Journal Of Dentistry[JOURNAL]
Sun
200 papers
Effect of silver diamine fluoride with or without potassium iodide treatment on retention of composite resin restorations in carious primary molars- a randomized clinical trial.
Kidwai AA, Bansal K, Mathur VP … +3 more , Tewari N, Morankar R, Mishra R
J Dent · 2026 May · PMID 42176772 · Publisher ↗
OBJECTIVE: To compare the retention of composite resin restorations (CRR) in carious primary molars after application of silver diamine fluoride (SDF) with and without potassium iodide (SSKI oral solution). METHODS: 150...
OBJECTIVE: To compare the retention of composite resin restorations (CRR) in carious primary molars after application of silver diamine fluoride (SDF) with and without potassium iodide (SSKI oral solution). METHODS: 150 children (age 4-9 years) with carious primary molars were randomised to one of the three interventions-Group A: 38% SDF application followed by KI and CRR; Group B: only 38% SDF application followed by CRR; Group C: CRR alone. Restorations were evaluated at 6 and 12 months using modified USPHS criteria. Primary outcome was the retention of restorations, while colour match, marginal discoloration and secondary caries were the secondary outcomes. Fisher's exact test was used for the comparison of the outcomes between the groups. RESULTS: 150 restorations (50 in each group) were performed. At 12 months, completely retained restorations were observed in 38 (76%), 37 (74%) and 36 (72%) teeth in Group A, B and C respectively, with no significant difference between the groups (p = 0.53). Colour match and marginal discoloration differed significantly between groups (p < 0.001). No significant difference was observed with respect to secondary caries (p = 0.78). CONCLUSION: SDF application with or without KI did not adversely affect the retention of composite resin restorations in primary molars over a 12-month period. Restorations after application of SDF with KI demonstrated better aesthetics as compared to SDF treated teeth. CLINICAL SIGNIFICANCE: SDF may be incorporated into caries management protocols prior to composite restoration in primary molars without compromising the retention. The use of SSKI following SDF application can improve the aesthetics.
Enamel damage from tooth-whitening- a systematic review and meta-analysis.
Márton P, Antal M, Kiss-Dala S … +5 more , Agócs G, Qian X, Hegyi P, Varga G, Ábrám E
J Dent · 2026 Sep · PMID 42176771 · Publisher ↗
OBJECTIVE: To determine whether hydrogen- or carbamide-peroxide bleaching alters human enamel microhardness using ISO 28,399-aligned eligibility criteria. METHODS: Following PRISMA 2020 and Cochrane Handbook guidelines (...
OBJECTIVE: To determine whether hydrogen- or carbamide-peroxide bleaching alters human enamel microhardness using ISO 28,399-aligned eligibility criteria. METHODS: Following PRISMA 2020 and Cochrane Handbook guidelines (PROSPERO CRD42023472326), four databases were systematically searched. In vitro studies measuring enamel Vickers or Knoop microhardness before and after bleaching were included. A multilevel random-effects meta-analysis using log-transformed ratios of means (ROM) was performed. Prespecified moderators, including peroxide concentration, exposure time, indentation load and dwell time, were examined using meta-regression. RESULTS: Of 81 eligible studies, nine entered quantitative synthesis. Pooled analysis showed a small microhardness reduction (ROM = 0.89; 95% CI: 0.84-0.94; p < 0.01). Exposure time was a significant moderator: a tenfold increase corresponded to a 6.8% decrease in Knoop hardness (95% CI: 13.0%-0.2%; p = 0.044). This association became non-significant after exclusion of one influential study (estimate: 1.9% decrease; 95% CI: 6.8% decrease - 3.3% increase). Residual heterogeneity remained moderate (tau = 0.074; I² = 50.8%). Time-course analyses suggested larger changes at lower peroxide concentrations. CONCLUSIONS: Peroxide-based bleaching produced statistically detectable but small, outlier-sensitive enamel microhardness reductions, without clear evidence of clinically meaningful effects (ROM exceeding 10%). Current evidence does not strongly support strict regulatory peroxide limits. Further ISO 28,399-compliant studies are needed. CLINICAL SIGNIFICANCE: Within the limitations of in vitro evidence, peroxide bleaching appears unlikely to cause clinically meaningful harm in enamel integrity, when used according to recommended protocols, supporting continued clinical use. More standardized, clinically relevant outcome measures rather than isolated laboratory hardness measurements are needed.
Synbiotic-fluoride therapy as a next-generation non-invasive approach for early enamel lesions.
Zaeneldin A, Bijle MN, Abdallah MM … +3 more , Kwok JCM, Rajasekar V, Yiu CKY
J Dent · 2026 Sep · PMID 42173473 · Publisher ↗
OBJECTIVE: To investigate the remineralization potential of a synbiotic-fluoride (SF) therapy combining l-arginine (Arg), sodium fluoride (NaF), and Lacticaseibacillus rhamnosus GG (LRGG) under a multi-species pH-cycling...
OBJECTIVE: To investigate the remineralization potential of a synbiotic-fluoride (SF) therapy combining l-arginine (Arg), sodium fluoride (NaF), and Lacticaseibacillus rhamnosus GG (LRGG) under a multi-species pH-cycling model. METHODS: Artificial enamel carious lesions were created on human enamel specimens and subjected to a 72-h pH-cycling protocol incorporating multi-species biofilm (Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii). Eight groups were assessed: control, 0.03%Arg, 0.22%NaF, LRGG, 0.22%NaF+0.03%Arg, 0.03%Arg+LRGG, 0.22%NaF+LRGG, and the SF therapy. Remineralization outcomes were quantified by mineral density (MD) and mineral gain (MG) assessments using micro-CT, SEM-EDX for Ca/P, change in surface nano-hardness (ΔSNH) and nanohardness recovery (SHR), and biochemical enamel calcium/phosphate content analysis. RESULTS: Post pH-cycling, SF therapy had the highest MD, MG, and % remineralization (p < 0.001). The SF therapy also exhibited the significantly highest Ca/P ratio on SEM-EDX (p < 0.001), along with the highest SNH, ΔSNH, and SHR , indicating superior remineralization than other groups (p < 0.001). Calcium and phosphate content further confirmed the enhanced remineralization potential of SF therapy. While dualagent combinations demonstrated greater remineralization than monotherapies, none matched the synergistic effect observed with the SF therapy. CONCLUSIONS: The combined application of Arg, F, and LRGG synergistically enhances enamel remineralization under dynamic biofilm-mediated conditions, outperforming both individual/combined treatment components. CLINICAL SIGNIFICANCE: Synbiotic-fluoride therapy represents a biofilm-mediated, noninvasive strategy for managing early enamel carious lesions, offering substantial advantages over fluoride alone. The therapy is aimed at high caries-risk individuals for primary and secondary caries prevention by promoting a biotic approach that ultimately aims to establish an eubiotic state.
Integrating artificial intelligence into dental student assessments: Current & future status.
Fine PD, Louca C, Tonni I … +1 more , Leung A
J Dent · 2026 Sep · PMID 42173472 · Publisher ↗
OBJECTIVES: Integrating AI into traditional forms of medical and dental education has been received optimistically, yet cautiously. Although the use of AI in healthcare student assessment is well established, its use in...
OBJECTIVES: Integrating AI into traditional forms of medical and dental education has been received optimistically, yet cautiously. Although the use of AI in healthcare student assessment is well established, its use in the assessment of dental students is in its infancy. Previous studies have indicated that dental educators are using AI for student assessment, but in a limited format. A lack of support, confidence and knowledge are common reasons for the limited use of AI. The aim of this study was to investigate the perceptions and experiences of international dental educators on integrating Artificial Intelligence into dental student assessment, to facilitate and enhance student learning. METHODS: A mixed methods study was used to analyse quantitative and qualitative data generated through a live online polling platform, Vevox ™. Data were collected, during a European dental educators' conference and results were shared with the participants in real time. A workshop setting was used to collect data relating to 3 themes in dental schools: i) the impact of AI on traditional methods of student assessment, ii) the effectiveness of AI supported assessments, iii) the impact on dental student learning. Analysis was descriptive and thematic, for quantitative and qualitative data, respectively. RESULTS: 152 participants actively contributed to the data. The mean age of the participants was 48.16 years (SD 11.119). Less than one-third (n = 37; 29.13%) of the participants were currently using AI in the assessment of dental students. Multiple Choice Questions (MCQs) were the most common type of assessment that used AI (n = 35, 31.25%). Only one participant (0.89%) reported using AI for reflective portfolios. Qualitative data emerged from the three themes identifying the current experiences and perceptions of dental educators. CONCLUSIONS: The limited use of AI in dental student assessment clearly demonstrates that international dental educators are still at the early stages of fully integrating these technologies into routine dental education. There continues to be apprehension with incorporating AI into student assessments. Dental educators should be encouraged to adopt the new technologies, whilst recognising the need to support them to adapt to the commensurate challenges. The implementation of clear recommendations and guidance is desirable. CLINICAL SIGNIFICANCE: The assessment of dental students is a critical factor in their training and in assuring the public of the graduate's fitness to practice dentistry. The use of Artificial Intelligence in supporting the assessment process is seen as a pivotal element in ongoing learning and has the potential to increase the robustness of the assessment process, resulting in clinically more adept practitioners.
Two-year clinical comparison of direct and indirect composite restorations in severely damaged molars: A split-mouth randomized clinical study.
Belleflamme M, Seidel L, Albert A … +2 more , Bolette A, Guéders A
J Dent · 2026 Sep · PMID 42173471 · Publisher ↗
OBJECTIVES: This randomized, split-mouth clinical study compared the clinical performance of direct restorations using a short fiber-reinforced composite veneered with a microhybrid composite and indirect CAD-CAM restora...
OBJECTIVES: This randomized, split-mouth clinical study compared the clinical performance of direct restorations using a short fiber-reinforced composite veneered with a microhybrid composite and indirect CAD-CAM restorations fabricated from a hybrid CAD-CAM block in severely damaged molars. METHODS: One hundred restorations in 42 patients-50 direct short fiber-reinforced composite restorations veneered with a microhybrid composite and 50 indirect CAD-CAM nanoceramic composite restorations-were randomly assigned to severely damaged molars in a split-mouth design; all restorations involved reconstruction of at least one cusp. All restorations were performed by a single qualified operator, and two independent calibrated examiners evaluated the restorations at baseline, 6 months, 1 year and 2 years using modified USPHS criteria. Patient satisfaction was also assessed at each evaluation. RESULTS: After two years of follow-up, all restorations remained functional, resulting in a 100% survival rate. One indirect restoration experienced debonding one week after placement, which was successfully re-bonded and showed no further complications during follow-up. Both restorative approaches demonstrated excellent clinical performance across all USPHS criteria, with no significant differences between direct and indirect composite restorations. CONCLUSIONS: Direct and indirect restorations showed high survival and success rates after 2 years. Patient satisfaction was high, with no significant difference between the two restorative approaches. CLINICAL SIGNIFICANCE: At the 2-year follow-up, direct restorations based on short fiber-reinforced composite showed clinical results comparable to those of indirect CAD-CAM composite restorations in severely damaged molars.
Porous phosphate glass microspheres loaded with dental pulp stem cell-derived exosomes for potential osteogenic applications.
Aghila Rani KG, Suresh S, Katamesh ME … +5 more , Al-Hroub HM, Gaballah K, Islam MT, Ahmed I, Abou Neel EA
J Dent · 2026 Sep · PMID 42167480 · Publisher ↗
OBJECTIVE: This study investigated porous phosphate-based glass microspheres (PGMS) as a delivery system for human dental pulp stem cell (hDPSC)-derived exosomes (Exo) and examined their effects on osteogenic responses i...
OBJECTIVE: This study investigated porous phosphate-based glass microspheres (PGMS) as a delivery system for human dental pulp stem cell (hDPSC)-derived exosomes (Exo) and examined their effects on osteogenic responses in human osteoblasts (HOB) in vitro. METHODS: PGMS (40PO-24MgO-16CaO-20NaO) were produced by flame spheroidization and characterized by SEM-EDX and FTIR to confirm their porous architecture, oxide distribution, and phosphate network integrity. hDPSC-derived exosomes were isolated, quantified, and validated by STEM and western blotting for CD9, CD63, and CD81 expression. HOBs were treated with PGMS (1 mg/mL), Exo (10 µg/mL), or PGMS loaded with Exo (PGMS+Exo), and cell responses were evaluated by viability assays, qPCR, western blotting, ALP activity, and mineralization. RESULTS: Exo alone significantly enhanced HOB viability at 24 h, which was further increased by PGMS+Exo over time. PGMS+Exo treatment yielded the highest expression of osteogenic genes (RUNX2, ALP, Col1, OC), elevated ALP activity, and greater mineral deposition and calcium release compared with PGMS or Exo alone. Western blotting further corroborated these findings. CONCLUSION: Exosome-loaded PGMS enhanced osteogenic outcomes in vitro compared with individual treatments, indicating their potential as a therapeutic platform for bone regeneration. CLINICAL SIGNIFICANCE: The results suggest that exosome‑loaded phosphate‑based microspheres offer a regenerative approach for enhancing dental and craniofacial bone repair, although the findings are limited to in vitro experiments and require in vivo validation.
Evaluation of dentinal microcrack formation during endodontic microsurgery: a micro-CT evaluation of piezoelectric root resection and root-end preparations with ultrasonic tips.
Lynn M, Ravenel T, Emecen-Huja P … +1 more , Eppes K
J Dent · 2026 Sep · PMID 42167479 · Publisher ↗
OBJECTIVES: Dentinal microcracks are frequently observed during endodontic microsurgery and are often considered unavoidable. Despite advances in surgical instrumentation, the influence of these technologies on microcrac...
OBJECTIVES: Dentinal microcracks are frequently observed during endodontic microsurgery and are often considered unavoidable. Despite advances in surgical instrumentation, the influence of these technologies on microcrack formation remains unclear. Therefore, this study aimed to evaluate the prevalence and potential propagation of dentinal microcracks associated with piezoelectric root resection and zirconium nitride-coated ultrasonic root-end preparation. METHODS: Sixty extracted human maxillary incisors were randomly allocated into four groups (n = 15). Root resection was performed using either a Lindemann bur or a piezoelectric instrument, followed by root-end preparation with either a diamond-coated or zirconium nitride-coated ultrasonic tip. Micro-computed tomography scans were obtained preoperatively, after root resection, and following root-end preparation. Two calibrated examiners independently assessed microcrack number and type and recorded procedural time. Statistical analysis included Bonferroni-adjusted pairwise comparisons and chi-square testing. RESULTS: No statistically significant differences were found among groups in microcrack frequency (p = 0.783) or microcrack type (p = 0.407), and all detected microcracks were present preoperatively. Mean resection time was 10.8 s with the Lindemann bur and 67.09 s with the piezoelectric insert. Mean preparation time was 68.27 s using the diamond-coated tip and 15.83 s using the zirconium nitride-coated tip. CONCLUSIONS: Piezoelectric instruments and zirconium nitride-coated ultrasonic tips did not significantly influence dentinal microcrack formation or propagation compared with conventional techniques, although notable differences in procedural efficiency were observed. CLINICAL SIGNIFICANCE: This study highlights how contemporary endodontic microsurgical techniques influence both dentinal integrity and procedural efficiency. While some approaches may require additional operative time, they may also offer advantages in surgical control and visualization.
Further treatments of non-surgically root canal-treated teeth in public dental service: A long-term register-based study.
Väisänen M, Palotie U, Tseveenjav B
J Dent · 2026 Sep · PMID 42167478 · Publisher ↗
OBJECTIVES: Our objective was to assess further restorative treatments, extractions and endodontic retreatments registered for root canal-treated teeth (RCTT) in a 13- to 15-year follow-up at Public Dental Service (PDS),...
OBJECTIVES: Our objective was to assess further restorative treatments, extractions and endodontic retreatments registered for root canal-treated teeth (RCTT) in a 13- to 15-year follow-up at Public Dental Service (PDS), and to examine the association of the frequency of further treatments with patient-, tooth-, and operator-related factors. METHODS: Data were collected from electronic patient records of the Helsinki PDS. Based on dental treatment codes, teeth with registered primary non-surgical root canal treatments (nsRCTs) (n = 16 954) between 2002 and 2004 were followed until the end of 2016. Estimation of incidence of further treatments was calculated with generalized linear model. Cox regression model was conducted to estimate the influence of patient-, tooth- and operator-related factors of the primary nsRCT for further restorative treatments, extractions, or endodontic retreatments. RESULTS: Further restorative treatments were the most often carried out treatments (38.2%) for RCTT, followed by extractions (19.5%), non-surgical retreatments (4.8%) and surgical retreatments (0.5%). Endodontic retreatments were often registered within few years of the primary nsRCT while the frequency of extractions remained nearly constant over the years. Younger age, anterior teeth, and teeth with indirect coronal restorations were mostly associated with lower incidence of further treatments. CONCLUSION: Our study demonstrated that RCTT were registered with mainly further restorative treatments after primary nsRCT. One-fifth of teeth were extracted during the study period, while endodontic retreatments were uncommon. Placement of indirect restoration was associated with lower incidence of further treatments, within the limitations of this study. CLINICAL SIGNIFICANCE: Knowledge of further treatments that root canal-treated teeth may require is highly important for both dentists and patients. Identification of risk factors that could have influence on further treatments after primary non-surgical root canal treatment should be part of the treatment planning to ensure favorable outcomes.
Volume, precision and trueness of additively manufactured inlay restorations.
Geyer AM, Kilian SK, Kiramira D … +3 more , Ziskoven PC, Abou-Ayash S, Deschner J
J Dent · 2026 May · PMID 42167477 · Publisher ↗
OBJECTIVES: Dental resins for single-tooth restorations undergo shrinkage during manufacture. The shrinkage can be compensated for by adjusting the internal tooth-restoration gap. This study examines the volume precision...
OBJECTIVES: Dental resins for single-tooth restorations undergo shrinkage during manufacture. The shrinkage can be compensated for by adjusting the internal tooth-restoration gap. This study examines the volume precision and trueness of additive manufactured inlays based on different gap widths. METHODS: Indirect restorations were fabricated with a dental resin (VarseoSmile Crown plus) on a digitised molar with a mesio-occlusal-distal cavity. A total of 42 inlays, with spacers ranging from 0 to 130 µm, were printed in 10 µm increments. Three print batches (P1, P2 and P3) were produced for each gap width. The printed inlays were digitised using an intraoral scanner. To evaluate volume precision, the intraclass correlation coefficient (ICC) was calculated. Trueness was analysed in relation to initial planning with a paired t-test. RESULTS: The printed inlays exhibited a mean shrinkage of 6.2% compared to the planned volumes, and the mean difference in the width of the internal gap was 41 ± 9 µm. All printed results differed significantly from the planned inlays in terms of volume measurement (p < 0.001). There were no significant differences in terms of volume between the three print batches, nor the mean gap widths between teeth and restorations. The ICC for the volume precision measurement was 0.991. CONCLUSIONS: The amount of volume shrinkage that occurs during 3D printing is consistent. Adjusting the width of the spacer can compensate for the volume loss. CLINICAL RELEVANCE: Additively manufactured inlays undergo consistent volume shrinkage, which may impact their fit. Examining the distances between the planned and printed inlays revealed that there is a minimum offset at which the restorations could be inserted. The combination of material and 3D printer resulted in repeatable precise prints. The fit of indirect restorations can be predictably improved by coordinating intraoral scanners, 3D printers and printing materials.
Deep learning based automated detection and grading of oral epithelial dysplasia: A comparative histopathological image analysis.
Bharti A, Kashyap N, Kamboj M … +5 more , Joshi K, Hooda S, Mishra D, Singh H, Pal D
J Dent · 2026 May · PMID 42167476 · Publisher ↗
OBJECTIVE: To develop and comparatively evaluate multiple deep learning architectures for automated detection and grading of oral epithelial dysplasia in hematoxylin and eosin (H&E)-stained histopathological images. METH...
OBJECTIVE: To develop and comparatively evaluate multiple deep learning architectures for automated detection and grading of oral epithelial dysplasia in hematoxylin and eosin (H&E)-stained histopathological images. METHODS: A total of 2080 digitized H&E-stained histopathological images representing mild, moderate and severe grades of OED, along with normal mucosa, were acquired at 100x and 400x magnifications. Following standardized preprocessing and augmentation, nine deep learning architectures, Vision Transformer (ViT), VGG16, YOLOv11, ResNet-50, YOLOv8, MobileNet-v3, Inception-v3, EfficientNet-B0, and DenseNet-121 were trained and evaluated. Model performance was assessed using accuracy, precision, recall, and F1- score metrics. RESULTS: Among these nine architectures, DenseNet-121 achieved the highest accuracy of 95.47% with a macro-average F1-score of 0.94, outperforming both transformer-based and conventional convolutional models. It demonstrated strong generalization and minimal overfitting, with class-wise F1-scores exceeding 0.95 for normal, mild, and severe grades of dysplasia. CONCLUSION: The DenseNet-121 model provides a reliable and generalizable framework for automated grading of oral epithelial dysplasia, offering enhanced diagnostic precision, reduced observer bias, and potential integration into digital pathology workflows for early detection and risk stratification of oral precancerous lesions. CLINICAL SIGNIFICANCE: Deep learning based automated grading of OED can enhance diagnostic accuracy and reproducibility in histopathological evaluation. Integration of such AI-assisted systems into digital pathology may support early identification of high-risk lesions and assist clinicians in making timely and evidence-based treatment decisions.
High prevalence of undiagnosed hyperglycemia and cardiovascular risk in dental clinics: evidence from a large retrospective study in China.
Wang M, Xiang Y, Tong W … +7 more , Jin L, Chen Y, He L, Zhou H, Xu D, Cheng T, Zhou Q
J Dent · 2026 Sep · PMID 42167475 · Publisher ↗
OBJECTIVES: This study aimed to assess the high prevalence of undiagnosed hyperglycemia and associated cardiovascular disease (CVD) risk among dental patients, and to explore the potential role of dental clinics as a key...
OBJECTIVES: This study aimed to assess the high prevalence of undiagnosed hyperglycemia and associated cardiovascular disease (CVD) risk among dental patients, and to explore the potential role of dental clinics as a key setting for early detection of undiagnosed or poorly controlled hyperglycemia, periodontitis, and elevated CVD risk. METHODS: A 10-year retrospective cohort study was performed involving 40,136 patients who received dental care between 2015 and 2024 for FPG level analysis. A matched subcohort of 1,461 patients with complete clinical data was selected for detailed analysis including FPG, diabetes awareness, periodontal evaluations, and coagulation profiles. Participants were divided into three groups based on ADA criteria: normal FPG (3.9- < 5.6 mmol/L), impaired fasting glucose (IFG, 5.6- < 7.0 mmol/L), and abnormal FPG ( ≥ 7.0 mmol/L). Relationships were assessed between FPG, diabetes awareness, periodontal severity, and CVD risk through appropriate statistical tests. RESULTS: In our sample, the prevalence of IFG reached 30.2% and abnormal FPG in 14.0% of cases, which significantly exceeded national estimates in China. Notably, over 96% of those with IFG and about 52% with abnormal FPG in subcohort had never received any diabetes-related diagnosis before. Around 60% with a confirmed diabetes diagnosis still had uncontrolled FPG levels. Higher FPG showed a clear positive association with worse periodontal status (p < 0.05). Coagulation markers differed noticeably depending on both glycemic control and periodontal severity, and patients with advanced periodontitis faced elevated CVD risk (p < 0.05). CONCLUSIONS: Dental patients carry a high burden of undiagnosed hyperglycemia and elevated cardiovascular risk. Dental clinics represent a valuable frontline setting for the early identification of undiagnosed or uncontrolled hyperglycemia and concurrent CVD risk. CLINICAL SIGNIFICANCE: Periodontitis is a critical risk factor for abnormal FPG and CVD risk in dental patients. Dental clinics can serve as pivotal platforms for oral-systemic comorbidity prevention and management by implementing FPG screening and establishing cross-disciplinary referral systems, which helps address the high rate of undiagnosed hyperglycemia and improve holistic patient health outcomes.
Overcoming Biofilm Barriers in Periodontitis: A Lectin-Targeted Conjugate for Enhanced Antimicrobial Photodynamic Therapy.
Tang W, Zhang Y, Zhang J … +2 more , Kong D, Wang D
J Dent · 2026 Sep · PMID 42167474 · Publisher ↗
OBJECTIVES: To address the limited efficacy of conventional antimicrobials against periodontal biofilms by developing a targeted antimicrobial photodynamic therapy (aPDT) platform and evaluating its activity against key...
OBJECTIVES: To address the limited efficacy of conventional antimicrobials against periodontal biofilms by developing a targeted antimicrobial photodynamic therapy (aPDT) platform and evaluating its activity against key periodontal pathogens. METHODS: The photosensitizer Rose Bengal was conjugated to the lectin Concanavalin A (ConA-RB). Its synthesis was spectroscopically confirmed. Antibacterial and antibiofilm activity against Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Prevotella intermedia was assessed following clinically relevant blue light irradiation, including bacterial uptake, viability, and membrane damage. Biocompatibility with human gingival fibroblasts was also evaluated following both short-term and prolonged exposure. RESULTS: ConA-RB exhibited significantly superior antibacterial and antibiofilm activity compared to free Rose Bengal. This was attributed to an approximate 4-fold increase in bacterial uptake, mediated by specific lectin-carbohydrate recognition, leading to enhanced localized reactive oxygen species generation and profound membrane damage. ConA-RB effectively inhibited biofilm formation and significantly disrupted mature in vitro biofilms while maintaining favorable biocompatibility in tested cell models. CONCLUSIONS: The ConA-RB bioconjugate is a potent, targeted, and biocompatible aPDT platform that substantially overcomes biofilm barriers. It represents a promising translational strategy for improving the clinical management of periodontitis. CLINICAL SIGNIFICANCE: By leveraging targeted photodynamic therapy, this ConA-RB platform offers a precise method to eradicate deep-seated periodontal pathogens and disrupt biofilms without inducing acute cytotoxicity in gingival tissues. This approach holds significant potential to enhance clinical outcomes in periodontitis treatment, particularly in cases resistant to conventional therapy.
Assessing the clinical deployability of AI tools for caries detection: A structured narrative synthesis and proposed framework.
Hegde S, Vasa R
J Dent · 2026 Sep · PMID 42162784 · Publisher ↗
OBJECTIVE: To synthesise how studies evaluating AI-based caries detection on bitewing radiographs report evidence relevant to real-world clinical use beyond discrimination metrics (e.g., sensitivity, specificity, and are...
OBJECTIVE: To synthesise how studies evaluating AI-based caries detection on bitewing radiographs report evidence relevant to real-world clinical use beyond discrimination metrics (e.g., sensitivity, specificity, and area under the curve [AUC]), and to propose a structured appraisal framework for assessing clinical deployability. METHODS: A structured narrative synthesis of peer-reviewed studies evaluating AI-based caries detection on bitewing radiographs was conducted. Reporting was mapped to seven deployability domains (population fit/prevalence, calibration/thresholding, predictive values, validation integrity, reference standards, robustness, and workflows/governance), and studies were grouped into descriptive evidence profiles (Types A-C). RESULTS: Thirty-nine studies met the inclusion criteria. Most were retrospective single-dataset evaluations. Type A evidence profiles predominated (33 studies), characterised by reporting of discrimination but limited information across several clinical-use domains. Type B profiles were less common (6 studies) and showed stronger validation practices (including patient-level separation and/or external validation) but persistent gaps in calibration and prevalence-sensitive reporting. No study met the criteria for Type C (documented regulatory clearance with deployment-level validation), limiting independent appraisal of commercial readiness from published sources. CONCLUSIONS: The current evidence base emphasises discrimination metrics but frequently omits key elements required for safe, interpretable, and governable clinical use. Appraisal should incorporate prevalence context, calibration and thresholds, validation integrity, reference standards, robustness and workflow/governance. The seven-pillar framework provides a pragmatic lens for clinicians, procurement officers, and regulators appraising marketed AI tools.
Zirconia in dentistry: A 25-year bibliometric analysis of research trends, thematic evolution, and emerging frontiers.
Zhang J, Chen G, Wu W … +2 more , Miao X, Luo Y
J Dent · 2026 May · PMID 42162783 · Publisher ↗
OBJECTIVES: This bibliometric analysis aimed to map the global research landscape of zirconia in dentistry over the past 25 years, focusing on publication output, collaboration patterns, thematic evolution, and emerging...
OBJECTIVES: This bibliometric analysis aimed to map the global research landscape of zirconia in dentistry over the past 25 years, focusing on publication output, collaboration patterns, thematic evolution, and emerging research fronts. METHODS: Records published between 2000 and 2025 were retrieved from the Web of Science Core Collection using a zirconia-specific search strategy. After screening, 6156 publications were included. Bibliometric analyses were conducted using VOSviewer, CiteSpace, and Bibliometrix to examine performance indicators, coauthorship and cocitation networks, keyword clustering, thematic evolution, and research frontiers. Journal metrics were obtained from the 2025 Journal Citation Reports. Correlation analyses between publication output and citation counts were performed using SPSS. RESULTS: Annual zirconia-related publications increased from fewer than 20 in 2000 to 494 by September 2025, reflecting sustained research activity over the observation period. The United States, Germany, Brazil, and Switzerland were the most productive contributors, while China, the Republic of Korea, and Turkey showed notable increases in output. The leading institutions included the University of Zurich, the University of São Paulo, and the University of Bern, with authors Kern, Sailer, and Özcan forming prominent collaboration networks. Cocitation and keyword analyses indicated thematic progression from structural reliability to bonding and interface research, esthetic-driven phase development, digital workflow accuracy, implant-supported zirconia components, and, more recently, additive manufacturing. Citation-burst detection highlighted emerging topics, including monolithic zirconia, translucency enhancement, computer-aided design and computer-aided manufacturing (CAD/CAM) precision, digital workflows, and three-dimensional (3D) printing. CONCLUSION: Zirconia-related dental research has evolved from a focus on mechanical reliability to broader themes encompassing bonding, esthetics, implant applications, and digital workflows, with emerging interest in additive manufacturing. CLINICAL SIGNIFICANCE: By mapping research trends and thematic evolution, this bibliometric analysis provides insights into the shifting focus of zirconia research toward digitally integrated and clinically contextualized domains. These findings may support future research prioritization and methodological refinement in digital prosthodontics and dental materials.
Clinical performance of paediatric zirconia crowns cemented with two luting agents: A 36-month split-mouth randomised controlled trial.
Bani-Hani T, Saleh MM, Tabnjh AK
J Dent · 2026 Sep · PMID 42155884 · Publisher ↗
BACKGROUND: Recently, paediatric zirconia crowns have gained widespread popularity as an esthetic restorative option. However, evidence regarding their clinical technique remains limited. The aim of this study was to com...
BACKGROUND: Recently, paediatric zirconia crowns have gained widespread popularity as an esthetic restorative option. However, evidence regarding their clinical technique remains limited. The aim of this study was to compare the clinical performance of Glass Ionomer Cement (GIC) and self-adhesive resin cement for luting paediatric zirconia crowns. MATERIALS AND METHODS: A split-mouth randomised clinical trial involved three-to-five-year-old children with carious primary incisors requiring restoration with zirconia crowns. Pair-matched incisors were randomly assigned to receive either GIC or resin cement for crown cementation. Crowns were clinically evaluated for retention, and gingival condition at 1-week, 1-, 3-, 6-, 12-, 24-, and 36-month recall appointments. Data were analysed using McNemar's test for crown retention and Wilcoxon signed-rank test for gingival index scores with statistical significance set at p < 0.05. RESULTS: Thirty-eight patients with 64 pair-matched incisors (128 teeth) were enrolled. Over the study period, three debonding events occurred in the GIC group resulting in cumulative retention rates of 96.9 %, 95.3 %, and 95.3 % at 12-, 24-, and 36-month follow-up respectively. Conversely, no debonding was recorded in the resin-cement group, yielding 100 % retention; however, the intergroup difference in retention was not statistically significant (p > 0.05; 95 % CI: -0.5 % to 9.9 %). No statistically significant differences were observed in gingival index scores between cement types at any follow-up point (p > 0.05, effect size (r) = 0.02-0.11). CONCLUSION: Both cements showed high clinical retention and favourable gingival health. Findings suggest that GIC may be considered a clinically acceptable alternative to self-adhesive resin cement for luting zirconia crowns in primary teeth. CLINICAL SIGNIFICANCE: The results of the study provide important clinical implications with regards to the selection of cement material for paediatric zirconia crowns.
Stability of flexural properties of experimental composites functionalized with bioactive glass under chemical and thermal accelerated aging.
Plancak L, Tauböck TT, Marovic D … +2 more , Tarle Z, Par M
J Dent · 2026 Sep · PMID 42155883 · Publisher ↗
OBJECTIVES: To evaluate flexural strength (FS) and flexural modulus (FM) of experimental composites containing bioactive glass (BG) 45S5 (C-series) or a customized low-sodium, fluoride-containing BG (F-series) after aggr...
OBJECTIVES: To evaluate flexural strength (FS) and flexural modulus (FM) of experimental composites containing bioactive glass (BG) 45S5 (C-series) or a customized low-sodium, fluoride-containing BG (F-series) after aggressive artificial aging. METHODS: A Bis-GMA/TEGDMA (60:40) resin was filled to 70 wt% total filler, comprising 5-40 wt% of either BG type, with the remaining filler fraction consisting of silanized barium glass and silica (2:1). Specimens (2 × 2 × 16 mm; NIST 4877) were artificially aged by immersion for 30 or 90 days in simulated body fluid (SBF; pH 7.4), lactic acid (pH 4.0), 75% ethanol or NaOH (pH 13.0), and by thermocycling (10,000 cycles; 5-55°C). FS and FM were measured by three-point bending test. Sample size was n = 20 per experimental group, and data were analyzed using three-way ANOVA with additional one-way ANOVAs at an overall significance level of α = 0.05. RESULTS: The C-series showed a BG dose-dependent decline in flexural properties at baseline and after artificial aging, while the F-series, particularly F-20, maintained higher FS and FM than the C-series under all aging conditions. At baseline, FS decreased from 139.6 to 23.9 MPa across the C-series (5-40 wt% BG), while the F-series maintained values between 147.7 and 176.6 MPa. After 90 days, F-20 retained FS of 133.6-134.8 MPa compared with 41.2-47.2 MPa for C-20, and FM remained substantially higher in the F-series (9.5 vs. 3.7 GPa in SBF). The effects of artificial aging media varied in both severity and time-dependent pattern of change; SBF and lactic acid produced moderate degradation, ethanol induced a marked reduction that leveled off between 30 and 90 days, and NaOH produced the most extensive deterioration over the 90-day observation period. Thermocycling showed intermediate effects and maintained comparable differences between composites. CONCLUSIONS: Reduced BG solubility improved tolerance to higher BG fractions under neutral and moderately acidic aqueous aging, whereas extreme ethanol and alkaline challenges primarily reflected matrix and interface vulnerability. CLINICAL RELEVANCE: Customized low-sodium BG improved flexural property retention under clinically relevant aqueous challenges compared with BG 45S5, while extreme chemical aging reduced differences between the materials by shifting degradation toward matrix and filler/matrix interface. The improved flexural stability of composites containing customized low-sodium BG suggests their potential for use in restorations with higher functional filler loadings.
Bone morphogenetic proteins in dentinogenesis and their potential role in pulp tissue regeneration: a scoping review.
Portes-Zeno AP, Dos Santos AG, Sipert CR … +3 more , Fonseca-Gonçalves A, Risso PA, Maia LC
J Dent · 2026 Sep · PMID 42155882 · Publisher ↗
OBJECTIVES: To map and categorize the existing literature on the use of bone morphogenetic proteins (BMPs) in dentinogenesis and pulp tissue regeneration, identifying research trends, experimental approaches, and knowled...
OBJECTIVES: To map and categorize the existing literature on the use of bone morphogenetic proteins (BMPs) in dentinogenesis and pulp tissue regeneration, identifying research trends, experimental approaches, and knowledge gaps to inform future studies and potential clinical translation. DATA/SOURCES: Studies investigating tooth-derived stem or progenitor cells (Population), under the direct application of bone morphogenetic proteins (BMPs) (Concept), employing in vitro and/or animal experimental models to assess dentinogenesis and pulp tissue regeneration-such as cellular differentiation, mineralization, or pulp tissue repair (Context)-were included. A systematic search without restrictions was conducted in August 2025 across PubMed/MEDLINE, Scopus, Web of Science, Embase, LILACS, and the Cochrane Library, complemented by grey literature searches. Findings were summarized by BMP type and main biological outcomes related to dentinogenesis and pulp tissue regeneration. STUDY SELECTION: Databases searches retrieved 2497 records and a total of 42 studies were included. BMP-2 was the most investigated (66%), across diverse experimental models using dental pulp stem cells, stem cells from the apical papilla, odontoblast-like cell lines, and dental papilla cells. Reported BMP-2 concentrations varied from 10 to 50 ng/mL. BMP-4 was studied in 19% of the studies, most in vitro models, using dental-derived mesenchymal and epithelial-mesenchymal interaction systems, with concentrations ranging from 10 to 100 ng/mL. BMP-7 was investigated in 14% of the studies, in dose-response in vitro studies, most often using dental pulp stem cells, with concentrations ranging from 2 to 250 ng/mL. BMP-9 was evaluated in a single in vitro study using stem cells from the apical papilla. Positive odontoblastic differentiation outcomes were reported in 90% of BMP-2 studies, 100% of BMP-4 studies, 40% of BMP-7 studies, and in the BMP-9 study. Mineralization outcomes were reported in 60% of BMP-2 studies, 62.5% of BMP-4 studies, and 60% of BMP-7 studies, while no mineralization assessment was reported for BMP-9. In vivo evidence of pulp repair and hard tissue formation was limited but suggested potential benefits of BMP-based strategies, particularly for BMP-2 and BMP-7, in promoting reparative dentin formation and pulp-like tissue regeneration. CONCLUSION: Exogenous BMPs-particularly BMP-2, followed by BMP-4 and BMP-7-promote odontoblastic differentiation and mineralized tissue formation in dental-derived cells. Evidence is largely based on heterogeneous in vitro models using diverse scaffold-based delivery systems. Despite consistent odontogenic potential, the lack of standardized protocols and clinically relevant models limits comparability and hinders translation to regenerative endodontic practice. CLINICAL SIGNIFICANCE: Regenerative endodontic procedures (REPs) aim to promote pulp tissue repair and continued root development through stem/progenitor cell differentiation and dentin matrix production. Bone morphogenetic proteins (BMPs) show promise as biological adjuncts, yet clinical translation remains limited. This scoping review maps evidence, identifies translational approaches, and highlights key knowledge gaps.
Evaluating retrieval-augmented generation for guideline-grounded textual planning in implant dentistry: A comparative study.
Chen J, Wang F
J Dent · 2026 Sep · PMID 42150729 · Publisher ↗
OBJECTIVES: To evaluate whether a retrieval-augmented generation (RAG) framework can enhance citation precision and improve the clinical reliability of large language models (LLMs) in implant dentistry. METHODS: A domain...
OBJECTIVES: To evaluate whether a retrieval-augmented generation (RAG) framework can enhance citation precision and improve the clinical reliability of large language models (LLMs) in implant dentistry. METHODS: A domain-specific knowledge base was constructed using major international consensus reports and established clinical treatment guides. Forty standardized clinical vignettes (35 real-world, 5 synthetic) were each processed twice by both a standard LLM (GPT-4o) and a RAG-LLM, yielding 160 treatment plans. Intra-model agreement was quantified using the weighted Cohen's kappa. Two independent experts evaluated the plans across five clinical domains using a double-blinded, consensus-driven protocol. RESULTS: Overall clinical accuracy showed no significant difference between models (P = 0.642). However, domain-specific analysis revealed that the RAG-LLM significantly outperformed the standard model in evidence traceability and citation precision (P = 0.046). Neither model exhibited severe literature fabrication. Conversely, the standard LLM demonstrated superior biomechanical spatial planning (P = 0.025). The RAG architecture exhibited "retrieval bias" in soft-tissue complication scenarios, leading to inappropriate hard-tissue augmentation. Sensitivity analysis revealed the RAG model's superiority diminished in out-of-distribution synthetic cases lacking thematic overlap with the knowledge base. CONCLUSIONS: Implementing RAG significantly improves evidence traceability, enhances citation precision, and demonstrates high intra-model consistency, with severe diagnostic shifts being exceedingly rare. However, text-based retrieval introduces diagnostic biases causing overtreatment, and its superiority relies heavily on conceptual overlap with the knowledge base. RAG-LLMs are promising adjunctive tools but require continuous expert oversight to compensate for spatial reasoning limitations. CLINICAL SIGNIFICANCE: This study demonstrates that retrieval-augmented generation (RAG) significantly enhances citation precision in implant dentistry by anchoring models to established clinical guidelines. While RAG enhances evidence traceability, clinicians must remain cautious of retrieval bias. This bias can lead to algorithmic overtreatment in soft-tissue complication management. Currently, RAG-enhanced AI serves as a valuable adjunctive tool but cannot replace the three-dimensional spatial reasoning of an experienced implantologist.
Adjunctive use of locally delivered 2% minocycline in the nonsurgical treatment of peri-implantitis: a multicenter randomized placebo-controlled trial.
Lee JH, Yang HJ, Han SJ … +5 more , An CM, Goh MS, Jung HW, Chae MS, Lee DW
J Dent · 2026 Sep · PMID 42150728 · Publisher ↗
OBJECTIVES: This randomized, single-blind, placebo-controlled multicenter trial aimed to evaluate the clinical, radiographic, microbiologic, and patient-reported efficacy of locally delivered adjunctive 2 % minocycline h...
OBJECTIVES: This randomized, single-blind, placebo-controlled multicenter trial aimed to evaluate the clinical, radiographic, microbiologic, and patient-reported efficacy of locally delivered adjunctive 2 % minocycline hydrochloride in the nonsurgical treatment of peri‑implantitis. METHODS: Forty-eight participants were randomized, and 46 (test, n = 22 [subgingival debridement + minocycline ointment]; control, n = 24 [subgingival debridement + placebo]) were included in the per-protocol efficacy analysis after two post-randomization withdrawals in the test group. Interventions were performed at baseline and weeks 1, 2, and 3. Clinical, radiographic, and microbiological parameters were assessed over a 12-week period, along with patient-reported outcomes including discomfort and oral health-related quality of life (OHRQoL). RESULTS: At 12 weeks, the test group showed lower baseline-adjusted probing pocket depth values and less frequent bleeding on probing than the control group. In the microbiologic analysis, adjunctive minocycline was associated with lower levels of selected peri‑implant pathogens at 8 weeks (p < 0.05), whereas between-group differences were less consistent at 12 weeks. Radiographic findings should be interpreted cautiously because the follow-up period was too short to support conclusions regarding structural stability. Early swelling was lower in the test group at 3 weeks than in the control group (p < 0.05), but no significant between-group differences were observed in OHRQoL improvement. CONCLUSION: Locally delivered adjunctive 2 % minocycline may provide short-term clinical benefits and exploratory microbiologic improvements when used with nonsurgical peri‑implantitis therapy. However, the 12-week follow-up herein does not allow conclusions regarding long-term radiographic stability, sustained local efficacy, or definitive disease resolution. CLINICAL SIGNIFICANCE: Adjunctive locally delivered 2 % minocycline may provide short-term clinical benefits in nonsurgical peri‑implantitis therapy while limiting systemic antibiotic exposure.
Chitosan nanoparticles promote TGF-Β1 release from dentin and support stem cell attachment and differentiation in vitro.
Belkadi R, Sanz-Serrano D, Ventura F … +3 more , Deber A, Farfan-Beltran N, Mercade M
J Dent · 2026 Sep · PMID 42150727 · Publisher ↗
OBJECTIVES: To evaluate, in vitro, the effect of chitosan nanoparticles (CSNPs), 17 % EDTA and 10 % citric acid (CA) on dentin-derived Transforming Growth Factor-Beta (TGF-β1) release, Dental Stem Cells SV40 (DSCS) morph...
OBJECTIVES: To evaluate, in vitro, the effect of chitosan nanoparticles (CSNPs), 17 % EDTA and 10 % citric acid (CA) on dentin-derived Transforming Growth Factor-Beta (TGF-β1) release, Dental Stem Cells SV40 (DSCS) morphology, attachment and osteogenic/odontogenic differentiation. MATERIALS AND METHODS: TGF-β1 release after 24 h was quantified by ELISA following 10-min treatment of 30 root segments with CSNPs, EDTA or CA. DSCS attachment and morphology were assessed by scanning electron microscopy (SEM) after 3 days of culture on conditioned dentin surfaces. Differentiation was evaluated using alizarin red staining and COL1A1 expression following exposure to 1:10,000 dilutions of each solution or 5 ng/mL TGF-β1. Data were analysed using one-way ANOVA with Tukey's post hoc test (α=0.05). RESULTS: CSNPs induced significantly higher TGF-β1 release compared to EDTA (p = 0.0480) and CA (p = 0.0045). SEM analysis showed comparable spindle-shaped DSCS morphology and attachment across all groups. CSNPs demonstrated the highest calcium deposition followed by the TGF-β1 group, while minimal deposition was observed with CA and EDTA. TGF-β1 treatment resulted in significantly higher COL1A1 expression compared to EDTA (p = 0.0258) and CA (p = 0.0323), while CSNPs showed a trend toward higher expression. CONCLUSIONS: CSNPs enhanced TGF-β1 release compared to 17 % EDTA and 10 % CA while supporting comparable DSCS morphology and attachment. CSNPs and TGF-β1 showed enhanced osteogenic/odontogenic differentiation compared to 17 % EDTA and 10 % CA. CLINICAL SIGNIFICANCE: CSNPs may represent a potential alternative dentin-conditioning agent capable of enhancing growth factor release and supporting favourable cellular responses; however, further studies are required to confirm their biocompatibility and clinical applicability.
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