Clinical Oral Investigations[JOURNAL]
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200 papers
Oral health outcomes following early-life exposure to war-related hardship: a cross-sectional study.
Tobias G, Mann J, Zini A … +1 more , Sgan-Cohen HD
Clin Oral Investig · 2026 Mar · PMID 41843190 · Full text
BACKGROUND: The Holocaust was a uniquely traumatic historical event marked by prolonged periods of starvation, extreme physical and psychological stress, and deprivation of basic human rights. While previous research has...
BACKGROUND: The Holocaust was a uniquely traumatic historical event marked by prolonged periods of starvation, extreme physical and psychological stress, and deprivation of basic human rights. While previous research has explored the general health consequences of Holocaust exposure, the long-term effects on oral health have received limited attention. Oral health is an essential component of overall well-being, with edentulism (complete tooth loss) recognized as a marker of severe oral disease and functional impairment in older adults. This purpose of this study was to assess the long-term impact of Holocaust exposure on oral health outcomes, specifically the prevalence of complete edentulism, among elderly Jewish Israelis more than six decades after World War II. METHODS: A cross-sectional analysis was conducted using data from a nationallyrepresentative Israeli survey of adults aged 65 and older, carried outbetween 2005 and 2006. The sample included 1,459 Jewish participants,of whom 396 were identified as Holocaust survivors. Data were collectedvia structured in-home interviews and, for a subset, clinical oralexaminations. Multivariate logistic regression was used to identifypredictors of having two full dentures, serving as a proxy for completetooth loss. RESULTS: Holocaust survivors exhibited significantly higher rates of complete edentulism compared to the control group (56.3% vs. 45.7%, p < 0.01). After adjusting for confounders, factors independently associated with having two full dentures included older age, smoking history, recent dental visits, Holocaust exposure, lower religiosity, and caregiver dependence. The final model explained 22.2% of the variance in denture status. CONCLUSION: Holocaust survivors exhibited poorer oral health compared to their peers,with several contributing factors identified in the analysis.These findings highlight the need for tailored dental and health servicesfor Holocaust survivors and other trauma-exposed populations, andunderscore the long-term oral health implications of early-life adversity.
A Randomised Controlled Trial Comparing Thermoformed and 3D-Printed Retainers in Young Adults: Evaluation of Post-treatment Stability and Patient Satisfaction.
Boo HS, Mohd Tahir NNZ, Bahar AD … +2 more , Littlewood SJ, Sivarajan S
Clin Oral Investig · 2026 Mar · PMID 41840261 · Full text
INTRODUCTION: To compare post-treatment stability and oral health-related quality of life (OHRQoL) in young adults wearing thermoformed retainers (TFR) versus direct 3D-printed retainers (3DPR) over a six-month part-time...
INTRODUCTION: To compare post-treatment stability and oral health-related quality of life (OHRQoL) in young adults wearing thermoformed retainers (TFR) versus direct 3D-printed retainers (3DPR) over a six-month part-time retention period. MATERIALS AND METHODS: This single-centre, two-arm parallel randomised controlled trial allocated 30 debonded orthodontic patients (≥ 18 years) to either TFR (Erkodur PETG, 1.0 mm) or 3DPR (NextDent Ortho Flex, 0.75 mm) in a 1:1 ratio. All retainers were worn part-time (8-12 h/day). Digital intraoral scans were obtained at baseline (T0) and six months (T2) using Trios 3, and post-treatment stability was assessed digitally using Little's Irregularity Index, intercanine width, intermolar width, arch length, overjet, and overbite. OHRQoL was evaluated at both time points using the OHIP-14(M) questionnaire. Non-parametric tests were applied following the Shapiro-Wilk assessment, and analyses were conducted using an intention-to-treat approach. RESULTS: One dropout in the 3DPR group at T2. At T2, no significant between-group differences were found in Little's Irregularity Index, intercanine width, intermolar width, arch length, or overjet (p > 0.05). Overbite values were statistically higher in the TFR group at T2 (p < 0.05); however, the difference was not clinically significant. Changes in post-treatment stability from T0 to T2 (ΔT2-T0) did not differ significantly between groups (p > 0.05). Total OHIP-14(M) scores improved significantly from T0 to T2 in both groups (TFR p = 0.016; 3DPR p = 0.013), with no significant between-group differences at either time point (p > 0.05). A small but significant difference was observed in the psychological disability domain at T2, with slightly higher scores in the 3DPR group (p = 0.020). No harm was observed. CONCLUSIONS: TFR and 3DPR demonstrated comparable post-treatment stability and similar improvements in OHRQoL after six months of part-time wear. REGISTRATION: ClinicalTrials.gov (Identifier NCT05968625). PROTOCOL: The protocol was published before trial commencement.
The influence of hypoxia on tissue regeneration in oral and maxillofacial surgery - a systematic review.
Gäde AHF, Schiegnitz E, Eckert AW … +3 more , Sagheb K, Al-Nawas B, Kupka JR
Clin Oral Investig · 2026 Mar · PMID 41838239 · Full text
PURPOSE: Hypoxia is an inevitable consequence of surgical interventions such as bone augmentation and soft tissue transplantation in oral and maxillofacial surgery. Cellular adaptation to hypoxic conditions critically in...
PURPOSE: Hypoxia is an inevitable consequence of surgical interventions such as bone augmentation and soft tissue transplantation in oral and maxillofacial surgery. Cellular adaptation to hypoxic conditions critically influences regenerative processes, including osseointegration, angiogenesis and tissue integration. This systematic review investigated the effects of hypoxic conditions and hypoxia-regulating strategies on tissue regeneration, with the aim of identifying mechanisms to enhance clinical outcomes. METHODS: Following the PRISMA guidelines, a systematic search was performed in MEDLINE (via PubMed), Cochrane, and Web of Science up to 31st May 2025, including reference list and citation screening. The risk of bias was assessed according to the SYRCLE risk of bias tool. RESULTS: Of 5790 studies, 9 met the inclusion criteria. These studies investigated various interventions, including gene therapy targeting hypoxia-inducible factor 1α (HIF-1α), oxygen-releasing biomaterial scaffolds, hyperbaric oxygen treatment and hypoxia preconditioning of bone marrow mesenchymal stem cells. Some studies showed enhanced bone formation and vascularization with HIF-1α upregulation or hypoxic preconditioning, while others highlighted HIF-1α’s role in osteoclast activation and bone resorption. Hyperbaric oxygen treatment consistently improved bone healing. CONCLUSION: Current evidence highlights a complex interplay between hypoxia and regenerative outcomes in oral and maxillofacial surgery. Although modulation of HIF-1α and the hypoxic microenvironment hold promise, further research is needed to clarify optimal strategies for maximizing benefits and minimizing detrimental effects. CLINICAL RELEVANCE: The ability to influence the HIF pathway in beneficial manner may be a cornerstone to unlocking the next generation of regenerative therapies in oral and maxillofacial surgery.
Stress-Controlled Torsional Fatigue Assessment of Selected Contemporary Endodontic Instruments.
Ohri K, Chien PY, Peters OA
Clin Oral Investig · 2026 Mar · PMID 41826551 · Full text
OBJECTIVES: To compare stress-controlled torsional fatigue resistance of TruNatomy (TN), ProTaper Next (PTN), and ProTaper Ultimate (PTUL) instruments of comparable sizes at both room and body temperature. MATERIALS AND...
OBJECTIVES: To compare stress-controlled torsional fatigue resistance of TruNatomy (TN), ProTaper Next (PTN), and ProTaper Ultimate (PTUL) instruments of comparable sizes at both room and body temperature. MATERIALS AND METHODS: Torsional strength and related twist angles were determined at both temperatures in a torque testing fixture. Stress-controlled torsional fatigue resistance (TFR) was determined by cycling instruments in a custom fixture to pre-set twist angles corresponding to 90% torsional strength until fracture. Data were analyzed using two-way ANOVA and Tukey post-hoc tests with the significance level set at 0.05. RESULTS: Overall, mean (± standard deviation) TFR ranged from 192 (± 66) to 841 (± 201) cycles; PTUL had the highest TFR and TN the lowest; the differences among the three instruments were statistically significant. At 37 °C compared to room temperature, PTUL had a similar TFR, while PTN had a higher and TN a lower one. Applying customized stress-controlled conditions resulted in differences in TFR among the 3 instrument types. Different environmental temperatures had varying effects on the tested instruments manufactured from differently heat-treated nickel-titanium (NiTi) alloy. CONCLUSIONS: Understanding TFR is relevant for clinical use of NiTi instruments for continuous rotation and reciprocation, specifically for motor settings. Within the limitations and specific testing parameters of this study, stress-controlled TFR varied among the three tested instruments. Different environmental temperatures had varying effects on the tested instruments manufactured from differently heat-treated nickel-titanium (NiTi) alloy. Variations in instrument design and the NiTi alloy type used may account for different torsional fatigue performance and suggest specific clinical usage parameters. CLINICAL SIGNIFICANCE: During canal preparation, instruments are stressed under cyclic load, a condition which is replicated in this experiment. The data is relevant for motor presets for continuous rotation and reciprocating motion as well as handling of contemporary heat-treated Nickel-titanium instruments.
Association and predictive value of C-reactive protein, fibrinogen and periodontal indices in periodontitis severity : a cross-sectional study.
Yang Z, Zhu J, Sun S … +4 more , Hu T, Yu Q, Xiao C, Zhu L
Clin Oral Investig · 2026 Mar · PMID 41824117 · Full text
OBJECTIVES: To assess associations between systemic inflammatory markers, periodontal parameters, and their combined ability to identify severe periodontitis. MATERIALS AND METHODS: A total of 215 patients with Stage I-I...
OBJECTIVES: To assess associations between systemic inflammatory markers, periodontal parameters, and their combined ability to identify severe periodontitis. MATERIALS AND METHODS: A total of 215 patients with Stage I-IV periodontitis were included. Periodontal parameters (PLI, GI, BI, PPD, and CAL) were recorded, and fasting blood samples were collected to measure serum CRP and plasma fibrinogen. Associations between inflammatory markers and periodontal parameters were analyzed using correlation and trend analyses. A multivariable logistic regression model was constructed to evaluate the combined predictive performance of CRP, fibrinogen, PPD, and CAL in distinguishing Stage IV from Stage III periodontitis. RESULTS: Among 215 patients across four periodontitis stages, age differed significantly by stage (P < 0.05), whereas gender, hypertension, and diabetes did not. PPD and CAL were strongly associated with periodontitis staging (P < 0.0001), while PI, GI, and BI showed no significant stage-related differences. Systemic inflammatory markers CRP and fibrinogen were significantly associated with periodontitis stage overall (P < 0.05). CRP correlated with PPD, CAL, and fibrinogen (P < 0.05), whereas fibrinogen was associated only with CRP. A composite model integrating CRP, fibrinogen, PPD, and CAL demonstrated good discriminatory ability for severe periodontitis (AUC = 0.885). In multivariable analysis, CRP, PPD, and CAL remained independently associated with Stage IV disease. CONCLUSION: Systemic inflammatory markers, particularly CRP, provide complementary information to established periodontal parameters. A composite model integrating CRP with PPD and CAL effectively identified severe periodontitis. CLINICAL RELEVANCE: Assessment of systemic inflammatory burden, especially CRP, may enhance risk stratification and support more individualized monitoring of patients with advanced periodontitis when used alongside routine clinical measures.
Evaluation of saliva and serum heme oxygenase, arylesterase and nuclear factor erythroid 2-related factor 2 levels in patients with stage III periodontitis: a cross sectional study.
Yildiz ZH, Ustaoğlu G, Avci E
Clin Oral Investig · 2026 Mar · PMID 41824104 · Full text
OBJECTIVES: This study aimed to evaluate total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), arylesterase (ARE), heme oxygenase-1 (HO-1), and nuclear factor erythroid 2–related facto...
OBJECTIVES: This study aimed to evaluate total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), arylesterase (ARE), heme oxygenase-1 (HO-1), and nuclear factor erythroid 2–related factor 2 (NRF-2) levels in saliva and serum samples of individuals with Stage III Grade B periodontitis, and to assess their relationship with disease activity and diagnostic potential in the pathogenesis of periodontitis. MATERIALS AND METHODS: Thirty-seven periodontally healthy individuals and thirty-seven patients with Stage III Grade B periodontitis were included in the study. After clinical measurements and sample collection ELISA method was used for analyses of TOS, TAS, OSI, ARE, HO-1, NRF-2 levels. RESULTS: Salivary TAS, serum TAS, serum ARE, serum NRF-2, salivary HO-1 levels were significantly lower in periodontitis patients compared to the healthy control group (p = 0.015, p = < 0.001, p = 0.031, p = 0.041, p = 0.001). No significant difference was found in salivary and serum TOS, salivary and serum OSI, salivary ARE, salivary NRF-2, serum HO-1 levels (p = 0.685, p = 0.256, p = 0.146, p = 0.738, p = 0.513, p = 0.910, p = 0.256). CONCLUSION: Within the limitations of this study, the results suggest that decreased antioxidant capacity, particularly involving HO-1 and NRF-2, may contribute to oxidative stress–related tissue damage in periodontitis. CLINICAL RELEVANCE: Understanding the roles of HO-1 and NRF-2 in the antioxidant defense system provides novel insights into the biological mechanisms underlying periodontal tissue destruction. These biomarkers may help clinicians identify individuals with heightened oxidative stress and increased susceptibility to disease progression, enabling earlier diagnosis and more personalized, targeted therapeutic interventions to improve periodontal health outcomes.
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, Brinkmann JC, Gómez-Costa D … +4 more , Sánchez-Labrador L, Hernández de Oliveira M, Rodríguez-Molinero J, López-Sánchez AF
Clin Oral Investig · 2026 Mar · PMID 41824090 · Full text
OBJECTIVES: The primary objective of this study was to analyze the overall prevalence of caries in teeth adjacent to implant-supported protheses (ISPs). Secondary objectives were to determine how different implant restor...
OBJECTIVES: The primary objective of this study was to analyze the overall prevalence of caries in teeth adjacent to implant-supported protheses (ISPs). Secondary objectives were to determine how different implant restoration placement options (direct to implant, intermediate abutment, or Ti-Base) and/or ISP location influence the occurrence of caries. MATERIALS AND METHODS: This retrospective cohort study was performed at the University Clinic of King Juan Carlos University (URJC, Madrid, Spain), between January 2018 and December 2023, following strict inclusion and exclusion criteria. Both single crowns and fixed partial dentures supported by implants were included. Descriptive statistics were calculated for the relevant variables. Associations between different groups (direct to implant, Ti-base, and intermediate abutment) were analyzed. RESULTS: The study evaluated 445 implant-supported protheses in 359 patients. The overall prevalence of caries in teeth adjacent to ISPs at patient level was 8.9% (95% CI: 5.95% to 11.84%) and 8.1% (95% CI: 5.56% to 10.63%) at prothesis level. Prevalence was higher in the molar region (9.6%; 95% CI: 5.7% to 13.4%), followed by premolar sites (8.6%; 95% CI: 4.2% to 12.9%). The highest prevalence of caries was found in teeth adjacent to ISPs placed direct to implant (11.4%; 95% CI: 7.3% to 15.4%); followed by teeth adjacent to implants restored with Ti-Base (10.5%; 95% CI: 0.0% to 24.2%). Those teeth adjacent to implants restored using intermediate abutments had the lowest prevalence (3.7%; 95% CI: 1% to 6.3%). Statistically significant differences between restoration groups were observed (p = 0.013). Moreover, the odds of caries increased by 3.37 times in teeth adjacent to ISPs placed direct to implant compared with those restored with intermediate abutments. CONCLUSIONS: The prevalence of caries in teeth adjacent to ISPs is significantly higher in implants restored direct to implant compared with those restored with intermediate abutments. CLINICAL RELEVANCE: Selecting the appropriate implant-supported restoration placement option may reduce caries in teeth adjacent to an ISP. Intermediate abutments would appear to reduce the risk of caries compared with direct implant restorations.
Clinical and gustatory features in taste disorder patients based on oral Candida culture status.
Kim SM, Kho HS
Clin Oral Investig · 2026 Mar · PMID 41824080 · Full text
OBJECTIVES: To investigate the clinical, gustatory, salivary, psychological, and laboratory features of patients with taste disturbances, stratified by burning mouth syndrome (BMS) and Candida status, and to determine th...
OBJECTIVES: To investigate the clinical, gustatory, salivary, psychological, and laboratory features of patients with taste disturbances, stratified by burning mouth syndrome (BMS) and Candida status, and to determine the contribution of oral Candida status independent of BMS subtype. MATERIALS AND METHODS: This retrospective study analyzed 141 patients with taste disturbances, classified into six groups based on burning mouth symptoms and oral Candida culture status: primary BMS, secondary BMS, and non-BMS patients, each subdivided by Candida status. To evaluate the independent role of Candida, positive Candida culture was not considered a local factor in defining secondary BMS. Clinical characteristics, taste test results, whole salivary flow rates, psychological profiles, and blood laboratory parameters were compared across groups, with age-matching applied when groups differed in age. RESULTS: In the primary BMS, Candida-positive patients showed no normogeusia and had significantly lower objective taste scores after age-matching. Stimulated whole salivary flow rates were significantly reduced in Candida-positive patients with primary BMS and in those without burning mouth symptoms. Psychological distress was more pronounced in the Candida-positive subgroups within the primary BMS and in overall BMS groups. CONCLUSIONS: A positive oral Candida culture is not universally associated with impaired taste but is associated with gustatory deficits, hyposalivation, and psychological stress in specific subgroups, particularly primary BMS. CLINICAL RELEVANCE: A positive oral Candida culture may aggravate oral symptoms and psychological distress in patients with BMS, particularly those with primary BMS. Recognizing Candida as an independent variable could improve etiology-based diagnosis and tailored management of taste-related complaints.
Comparison of the temporomandibular joint-space volume after mandibular reconstruction using patient-specific plate-positioning guides and the conventional method: a randomized controlled trial.
Le PH, Hoang HT, Lam PH … +2 more , Van Nguyen T, Le CT
Clin Oral Investig · 2026 Mar · PMID 41817878 · Publisher ↗
OBJECTIVES: This study aimed to compare pre- to postoperative changes in temporomandibular joint-space (TMJ-space) volumes after mandibular reconstruction using patient-specific plate-positioning guides (PPG) versus the...
OBJECTIVES: This study aimed to compare pre- to postoperative changes in temporomandibular joint-space (TMJ-space) volumes after mandibular reconstruction using patient-specific plate-positioning guides (PPG) versus the conventional method (CM). MATERIALS AND METHODS: This single-center, non-blinded, randomized clinical trial included 36 adults who underwent mandibular reconstruction using pre-bent plates, allocated 1:1 to the PPG or CM groups. Preoperative and 1-week postoperative computed tomography images obtained in maximum intercuspation (habitual intercuspal position) were three-dimensionally segmented and analyzed using predefined craniomaxillofacial reference planes to quantify TMJ-space volumes, including the total, anterior-, posterior-, medial-, and lateral-compartment volumes. The primary endpoint was the absolute volume change on the operated side, and the secondary endpoints were occlusion-standardized changes. Eligibility excluded Brown classes Ic, IIc, and IVc (disarticulation defects); there were no restrictions on defect size. Paired t/Wilcoxon tests were used for within-group comparisons and Welch/U tests for between-group comparisons, with 95% CIs. RESULTS: At 1 week, for absolute changes, |Δ|TSV favored PPG (PPG–CM = − 205.59 mm³; 95% CI − 360.86 to − 50.33; p = 0.012) and |Δ|LSV likewise favored PPG (PPG–CM = − 92.38 mm³; 95% CI − 183.17 to − 1.59; p = 0.046). For occlusion-standardized changes on the operated side, all |Δ|TSV (PPG–CM = − 166.12 mm³; 95% CI − 230.39 to − 73.19; p = 0.002), |Δ|PSV (PPG–CM = − 123.37 mm³; 95% CI − 211.03 to − 63.02; p = 0.003), and |Δ|LSV (PPG–CM = -71.44 mm³; 95% CI -129.92 to -12.95; p = 0.019) favored PPG, whereas no between-group differences were significant on the non-operated side. Operative time was shorter with PPG (median 120.5 vs. 160.5 min; p = 0.001). CONCLUSIONS: PPG-assisted reconstruction resulted in smaller absolute and occlusion-standardized changes in TMJ-space volumes than CM, suggesting reduced variation in joint-space geometry and more stable early postoperative condyle–fossa relationships as inferred from joint-space measurements. CLINICAL RELEVANCE: Smaller alterations in TMJ-space volumes together with greater operative efficiency suggest that PPG may help maintain more consistent early postoperative TMJ-space geometry after mandibular reconstruction; future studies incorporating direct three-dimensional analyses of condylar position and rotation are warranted.
Anterior vertical relationship: validation of an artificial intelligence model vs. digitally assisted human observers.
Abdelmagid N, Talaat W, Kaboudan A … +5 more , Hamed A, Mahmoud E, Talaat S, Shalaby L, Sadek M
Clin Oral Investig · 2026 Mar · PMID 41817634 · Publisher ↗
OBJECTIVE: This study aimed to develop and validate an artificial intelligence (AI) system for measuring and categorizing anterior vertical relationships, and to evaluate its performance against manual assessments by a h...
OBJECTIVE: This study aimed to develop and validate an artificial intelligence (AI) system for measuring and categorizing anterior vertical relationships, and to evaluate its performance against manual assessments by a human observer. MATERIALS AND METHODS: The study was structured in three phases: model training, validation, and final testing. A dataset of 750 intraoral frontal photographs from patients treated at the University of … was used for training and validation, while 300 additional intraoral images and scans formed the testing set. A YOLOv8-segmentation (YOLOv8-seg) model was developed to perform automated tooth segmentation, followed by measurement and classification of anterior vertical relationships according to the Index of Complexity, Outcome, and Need (ICON). Manual measurements on intraoral scans were obtained using OrthoCAD software. Agreement between AI and human classifications was assessed with the Kappa statistic, while chi-square tested goodness-of-fit. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, likelihood ratios, accuracy, and area under the curve (AUC). RESULTS: The AI system achieved 92% accuracy with excellent agreement to manual assessments (Kappa = 0.89, p < 0.0001). Discrepancies were minimal at 3%. For deep bite detection, sensitivity was 95.9%, specificity 100%, and accuracy 97.2% (AUC = 0.979). For open bite detection, sensitivity reached 96.3%, specificity 100%, and accuracy 98.5% (AUC = 0.98). CONCLUSION: The AI model demonstrated high accuracy and excellent agreement with manual measurements, confirming its potential as a reliable and objective tool for automated quantification of anterior vertical relationships in orthodontic diagnosis.
Comparative analysis of chemical properties and biocompatibility among high ceramic filler-based 3D printed resins, low filler-based 3D printed resins and CAD/CAM ceramics.
Zhang Z, Lim JH, Ma Y … +5 more , Chen D, Jin G, Yim YW, Lee SH, Kim JE
Clin Oral Investig · 2026 Mar · PMID 41806018 · Publisher ↗
OBJECTIVE: This study aimed to compare surface properties, degree of conversion (DC), short-term eluate levels, and biocompatibility between high-filler three-dimensional (3D) printed dental resins, low-filler 3D printed...
OBJECTIVE: This study aimed to compare surface properties, degree of conversion (DC), short-term eluate levels, and biocompatibility between high-filler three-dimensional (3D) printed dental resins, low-filler 3D printed dental resins, and milled ceramic materials. MATERIALS AND METHODS: Two commercial high-filler 3D printed resins (containing zirconia and silica), one commercial low-filler 3D printed resin, one hybrid milled ceramic, and one zirconia milled ceramic were tested. The surface properties evaluated were degree of conversion (DC) (n = 10), contact angle and surface free energy (SFE) (n = 10), surface roughness using contact-type profiler (n = 10) and Atomic Force Microscopy (AFM, n = 1) and surface morphology using Scanning Electronic Microscopy (SEM, n = 1). Biocompatibility was assessed by measuring the viability (n = 10), proliferation (n = 3), and migration (n = 6) of human gingival fibroblasts after exposure to material eluates. Eluates were analyzed subjectively using liquid chromatography–tandem mass spectrometry (n = 1). Data were analyzed statistically using one-way ANOVA with Tukey’s HSD test (α = 0.05). RESULTS: High-filler resins showed significantly higher DC than the low-filler resin (p < 0.05). Postcuring increased DC in the low-filler resin but not in high-filler resins. High-filler resins and the hybrid ceramic exhibited higher surface energy and lower contact angles than zirconia and the low-filler resin, while surface roughness was highest in the hybrid ceramic and lowest in the low-filler resin (p < 0.05). Eluates had no effect on viability or proliferation but significantly reduced fibroblast migration for the high-filler resins and hybrid ceramic (p < 0.05). CONCLUSIONS: High-filler 3D printed resins demonstrated higher DC and surface energy but released more residual monomers than the low-filler resin and ceramics. While eluates did not impair cell viability or proliferation, they reduced fibroblast migration, suggesting possible implications for soft-tissue healing. CLINICAL RELEVANCE: High-filler 3D printed resins exhibit acceptable biocompatibility with potential concerns regarding migration, making them potential alternatives to conventional milled ceramics in prosthodontics. However, the potential impact of released residual monomers on soft-tissue healing highlight the need for further optimization and long-term safety evaluations.
MRI characteristics of diffuse sclerosing osteomyelitis of the mandible and the association of perineural edema with pain relapse: a retrospective cohort study.
Dewenter I, Stoecklein S, Hesse E … +4 more , Fliefel R, Schmidmaier R, Otto S, Obermeier KT
Clin Oral Investig · 2026 Mar · PMID 41806010 · Publisher ↗
OBJECTIVES: Diffuse sclerosing osteomyelitis (DSO) is a diagnosis of exclusion with incompletely understood mechanisms underlying acute pain episodes. This study aimed to characterize Magnetic Resonance Imaging (MRI) fea...
OBJECTIVES: Diffuse sclerosing osteomyelitis (DSO) is a diagnosis of exclusion with incompletely understood mechanisms underlying acute pain episodes. This study aimed to characterize Magnetic Resonance Imaging (MRI) features of DSO to investigate imaging findings associated with acute pain during disease relapse. MATERIALS AND METHODS: This single-center, retrospective observational study included 14 patients diagnosed with DSO. All subjects underwent MRI using a 3T Siemens MAGNETOM Vida scanner equipped with a 15-channel mandibular coil. MRI datasets were evaluated for cortical bone alterations, lymph node enlargement, contrast enhancement patterns, and soft-tissue or perineural edema. RESULTS: MRI demonstrated thickened cortical bone (85.7%, 95% CI 57.2–97.8), cortical destruction (35.7%, 95% CI 12.8–64.9%), pathologically enlarged lymph nodes (64.3%, 95% CI 35.1–87.2) and contrast enhancement within the mandibular bone (78.6%, 95% CI 49.2–95.3) and masticatory muscles 42.9%, (95% CI 17.7–71.1) as characteristic features of DSO. Perineural edema was present in 57.1% (95% CI: 28.9–82.3) of all patients and in 100% of patients with active pain relapse. CONCLUSION: In DSO patients, mandibular-coil MRI can reveal perineural inflammation, particularly perineural edema, which appears to be associated with pain symptoms and may serve as a diagnostic aid in the often-challenging identification of DSO. These observations are based on the present data and do not establish a causal relationship between perineural edema and pain. CLINICAL RELEVANCE: MRI may enhance diagnostic accuracy in DSO, help identify relapse-associated inflammatory changes, and improve understanding of pain mechanisms, thereby supporting more tailored therapeutic strategies.
Epidemiological trends in enamel hypomineralisation and molar-incisor hypomineralisation: a systematic review and meta-analysis.
Ammar N, Fresen KF, Schwendicke F … +1 more , Kühnisch J
Clin Oral Investig · 2026 Mar · PMID 41803535 · Full text
OBJECTIVE: Recently, the systematic review and meta-analysis "Epidemiological Trends in Enamel Hypomineralisation and Molar-Incisor Hypomineralisation: A Systematic Review and Meta-Analysis" was published in Clinical Ora...
OBJECTIVE: Recently, the systematic review and meta-analysis "Epidemiological Trends in Enamel Hypomineralisation and Molar-Incisor Hypomineralisation: A Systematic Review and Meta-Analysis" was published in Clinical Oral Investigations. In 2025 a reader brought the omission of an epidemiological study from North America to the attention of the author group. MATERIALS AND METHODS: After checking the eligibility for inclusion we aimed at updating the meta-analysis. After inclusion of this overlooked study the systematic review and meta-analysis covers 139 studies and data from a total of 199,999 participants. RESULTS: For North America, the MIH prevalence estimate decreased slightly from 0.239 (95% CI: 0.144-0.334) to 0.223 (95% CI: 0.140-0.306). Notably, the global prevalence estimate for MIH remained unchanged at 0.155 (95% CI: 0.144-0.166). CONCLUSION: The addition of the overlooked study influenced slightly the MIH outcome for North America but had no impact on the previously drawn conclusions. CLINICAL RELEVANCE: Enamel hypomineralisation/ Molar incisor hypomineralisation is prevalent across the globe and needs attention by dental practitioners.
Transfer accuracy of three different virtually designed CAD/CAM retainers - baseline results of a randomized clinical trial.
Linnerz F, Aghamiri RV, Ayad I … +5 more , Kuijpers M, Hoekstra JW, Chhatwani S, Danesh G, Möhlhenrich SC
Clin Oral Investig · 2026 Mar · PMID 41801532 · Full text
OBJECTIVES: This study aimed to evaluate the immediate three-dimensional (3D) transfer accuracy of three virtually designed CAD/CAM lingual retainers fabricated from nickel–titanium (NiTi), titanium grade 5 (Ti5), and co...
OBJECTIVES: This study aimed to evaluate the immediate three-dimensional (3D) transfer accuracy of three virtually designed CAD/CAM lingual retainers fabricated from nickel–titanium (NiTi), titanium grade 5 (Ti5), and cobalt–chromium (CoCr). The investigation represents the baseline (T = 0) phase of a registered randomized clinical trial (DRKS00028974). MATERIALS AND METHODS: Sixty patients (32 females, 28 males; mean age 19.2 ± 6.9 years) were randomly allocated to receive one of the three CAD/CAM retainers. Immediately after bonding (T0–T1), intraoral scans were superimposed with the digital design to determine deviations at predefined interproximal contact points. Non-parametric Kruskal–Wallis tests with Dunn’s post-hoc comparisons were applied (p ≤ 0.05). RESULTS: All 60 patients completed the baseline assessment. Transfer deviations were lowest in the NiTi group (0.17 mm, IQR 0.16–0.21), followed by Ti5 (0.37 mm, IQR 0.32–0.41) and CoCr (0.35 mm, IQR 0.30–0.40). NiTi showed significantly higher transfer accuracy compared with Ti5 (p < 0.001) and CoCr (p < 0.001). No significant difference was observed between Ti5 and CoCr (p > 0.999). No adverse events occurred. CONCLUSIONS: Laser-cut NiTi CAD/CAM retainers demonstrated significantly higher immediate transfer precision than milled Ti5 and CoCr retainers. These findings represent the baseline phase of the ongoing randomized clinical trial; subsequent analyses will determine whether such accuracy differences translate into clinically relevant stability outcomes. CLINICAL RELEVANCE: Accurate passive fit of CAD/CAM retainers is essential to prevent unwanted forces on teeth. Understanding material-dependent transfer deviations may improve digital bonding workflows and guide material selection in clinical orthodontics. TRIAL REGISTRATION: DRKS00028974 (registered May 2022)
Prospective, randomized, paired-comparison clinical trial of a new universal adhesive in posterior composite restorations: A 2-year evaluation.
Perdigão J, Trauger KA, Campbell CI … +3 more , Chew HP, Lee IK, Woodis K
Clin Oral Investig · 2026 Mar · PMID 41801514 · Full text
OBJECTIVE: This prospective, randomized, post-market, paired-comparison controlled trial compared the 2-year clinical performance of a new universal adhesive, Scotchbond Universal Plus Adhesive (SBU+), with that of Scotc...
OBJECTIVE: This prospective, randomized, post-market, paired-comparison controlled trial compared the 2-year clinical performance of a new universal adhesive, Scotchbond Universal Plus Adhesive (SBU+), with that of Scotchbond Universal Adhesive (SBU). Both were applied as self-etch (SE) adhesives for composite resin restoration of Class I and Class II preparations. MATERIALS AND METHODS: Two posterior teeth in each of 51 subjects were randomized in a 1:1 ratio to a restoration with SBU + or to a restoration with SBU (control) applied with the SE strategy. Class I and/or Class II preparations were restored with Filtek Universal Restorative. Two calibrated and blinded examiners evaluated the restorations at baseline, 6 months, 1 year, and 2 years, using the modified FDI criteria. The Wilcoxon signed-rank test was used to compare the outcomes. RESULTS: At the 2-year evaluation, retention was 100% for both the SBU + and SBU groups. Regarding fracture and retention, 36 of the 37 SBU+ restorations (97%) were graded “Clinically Excellent/Very Good,” while 1/37 (3%) was graded “Clinically Satisfactory.” All 38 SBU restorations (100%) were graded “Clinically Excellent/Very Good”. Marginal adaptation was clinically acceptable for all restorations at 2 years, with no statistically significant difference between the two adhesive materials. Furthermore, no recurrent caries lesions were observed at 2 years, and no restorations received a “Clinically Insufficient/Unsatisfactory” or “Clinically Poor” grade for any FDI criteria during any evaluation visit. CONCLUSIONS: At 2 years, SBU+ exhibited clinical efficacy similar to its predecessor, SBU, in Class I and Class II restorations in adult patients when using the self-etch (SE) technique. CLINICAL RELEVANCE: Mildly acidic universal dental adhesives may be used for posterior composite restorations without prior phosphoric acid etching.
Periapical lesion healing in osteoporosis patients: an explorative retrospective, controlled pilot cohort study.
Wolf TG, Geiger SS, Briseño-Marroquin B … +4 more , Campus G, Donnermeyer D, Deschner J, Damanaki A
Clin Oral Investig · 2026 Mar · PMID 41801456 · Full text
AIMS: Osteoporosis is a systemic disease characterized by reduced bone density. The aim of this exploratory, retrospective controlled pilot study following STROBE guidelines, was to descriptively assess periapical lesion...
AIMS: Osteoporosis is a systemic disease characterized by reduced bone density. The aim of this exploratory, retrospective controlled pilot study following STROBE guidelines, was to descriptively assess periapical lesion healing following endodontic treatment in patients with osteoporosis compared with matched healthy controls and to generate hypotheses for future studies. METHODS: Digital X-ray images of patients who underwent endodontic treatment at a German university dental clinic between January 2011 and December 2020 were evaluated. Patients with radiographically visible periapical lesions, a follow-up radiograph obtained 6–12 months after treatment, and a documented diagnosis of osteoporosis were included. Changes in periapical lesion size and Periapical Index (PAI) scores were assessed and compared with an age- and tooth-group-matched control cohort. Given the limited sample size, analyses were considered exploratory. RESULTS: Out of 103,385 screened patients, 13 patients with osteoporosis (4 male, 9 female) fulfilled all inclusion criteria and were matched to 13 healthy controls. Both groups demonstrated a reduction in periapical lesion size over time (mean change: -2.47 mm in the osteoporosis group and − 1.90 mm in controls). A mean improvement of one PAI grade was observed in both cohorts. No statistically significant group differences were detected. CONCLUSIONS: Within the limitations of this exploratory pilot study, no statistically significant differences in radiographic periapical healing were observed between patients with osteoporosis and matched healthy controls. Due to the limited sample size and the resulting limited statistical significance, these findings should be interpreted with caution, and further studies are needed to clarify the possible influence of osteoporosis on endodontic healing. CLINICAL RELEVANCE: With demographic change, the potential influence of osteoporosis on endodontic healing is of increasing clinical interest. This study highlights both feasibility and methodological challenges when addressing this question in retrospective clinical cohorts.
Timing and extent of Peri-Implant bone loss for dental implant removal: A retrospective Cross-Sectional analysis.
Halstenbach T, Semper-Hogg W, Cieplik F … +4 more , Würflein E, Kernen F, Metzger M, Schmelzeisen R
Clin Oral Investig · 2026 Mar · PMID 41793531 · Full text
OBJECTIVES: The occurrence of dental implant loss has not been systematically investigated. This study assessed the extent of radiological crestal bone loss at time of dental implant removal and the timing of dental impl...
OBJECTIVES: The occurrence of dental implant loss has not been systematically investigated. This study assessed the extent of radiological crestal bone loss at time of dental implant removal and the timing of dental implant removal. MATERIALS AND METHODS: Patients transferred to the Department of Oral- and Craniomaxillofacial Surgery of the University clinic of Freiburg, Germany, between 2014 and 2024 for dental implant removal were retrospectively analyzed. Radiological bone loss was determined using panoramic and intraoral radiographs. Further data included patient demographics, implant characteristics, bone defect morphology, and specific reasons for removal. RESULTS: 738 implant removals in 462 patients were included. Peri-implant inflammation accounted for 71% of implant removals, with 83% of late implant losses attributed to this cause. The mean radiological bone loss at time of implant removal was 51% (SD: 28%) and was significantly higher in the mandible than in the maxilla (p < 0.001). Most implants were lost three years after placement. At later time points, less implants were removed. Average bone loss levels at the time of implant removal increased over time, ranging from 36% in the first three years to 60% in years 8 to 10 (p = 0.002). Complete loss of osseointegration was observed more frequently over time. CONCLUSION: This study provides the first large-scale systematic assessment of dental implant loss. Peri-implant bone loss was confirmed as the leading cause of dental implant failure. Within this monocentric clinical setting, dental implant removal was closely associated with a radiographic bone loss threshold of around 50%, underscoring its potential value for clinical decision-making in advanced peri-implant disease. CLINICAL RELEVANCE: A radiographic bone loss level of approximately 50 % may serve as a pragmatic threshold to escalate from salvage concepts towards the decision of implant removal in advanced peri-implant disease. The high proportion of implant removals occurring in the early years after placement highlights the importance of early clinical surveillance.
Prognostic factors and cervical lymph node management in tongue squamous cell carcinoma: a retrospective cohort study.
Scheurer M, Daut T, Schulze J … +8 more , Grunert M, Schramm A, Kasper R, Wilde F, Schramm A, Rana M, Ebeling M, Sakkas A
Clin Oral Investig · 2026 Mar · PMID 41793507 · Full text
OBJECTIVES: The optimal management of cervical lymph nodes in tongue squamous cell carcinoma (TSCC) remains controversial, given the need to balance oncological safety with functional preservation. This study aimed to id...
OBJECTIVES: The optimal management of cervical lymph nodes in tongue squamous cell carcinoma (TSCC) remains controversial, given the need to balance oncological safety with functional preservation. This study aimed to identify clinicopathological predictors of recurrence and survival to improve patient-specific strategies for neck management. MATERIALS AND METHODS: This retrospective study included 74 patients with histologically confirmed TSCC. All patients underwent standardized staging including [¹⁸F] FDG PET/CT. Predictor variables included clinical tumor size (cT), suspicious cervical nodes (cN) and number of metastatic lymph nodes (pN). Outcome parameters comprised overall survival (OS), recurrence-free survival (RFS), local recurrence, regional recurrence and contralateral nodal recurrence and disease-specific mortality. RESULTS: The 1- and 5-year OS rates were 97% and 83%, respectively, and RFS rates were 80% and 61%. Perineural invasion (PNI) was significantly associated with inferior OS (p = 0.03) and RFS (p = 0.021). The number of metastatic lymph nodes independently predicted mortality (OR = 1.5; 95% CI: 1.08–2.16; p = 0.018). Each additional suspicious node on [18F] FDG PET/CT increased the odds of advanced nodal stage (pN2b OR = 2.49; p = 0.008; pN3b OR = 2.65; p = 0.001). Contralateral lymphatic drainage occurred in 21.6% and metastases in 5.4% of patients. CONCLUSIONS: Preoperative [18F] FDG PET/CT nodal burden, tumor size and contralateral drainage patterns are potential predictors for patient-specific tailoring of the extent and laterality of neck dissection in TSCC. CLINICAL RELEVANCE: Quantifying nodal burden and integrating biological factors such as perineural invasion and sex-related differences may refine individualized surgical strategies and improve prognostic accuracy beyond conventional TNM staging.
Clinical outcomes of digital straightwire lingual versus labial fixed appliances assessed with American Board of Orthodontics indices: a retrospective cohort study.
Nguyen VA, Nguyen TT, Vo TNN … +2 more , Tong MS, Nguyen TA
Clin Oral Investig · 2026 Mar · PMID 41790284 · Publisher ↗
OBJECTIVES: Digitally enabled straightwire lingual systems aim to simplify lingual orthodontics, but evidence based on objective indices remains limited. METHODS: This retrospective observational study included 200 adult...
OBJECTIVES: Digitally enabled straightwire lingual systems aim to simplify lingual orthodontics, but evidence based on objective indices remains limited. METHODS: This retrospective observational study included 200 adults treated with fixed appliances and allocated into 4 equal groups (n = 50 each): lingual nonextraction, lingual extraction, labial nonextraction, and labial extraction. Pretreatment severity was scored using the American Board of Orthodontics (ABO) Discrepancy Index (DI), and posttreatment finishing was assessed using the ABO Objective Grading System (OGS) cast–radiograph evaluation. Baseline characteristics were compared using Kruskal–Wallis tests for continuous variables and chi-square tests for categorical variables. OGS total and treatment duration were analyzed using covariate-adjusted ANCOVA via multiple linear regression with an appliance-by-extraction interaction, using heteroskedasticity-robust standard errors. RESULTS: Pretreatment DI total did not differ significantly among the 4 groups (P = 0.149). Mean OGS totals were 17.3 ± 4.5 (lingual nonextraction), 15.7 ± 4.3 (lingual extraction), 16.7 ± 4.4 (labial nonextraction), and 16.2 ± 5.7 (labial extraction). All cases had OGS totals ≤ 25. In adjusted analyses, OGS total showed no significant main effects of appliance type or extraction protocol and no significant interaction (all P > 0.05). Treatment duration was longer with lingual than labial appliances (P = 0.003) and longer in extraction than nonextraction protocols (P < 0.001), with no significant interaction (P = 0.100). CONCLUSION: Digital straightwire lingual treatment achieved posttreatment ABO-OGS outcomes comparable to labial fixed appliances in adults, while requiring longer treatment duration; extraction therapy was also associated with longer treatment time. CLINICAL RELEVANCE: For adult patients seeking an esthetic appliance, digitally enabled straightwire lingual treatment can deliver outcomes comparable to labial appliances.
Maintenance of physicochemical, optical, and biological properties of conventional glass ionomer cement enriched with an anacardic acid-derivative compound.
Genari B, Endres BL, Rabelo E … +7 more , Romeiro LAS, de Oliveira AS, Do T, El-Gendy R, da Silva VBS, Dame-Teixeira N, Garcia FCP
Clin Oral Investig · 2026 Mar · PMID 41790174 · Full text
OBJECTIVES: To evaluate the physicochemical, optical, and antimicrobial properties of a conventional glass ionomer cement (GIC) modified with anacardic acid (LDT11). MATERIALS AND METHODS: LDT11, extracted from cashew nu...
OBJECTIVES: To evaluate the physicochemical, optical, and antimicrobial properties of a conventional glass ionomer cement (GIC) modified with anacardic acid (LDT11). MATERIALS AND METHODS: LDT11, extracted from cashew nutshells, was incorporated into GIC (FX ULTRA, Shofu, USA) at 0.5%, 1%, and 2% (w/w), with 0% as control. Disc-shaped specimens (6-15 mm diameter × 1 mm thickness) were prepared for all evaluations. Setting time (ISO 9917; n = 3), acid-base reaction efficiency (FTIR, COO/COOH ratio; n = 3), water sorption and solubility (ISO 4049; n = 5), diffusion coefficient (n = 5), surface roughness (Ra, Rz, Rv; n = 5), and color parameters (CIELab, CIEDE2000; n = 5) were measured. Antimicrobial characterizations were carried out, with discs inoculated with Streptococcus mutans UA159 and incubated anaerobically for 7 days (early biofilms) and 14 days (mature biofilms). Biofilms were dyed with the Live/Dead biofilm viability kit and then imaged using confocal laser scanning microscopy (n = 6). Data were analyzed using one-way ANOVA with Tukey post hoc or Kruskal-Wallis with Dwass-Steel-Critchlow-Fligner tests (p < 0.05). RESULTS: LDT11 incorporation did not significantly affect setting time, acid-base reaction efficiency, solubility, diffusion coefficient, and surface roughness. FTIR spectra revealed no alterations in setting-related functional groups, while LDT11 was identified in the 1000-1100 cm⁻¹ range. At 2%, LDT11 significantly increased water sorption and caused visible color changes (p < 0.05). The 0.5% and 1% groups significantly reduced S. mutans viability compared to control, with the 1% group exhibiting the most pronounced and sustained effect (p < 0.0001). CONCLUSIONS: Incorporation of the anacardic acid derivative up to 1% maintained physicochemical properties of GIC while providing antimicrobial activity.
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