Clinical Oral Investigations[JOURNAL]
Sun
200 papers
Radiomics-driven prediction of postoperative infection risk in maxillofacial fractures: multidimensional risk factor analysis and model construction based on absorbable plate fixation.
Liu Q, Zhao W, Jiang B … +2 more , Dong H, Wang Z
Clin Oral Investig · 2026 Jun · PMID 42277335 · Publisher ↗
OBJECTIVES: This study proposes a predictive model that integrates radiological features with multidimensional clinical factors for the accurate prediction of postoperative infection in maxillofacial fracture patients tr...
OBJECTIVES: This study proposes a predictive model that integrates radiological features with multidimensional clinical factors for the accurate prediction of postoperative infection in maxillofacial fracture patients treated with absorbable fixation plates. METHODS: This model incorporates a fusion algorithm based on K-means clustering and fully connected neural networks to perform in-depth analysis of non-contrast and reconstructed maxillofacial CT images. It also includes frequently overlooked clinical variables, such as surgery-related factors and individual patient characteristics, thereby enhancing the model's interpretability and generalizability. The study involved 1200 maxillofacial CT images from 100 patients at the First Affiliated Hospital of Dalian Medical University. The dataset was randomly split into training and testing sets in an 8:2 ratio for validation. RESULTS: The combined model achieved an area under the AUC-ROC curve of 0.96. The Results demonstrated that the model exhibited consistent and excellent performance in testing, reliably identifying high-risk factors for postoperative infection. The establishment of this model holds positive significance for promoting the application of absorbable materials and advancing personalized treatment for trauma patients. CONCLUSION: The integrated habitat-clinical model demonstrates improved predictive performance. Combining habitat analysis with clinical features offers a promising approach for the prediction of postoperative infection of absorbable bone plates. CLINICAL RELEVANCE: The establishment of this model holds positive significance for promoting the application of absorbable materials and advancing personalized treatment for trauma patients.
Up to 30 years of clinical performance of double-crown-retained removable dental prostheses with spark-eroded friction pins placed in a general dental practice.
Zierden K, Werdecker S, Wöstmann B … +1 more , Rehmann P
Clin Oral Investig · 2026 Jun · PMID 42274800 · Full text
PURPOSE: The purpose of this retrospective cohort study was to investigate the clinical performance and longevity of double-crown-retained removable-dental-prostheses (DCR-RDP) with spark-eroded friction pins inserted in...
PURPOSE: The purpose of this retrospective cohort study was to investigate the clinical performance and longevity of double-crown-retained removable-dental-prostheses (DCR-RDP) with spark-eroded friction pins inserted in a general dental practice and followed up over a period of 30 years. MATERIALS AND METHODS: This retrospective cohort study observed the influence of various factors on the longevity of the DCR-RDPs with spark-eroded friction pins and the abutment teeth using Kaplan-Meier estimation (log-rank test, p < .05) estimation and Cox regression (α = 0.05). RESULTS: During a mean follow-up of 14.07 ± 7.89 years (max 31.66 years), 196 prostheses and 563 abutments were observed. 30.61% (n = 60) of the prostheses and 39.43% (n = 222) of the abutments failed. The mean survival time for the prostheses was 22.66 ± 0.86 years (95% CI:20.97 to 24.24 years), and for the abutments, 20.29 ± 0.51 years (95% CI: 19.29 to 21.29 years). The following factors had a significant influence on the performance of either the prostheses or the abutment teeth: Kennedy class, number of replaced teeth, opposing dentition, number of abutments, crown-root ratio, probing depth, location, and vitality (p<.05). CONCLUSIONS: The highest survival rates were shown by Kennedy Class III DCR-RDPs and abutment teeths, while the lowest were seen with prostheses with 11 or more replaced teeth. The number of abutment teeth, pocket depth, vitality, and crown/root length ratio should also be considered in terms of the abutment teeth's longevity.
Anhydrous stannous fluoride toothpaste in dentin hypersensitivity: clinician-assessed and patient-reported outcomes from two controlled trials.
Qiu J, Creeth JE, Mohammad A … +5 more , Milleman KR, Gallob J, Milleman J, Pradhan M, Qaqish J
Clin Oral Investig · 2026 Jun · PMID 42262610 · Full text
OBJECTIVES: To confirm anti-sensitivity efficacy of a new anhydrous 0.454% stannous fluoride (SnF) toothpaste formulation compared to a standard fluoride toothpaste after 28 and 56 days of twice-daily brushing, using cli...
OBJECTIVES: To confirm anti-sensitivity efficacy of a new anhydrous 0.454% stannous fluoride (SnF) toothpaste formulation compared to a standard fluoride toothpaste after 28 and 56 days of twice-daily brushing, using clinician-assessed measures and patient-reported outcomes. MATERIALS AND METHODS: Two independent, examiner-blind, parallel studies enrolled healthy adults with dentin hypersensitivity (DH). Participants were randomized to brush twice-daily with either the SnF₂ toothpaste (Test) or a standard fluoride toothpaste (Reference). DH was assessed by clinician via evaporative (Schiff scale) and tactile (Yeaple probe) stimuli. Participant-reported outcomes were measured using the Labelled Magnitude Scales (LMS) (for DH pain), and the DH Experience Questionnaire (DHEQ-48) (for impact on oral health-related quality-of-life). RESULTS: 104 participants in Study 1 and 113 participants in Study 2 (18-65 years) were randomized. In both studies, the Test treatment showed a statistically significant decrease in Schiff sensitivity scores, an increase in tactile threshold, and an improvement in LMS domain scores from baseline to Day 28 and 56. The improvements in all three measures were greater than those observed for the Reference treatment (all, p < 0.05). Additionally, Study 1 showed significantly greater improvements in DHEQ scores in the Test treatment versus the Reference at Day 56. Toothpastes were generally well-tolerated. CONCLUSIONS: Twice-daily use of the 0.454% SnF₂ toothpaste significantly and progressively reduced examiner-assessed and perceived DH over 56 days versus standard fluoride toothpaste. CLINICAL RELEVANCE: The studies confirm the efficacy of the novel 0.454% SnF₂ toothpaste in delivering meaningful relief from DH, supporting its role as a patient-centred treatment.
A retrospective pragmatic clinical study of healing and predictors of success following gentlewave and conventional endodontic irrigation.
Amber A, Nicholas DH, Shilpa T … +4 more , Rene S, Vanessa C, Caroline C, Ruparel NB
Clin Oral Investig · 2026 Jun · PMID 42260197 · Publisher ↗
OBJECTIVE: This retrospective pragmatic study aimed to evaluate and compare the healing outcomes of the multisonic GentleWave irrigation system with conventional syringe-needle irrigation used for non-surgical endodontic...
OBJECTIVE: This retrospective pragmatic study aimed to evaluate and compare the healing outcomes of the multisonic GentleWave irrigation system with conventional syringe-needle irrigation used for non-surgical endodontic treatment. METHODS: The study included 46 teeth that underwent nonsurgical endodontic treatment using two different irrigation protocols: (1) GentleWave irrigation system, and (2) Conventional syringe-needle irrigation, with a minimum follow-up of 1 year. Preoperative and follow-up data from treatment records, including clinical signs and symptoms, periapical radiographs, and cone-beam computed tomography (CBCT) images when available, were collected. Two independent evaluators scored the radiographs and CBCT scans based on the 2D periapical index (PAI) and 3D CBCT-PAI index, respectively. Based on clinical data and radiographic evaluation, treatment outcomes were categorized as healed, healing, or diseased. The success rate was assessed using both strict and loose criteria. Statistical analyses included Fisher's exact tests, and Wilcoxon rank-sum tests, where appropriate. The significance level was set at 0.05. RESULTS: Based on the periapical index and clinical evaluation, both the GentleWave and conventional groups exhibited comparable percentages of healed cases, corresponding to success rates of 69% and 70%, respectively (strict criteria). Using loose criteria, the success rate based on periapical imaging was 96% for conventional and 85% for GW groups. No statistically significant difference in healing outcomes/success rate was observed between the groups on both periapical radiograph and CBCT interpretation. Male sex, negative pulp vitality, presence of pre-operative periapical radiolucency (PARL), and absence of pre-operative symptoms were associated with reduced healing in the Conventional group. Pre-operative PARL and non-surgical root canal retreatment were associated with reduced healing in the GW group. CONCLUSION: There were no differences in success rates or healing outcomes of endodontic treatment between the GentleWave irrigation system and conventional syringe-needle irrigation at 12-month follow-up. The presence of pre-operative PARL was significantly correlated with reduced success in both groups. CLINICAL RELEVANCE: This study highlights similar success rates and healing outcomes for endodontic treatment with the GentleWave irrigation system compared to conventional syringe-needle irrigation at 12 months follow-up.
Dietary patterns characterized by high fiber intake in vegan and omnivorous individuals are associated with distinct salivary proteomic signatures linked to oral homeostasis.
Vargas CJ, Rivera C, Marín LM … +2 more , Duran-Aguero S, Fernández CE
Clin Oral Investig · 2026 Jun · PMID 42249210 · Publisher ↗
OBJECTIVES: We compared the salivary proteome and metaproteome of individuals with real-world dietary patterns differing in fiber intake (i.e., high- versus low-fiber intake) to examine whether their diet was associated...
OBJECTIVES: We compared the salivary proteome and metaproteome of individuals with real-world dietary patterns differing in fiber intake (i.e., high- versus low-fiber intake) to examine whether their diet was associated with distinct molecular signatures in saliva. MATERIALS AND METHODS: Sixteen participants from a cross-sectional study were classified into high-fiber (n = 8) and low-fiber (n = 8) intake groups based on dietary assessment. Although these groups corresponded to vegan and omnivorous patterns, respectively, classification was based on fiber intake. Groups were matched for age, sex, socioeconomic status, while major dietary differences inherent to vegan and omnivorous patterns were explicitly considered in the interpretation. Stimulated whole saliva was collected under standardized fasting conditions. Human proteomic and microbial metaproteomic analyses were performed using bottom-up DIA-PASEF. Differentially abundant proteins, enriched pathways, and metaproteomic profiles were identified using bioinformatic analyses. RESULTS: From 3,332 identified proteins, 1,566 were quantifiable, and 66 were differentially abundant between groups (FDR [False Discovery Rate] < 0.05). Multivariate analyses revealed separation according to dietary patterns differing in fiber intake: high-fiber exhibited enrichment of homeostasis, lipid metabolism, and cytoprotective pathways, with increased abundance of PRP-1/2, CA6, APOA1, and HYOU1. Low-fiber showed enrichment of immune and oxidative stress pathways, with higher SOD1, GPX1, ANXA2, ANXA8, and S100A8. Metaproteomics analysis revealed no major taxonomic differences but greater interindividual variability in the low-fiber intake group. CONCLUSION: Dietary patterns characterized by different dietary fiber intake appear associated with distinct salivary proteomic signatures. Although the contribution of other co-occurring dietary factors cannot be excluded, these findings, based on a small, highly selected cohort, suggest that fiber-rich dietary patterns may support oral homeostasis through host-driven molecular pathways rather than major shifts in microbial composition. CLINICAL RELEVANCE: Our findings strengthen the rationale for considering dietary patterns with high-fiber intake not only as a systemic health determinant but also as a modulator of salivary molecular functions relevant to oral disease prevention and personalized care.
Baseline and treatment-induced change of salivary CYFRA 21 - 1 as independent predictors of recurrence in oral squamous cell carcinoma.
Stamatoski A, Monevska DP, Pancevski G … +8 more , Dvojakovska S, Iliev A, Kirkov A, Koneski F, Idoska S, Taseva H, Mladenov M, Hadzi-Petrushev N
Clin Oral Investig · 2026 Jun · PMID 42249204 · Publisher ↗
OBJECTIVES: Cytokeratin 19 fragment (CYFRA 21 - 1) has shown diagnostic utility in oral squamous cell carcinoma (OSCC), but its prognostic value and treatment-induced dynamics remain unclear. This study evaluated baselin...
OBJECTIVES: Cytokeratin 19 fragment (CYFRA 21 - 1) has shown diagnostic utility in oral squamous cell carcinoma (OSCC), but its prognostic value and treatment-induced dynamics remain unclear. This study evaluated baseline and early post-treatment salivary and serum CYFRA 21 - 1 concentrations in patients with OSCC to assess associations with clinicopathological characteristics and recurrence-free survival. MATERIALS AND METHODS: We prospectively enrolled 40 patients with primary, resectable OSCC and measured salivary and serum CYFRA 21 - 1 by ELISA before surgery and 14 days post-operatively. The primary outcome was recurrence-free survival. RESULTS: Pretreatment salivary CYFRA 21 - 1 was higher in T3-4 versus T1-2 tumors (p = 0.033) and associated with nodal metastasis (p = 0.040). Surgical resection significantly reduced CYFRA 21 - 1 levels. However, larger absolute reductions in salivary levels (≥ 0.74 ng/mL) predicted higher recurrence risk (OR = 6.09), as did elevated baseline salivary CYFRA 21 - 1 (≥ 2.66 ng/mL; OR = 9.35). Both metrics independently predicted recurrence-free survival in multivariate Cox regression (HR = 3.00-4.10), while standard clinical factors including TNM stage and nodal status did not. Salivary and serum CYFRA 21 - 1 correlated weakly to moderately (r = 0.33, p < 0.05). CONCLUSIONS: Baseline salivary CYFRA 21 - 1 and large post-treatment reductions independently predicted OSCC recurrence, outperforming TNM staging in multivariate analysis. Larger CYFRA 21 - 1 reductions were associated with increased relapse risk, potentially reflecting aggressive tumor biology, though this counterintuitive finding requires validation in larger independent cohorts before definitive mechanistic conclusions can be drawn. Monitoring CYFRA 21 - 1 kinetics may provide biologically informed prognostication beyond anatomical classification. CLINICAL RELEVANCE: Salivary CYFRA 21 - 1 offers a non-invasive biomarker for postoperative risk stratification that could guide personalized surveillance strategies, enabling early identification of high-risk patients who may benefit from intensified follow-up or adjuvant therapy.
Effectiveness of BRIX3000 for chemo-mechanical caries removal: a systematic review and meta-analysis of time and pain outcomes.
AlShawish JF, Al-Hanaktah M, Alsunna A … +5 more , Ali A, Jamous AA, Ali D, Alhasan TO, Abu Agha TS
Clin Oral Investig · 2026 Jun · PMID 42249146 · Publisher ↗
AIMS: This systematic review was conducted to critically assess and statistically synthesise data from all available clinical studies on this topic. This study focused on the efficacy and safety of this agent (BRIX3000),...
AIMS: This systematic review was conducted to critically assess and statistically synthesise data from all available clinical studies on this topic. This study focused on the efficacy and safety of this agent (BRIX3000), the time required for caries removal, and the pain experienced by patients during the procedure, to provide clinicians and researchers with clear evidence on whether BRIX3000 is genuinely effective. MATERIALS AND METHODS: Electronic literature searches were performed using PubMed, Scopus, and Web of Science to collect eligible randomised clinical trials that had evidence regarding the efficacy of BRIX3000 for chemo-mechanical caries removal in comparison with the conventional rotary instruments and other atraumatic restorative treatment (ART) methods. The selected studies included children and adults of both sexes, with no age or gender preference, who had dentinal carious lesions in primary or permanent teeth without pulpal involvement. RESULTS: Nine randomised trials (eight in paediatric and one in adult populations) were included. Pooled analyses indicated that BRIX3000 was associated with a longer mean caries removal time than control techniques (MD 4.58 min, 95% CI 2.45 to 6.70; p < 0.0001; I² = 96%) and with lower pain scores on the Wong-Baker FACES scale among paediatric patients (MD - 2.50, 95% CI - 4.37 to - 0.62; p = 0.009; I² = 92%). Complete caries removal did not differ significantly between groups in either the paediatric (OR 0.45, 95% CI 0.02 to 8.34; p = 0.59) or adult (OR 0.73, 95% CI 0.15 to 3.49; p = 0.69) subgroup. All pooled estimates exhibited substantial heterogeneity, and the adult evidence comprised only two trials. Most included studies were judged to be at low overall risk of bias on the RoB 2 tool. CONCLUSION: Within the limits of substantial heterogeneity, short follow-up, and a small adult evidence base, BRIX3000 may represent a useful chemo-mechanical alternative - particularly in paediatric and anxiety-prone patients - at the cost of a modest increase in procedural time. Adequately powered trials with longer follow-up are required to confirm these preliminary findings. CLINICAL RELEVANCE: Our results indicate that BRIX3000 can be a viable option for patients with extensive fear of conventional methods, as well as for the paediatric population.
Changes in the sagittal pharyngeal airway dimension following levelling and alignment in class II division 2 patients: a prospective clinical trial.
Eid FY, Madian AM, Elfouly D
Clin Oral Investig · 2026 Jun · PMID 42247179 · Full text
OBJECTIVES: This study aimed to evaluate changes in the sagittal pharyngeal airway dimensions (SPAD) and the related mandibular position following maxillary levelling and alignment in late adolescent Class II division 2...
OBJECTIVES: This study aimed to evaluate changes in the sagittal pharyngeal airway dimensions (SPAD) and the related mandibular position following maxillary levelling and alignment in late adolescent Class II division 2 (Class II/2) patients. MATERIALS AND METHODS: Thirty Class II/2 patients (mean age 14.07 ± 1.21 years) were included. Pre-treatment orthodontic records were acquired, including panoramic and lateral cephalometric x-rays (T0), photographs, and study models, followed by the onset of levelling and alignment in the upper arch. Lateral cephalometric x-rays and photographs were repeated six months later at the termination of this stage (T1), and measurements were performed in comparison to T0. SPAD was assessed at the nasopharyngeal, oropharyngeal, and laryngopharyngeal levels. Mandibular position was evaluated using the Ba-Ar distance, while sagittal and vertical skeletal relationships were assessed using SNA°, SNB°, ANB°, and FMA°. Upper incisor inclination was accounted for using the U1-FH° measurement. RESULTS: Alignment of the maxillary arch in Class II/2 patients elicited a significant SPAD increase at the nasopharyngeal and the oropharyngeal levels (p < 0.001), with a non-significant change evoked at the laryngopharyngeal level (p = 0.42). Antero-posteriorly, a significant increase in the SNAº, SNBº, together with a significant decrease in the ANBº angle have been documented at T1. A significant increase in the Ba-Ar has been noted at T1 in contrast to T0, in addition to a significant reduction in the vertical dimension (FMAº). Dentally, a significant increase in the U1-FHº has been documented following the implemented treatment stage (p < 0.001). CONCLUSIONS: Results of this study may suggest that maxillary levelling and alignment in Class II/2 patients during the decelerating growth phase is associated with augmentation of the nasopharyngeal and oropharyngeal airways. These changes coincide with the significant labial tipping of the maxillary incisors and subsequent functional mandibular advancement, which collectively improve the intermaxillary relationship and reduce the vertical skeletal dimension. While natural growth cannot be entirely excluded, the rapid change suggests that these improvements are closely linked to the functional mandibular response. CLINICAL RELEVANCE: Maxillary alignment in Class II division 2 cases may enhance upper airway patency by triggering a forward functional mandibular response, highlighting a potential link between orthodontic correction and upper airway patency. Name of the Registry: ClinicalTrials.gov Trial Registration Number: NCT06602518 Date of Registration: 19/09/2024 "Retrospectively registered". URL: https://clinicaltrials.gov/study/NCT06602518?cond=nct06602518&rank=1.
Minimally invasive versus conventional apical enlargement during retreatment of severely curved mesial canals: A micro-CT study.
da Silva PJP, Marceliano-Alves MFV, Sousa Gonçalves L … +2 more , Alves FRF, Provenzano JC
Clin Oral Investig · 2026 Jun · PMID 42247014 · Full text
OBJECTIVES: This study used micro-computed tomography (micro-CT) to compare a minimally invasive retreatment approach (reinstrumentation 30/0.04) with a conventional retreatment protocol (reinstrumentation 40/0.04) durin...
OBJECTIVES: This study used micro-computed tomography (micro-CT) to compare a minimally invasive retreatment approach (reinstrumentation 30/0.04) with a conventional retreatment protocol (reinstrumentation 40/0.04) during different stages of filling removal in curved mesial roots of mandibular molars. MATERIALS AND METHODS: Fourteen extracted mandibular first molars with Vertucci type IV and severe curvature (25°-40°) were selected, endodontically prepared (25/0.04), and obturated. A paired intra-root design compared minimally invasive retreatment (D-Race + iRace to 30/0.04) with a conventional protocol (Mtwo to 40/0.04). Retreatments were performed without solvents, and micro-CT scans were taken at three stages. Residual filling material was quantified and analyzed at a 5% significance level. RESULTS: Initial filling volumes were similar between protocols (P > .05). After desobstruction, the minimally invasive protocol removed more material (P < .01), leaving 0.2 mm³ (95%) versus 1.1 mm³ (70%). However, after reinstrumentation, no significant differences were observed (P > .05), with both protocols achieving high removal rates (98% vs. 95%). CONCLUSION: The minimally invasive protocol showed greater efficiency in the initial removal of obturation material. After final reinstrumentation, both approaches achieved similar outcomes, with < 5% residual material. These findings suggest that conservative enlargement to 30/0.04 may be as effective as 40/0.04 while better preserving radicular dentin. CLINICAL RELEVANCE: Extensive apical enlargement (40/0.04) is not essential for effective removal of obturation material in severely curved canals. A conservative approach (30/0.04) achieves similar cleanliness while better preserving radicular dentin and structural integrity.
Endodontic-sinus communications: a 10-year retrospective observational study on maxillary posterior teeth.
Bugea C, Cerutti F, Sforza F … +5 more , Sciancalepore EN, Heranin S, Pedullà E, Qorri E, Scarano A
Clin Oral Investig · 2026 Jun · PMID 42243556 · Full text
OBJECTIVES: To describe the clinical characteristics, anatomical distribution, and long-term outcomes of unintended endodontic-sinus communication involving maxillary posterior teeth that occurred during endodontic treat...
OBJECTIVES: To describe the clinical characteristics, anatomical distribution, and long-term outcomes of unintended endodontic-sinus communication involving maxillary posterior teeth that occurred during endodontic treatment. MATERIALS AND METHODS: This retrospective observational study reviewed clinical records collected over approximately 10 years of routine clinical practice. Among 10,345 maxillary premolars and molars treated endodontically, cases presenting intraoperative endodontic-sinus communication were identified. Preoperative periapical radiographs were obtained in all cases, with cone-beam computed tomography (CBCT) available in selected patients. Endodontic treatment was performed under rubber dam isolation using electronic apex locators and rotary nickel-titanium instruments. The Valsalva maneuver was systematically performed intraoperatively to detect communication. Root canal obturation was completed in one or two visits using bioceramic techniques. Clinical and radiographic follow-up was scheduled at 3, 5, and 10 years. RESULTS: Thirty-one patients (18 males, 13 females) presented an endodontic-sinus communication, corresponding to an incidence of 0.30% (31/10,345). The affected teeth included 14 maxillary second molars, 15 maxillary first molars, and 2 maxillary second premolars. A total of 32 root-level communications were identified. Vital primary treatments accounted for 22 cases (70.97%), retreatments for 7 cases (22.58%), and necrotic teeth for 2 cases (6.45%). The Valsalva maneuver was positive in all cases. The mean follow-up duration was 48 months (range: 36-120 months). All evaluated teeth remained functional, with no persistent sinus-related symptoms and no need for surgical intervention. CONCLUSIONS: Unintended endodontic-sinus communication is a rare intraoperative event during treatment of maxillary posterior teeth. Early recognition, strict apical control, and conservative management may allow favorable long-term outcomes without the need for surgical intervention. However, these findings should be interpreted cautiously in light of the retrospective design, limited sample size, and absence of a control group.
Development and validation of the short form OHIP-TMD (SF-OHIP-TMD): a four-factor eight-item scale for assessing oral health impact in temporomandibular disorders.
Zheng Y, Yap AU, Wong HL … +4 more , Tao W, Liu C, Wang J, Xiong X
Clin Oral Investig · 2026 Jun · PMID 42243541 · Publisher ↗
OBJECTIVE: To develop and validate a short-form version of the Oral Health Impact Profile for Temporomandibular Disorders (SF-OHIP-TMD) that provides an efficient yet comprehensive assessment of TMD-specific oral health-...
OBJECTIVE: To develop and validate a short-form version of the Oral Health Impact Profile for Temporomandibular Disorders (SF-OHIP-TMD) that provides an efficient yet comprehensive assessment of TMD-specific oral health-related quality of life. METHODS: An observational cross-sectional study included 1,149 participants diagnosed with TMD according to DC/TMD criteria (397 intra-articular, 240 pain-related, 512 combined TMD). Participants completed the 22-item OHIP-TMD, pain Numeric Rating Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Jaw Function Limitation Scale-8. Parallel analysis and exploratory factor analysis (EFA) were performed on a random split-half sample, followed by confirmatory factor analysis (CFA) on the second split-half. Items were selected based on factor loadings and conceptual coverage. Reliability, validity, and item response theory analyses were conducted. RESULTS: Parallel analysis and EFA revealed a four-factor structure (psychological impact, social impact, oral function, orofacial pain) explaining 61% of variance. Eight items with two per factor were selected for the SF-OHIP-TMD. CFA demonstrated excellent model fit (CFI = 0.989, TLI = 0.979, RMSEA = 0.057, SRMR = 0.024). SF-OHIP-TMD showed high reliability (Cronbach's α = 0.87, McDonald's ω = 0.93) and strong correlation with the 22-item version (ρ = 0.959, p < 0.001). Convergent validity (AVE = 0.69) and discriminant validity (HTMT < 0.85) were satisfactory, with strong criterion validity demonstrated through significant correlations between factors and corresponding measures (ρ > 0.4). Item response theory analysis revealed excellent discrimination and differential response patterns between painful and non-painful TMD subtypes. CONCLUSION: The 8-item SF-OHIP-TMD maintains the four-factor structure and psychometric robustness of the original 22-item version while significantly reducing assessment burden, making it ideal for routine clinical assessment, longitudinal follow-up and large-scale research applications.
Simultaneous implant placement with guided bone regeneration for horizontal ridge augmentation using a 3D-preformed resorbable PLGA membrane: A prospective single-arm clinical study.
Son SH, Lim KO, Han SH … +4 more , Min GH, Kim J, Morawiec T, Lee WP
Clin Oral Investig · 2026 Jun · PMID 42240865 · Full text
OBJECTIVES: This study aimed to evaluate the clinical effectiveness and safety of guided bone regeneration (GBR) using a three-dimensional preformed resorbable Polylactic-co-glycolic acid membrane (3D-PRPM) with simultan...
OBJECTIVES: This study aimed to evaluate the clinical effectiveness and safety of guided bone regeneration (GBR) using a three-dimensional preformed resorbable Polylactic-co-glycolic acid membrane (3D-PRPM) with simultaneous implant placement. MATERIALS AND METHODS: Twenty patients (21 sites) with localized ridge defects were treated using implants placed concurrently with GBR using a 3D-PRPM. Cone-beam computed tomography scans were taken preoperatively, immediately postoperatively, and at 5 months. Horizontal bone augmentation (BA), hard tissue gain (HG), bone resorption (BR), and hard tissue gain rate (HGR) were assessed. Changes beyond the original bony envelope were evaluated. Statistical analyses included the Wilcoxon signed-rank and Friedman tests. RESULTS: Mean BA was 2.99 ± 1.15 mm, and mean HG at 5 months was 2.64 ± 1.10 mm. Mean BR was 0.35 ± 0.23 mm, and mean HGR was 87.2% ± 8.2%. Envelope analysis confirmed a significant increase after augmentation with partial reduction during healing; however, ridge dimensions at 5 months remained significantly greater than baseline (P < 0.001). No membrane exposure, infection, or wound dehiscence occurred. CONCLUSION: 3D-PRPM enabled predictable horizontal ridge augmentation with excellent volumetric stability and favorable short-term safety. CLINICAL RELEVANCE: A 3D-PRPM may provide a stable, fixation-free resorbable barrier for horizontal ridge augmentation, potentially simplifying GBR procedures and reducing the need for secondary removal.
Early childhood caries-related complications in pediatric dental emergencies: a 7-year retrospective study from Romania.
Marton RD, Moca AE, Opriș P … +2 more , Iurcov R, Juncar M
Clin Oral Investig · 2026 Jun · PMID 42240723 · Full text
OBJECTIVES: Early childhood caries (ECC) is a highly prevalent and largely preventable disease that may lead to severe complications requiring emergency dental care. This study aimed to retrospectively analyze the presen...
OBJECTIVES: Early childhood caries (ECC) is a highly prevalent and largely preventable disease that may lead to severe complications requiring emergency dental care. This study aimed to retrospectively analyze the presentation patterns, clinical characteristics, and management of ECC-related complications among children presenting to a pediatric dental emergency service over a seven-year period. MATERIALS AND METHODS: A retrospective observational study was conducted using medical records from the dental emergency department of the County Clinical Emergency Hospital in Oradea, Romania, covering the period January 2019 to December 2025. Children aged 0-71 months presenting with ECC-related complications were included. Demographic variables, diagnosis, tooth location, and emergency treatment were recorded. Descriptive statistics were applied, and associations between variables were assessed using chi-square and Kruskal-Wallis tests. RESULTS: A total of 1490 children were included (mean age: 4.81 ± 1.11 years). Furcation periodontitis (38.1%) and pulpitis (36.8%) were the most frequent diagnoses, followed by dental abscesses (22.4%). Mandibular posterior teeth were predominantly affected (59.5%). Children from rural areas presented proportionally more often with advanced complications (p = 0.009). Significant associations were observed between diagnosis and tooth location (p < 0.001), as well as between diagnosis and age (p < 0.001). A marked reduction in emergency presentations was observed during 2020-2021, followed by a progressive increase after 2022. CONCLUSIONS: ECC-related complications remain a major cause of pediatric dental emergency visits, with most children presenting at advanced stages of disease. CLINICAL RELEVANCE: These findings highlight delayed access to preventive dental care and underscore the need for early, community-based preventive strategies to reduce severe ECC complications and emergency dental service utilization.
Impact of soy- and milk-based yogurts on enamel preservation: erosion and abrasion under simulated conditions.
Kim RR, Braga AS, Floret GP … +4 more , Roehler A, Schultheiss J, Magalhães AC, Esteves-Oliveira M
Clin Oral Investig · 2026 Jun · PMID 42240712 · Full text
OBJECTIVES: This study evaluated the effect of soy-based and milk-based yogurts against enamel erosive-abrasive surface loss. MATERIALS AND METHODS: Ninety-eight bovine enamel specimens were randomly allocated to seven e...
OBJECTIVES: This study evaluated the effect of soy-based and milk-based yogurts against enamel erosive-abrasive surface loss. MATERIALS AND METHODS: Ninety-eight bovine enamel specimens were randomly allocated to seven experimental groups (n = 14). Over seven days, specimens underwent six daily erosive cycles (0.05 M citric acid, pH 2.3, 2 min), interspersed with remineralizing solution (pH 6.5). Post-acid preventive measures consisted of immersion in milk-based yogurt (pH 4.4), soy-based yogurt (pH 4.7), or tap water for 3 min twice daily. Under erosion-abrasion conditions, specimens underwent simulated toothbrushing using stannous ions-containing fluoride toothpaste. Fluoride-free toothpaste served as abrasion control. Enamel surface loss was measured after 7 days using three-dimensional laser scanning microscopy. Calcium and phosphorus contents were quantified by optical emission spectrometry. RESULTS: Abrasion with a stannous ions-containing fluoride toothpaste combined with soy-based yogurt resulted in significantly lower enamel surface loss (7.9±3.3 μm) compared with the fluoride toothpaste only (12.2 ± 2.7 μm; p<0.05). Under erosion-only conditions, no significant differences were detected among preventive measures. Milk-based yogurt presented significantly higher calcium and phosphorus contents (Ca: 1434.1±190.3 µg/g; P: 1033.8±128.1 µg/g) than soy-based yogurt (Ca: 168.4±15.5 µg/g; P: 623.2±47.7 µg/g). CONCLUSIONS: The tested soy yogurt may offer adjunctive protection in patients exposed to erosive and abrasive challenges. CLINICAL RELEVANCE: The tested soy yogurt significantly enhances anti-erosive efficacy of fluoride-stannous formulations, providing clinicians with an evidence-based dietary intervention to optimize preventive strategies against erosive enamel loss.
Hydroxyapatite composite sodium hyaluronate for alveolar ridge preservation: a prospective, randomized, parallel-controlled, single-blind, non-inferiority multicenter clinical trial.
Xue Y, Liu L, Xue C … +4 more , Sun Y, Wang B, Meng J, Zhou H
Clin Oral Investig · 2026 Jun · PMID 42240710 · Publisher ↗
OBJECTIVES: Evaluate the efficacy and safety of the combination of sodium hyaluronate and hydroxyapatite for alveolar ridge preservation in fresh extraction sockets with bone defects. MATERIALS AND METHODS: A total of 20...
OBJECTIVES: Evaluate the efficacy and safety of the combination of sodium hyaluronate and hydroxyapatite for alveolar ridge preservation in fresh extraction sockets with bone defects. MATERIALS AND METHODS: A total of 200 patients, who required tooth extraction due to dental, periodontal, or periapical diseases, were enrolled in five dental clinic centers across China. Alveolar bone defects were identified, and bone grafting was indicated for defects with a depth of ≥ 3 mm on one or more sides of the affected tooth's bone wall, as measured by Cone Beam CT (CBCT). Participants were randomly and equally assigned to either the experimental group, which received hydroxyapatite composite sodium hyaluronate (HAp/HA) implants in the fresh tooth extraction socket, or the control group, which was given a reference bone substitute. Postoperative follow-up assessments were conducted for up to 24 weeks. Changes in alveolar ridge height and width at the implantation site were evaluated blindly using CBCT. Simultaneously, the local healing condition and systemic safety profiles were evaluated. RESULTS: HAp/HA exhibits superior adhesion, facilitating easier filling and shaping during dental procedures in comparison to control material. Postoperative CBCT images, performed right after the operation and at the 24-week follow-up, showed a minimal alteration in alveolar ridge height (-0.33 ± 1.74 mm) and width (-0.60 ± 1.95 mm) subsequent to HAp/HA implantation, indicating no significant variance when compared to the control material. At the 24-week follow-up, the osseointegration of the implanted material with the alveolar bone was scored using a 3-grade system, with the HAp/HA group showing slightly higher average scores than the control group, though not statistically significant. No post-operative infections or material rejections were observed in either group. CONCLUSIONS: HAp/HA can be an effective and safe material for alveolar ridge preservation in tooth extraction sockets with defects. CLINICAL RELEVANCE: Hydroxyapatite composite sodium hyaluronate possess clinical value for alveolar ridge preservation.
Clinical performance of an innovative self-cure bulk-fill composite compared to dual-cure and light-cure bulk-fill composite in posterior restorations: a 1-year randomized controlled clinical trial.
Ragab MA, Elmahy WA, Elgayar M
Clin Oral Investig · 2026 Jun · PMID 42234256 · Full text
OBJECTIVES: To evaluate and compare the 1-year clinical performance of self-cure, dual-cure, and light-cure bulk-fill composites in class II restorations. MATERIALS AND METHODS: Twenty patients received sixty direct clas...
OBJECTIVES: To evaluate and compare the 1-year clinical performance of self-cure, dual-cure, and light-cure bulk-fill composites in class II restorations. MATERIALS AND METHODS: Twenty patients received sixty direct class II restorations, which were divided into three groups (n = 20): Group I: Self-cure bulk-fill (Stela capsules) with Stela primer, Group II: Dual-cure bulk-fill (Fill-Up) with ParaBond adhesive system, Group III: Light-cure bulk-fill (Tetric N-Ceram Bulk Fill) with Tetric N-Bond Universal adhesive. Using the Revised FDI criteria, restorations were assessed after 1 week (baseline) and at 3, 6, 9, and 12 months. FDI scores were compared between groups and across different time points using Friedman and Bonferroni post-hoc tests (P < 0.05). RESULTS: All restorations demonstrated acceptable FDI scores, with a 100% survival rate over 12 months. For all functional and biological criteria, no significant differences were observed among the groups. Esthetic differences were observed where Tetric N-Ceram Bulk Fill demonstrated superior surface luster and texture compared with Stela capsules (P < 0.05), while Fill-Up showed intermediate performance. Stela capsules and Tetric N-Ceram Bulk Fill exhibited the highest color match scores, whereas Fill-Up was significantly lower (P < 0.05). No significant changes were observed over time. CONCLUSIONS: Stela capsules and Fill-Up showed comparable 1-year functional and biological outcomes to Tetric N-Ceram Bulk Fill in class II restorations, while esthetic outcomes were material-dependent. CLINICAL RELEVANCE: Self- and dual-cure bulk fill composites represent reliable alternatives to light-cure bulk fill materials for posterior restorations where esthetics are of lesser concern, offering simplified placement without compromising short-term clinical performance.
Impact of electrode distance, axial position, and energization time on cauterization of root canal isthmuses using high-frequency current.
Alkuwaykibi AS, Sugaya T, Alruwaili MK … +1 more , Takahashi N
Clin Oral Investig · 2026 Jun · PMID 42234213 · Publisher ↗
OBJECTIVES: This in vitro proof-of-concept study evaluated how the isthmus gap width, distance between electrodes, and duration of high-frequency electrical current application affect surface morphological changes of sim...
OBJECTIVES: This in vitro proof-of-concept study evaluated how the isthmus gap width, distance between electrodes, and duration of high-frequency electrical current application affect surface morphological changes of simulated isthmus inner surfaces. MATERIALS AND METHODS: Simulated isthmus models were prepared using bovine dentin blocks immersed in Plank-Rychlo solution to create organic layers. Isthmus gap widths of 0.1, 0.2, and 0.3 mm were created. Two root canals were prepared at distances of 2 mm or 5 mm, creating six groups (n = 10 each). Root canals were filled with NaOCl, and #35 K-files served as electrodes. A high-frequency current (225 V, 520 kHz) was applied for 5 or 10 s. The demineralized surface morphology (decalcified surface) prior to HFC application served as the baseline reference for evaluating cauterization outcomes. Isthmus surfaces were analyzed using scanning electron microscopy and energy dispersive X-ray spectroscopy. RESULTS: High-frequency current application produced surface morphological changes consistent with cauterization, including exposure of dentinal tubules. Fisher's exact test showed significant differences in cauterization rates, since Group 1 showed less organic residue than Groups 4 and 5 (p < 0.05). In Groups 3 and 4, 10-s application significantly decreased organic material compared to 5-s application (p < 0.001). Ordinal logistic regression analysis confirmed that electrode distance (OR = 0.854, p < 0.0001), axial position (OR = 0.444, p < 0.0001), and energization time (OR = 3.276, p < 0.0001) were significant predictors, whereas gap width was not (p = 0.542). Coronal regions showed significantly higher cauterization rates than apical regions (91.6% [466/509] vs 68.2% [347/509]). CONCLUSIONS: Within the limitations of this in vitro proof-of-concept study, electrode distance, axial position, and energization time significantly influenced surface morphological outcomes. Extending energization time from 5 to 10 s increased the odds of achieving higher-grade surface morphological changes by 3.3-fold. Gap width did not significantly affect the outcome. CLINICAL RELEVANCE: Electrode distance, axial position, and energization time are critical parameters for high-frequency cauterization of simulated root canal isthmuses. These proof-of-concept findings may inform future investigations into the clinical application of this technique for areas inaccessible to conventional instrumentation.
Accuracy and bias of high-frequency ultrasonography in measuring white spot lesion depth: an in-vitro comparison with micro-CT.
Toothman Sulkowski T, Makowka S, Kripfgans OD … +3 more , Tanberg W, Warunek S, Al-Jewair T
Clin Oral Investig · 2026 Jun · PMID 42234205 · Full text
OBJECTIVES: This in vitro study aimed to evaluate the accuracy and bias of Ultrasound (US) in measuring the depth of white spot lesions (WSLs), in comparison to micro-CT (µ-CT). MATERIALS AND METHODS: The study included...
OBJECTIVES: This in vitro study aimed to evaluate the accuracy and bias of Ultrasound (US) in measuring the depth of white spot lesions (WSLs), in comparison to micro-CT (µ-CT). MATERIALS AND METHODS: The study included 120 bovine maxillary incisors. Artificial WSLs were created on the facial surface of each incisor. Incisors were categorized into two groups, shallow WSLs and deep WSLs and subjected to 2-day and 4-day pH cycling protocols, respectively. All samples were imaged with both µ-CT and US using second harmonic imaging at 12/24 MHz. WSL depth was measured and the average calculated. Enamel thickness was assessed on the µ-CT images using the same methodology. RESULTS: Mean lesion depths in the shallow WSLs group were 138.3±17.8 μm (µ-CT) and 169.2 ± 37.8 μm (US), while in the deep WSLs group, depths averaged 299.9 ± 47.7 μm (µ-CT) and 309.3 ± 75.7 μm (US). The absolute mean differences between µ-CT and US were significantly different from zero (p < 0.001). US consistently overestimated lesion depth compared to µ-CT in both groups, with a significant difference in the shallow WSLs group (p < 0.001). CONCLUSIONS: US demonstrates lower accuracy than µ-CT in measuring WSL depth, consistently overestimating lesion depths, particularly in the shallow WSLs group. CLINICAL RELEVANCE: The ability of a diagnostic method to measure WSLs of varying depths is clinically important, as treatment efficacy depends on lesion depth and the extent of enamel demineralization. US in non-invasive and demonstrates potential for clinical use; however, further validation is required before it can be reliably applied to the clinical assessment of WSL depth. Clinicians must also consider practical factors such as equipment cost and size, the need for coupling materials, and requirements for operator training and calibration.
Clinical performance of the ethanol-wet bonding technique with different adhesive systems in noncarious cervical lesion restorations: a 6-year randomized clinical trial.
Souza LDS, Monnerat MF, Souza MY … +3 more , Rocha MB, Caneppele TMF, Bresciani E
Clin Oral Investig · 2026 Jun · PMID 42234047 · Full text
OBJECTIVES: This randomized clinical trial evaluated the six-year clinical performance of the ethanol-wet bonding technique (EWBT) combined with different adhesive protocols in non-carious cervical lesions (NCCLs). The r...
OBJECTIVES: This randomized clinical trial evaluated the six-year clinical performance of the ethanol-wet bonding technique (EWBT) combined with different adhesive protocols in non-carious cervical lesions (NCCLs). The research question was whether EWBT improves long-term restoration retention compared with conventional water-wet bonding. MATERIAL AND METHODS: Patients presenting at least one NCCL, regardless of lesion etiology (abrasion, erosion, abfraction, or mixed), were included. A total of 148 NCCLs were randomized at the restoration level into four groups: [NE] water-wet bonding with a three-step etch-and-rinse adhesive (Adper Scotchbond Multi-Purpose, 3M ESPE); [EMP] EWBT + Adper Scotchbond Multi-Purpose (3M ESPE); [EB] EWBT + hydrophobic bonding resin (Adper Scotchbond Multi-Purpose Bond, 3M ESPE); and [EU] EWBT + universal adhesive (Single Bond Universal, 3M ESPE). EWBT consisted of applying 100% ethanol actively for 60 s to dentin prior to adhesive application. All restorations were placed using a nanohybrid composite resin (Filtek Z350 XT, 3M ESPE). Clinical evaluations were performed at baseline, 6, 18 months and after six years using modified USPHS criteria. The unit of analysis was the restoration. Intergroup comparisons at each time point were performed using Fisher's exact test, and survival analysis was conducted using Kaplan-Meier estimates and log-rank tests (α = 0.05). RESULTS: After six years, 42 patients (108 restorations) were clinically evaluated (72.9% recall), while all 148 restorations were included in the intention-to-treat analysis. Survival rates were 88.9% (NE), 81.1% (EU), 77.8% (EMP), and 48.7% (EB). The EB group showed significantly lower survival than all other groups (log-rank, p = 0.008). No significant differences were observed among the hydrophilic protocols (p > 0.05). CONCLUSIONS: The effectiveness of EWBT is influenced by the hydrophilicity of the adhesive system. Hydrophilic adhesives showed stable long-term performance regardless of ethanol pretreatment, whereas the use of EWBT with a purely hydrophobic bonding resin resulted in significantly reduced retention. CLINICAL RELEVANCE: EWBT does not improve longevity when used with hydrophilic adhesives but may compromise performance when associated with simplified hydrophobic bonding strategies.
Comparative efficacy of electric toothbrush technologies in plaque and gingivitis reduction: a network meta-analysis.
Luo C, Chen N, Jing Q … +6 more , Hu S, Wan S, Zhang S, Liu G, Li N, Zhao LY
Clin Oral Investig · 2026 Jun · PMID 42234020 · Full text
BACKGROUND: The comparative efficacy of different types of electric toothbrushes relative to each other and to manual toothbrushes remains a subject of clinical investigation. This network meta-analysis (NMA) aims to ran...
BACKGROUND: The comparative efficacy of different types of electric toothbrushes relative to each other and to manual toothbrushes remains a subject of clinical investigation. This network meta-analysis (NMA) aims to rank the efficacy of various electric toothbrush technologies for plaque and gingivitis reduction. METHODS: A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was conducted from inception to June 2025. Randomized controlled trials (RCTs) comparing electric (oscillating-rotating, sonic, ultrasonic, other) and manual toothbrushes were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A frequentist NMA was performed, and treatments were ranked using Surface Under the Cumulative Ranking (SUCRA) values. Consistency between direct and indirect evidence was evaluated. RESULTS: Nineteen RCTs were included. In terms of plaque reduction, oscillating-rotating brushes were ranked first (SUCRA = 89.2%), followed by sonic (SUCRA = 72.4%), ultrasonic (SUCRA = 54.1%), other electric (SUCRA = 45.3%), and manual toothbrushes (SUCRA = 18.3%). A similar ranking was observed for gingivitis reduction. Subgroup analyses indicated superior benefits for orthodontic patients and children. The overall risk of bias was low, and no significant inconsistency was detected. CONCLUSION: Oscillating-rotating electric toothbrushes demonstrated the highest probability of being among the most effective interventions for reducing plaque and gingivitis among the compared technologies. This evidence suggests that they may be considered a preferred choice for improved oral hygiene in clinical practice, particularly in high-risk groups such as orthodontic patients and children.
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