Clinical Oral Investigations[JOURNAL]
Sun
200 papers
Effect of a cannabidiol-based mouthwash on dental enamel properties and biofilm control: an In situ study.
Pimenta ALA, de Sousa LA, Martins CHG … +1 more , de Carvalho Panzeri F
Clin Oral Investig · 2026 Jul · PMID 42380527 · Full text
OBJECTIVES: This study evaluated the antibiofilm activity of experimental mouthwash containing different concentrations of cannabidiol (CBD) and the in situ effects on the physical and mechanical properties of dental ena...
OBJECTIVES: This study evaluated the antibiofilm activity of experimental mouthwash containing different concentrations of cannabidiol (CBD) and the in situ effects on the physical and mechanical properties of dental enamel. METHODS: Bovine enamel fragments (6 × 6 × 2 mm) were mounted in intraoral appliances worn by 14 participants in a crossover design. Mouthwash containing CBD (0%, 0.01%, 0.05%, and 0.1%) and 0.12% chlorhexidine (CHX) were tested. Each experimental phase lasted 7 days, separated by washout periods. One side of the appliance was exposed to a cariogenic challenge (20% sucrose) prior to treatment. Surface roughness (Ra), microhardness (%KHN), and color change (ΔE00) were measured before and after treatments. Biofilm and yeast counts (log10 CFU) were quantified, and enamel surfaces were analyzed by scanning electron microscopy. Data were analyzed using two-way ANOVA with Bonferroni post hoc tests and Kruskal-Wallis with Dunn's test (P < 0.05). RESULTS: Sucrose did not significantly affect Ra (P > 0.05), although CBD 0.1% showed higher roughness than CHX under sucrose exposure (P < 0.05). No significant differences in %KHN were observed among treatments; however, sucrose reduced microhardness in the placebo and CBD 0.01% groups (P < 0.05). CHX exhibited the highest ΔE00 values (P < 0.05). Biofilm formation was similar among CHX, CBD 0.05%, and CBD 0.1% (P > 0.05), while CHX showed lower yeast counts than CBD 0.01% and CBD 0.1% (P < 0.05). CONCLUSION: CBD 0.05% demonstrated potential for biofilm control without adversely affecting enamel properties. CLINICAL RELEVANCE: This study provides evidence supporting a natural compound-based mouthwash as a clinically viable alternative to chlorhexidine, showing similar efficacy and no associated adverse effects under the conditions tested.
Relationship between C-shaped root canal configuration in mandibular second molars and radix entomolaris in mandibular first molars: a CBCT-based study in a Western Chinese population.
Al-Awdi HH, Al-Shujaa EA, Madfa AA … +1 more , Peng L
Clin Oral Investig · 2026 Jun · PMID 42377571 · Publisher ↗
OBJECTIVES: Mandibular molars exhibit considerable morphological variability in root and root canal anatomy among individuals and across populations. The aim of this study was to investigate whether an association exists...
OBJECTIVES: Mandibular molars exhibit considerable morphological variability in root and root canal anatomy among individuals and across populations. The aim of this study was to investigate whether an association exists between C-shaped root canal configuration (CSRC) in mandibular second molars (MSMs) and the presence of radix entomolaris (RE) in mandibular first molars (MFMs). MATERIALS AND METHODS: This retrospective CBCT study included 1637 subjects (682 males and 955 females), involving 3274 MSMs and 3274 MFMs. CSRCs in MSMs were categorized using the Fan et al. categorization system (C1-C5). Whereas RE in MFMs were assessed according to American Association of Endodontists (AAE) in which RE identified as an extra distolingual root, both anatomical features were evaluated for frequency and bilateral symmetry. McNemar's tests were used to evaluate bilateral symmetry. The chi-square test and Cramer's V were used to examine the relationship between CSRCs and REs as well as the association between age and gender on the co-occurrence of these characteristics. Binary logistic regression analysis was used to assess if CSRCs might predict the existence of REs. The level of statistical significance was P < 0.05. RESULTS: A total of 1637 patients and 6548 teeth were evaluated in this study. The prevalence of CSRC in MSMs was 46%, while radix RE in MFMs was observed in 31.6% of cases. CSRCs prevalence were slightly higher on the left side, whereas RE was more frequent on the right side. Bilateral symmetry of CSRCs was (86.6%) while was high (90.7%) for REs, A significant association was found between CSRC and RE (χ² = 4.884, p = 0.027). Logistic regression analysis demonstrated that the presence of CSRCs significantly increased the odds of REs by 1.27 times (OR = 1.265, 95% CI: 1.027-1.559, p = 0.027). No significant association was observed between age group and the coexistence of both variations (χ² (2) = 2.654, p = 0.265). In contrast, gender showed a significant association with both variation (χ² (1) = 20.431, P < 0.001), with females demonstrating a higher prevalence compared to males. CONCLUSIONS: RE in MFMs was associated with CSRC in MSMs. Both variations were more common in females, unaffected by age, and showed high bilateral symmetry, highlighting the importance of careful clinical and radiographic assessment for endodontic treatment planning. CLINICAL RELEVANCE: The presence of C-shaped root canal configuration may indicate an increased likelihood of anatomical complexity in mandibular molars. Careful radiographic evaluation, preferably using CBCT, can improve the detection of root canal variations and support more accurate endodontic treatment planning.
Increased TET3 expression associates with proinflammatory cytokines and reduced 5-hydroxymethylcytosine in periapical lesions.
Pacheco M, Rodríguez C, Baeza M … +5 more , Morales B, Bordagaray MJ, Britos M, Fernández A, Hernández M
Clin Oral Investig · 2026 Jun · PMID 42377549 · Publisher ↗
OBJECTIVES: To evaluate the association between apical periodontitis (AP) diagnosis and cytokine expression, exploring the mediating role of global 5-hydroxymethylcytosine (5-hmC) and the enzymes involved in DNA methylat...
OBJECTIVES: To evaluate the association between apical periodontitis (AP) diagnosis and cytokine expression, exploring the mediating role of global 5-hydroxymethylcytosine (5-hmC) and the enzymes involved in DNA methylation and demethylation. MATERIALS AND METHODS: A cross-sectional study included individuals with symptomatic AP (SAP; n = 18), asymptomatic AP (AAP; n = 19), and healthy periodontal ligament (HPL) (n = 11). mRNA levels of DNA methyltransferases (DNMT): DNMT1, DNMT3A; Ten-Eleven Translocation (TET) enzymes: TET2, TET3; and cytokines: IL-1β, and IL-6 were assessed by qRT-PCR in apical lesions and healthy periodontal ligament. Global %5-hmC was quantified by ELISA. Generalized structural equation models (GSEM) were used to evaluate the association between AP diagnosis and cytokine expression, considering %5-hmC and the expression of DNMT and TET genes as potential mediators, adjusted for age. RESULTS: SAP samples showed significantly higher DNMT1, DNMT3A, TET2, TET3, IL-1β, and IL-6 mRNA levels (p ≤ 0.05) and lower %5-hmC compared to HPL, but not when compared with AAP (p > 0.05). In AAP and SAP, DNMT3A, TET2, and TET3 correlated positively with IL-1β and IL-6, while in SAP, DNMT1, DNMT3A, and TET3 were inversely correlated with %5-hmC (p ≤ 0.05), an association not observed in AAP (p > 0.05). Furthermore, higher TET3 expression was associated with increased IL-1β and IL-6 mRNA levels (p ≤ 0.05) and with decreased global %5-hmC levels (p ≤ 0.05) in apical tissues. CONCLUSIONS: Upregulated TET3 expression is associated with proinflammatory responses and global methylation profiles in apical lesions, suggesting a potential role in the epigenetic regulation of AP. CLINICAL RELEVANCE: Epigenetic regulation of inflammatory cytokines may contribute to disease activity in periapical periodontitis.
Safer and faster: evaluation of a dental implant checklist.
Kupka JR, Renouard F, Sagheb K … +3 more , Al-Nawas B, Eckert AW, Schiegnitz E
Clin Oral Investig · 2026 Jun · PMID 42371252 · Full text
OBJECTIVE: Systematic safety approaches, remain largely unevaluated in dental implantology. This prospective interventional study aimed to evaluate the impact of a structured surgical safety checklist on clinical inciden...
OBJECTIVE: Systematic safety approaches, remain largely unevaluated in dental implantology. This prospective interventional study aimed to evaluate the impact of a structured surgical safety checklist on clinical incidents and organizational efficiency in dental implant surgery. METHODS: A before-and-after study design was implemented at a high-volume center, documenting 124 consecutive dental implant surgeries (61 without, 63 with checklist) using a previously by Kupka et al. developed safety checklist. The primary endpoint was the occurrence of incidents divided into clinical deviations and workflow disruptions; the secondary endpoint was procedure duration. RESULTS: Checklist implementation resulted in a statistically significant reduction in mean surgery duration. Mean operative time decreased from 75.4 min (SD 31.9) to 60.3 min (SD 31.4), representing a median decrease: 15.0 min (p < 0.01). The rate of surgeries with at least one incident decreased from 36.1% (22/61) to 23.8% (15/63), which was not statistically significant (p = 0.170). However, clinical deviations dropped significantly from 13.1% to 0.0% (p = 0.003). CONCLUSION: To our knowledge, this is the first study investigating checklist effects on incidents and operating time in implant dentistry, and the largest case number in oral surgery. Introducing a surgical checklist significantly improved efficiency by reducing procedure duration. While the reduction in overall incidents was not statistically significant, the elimination of clinical deviations suggests a safety benefit. Structured checklists might be a valuable tool to enhance patient safety and operational workflow in elective implant surgery.
Correction to: Caries prevention in permanent teeth - basic recommendations of the German S 3 guideline.
Schlueter N, Hellwig E, Geurtsen W … +1 more , Rupf S
Clin Oral Investig · 2026 Jun · PMID 42360521 · Full text
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Preparation and In Vitro Characterization of Quercetin and Chlorhexidine-loaded PLGA Nanoparticles for Oral Biofilm-Associated Pathologies.
İnce İ, Yıldırım Y, Emingil G … +4 more , Gümüştaş B, Yakar N, Özdemir G, Kantarcı A
Clin Oral Investig · 2026 Jun · PMID 42360515 · Full text
OBJECTIVES: This study aimed to develop and evaluate a dual-drug-loaded PLGA nanoparticle system incorporating quercetin (QUE) and chlorhexidine (CHX) for localized, sustained delivery, with potential application in biof...
OBJECTIVES: This study aimed to develop and evaluate a dual-drug-loaded PLGA nanoparticle system incorporating quercetin (QUE) and chlorhexidine (CHX) for localized, sustained delivery, with potential application in biofilm-associated pathologies. MATERIALS AND METHODS: Single- and dual-drug systems containing CHX and QUE at different concentrations (1.5%, 5%, and 15%) were successfully loaded into poly(lactic-co-glycolic acid) nanoparticles (PLGA NPs) with high encapsulation efficiency. Physicochemical characterization was performed using dynamic light scattering (DLS), zeta potential analysis, SEM-EDX, FTIR, and thermal analysis (DSC and TGA). Release kinetics of QUE- and CHX-loaded nanoparticles were evaluated in an artificial saliva environment, and the amounts of CHX and QUE released were quantified by high-performance liquid chromatography (HPLC). Antimicrobial activity was assessed against Staphylococcus aureus and Escherichia coli using the disc diffusion method. RESULTS: The prepared nanoparticles displayed spherical morphology with sizes ranging from 54.08 to 356.1 nm and zeta potentials from - 2.11 to -12.46 mV, indicating colloidal stability. FTIR and thermal analysis confirmed molecular dispersion of drugs and polymer-drug interactions. QUE showed complete release within 168 h in the single-drug system, whereas co-loading with CHX extended QUE retention, with 20% remaining after 240 h. CHX release reached ∼80% in both formulations. CHX/QUE nanoparticles demonstrated superior antibacterial activity compared to QUE-only systems, effectively inhibiting both Gram-positive and Gram-negative bacteria. CONCLUSION: These compounds and formulations are designed for clinical applications due to their slow, controlled release of the dual-active PLGA NP system.
Gallic acid as a biointeractive dentin conditioning agent for universal adhesives: bond strength, iron retention, and surface characterization following ferric sulfate hemostatic contamination.
Yılmaz NA
Clin Oral Investig · 2026 Jun · PMID 42350719 · Full text
OBJECTIVES: This study evaluated the effects of two universal adhesives, applied under three protocols, self-etch (SE), conventional total-etch (CTE), and modified total-etch (MTE) with 1% (w/v) gallic acid, on shear bon...
OBJECTIVES: This study evaluated the effects of two universal adhesives, applied under three protocols, self-etch (SE), conventional total-etch (CTE), and modified total-etch (MTE) with 1% (w/v) gallic acid, on shear bond strength (SBS), iron retention, and surface characteristics of noncontaminated and ferric sulfate-contaminated dentin. MATERIALS AND METHODS: One hundred eighty dentin specimens prepared from ninety extracted human molars were allocated to 12 groups (n = 15) by adhesive type (All Bond Universal [ABU] or Tokuyama Universal Bond [TUB]), application protocol (SE, CTE, or MTE), and contamination condition (noncontaminated or 20% ferric sulfate-contaminated [ViscoStat]. After composite build-up and 5,000x thermocycling, SBS was measured. Surface morphology (n = 3, 6 groups) and elemental composition (n = 5, 5 groups) were characterized by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). SBS data were analyzed by three-way ANOVA (α = 0.05). RESULTS: All three variables significantly affected SBS (p < 0.001). SE yielded the lowest SBS values (17.46 ± 3.19 MPa) among all protocols (p < 0.001). CTE and MTE protocols showed comparable SBS values (20.30 ± 3.20 vs. 20.80 ± 3.05 MPa; p = 0.591). After ferric sulfate contamination, CTE produced no detectable iron residue, whereas MTE retained iron-associated surface deposits. EDS revealed descriptively higher mineral content in gallic acid-conditioned dentin, and SEM showed protocol-dependent surface patterns. CONCLUSIONS: Gallic acid yielded short-term bond strength comparable to phosphoric acid, while inducing a more conservative surface modification. However, gallic acid conditioning following ferric sulfate contamination should be regarded cautiously, as iron-associated deposits are preserved. CLINICAL RELEVANCE: Gallic acid may be considered a conservative preconditioning option for noncontaminated dentin. After ferric sulfate contamination, phosphoric acid remains the more predictable choice given its iron-removal capacity.
Temporal dynamics of human biomarkers of orthodontically-induced root resorption: A systematic review.
Feng W, Van Orshoven L, Bostanci N … +2 more , Nilsen BW, Cadenas de Llano Perula M
Clin Oral Investig · 2026 Jun · PMID 42347988 · Publisher ↗
OBJECTIVE: To summarize time-related biomarker changes in orthodontically-induced root resorption (OIRR), classify biomarkers by function, and examine trajectories across OIRR stages. MATERIALS AND METHODS: PubMed/MEDLIN...
OBJECTIVE: To summarize time-related biomarker changes in orthodontically-induced root resorption (OIRR), classify biomarkers by function, and examine trajectories across OIRR stages. MATERIALS AND METHODS: PubMed/MEDLINE, Embase, Scopus, Web of Science, CENTRAL, CINAHL and grey literature, were searched from inception to October 1, 2025. Reference lists were manually searched. The risk of bias was assessed using the Cochrane RoB 2 for RCTs and ROBINS-I for non-RCTs. The certainty of evidence was evaluated via GRADE. Because of heterogeneity, findings were synthesized narratively. RESULTS: From 11,434 records, 14 studies (225 participants) were included. Gingival crevicular fluid, saliva and serum were analyzed, mainly using enzyme-linked immunosorbent assay. RoB was 'moderate'- 'serious' (non-RCTs) or 'some concerns' (RCTs). Studies reported a rise of pro-inflammatory cytokines right after force application. Subsequent force application phases showed signals of osteoclastic activity and regulation, followed by detection of root hard tissue degradation products that correlated with OIRR volume. Higher baseline salivary secretory IgA and anti-dentin humoral responses and lower baseline mineralized-tissue regulators were associated with greater OIRR severity. CONCLUSION: Evidence suggests time-related changes involving early inflammatory activation and later matrix degradation, which may be shaped by interaction between orthodontic force and patients' biological responses. Standardized multicenter prospective cohorts are needed for validation. CLINICAL RELEVANCE: Early cytokines changes and later signals of osteoclast regulation and root hard tissue degradation may help define candidate monitoring method for OIRR during treatment. Baseline immune profiles could inform future risk stratification, while bone turnover biomarkers may reflect tooth movement rather than resorption.
Correction to: Prevalence of caries in teeth adjacent to implant-supported prostheses and relationship with implant location and the manner of restoration placement: a retrospective cohort study.
Lastra-Prados P, Cortés-Bretón Brinkmann J, Gómez-Costa D … +4 more , Sánchez-Labrador L, Hernández de Oliveira M, Rodríguez-Molinero J, López-Sánchez AF
Clin Oral Investig · 2026 Jun · PMID 42340490 · Full text
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A proof-of-concept for a novel mandibular dental implant model in mice.
Blanc-Sylvestre N, Bensidhoum M, Sadoine J … +6 more , Tapie L, Carra MC, Biosse Duplan M, Bouchard P, Chaussain C, Bardet C
Clin Oral Investig · 2026 Jun · PMID 42334697 · Publisher ↗
AIMS: Animal models are needed to further investigate the osseointegration process after dental implant placement. The aim of this study was to introduce a proof-of-concept for a novel preclinical mandibular dental impla...
AIMS: Animal models are needed to further investigate the osseointegration process after dental implant placement. The aim of this study was to introduce a proof-of-concept for a novel preclinical mandibular dental implant in mice. METHODS: Morphometric analyses of maxillaries from C57BL/6 mice were performed using micro-computed tomography (micro-CT) to identify suitable implant site. The bone surrounding the mandibular first molar was selected due to its similarity to human bone characteristics (cortical/trabecular bone and crown/root ratio), and vertical shape which allows for implant complete bone coverage. Considering dental development and alveolar bone density, mandibular first molars were extracted 5 weeks postnatally. Implants were designed based on the characteristics of the alveolar bone healing site and manufactured in medical Ti-6Al-4 V. One implant was placed per mouse at the tooth extraction site and maintained to 35 days post-extraction. Bone-to-implant contact was measured by longitudinal micro-CT imaging. RESULTS: Following morphometric evaluation, the mandibular first molar site was selected for implant placement based on its sufficient bone volume. Five weeks after extraction, the surgical site showed a bone volume-to-total volume ratio similar to that of native bone (83% vs. 84%, respectively). Implant follow-up showed that peri-implant bone volume plateaued from day 28 and indicated intimate contact between bone and implant surfaces (84.6%) at day 35 after implantation, confirmed through histological analyses. CONCLUSION: This proof-of-concept study establishes a reliable preclinical mouse model for mandibular dental implantation. Beyond implantology, this model offers promising applications for investigating how systemic or genetic conditions influence bone healing and implant success.
Do polyphenol-rich solutions derived from tropical fruit seeds protect dentin against erosive-abrasive challenges?
de Alencar Camacho ELC, Carneiro PMA, Loretto SC … +5 more , de Oliveira RP, Silva AM, Besegato JF, Otárola WGE, de Melo Alencar C
Clin Oral Investig · 2026 Jun · PMID 42322451 · Full text
OBJECTIVES: To evaluate the effect of polyphenol-rich hydroalcoholic extracts derived from the seeds of four tropical fruits-Paullinia cupana (guaraná), Euterpe oleracea (açaí), Byrsonima crassifolia (murici), and Bactri...
OBJECTIVES: To evaluate the effect of polyphenol-rich hydroalcoholic extracts derived from the seeds of four tropical fruits-Paullinia cupana (guaraná), Euterpe oleracea (açaí), Byrsonima crassifolia (murici), and Bactris gasipaes (peach palm)-on dentin under erosive-abrasive conditions. MATERIALS AND METHODS: Seed-derived hydroalcoholic extracts were prepared and chemically characterized in terms of total polyphenol content and antioxidant capacity using DPPH and ABTS assays. Human dentin specimens (n = 180) were subjected to an initial erosive challenge and randomly allocated into six experimental groups (n = 30). Treatments were applied prior to a 7-day erosive-abrasive cycling model. Dentin surface loss (dSL), collagen degradation (dCol), and calcium release (CaR) were quantitatively assessed, and surface morphology was qualitatively evaluated using scanning electron microscopy (SEM). Data were analyzed using one-way ANOVA followed by Tukey's test (α = 0.05). Exploratory linear regression analyses were performed to assess the association between total polyphenol content and dentin outcomes. RESULTS: P. cupana and E. oleracea exhibited the highest polyphenol content and antioxidant capacity and were associated with significantly reduced dSL, dCol, and CaR compared with the untreated control (p < 0.05). Qualitative analysis suggested a more compact surface with reduced dentinal tubule exposure in these groups. B. crassifolia demonstrated moderate protective effects, whereas B. gasipaes showed limited efficacy. Exploratory regression analyses indicated a negative association between total polyphenol content and dentin outcomes. CONCLUSIONS: Polyphenol-rich extracts derived from tropical fruit seeds-particularly P. cupana and E. oleracea-were associated with protective effects on dentin under erosive-abrasive conditions, reducing mineral loss and collagen degradation. However, the underlying mechanisms remain unclear and should be further investigated in future studies. CLINICAL SIGNIFICANCE: Plant-derived polyphenol-rich extracts may represent a promising adjunctive approach in preventive strategies for erosive tooth wear.
Translation and validation of the Hebrew version of the xerostomia inventory.
Aizenbud N, Aframian DJ, Nussbaum G … +1 more , Almoznino G
Clin Oral Investig · 2026 Jun · PMID 42315815 · Full text
OBJECTIVES: Xerostomia significantly affects oral health and quality of life, yet no validated Hebrew assessment exists. This study aimed to translate the Xerostomia Inventory (XI) into Hebrew (HXI) and evaluate its vali...
OBJECTIVES: Xerostomia significantly affects oral health and quality of life, yet no validated Hebrew assessment exists. This study aimed to translate the Xerostomia Inventory (XI) into Hebrew (HXI) and evaluate its validity and reliability. METHODS: The XI was translated into Hebrew using cross-cultural adaptation guidelines. The HXI was examined for internal consistency, using Cronbach's alpha, as well as for construct validity (convergent and discriminant validity). RESULTS: The HXI was completed by 102 xerostomia patients, 89.2% women, and the mean age was 63.5 ± 13.8 years with age range of 20-90 years. The mean HXI score was 39.9 ± 1.2, with score range 12-55. The HXI exhibited a high level of reliability with Cronbach's α = 0.975. The convergent validity of the HXI, indicated by Spearman's correlation between the HXI and the unstimulated salivary flow (USF) whole volume, demonstrated a strong, negative, and statistically significant correlation (r = -0.862). Strong negative correlations were also found between the total HXI score and other sialometry variables (ranging from r=-0.696 to r=-0.879). The absence of significant associations between the HXI scores and unrelated sociodemographic variables supports the discriminant validity of the HXI. Confirmatory factor analysis supported a robust unidimensional structure for the Hebrew 11-item HXI, with a single factor accounting for 80.3% of the total variance and all item loadings exceeding 0.82. CONCLUSIONS: The HXI is a valid and reliable instrument for assessing xerostomia in Hebrew-speaking populations, demonstrating psychometric robustness consistent with international versions. CLINICAL RELEVANCE: The HXI provides a valid and reliable tool for assessing patient-reported oral dryness, supporting diagnosis, treatment, and evaluation of interventions in Hebrew-speaking populations.
Deflection of occlusal splints under bruxism-like conditions: An exploratory in vitro investigation.
Merle CL, Rauch A, Wulff J … +2 more , Schmidt MB, Rosentritt M
Clin Oral Investig · 2026 Jun · PMID 42315673 · Publisher ↗
OBJECTIVE: Occlusal splints are common part of bruxism management to reduce occlusal forces. This preliminary study investigates in vitro the deflection of occlusal splint materials. MATERIALS AND METHODS: Two occlusal s...
OBJECTIVE: Occlusal splints are common part of bruxism management to reduce occlusal forces. This preliminary study investigates in vitro the deflection of occlusal splint materials. MATERIALS AND METHODS: Two occlusal splints per material were fabricated by casting (Palapress vario), thermoforming (Erkodur 1.0 mm and 1.5 mm), milling (Bio Splint P HI, Bio Splint C, ClearSplint), and 3D printing (LuxaPrint Ortho Plus, 0° and 45° orientation). Each splint was applied to a functional dental model featuring movable plastic teeth. The right upper incisor, canine, and second premolar were loaded up to 50 N on occlusal and buccal sides using a universal testing machine (Z010, Zwick; four measurements). Statistical analysis used Kruskal-Wallis and Dunn's test with Bonferroni correction (α = 0.05). RESULTS: Mean deflection of the tooth-splint-system ranged from 0.8 mm to 2.7 mm. Significant differences between the materials were detected (p < 0.001), with the highest values for Erkodur 1.0 mm and ClearSplint and the lowest for Bio Splint P HI and Erkodur 1.5 mm. No significant differences were observed between the two print orientations of LuxaPrint Ortho Plus. CONCLUSIONS: This preliminary study demonstrates material-dependent differences in the deflection of occlusal splints under load. Clinically oriented test setups may provide valuable insight for evidence-based material selection in bruxism management.
Piezosurgery-assisted protocol for impacted mandibular third molar removal with 3D facial swelling analysis: a randomized split-mouth clinical trial on post-surgical sequelae.
Antonelli A, Brunello G, Salviati M … +4 more , Barone S, Bennardo F, Jones JM, Giudice A
Clin Oral Investig · 2026 Jun · PMID 42310125 · Full text
OBJECTIVES: This split-mouth randomized controlled trial aimed to compare a novel piezosurgery protocol versus a conventional rotary technique for the extraction of mesio-angulated and horizontally impacted mandibular th...
OBJECTIVES: This split-mouth randomized controlled trial aimed to compare a novel piezosurgery protocol versus a conventional rotary technique for the extraction of mesio-angulated and horizontally impacted mandibular third molars (MA-HM3Ms), evaluating postoperative inflammatory sequelae and patient-centered outcomes. MATERIALS AND METHODS: Forty-seven healthy adult patients underwent bilateral MA-HM3M extraction with piezosurgery protocol (test group, TG) and, contralaterally, with conventional rotary instruments and manual elevators (control group, CG). Facial swelling was objectively quantified using three-dimensional facial scans at 2 and 7 days postoperatively. Secondary outcomes included postoperative pain, maximum mouth opening, bleeding, surgical time, analgesic intake, complications, and patient-reported outcomes assessed using the PoSSe scale. Statistical analysis was performed using paired comparisons and regression models (α = 0.05). RESULTS: Ninety-four extractions were analyzed. After 2 days, lower facial swelling was significantly reduced in TG compared with CG (p = 0.01), together with less pronounced trismus (p = 0.016). Pain was consistently lower in the TG at all timepoints, while postoperative bleeding and analgesic intake were significantly higher in the CG (p < 0.05). Surgical time was longer in TG than in CG (p < 0.001). The piezosurgery protocol significantly reduced interference with daily activities and resulted in higher patient satisfaction. Regression analyses showed a direct association between swelling and PoSSe scale in both groups. No permanent neurological complications were observed; alveolitis occurred in 3 CG and 2 TG sites. CONCLUSIONS: This split-mouth randomized controlled trial suggests that piezosurgery for MA-HM3M extraction effectively reduces early postoperative inflammatory sequelae, improving patient-centered outcomes and quality of life, despite longer operative times. CLINICAL RELEVANCE: The proposed piezoelectric protocol could represent a minimally invasive alternative to conventional rotary techniques, particularly in complex MA-HM3M extractions, enhancing patient comfort and quality of life during the most critical postoperative period while supporting a more controlled and refined surgical approach. Registry: ClinicalTrials.gov, TRN: NCT06212232, Registration date: 25 January 2024.
Salivary innate immune peptides are associated with dental caries experience in young adults.
Lozano CP, Echeverría C, García-Manríquez N … +2 more , Gambetta-Tessini K, Giacaman RA
Clin Oral Investig · 2026 Jun · PMID 42289614 · Publisher ↗
BACKGROUND: Saliva has traditionally been studied in relation to dental caries through parameters such as flow rate, pH, and buffering capacity. However, additional components, particularly proteins of the innate immune...
BACKGROUND: Saliva has traditionally been studied in relation to dental caries through parameters such as flow rate, pH, and buffering capacity. However, additional components, particularly proteins of the innate immune system, may also contribute to caries development or prevention. This study evaluated whether antimicrobial peptides (AMPs) in saliva are associated with caries status in young adults. METHODS: Forty healthy volunteers (18-35 years) attending the University Dental Clinics provided stimulated saliva samples and were assigned to either a low-caries group or a high caries experience group, based on ICDAS criteria and DMFS index scores. Levels of human β-defensins 1-3, histatin-5, and cathelicidin LL-37 were quantified using peptide-specific ELISA kits. RESULTS: All AMP concentrations were significantly higher in individuals with low caries compared with those with high caries (p < 0.001). Moreover, a negative association was observed between D1-6MFS scores and salivary AMP concentrations. CONCLUSIONS: These findings indicate that salivary AMPs levels are associated with caries experience and may reflect differences in host innate immune response. CLINICAL RELEVANCE: Salivary AMPs may represent promising non-invasive biomarkers to support caries risk assessment and preventive strategies.
Accuracy of palatal orthodontic miniscrew placement: Static vs dynamic computer-guided techniques in a randomized clinical trial.
Brilli D, Giansanti M, Altieri F … +1 more , Cassetta M
Clin Oral Investig · 2026 Jun · PMID 42289607 · Publisher ↗
OBJECTIVES: This randomized clinical trial compared the accuracy of palatal paramedian miniscrew placement using static computer-assisted surgery (s-CAS) and dynamic computer-assisted surgery (d-CAS). MATERIALS AND METHO...
OBJECTIVES: This randomized clinical trial compared the accuracy of palatal paramedian miniscrew placement using static computer-assisted surgery (s-CAS) and dynamic computer-assisted surgery (d-CAS). MATERIALS AND METHODS: Forty subjects (11-17 years) requiring palatal paramedian miniscrew insertion were randomized into two groups to receive two miniscrews placed with s-CAS (Group A; n = 20 subjects, 40 miniscrews) and d-CAS (Group B; n = 20 subjects, 40 miniscrews). Preoperative digital intraoral scans and CBCT images were used for virtual planning. Group A procedures employed patient-specific surgical guides, while group B procedures were performed with real-time navigation. Immediate postoperative CBCT scans were superimposed to measure four accuracy parameters: coronal, apical, depth, and angular deviation from the planned position. Statistical analysis included the mixed-effect model analysis. RESULTS: Eighty miniscrews were analyzed. Mean coronal (p < 0.001), apical (p < 0.001) and angular deviations (p = 0.001) were significantly lower in the s-CAS group compared to the d-CAS group. No significant difference was observed for depth deviation (p = 0.065). The s-CAS technique also exhibited smaller standard deviations and lower maximum deviations across all parameters. CONCLUSIONS: Static computer-assisted surgery achieved greater linear and angular accuracy than dynamic navigation for palatal miniscrew insertion, while vertical control was comparable between the two approaches. CLINICAL RELEVANCE: In the present study, static computer-assisted surgery offered superior consistency and accuracy in palatal miniscrew placement, supporting its use in anatomical areas where spatial accuracy is critical to avoid adjacent anatomical structures. Dynamic navigation remains a viable alternative when flexibility, visibility, or same-day digital workflows are prioritized. CLINICAL TRIAL REGISTRATION: The trial was registered in clinicaltrials.gov; reference number. NCT07378618.
Effect of curing mode and composite pre-heating on bonding performance of flowable resin composite to enamel.
Li Z, Zhu J, Guo J … +2 more , Tang C, Huang C
Clin Oral Investig · 2026 Jun · PMID 42289599 · Publisher ↗
OBJECTIVES: This study aimed to investigate the influence of application methods combining different curing modes (pre-curing or co-curing) and flowable composite temperature (room temperature or pre-heating to 68 °C) on...
OBJECTIVES: This study aimed to investigate the influence of application methods combining different curing modes (pre-curing or co-curing) and flowable composite temperature (room temperature or pre-heating to 68 °C) on the shear bond strength (SBS) and microleakage of flowable composite to enamel. MATERIALS AND METHODS: Bovine enamel specimens (5 × 5 mm) were prepared (n = 10/group) and embedded in acrylic resin. A universal adhesive (Single Bond Universal Adhesive, 3M ESPE) and flowable resin composite (Filtek Z350 XT Flowable Restorative, 3M ESPE) were applied under four protocols: (1) Pre-curing adhesive combined with room-temperature composite (pre-curing + room-temperature); (2) Pre-curing adhesive combined with pre-heated composite (pre-curing + pre-heating); (3) Co-curing adhesive combined with room-temperature composite (co-curing + room-temperature); (4) Co-curing adhesive combined with pre-heated composite (co-curing + pre-heating). The immediate and aged (after 10,000 thermocycles) SBS were measured. Microleakage was assessed using the methylene blue dye penetration method (n = 10/group). The ultrastructure of adhesive-enamel interfaces was characterized by scanning electron microscopy (SEM). Data were analyzed using two-way ANOVA and Kruskal-Wallis tests (p < 0.05). RESULTS: SBS was not significantly influenced by the application methods (p > 0.05), indicating no significant difference in SBS was found among the groups, either immediately or after aging. Aging significantly reduced SBS (p < 0.05). Microleakage scores showed no significant difference among four protocols (p > 0.05), though aging increased marginal microleakage in most groups (p < 0.05) except co-curing with room-temperature composite. SEM revealed typical composite-adhesive-enamel interfaces with clear adhesive layers, while the adhesive layer in co-curing groups showed a slightly less uniform thickness. CONCLUSIONS: Neither curing mode nor pre-heating of the flowable composite resin significantly influenced the bonding performance to enamel, either immediately or after thermocycling aging. In the scenario of simple enamel restoration, the co-curing technique offers the advantages of simplifying the clinical procedure with comparable bonding performance to the conventional pre-curing method. CLINICAL RELEVANCE: The co-curing protocol provides a simplified application method without compromising bonding performance when bonding to enamel.
Retrospective analysis of risk indicators for erosive tooth wear in patients from Midwest US.
Messias DC, Leme-Kraus AA, Lewis SE … +1 more , Teixeira EC
Clin Oral Investig · 2026 Jun · PMID 42287456 · Full text
OBJECTIVES: This retrospective study aimed to identify risk indicators for erosive tooth wear (ETW) in patients from the Midwest US. MATERIALS AND METHODS: Clinical records from 2019 to 2023 were reviewed from 2,482 adul...
OBJECTIVES: This retrospective study aimed to identify risk indicators for erosive tooth wear (ETW) in patients from the Midwest US. MATERIALS AND METHODS: Clinical records from 2019 to 2023 were reviewed from 2,482 adult patients diagnosed with ETW at the University of Iowa College of Dentistry. A control group of 2,967 patients without ETW was randomly selected from the same timeframe. Data on demographic information, self-reported medical history, and oral health condition/habits were extracted. Logistic regression analysis (α = 0.05) was used to evaluate associations between ETW and potential risk indicators. RESULTS: ETW was significantly associated with age (35-54 years: OR = 1.24; p = 0.03), male sex (OR = 1.43; p < 0.001), parafunctional habits (OR = 1.44; p < 0.001), and eating disorders (OR = 1.90; p = 0.014). No significant associations were found for Social Deprivation Index (SDI), sleep apnea, dry mouth, toothbrushing frequency, alcohol use, or GERD. CONCLUSIONS: Within the limitations of this retrospective study, age (35-54 years), male sex, parafunctional habits (clenching, grinding or bruxism), and eating disorders (bulimia and/or anorexia nervosa) were identified as significant risk indicators for erosive tooth wear. Recognition of these factors may support earlier diagnosis and tailored preventive strategies. CLINICAL RELEVANCE: Dental professionals should be particularly attentive to patients aged 35-54 years, males, and those with parafunctional habits or eating disorders, as they are more likely to present with erosive tooth wear. Early identification of these risk indicators can guide preventive counseling and individualized management to reduce the progression and long-term impact of the condition.
Intraoral fluoride retention after using experimental toothpaste containing titanium tetrafluoride and chitosan.
Francese MM, Bicalho JP, Barros HZ … +6 more , Kim RR, Floret GP, Ferrari CR, Thomassian LTG, da Rocha DRC, Magalhães AC
Clin Oral Investig · 2026 Jun · PMID 42287446 · Full text
OBJECTIVES: This clinical study evaluated the intraoral fluoride retention using Titanium tetrafluoride (TiF)/Chitosan (Ch) toothpaste. MATERIALS AND METHODS: Participants (n = 20) were randomly divided into double-blind...
OBJECTIVES: This clinical study evaluated the intraoral fluoride retention using Titanium tetrafluoride (TiF)/Chitosan (Ch) toothpaste. MATERIALS AND METHODS: Participants (n = 20) were randomly divided into double-blind and crossover phases according to the toothpastes: (1) TiF₄/Ch (1400 ppm F, pH 4.5, 0.5% chitosan); (2) TiF₄ (1400 ppm F, pH 4.5); (3) Elmex Caries Protection (positive control, 1450 ppm F, AmF, pH 4.5); and (4) Placebo (negative control, pH 7.0). Each participant received all treatments, with a 7-day washout period between phases. After seven days, stimulated saliva and biofilm samples were collected 1 h and 12 h after brushing. Fluoride concentrations (ppm F) were determined with specific electrodes and statistically analyzed (ANOVA/Tukey, p < 0.05). RESULTS: After 1 h, TiF₄/Ch toothpaste increased the mean fluoride levels in saliva (4.33 vs. 0.81 ppm for the placebo), biofilm fluid (0.25 vs. 0.18 ppm), solid biofilm (12.66 vs. 3.73 ppm), and total biofilm (22.14 vs. 3.19 ppm), similarly to TiF₄ and Elmex. After 12 h, mean fluoride levels in saliva and biofilm fluid returned to baseline, while elevated levels persisted in the solid biofilm (8.29 vs. 3.15 ppm) and total biofilm (6.57 vs. 2.03 ppm). CONCLUSIONS: TiF₄/Ch toothpaste maintained fluoride retention in stimulated saliva and biofilm, similarly to the TiF and Elmex. Fluoride retention in saliva and biofilm fluid was observed at 1 h after use, whereas in biofilm it persisted for 12 h. CLINICAL RELEVANCE: TiF₄/Ch toothpaste showed prolonged fluoride retention in biofilm, comparable to the commercial toothpaste, supporting its potential as an alternative for maintaining intraoral fluoride reservoirs. TRIAL REGISTRATION: This study was registered at the Brazilian Registry of Clinical Trials (ReBEC) under number RBR-3f5c5hx.
Age-specific patterns of lymph node involvement in elderly patients with oral squamous cell carcinoma: a retrospective cohort study.
Schmitz AM, Kern N, Brauckmann M … +7 more , Hofmann C, Mrosk F, Rendenbach C, Doll C, Richter M, Heiland M, Koerdt S
Clin Oral Investig · 2026 Jun · PMID 42283899 · Full text
OBJECTIVES: Age-related alterations in lymphatic and immune function may influence nodal disease patterns in elderly patients with oral squamous cell carcinoma (OSCC). This study aimed to evaluate the association between...
OBJECTIVES: Age-related alterations in lymphatic and immune function may influence nodal disease patterns in elderly patients with oral squamous cell carcinoma (OSCC). This study aimed to evaluate the association between chronological age and lymph node metastasis (LNM) and to assess whether the lymph node ratio (LNR) retains prognostic relevance for overall survival (OS) across different elderly age groups. MATERIALS AND METHODS: This retrospective cohort study included 363 patients aged ≥ 65 years who underwent primary surgical treatment for OSCC. Age was analyzed both as predefined age groups and as a continuous variable using natural cubic spline modeling. Associations between age and LNM were examined using logistic regression. The impact of age and LNR on OS was evaluated using Cox proportional hazards models, supplemented by time-dependent receiver operating characteristic analyses. RESULTS: Chronological age showed no significant linear association with LNM, while spline analyses indicated only a weak non-linear relationship. Higher comorbidity burden was inversely associated with LNM. LNR was not correlated with age and showed comparable distributions across elderly age strata. In survival analyses, LNR demonstrated a strong non-linear association with OS, whereas age exerted only a modest effect. Overall survival did not differ significantly between elderly age groups. CONCLUSIONS: Chronological age alone was not a major determinant of nodal involvement or survival in elderly OSCC patients. LNR remained a robust prognostic indicator independent of age. CLINICAL RELEVANCE: LNR may aid in risk stratification and postoperative decision-making in elderly OSCC patients, supporting individualized oncologic management beyond chronological age alone.
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