of robotic CAIS, and how it compares with the other well-established treatment modalities, thus demonstrating the potential of this technology to reach superior accuracy, which can be utilized in cases demanding high precision, such as immediacy with prefabricated components, or flapless surgery.
Multiomics Analyses in Young Grade C Molar Incisor Pattern Periodontitis.
Alamri MM, Proctor G, Garcia-Guevara F … +4 more , Guennec AL, Mainas G, Shoaie S, Nibali L
J Dent · 2026 Jun · PMID 42379260 · Publisher ↗
OBJECTIVE: To explore the microbial profiles in plaque and saliva and metabolic profiles in saliva and serum collected from young patients (≤25 years old) with grade C molar incisor pattern periodontitis (C/MIP), to comp...
OBJECTIVE: To explore the microbial profiles in plaque and saliva and metabolic profiles in saliva and serum collected from young patients (≤25 years old) with grade C molar incisor pattern periodontitis (C/MIP), to compare them to age-matched controls and integrate both omics to elucidate C/MIP pathogenesis. MATERIAL AND METHOD: Thirty-one young patients with C/MIP and 31 periodontally healthy age-matched controls were recruited. Bacterial profiles were investigated in unstimulated saliva and subgingival plaque using shotgun sequencing metagenomics while metabolic profiles were assessed in saliva using nuclear magnetic resonance and serum using mass spectrometry. Data from both omics analyses were integrated and visualised as interaction networks using Cytoscape software. RESULTS: C/MIP showed significantly lower levels of several salivary (e.g., dimethylamine, proline, glycine) and serum metabolites, and higher levels of others including methyl indole-3-acetate and sulfosalicylic acid, compared to controls (P<0.001). Fifteen bacteria, of which twelve were associated with C/MIP, were differentially prevalent between groups. The plaque microbiome in C/MIP was enriched with pathogenic species such as D. oralis, C. rectus, T. denticola, and P. endodontalis, while health-associated bacteria like R. mucilaginosa and L. hongkongensis were more prevalent in controls. D. oralis and GGB10485-SGB49305 emerged as potential microbial biomarkers. Notably, metabolites such as DL-glutamine and taurine were significantly associated with periodontal pathogens. CONCLUSION: C/MIP is marked by a distinct dysbiotic microbiome and altered metabolic profile. While key pathogens and metabolites likely contribute to disease progression, the underlying mechanisms remain only partially understood due to the complexity and incomplete characterisation of many associated factors. CLINICAL SIGNIFICANCE: This study highlighted the multifactorial nature of C/MIP, driven by microbial dysbiosis, immune disturbances, and metabolic alterations. A comprehensive multi-omics approach offered a foundation for understanding microbial-metabolite dynamics in young patients, and highlighted candidate biomarkers for future diagnostics and therapeutics.
Breath-Based Detection of Oral Diseases Using Sensors and Machine Learning.
Haiek M, Broza Y, Farber A … +4 more , Miropolski M, Haick H, Weiss E, Houri-Haddad Y
J Dent · 2026 Jun · PMID 42379259 · Publisher ↗
OBJECTIVES: Diagnostic limitations contribute to variability in clinical decision-making, highlighting the need for objective diagnostic tools. Biomarker-based approaches enable detection of subclinical pathological chan...
OBJECTIVES: Diagnostic limitations contribute to variability in clinical decision-making, highlighting the need for objective diagnostic tools. Biomarker-based approaches enable detection of subclinical pathological changes and may improve diagnostic accuracy. Exhaled breath contains volatile organic compounds (VOCs) that reflect host and microbial metabolic activity and therefore represent a promising non-invasive diagnostic medium. This study evaluated the feasibility of a nanosensor array outputs to classify caries, gingivitis, periodontitis, and peri-implantitis using breath VOC profiles. METHODS: A priori power analysis (η²=0.02) yielded 346 participants across five oral phenotypes. Exhaled VOCs were analyzed via GC-MS, with a subset assessed using a 40-sensor nanoarray. VOCs were age-adjusted (residual regression), filtered (≥50% presence; 47 compounds), log-transformed, and tested (Kruskal-Wallis, Bonferroni αadj=0.0167). Nanoarray data underwent Principal Component Analysis (PCA) (15 factors; αadj=0.01), Canonical Discriminant Analysis (CDA), and supervised Machine Learning (ML) (80:20 split). RESULTS: GC-MS identified one significant VOC (RT≈2.81 min) differentiating periodontitis from caries (p=0.006) and gingivitis (p=0.043), while 13 VOCs distinguished implant groups (p<0.05). Nanoarray CDA showed two significant functions (Wilks' Λ=0.1697, p<0.0001; 87.64% variance). A 10-sensor ML model achieved 69.6% training and 58.8% validation accuracy. Validation sensitivities were polarized (100% periodontitis/healthy implants; 25-50% others), with high specificities (0.714-1.000) and ROC-AUC (0.88-0.97). CONCLUSIONS: Although validation performance across all disease categories remained variable, and discriminatory capacity was limited for early dysbiotic and non-inflammatory conditions, the predictive models demonstrated strong classification accuracy for inflammatory phenotypes, particularly periodontitis and implant-related states. These findings highlight both the promise of volatilomic diagnostics and the current limitations imposed by sample size, biological variability, and metabolic overlap, particularly in early disease stages. CLINICAL SIGNIFICANCE: Nevertheless, the strong performance observed in inflammatory conditions underscores the potential clinical utility of this platform as a non-invasive adjunct for disease detection and monitoring. Continued advancements in sensor technologies and machine learning methodologies are likely to enhance model robustness and generalizability, facilitating translation into clinical practice.
The influence of psychological factors on biofilm-related oral outcomes in adults: A systematic review of prospective studies.
Valeriani L, Liguori MG, Giovannini A … +2 more , Montevecchi M, Covelli V
J Dent · 2026 Jun · PMID 42379258 · Publisher ↗
OBJECTIVE: The present systematic review aimed to determine whether psychological factors are associated with subsequent biofilm-related oral health outcomes in adults. DATA: The review followed PRISMA guidelines. The pr...
OBJECTIVE: The present systematic review aimed to determine whether psychological factors are associated with subsequent biofilm-related oral health outcomes in adults. DATA: The review followed PRISMA guidelines. The protocol was registered in PROSPERO (CRD420251119213). Risk of bias was assessed using the NHLBI tool. SOURCES: MEDLINE, PsycINFO, and Web of Science were searched through May 2026. STUDY SELECTION: Eligible prospective longitudinal studies in adults assessed a broad range of psychological exposures (e.g., depression, anxiety, stress, self-efficacy, health beliefs, personality traits, and sense of coherence) before oral outcomes. Outcomes included periodontal parameters, dental caries, tooth loss, and oral-hygiene behaviours. RESULTS: Ten prospective studies of fair-to-good quality were included. Findings for cognitive constructs were mixed: self-efficacy was associated with subsequent self-reported oral hygiene behaviours and, following motivation and oral hygiene instruction, clinically assessed plaque control, but not consistently across studies or outcomes; perceived treatment benefits, particularly when combined with perceived susceptibility, and Theory of Reasoned Action variables were associated with subsequent gingival or plaque outcomes. Data on psychopathology were sparse but suggested associations of depression and stress with poorer oral self-care and periodontal outcomes. A small number of studies also indicated possible relationships between personality traits and periodontal and caries outcomes, whereas the only study assessing sense of coherence found no association. CONCLUSIONS: Prospective associations with oral health behaviours or clinical outcomes were observed for several of the psychological constructs examined, although the evidence base remains limited and heterogeneous. More robust longitudinal studies are needed to clarify these relationships across different oral diseases. CLINICAL SIGNIFICANCE: Available prospective evidence suggests that psychological factors may play a role in subsequent oral hygiene behaviours, periodontal outcomes, and treatment response. These findings may inform future research on risk assessment and personalised preventive care.
Ebselen-loaded silver-containing mesoporous bioactive glass for the control of Enterococcus faecalis and Streptococcus mutans in endodontic infections.
Wei CY, Chen WC, Kung JC … +1 more , Shih CJ
J Dent · 2026 Jun · PMID 42373040 · Publisher ↗
OBJECTIVE: Calcium silicate-based sealers are widely used in endodontics, however, their efficacy against persistent biofilms remains limited. This study aimed to investigate the antibacterial and antibiofilm properties,...
OBJECTIVE: Calcium silicate-based sealers are widely used in endodontics, however, their efficacy against persistent biofilms remains limited. This study aimed to investigate the antibacterial and antibiofilm properties, hydroxyapatite (HA)-formation ability, and cytocompatibility of mesoporous bioactive glass loaded with silver and Ebselen (Ebselen/MBG-Ag), a bioceramic material with potential application in future endodontic sealers. METHODS: Silver-containing mesoporous bioactive glass (MBG-Ag) was synthesized via a sol-gel method, followed by Ebselen loading through solvent impregnation to produce Ebselen/MBG-Ag. The synthesized materials were characterized using Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), and energy-dispersive X-ray spectroscopy (EDS) elemental mapping. The release profiles of silver ions and Ebselen were evaluated using inductively coupled plasma mass spectrometry (ICP-MS) and high-performance liquid chromatography (HPLC), respectively. Antibacterial and antibiofilm activities against Enterococcus faecalis (E. faecalis) and Streptococcus mutans (S. mutans) were assessed. The HA-forming ability was evaluated by examining HA deposit on dentin surfaces after immersion in phosphate-buffered saline (PBS). RESULTS: Characterization confirmed the successful synthesis of Ebselen/MBG-Ag and the uniform distribution of silver within the mesoporous matrix. Sustained release of silver ions and Ebselen was observed for up to 336 h. Compared with MBG-Ag alone, Ebselen/MBG-Ag exhibited significantly enhanced antibacterial and antibiofilm activities against E. faecalis and S. mutans. Furthermore, rapid HA formation was observed on treated dentin surfaces. In addition, Ebselen loading reduced the in vitro cytotoxicity of MBG-Ag, indicating improved cytocompatibility. CONCLUSION: The incorporation of Ebselen into MBG-Ag enhanced antibacterial and antibiofilm activities endodontic pathogens, while promoting HA formation and reducing in vivo cytotoxicity. These findings suggest that Ebselen/MBG-Ag may serve as a candidate bioceramic material for future endodontic sealer development. Further long-term in vivo studies are warranted to confirm its biocompatibility, sealing performance, and clinical applicability. CLINICAL RELEVANCE: The novel Ebselen/MBG-Ag bioceramic presents a dual-functional approach for endodontics. By simultaneously eliminating resilient bacterial biofilms and accelerating dentin remineralization via hydroxyapatite precipitation, it effectively targets the main drivers of root canal failure, offering a promising strategy to enhance long-term treatment success.
"How obsessive are dental students?" - A personality styles & disorder inventory-based cross-sectional, controlled study.
Wolf TG, Röthlin C, Hilse L … +1 more , Peter B
J Dent · 2026 Jun · PMID 42365926 · Publisher ↗
OBJECTIVES: To assess whether personality styles vary across student and professional cohorts in dentistry, using psychology controls. METHODS: A total of 249 dental students and 162 practicing dentists were compared wit...
OBJECTIVES: To assess whether personality styles vary across student and professional cohorts in dentistry, using psychology controls. METHODS: A total of 249 dental students and 162 practicing dentists were compared with 160 psychology students and 430 psychotherapists. All participants completed the Personality-Styles-and-Disorders-Inventory (PSDI). Fourteen personality styles were analyzed across disciplines and career stages. RESULTS: MANOVA with post-hoc-tests showed significant differences among the four groups (dental and psychology students and professionals). Both student groups showed strong fluctuations around the normative mean, indicating higher emotional levels and peaks in stress-dependent styles. Dental students showed signs of severe stress and burnout tendencies. Their depression scores were highest, while optimism was lowest. Professionals generally showed lower values than students, often below the norm, indicating "functional adaptation" and professional stability. Psychotherapists showed the most balanced profile with the lowest values. Dentists remained moderately higher than psychotherapists, indicating higher stress. Their most distinctive characteristic was "compulsiveness", reflecting precision and perfectionism, already elevated during training and increasing in practice. While psychotherapists developed from higher stress levels during their studies to a balanced profile, dentists maintained higher stress and increased their perfectionism. CONCLUSIONS: Dentists demonstrate stronger tendencies towards precision and perfectionism than psychologists, who show greater flexibility and openness. Professionalization appears associated with adaptive personality style, although compulsive tendencies in dentistry remain elevated and may increase with clinical experience. These findings suggest an interplay between pre-existing dispositions and occupational socialization. Longitudinal studies are needed to clarify whether these differences are present before training or arise during professional practice. CLINICAL SIGNIFICANCE STATEMENT: Insights into the differences in personality styles between dental students and dentists may inform dental education and prompt further research on dentist-patient relationships and treatment outcomes.
Association between masticatory performance and physical fitness in Japanese elementary schoolchildren: The Osaka MELON Study.
Hiramatsu R, Kosaka T, Otsugu M … +7 more , Nishimoto T, Yoshimatsu M, Murotani Y, Sakanoshita N, Ueda Y, Nakano K, Ikebe K
J Dent · 2026 Jun · PMID 42365925 · Publisher ↗
OBJECTIVES: This study aimed to examine the association between masticatory performance and physical fitness in Japanese elementary school children. METHODS: This cross-sectional study included 1,225 children (608 boys a...
OBJECTIVES: This study aimed to examine the association between masticatory performance and physical fitness in Japanese elementary school children. METHODS: This cross-sectional study included 1,225 children (608 boys and 617 girls) aged 9-10 years in Osaka, Japan. Masticatory performance was assessed using a color-changeable chewing gum. Physical fitness was evaluated using seven standardized tests (handgrip strength, sit-ups, side-to-side jump, 20-m shuttle run, 50-m sprint, standing long jump, and softball throw), and a composite physical fitness score was calculated as the mean of sex-standardized z-scores. Associations between masticatory performance and physical fitness were examined using Pearson's correlation coefficients and multivariable linear regression analyses adjusted for height and weight. Sex-stratified analyses were also performed. RESULTS: In the overall analysis, masticatory performance was significantly associated with side-to-side jump, 20-m shuttle run, 50-m sprint, softball throw, and the composite physical fitness score. In boys, significant correlations were observed for sit-ups, 20-m shuttle run, softball throw, and the composite physical fitness score, whereas in girls, only the 20-m shuttle run showed a significant correlation. In sex-stratified multivariable analyses, masticatory performance was significantly associated with the composite physical fitness score in boys, but not in girls. CONCLUSION: Masticatory performance was associated with several physical fitness components, as well as the composite physical fitness score, in Japanese elementary school children, particularly in boys. CLINICAL SIGNIFICANCE: These findings highlight the importance of developing and maintaining adequate masticatory function during childhood, which was associated with higher physical fitness in the present study.
Evaluation of intravenous sedation in dental implant surgeries: A prospective cohort study.
Liu X, Cai Z, Chen C … +7 more , Zhang J, He F, Xiang Q, Peng W, Xia H, Zhou Y, Wu T
J Dent · 2026 Jun · PMID 42364899 · Publisher ↗
PURPOSE: This study aimed to evaluate the impact of intravenous sedation on patient-centered outcomes during implant and bone augmentation surgeries. METHOD: A prospective observational cohort study included 40 patients...
PURPOSE: This study aimed to evaluate the impact of intravenous sedation on patient-centered outcomes during implant and bone augmentation surgeries. METHOD: A prospective observational cohort study included 40 patients undergoing placement of ≥3 implants, with or without bone augmentation. Patients underwent surgery under either intravenous sedation (n = 20) or local anesthesia alone (n = 20), according to routine clinical decision-making and patient preference. The sedation group received intravenous sedation with a multimodal regimen comprising remimazolam, dexmedetomidine, alfentanil, and low-dose esketamine, whereas the control group received local anesthesia only. Patient-reported outcome measures, hemodynamic parameters (SBP, DBP, HR, SpO), postoperative pain (0-10 scale), and OHRQoL (OHIP-14) were recorded from baseline through 7 days post-surgery. RESULTS: Intravenous sedation was associated with significantly lower intraoperative pain (0.5 [IQR: 0∼2.75] vs. 3.25 ± 2.40, p = 0.003), anxiety (1 [IQR: 0∼2.75] vs. 4 [IQR: 3∼6], p = 0.001), and experienced discomfort (2 [IQR: 1∼3.75] vs. 4.15 ± 2.16, p = 0.016), and shortened perceived treatment duration (2.90 ± 2.34 vs. 5 [IQR: 4∼5], p = 0.020). Early postoperative pain was lower in the sedation group from Days 1-4 (p = 0.003-0.010). Hemodynamic parameters were more stable under sedation, with lower SBP (116.42 ± 13.32 vs. 144.11 ± 17.42 mmHg, p < 0.001), DBP (73.21 ± 10.28 vs. 82.37 ± 11.03 mmHg, p = 0.012), and HR (71.00 [IQR: 62.50∼79.25] vs. 85.00 ± 10.72 bpm, p = 0.021). OHRQoL scores favored the sedation group in swallowing, diet, malaise, and daily activities, particularly during the first three postoperative days (p=0.006-0.040). CONCLUSION: Intravenous sedation may enhance the patient experience during implant and/or bone augmentation procedures by reducing intraoperative pain and anxiety, improving hemodynamic stability, and promoting better early-postoperative recovery and OHRQoL. These findings suggest that intravenous sedation provides a safe and effective alternative for implant dentistry surgery, particularly for anxious or pain-sensitive individuals.
A Practical, Descriptive Comparison of Seven Guided Implant Surgery Planning Software Using Clinical Scenarios.
Zadrożny Ł, Abduo J, Rutkunas V … +3 more , Tallarico M, Omar S, Darby I
J Dent · 2026 Jun · PMID 42364898 · Publisher ↗
OBJECTIVES: To provide a practical and descriptive comparison of contemporary clinical planning software for guided implant surgery, focusing on digital workflow feasibility, user experience, system requirements, cost mo...
OBJECTIVES: To provide a practical and descriptive comparison of contemporary clinical planning software for guided implant surgery, focusing on digital workflow feasibility, user experience, system requirements, cost models, and the availability of prosthetic component libraries, based on real‑world expert use. MATERIALS AND METHODS: Seven implant planning software platforms (DentiqGuide, BlueSkyPlan, CoDiagnostix, Implant Studio, R2Gate, ExoPlan, and RealGuide) were evaluated by experienced clinicians using two predefined clinical scenarios representing moderate and high planning complexity. User interface (UI) friendliness was assessed using a Likert scale, and planning time was recorded according to standardized task definitions. Hardware requirements, pricing models, available functionalities, and workflow completeness were compared. All quantitative outcomes were analysed descriptively. RESULTS: Descriptive values of UI scores ranged from 5.3 to 10, while planning times ranged from 10 to 67 minutes depending on workflow completeness and task availability. Based on a predefined complete workflow (CW), only DentiqGuide and BlueSkyPlan enabled completion of all planning steps within a single clinical software environment, whereas other platforms required additional modules or external tools. System requirements and cost structures differed substantially, including license‑based and pay‑per‑use models. Semi‑automated functions, such as wax‑up-guided implant positioning, were available in several platforms. However, none provided fully automated planning. A consistent limitation across all evaluated software was restricted availability of prosthetic components within integrated libraries. CONCLUSIONS: Within the limits of this descriptive, expert‑based evaluation, the findings should be interpreted as exploratory and hypothesis‑generating rather than as comparative performance rankings. However, current clinical implant planning software may demonstrate substantial variability in workflow integration, usability and cost structure, and a common limitation in the availability of prosthetic component libraries. These findings highlight a persistent gap in achieving fully prosthetically driven digital workflows in clinical planning environments. The present findings reflect expert-dependent interaction with individual software platforms and were not validated using inter-rater reliability assessment. Therefore, the reported outcomes should not be interpreted as standardized or directly comparable measures of usability or workflow performance. CLINICAL SIGNIFICANCE: Understanding practical digital workflow limitations, particularly restricted prosthetic component libraries, may support clinicians in selecting implant planning software that aligns with their experience level, case complexity, and clinical setting, while emphasizing the need for careful verification of prosthetic feasibility during digital treatment planning.
Evaluation of caries incidence and caries risk among elementary school children in Japan: results from A-CHILD longitudinal study.
Shimada S, Aida J, Isumi A … +1 more , Fujiwara T
J Dent · 2026 Jun · PMID 42364897 · Publisher ↗
OBJECTIVES: A population approach focuses on improving the health status of the entire population, depending on the fact that the majority of diseases occur among low-risk individuals rather than high-risk individuals. H...
OBJECTIVES: A population approach focuses on improving the health status of the entire population, depending on the fact that the majority of diseases occur among low-risk individuals rather than high-risk individuals. However, the onset of permanent tooth caries in children with high or low caries risk remains unclear, especially among children of different socioeconomic statuses. This study investigated the distribution of caries occurrence in children across different caries experience and income groups. METHODS: This cohort study was based on the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, which surveyed all elementary school children in Adachi City, Japan. The explanatory variables were the number of permanent carious teeth and three tertiles of income when children were 7 or 8 years old in 2016. The outcome was an increase in permanent carious teeth when children were 11 or 12 years old, between 2016 and 2020. Negative binomial regression analyses were applied with adjustment for sex. RESULTS: Among the participants (n=3,321), the low-income group had 1.44 (95% CI: 1.14; 1.81) times higher risk than the high-income group. Children with two or more carious teeth showed 2.52 (95% CI: 1.57; 4.06) times higher caries risk than caries-free children. However, over 80% of carious teeth occurred among caries-free children in all income groups. CONCLUSIONS: The majority of new caries cases occurred not merely in high-risk children but in a large number of initially low-risk children, regardless of income level. These findings suggest the importance of a population approach in preventing caries. CLINICAL SIGNIFICANCE: The majority of new caries lesions occurred in caries-free children across all income statuses. The population approach appears appropriate for preventing the incidence of dental caries among elementary school children.
Dentists' perceived barriers to implementing preventive actions in dental practice: a qualitative study of professional and structural influences.
Díaz-Arizmendi LJ, Santoyo-Río E, Aguilar-Díaz FDC
J Dent · 2026 Jun · PMID 42364896 · Publisher ↗
INTRODUCTION: Oral diseases remain a major public health challenge in Mexico. Despite the proven effectiveness of preventive measures, dentists do not consistently implement them in clinical practice. Understanding the f...
INTRODUCTION: Oral diseases remain a major public health challenge in Mexico. Despite the proven effectiveness of preventive measures, dentists do not consistently implement them in clinical practice. Understanding the factors underlying this gap is essential to strengthening prevention-oriented care. OBJECTIVE: To identify perceived barriers to implementing preventive actions in dental practice. METHODS: A qualitative study based on grounded theory was conducted using focus groups. Twenty-seven dental professionals from urban, semi-urban, and rural settings in Mexico participated in five virtual sessions. Data were recorded, transcribed, and analyzed using thematic coding. RESULTS: Barriers to implementing preventive actions in dental practice were grouped into three categories: patient-related (lack of preventive habits, misinformation, financial constraints, fear of dental visits); dentist-related (biomedical training, professional prestige linked to complex procedures, financial incentives, and time constraints); and structural (limited institutional support, unequal service distribution, and poor integration of oral health into health policies). A subgroup of dentists reported consistent implementation of preventive actions, characterized by a biopsychosocial approach, stronger communication skills, and a health promotion-oriented professional identity. CONCLUSIONS: Cultural, professional, and structural factors interact to shape the implementation of prevention in dental practice in Mexico. Strengthening communication skills, reorienting dental education toward prevention, and enhancing institutional support may facilitate the integration of preventive actions into routine care. CLINICAL SIGNIFICANCE: Understanding multilevel barriers to prevention may help dentists integrate preventive actions into routine care by strengthening communication strategies, addressing patient expectations, and adapting clinical decision-making to social and structural contexts.
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