Clinical Oral Investigations[JOURNAL]
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200 papers
Effect of thermal aging on the radiopacity of universal composite resins at two thickness levels.
Ozdemir SB, Ozdemir B
Clin Oral Investig · 2026 May · PMID 42178431 · Full text
OBJECTIVES: The aim of this study was to investigate the effects of material type, specimen thickness, and thermocycling on the radiopacity of universal composite resins using equivalent aluminum thickness (mm Al). MATER...
OBJECTIVES: The aim of this study was to investigate the effects of material type, specimen thickness, and thermocycling on the radiopacity of universal composite resins using equivalent aluminum thickness (mm Al). MATERIALS AND METHODS: Four universal paste-type (Filtek Z250 Universal Restorative; FZ250, Omnichroma; OC, Vittra APS Unique; VU, and G-aenial Universal A'Chord; GU) and three universal flowable composite resins (Omnichroma Flow; OCF, Vittra APS Unique Flow; VUF, and G-aenial Universal Flo; GUF) were tested. Disk-shaped specimens (12 mm diameter) were prepared at 1 mm and 2 mm thicknesses (n = 10 per group). Radiographic images were obtained using a digital X-ray system together with an aluminum step wedge and enamel-dentin references. Mean gray values (MGV) were measured using ImageJ software and converted to equivalent mm Al. Specimens were subjected to 10,000 thermocycles (5-55 °C). Data were analyzed using three-way ANOVA (p < 0.05). RESULTS: Radiopacity differed significantly among the tested materials (p < 0.001). FZ250 and VU exhibited the highest mm Al values at both thickness levels. Specimen thickness significantly affected radiopacity, with 2 mm specimens showing higher values than 1 mm specimens across all materials (p < 0.001). After thermocycling, statistically significant decreases were observed in the 2 mm specimens of the VU and VUF groups (p < 0.001). All materials exhibited radiopacity values equal to or greater than 1 mm Al at 1 mm thickness. CONCLUSION: All tested universal composite resins met the minimum ISO 4049 radiopacity requirement. Radiopacity was influenced by material type and specimen thickness. Thermocycling caused a decrease in radiopacity values in some composite resin groups. CLINICAL RELEVANCE: Thermocycling may affect radiopacity depending on material type and specimen thickness and should be considered by clinicians during radiographic evaluation of composite restorations.
Effects of different polishing systems on gloss and roughness of CAD/CAM reinforced resin composites: an in vitro study.
Babaier R, Garoushi S, Vallittu P … +3 more , Säilynoja E, Lassila L, Watts DC
Clin Oral Investig · 2026 May · PMID 42176087 · Publisher ↗
OBJECTIVES: This study investigates the effectiveness of three polishing systems on the surface roughness and gloss of different CAD/CAM reinforced resin composites, one of which is an experimental short fiber-reinforced...
OBJECTIVES: This study investigates the effectiveness of three polishing systems on the surface roughness and gloss of different CAD/CAM reinforced resin composites, one of which is an experimental short fiber-reinforced composite (SFRC CAD). A secondary objective was to evaluate whether specific material-polishing system combinations could achieve clinically acceptable thresholds for surface roughness and gloss. MATERIALS AND METHODS: Ninety plate-shaped specimens were prepared from three CAD/CAM reinforced resin composite blocks: experimental SFRC CAD, TRINIA (TR), and Lava Ultimate (LU). Surface roughness and gloss measurements for all specimens were determined at baseline. Then, material specimens were divided into three study groups (n = 10): Sof-Lex diamond polishing system (SOF), OptraGloss polishing system (OPT), and silicon carbide papers (1200-4000 grit) (SIC). Surface roughness and gloss were measured again after polishing. Scanning electron microscopic (SEM) images were taken for one representative specimen from each group pre- and post-polishing. Two-way ANOVA, Bonferroni-adjusted pairwise comparisons and Games-Howell post hoc tests were performed to determine the effectiveness of polishing on roughness and gloss on each material (p < 0.05). RESULTS: Polishing significantly reduced surface roughness (Ra) and increased gloss in CAD/CAM resin composites (p = 0.001), with wide variations ranging between 0.121 and 3.635 μm and from 5.9 to 124.9 GU, respectively. SFRC and LU showed smoother surfaces with SOF and SIC (p = 0.001), while LU exhibited higher gloss with OPT. TR had the roughest surfaces and lowest gloss, especially with OPT (p = 0.001). CONCLUSIONS: Within the limitations of this study, the new SFRC CAD, polished with Sof-Lex or silicon carbide papers, achieved smoothness and gloss comparable to Lava Ultimate (LU), supporting its potential as an aesthetically restorative material. TR exhibited less favorable surface roughness and gloss upon polishing with the OptraGloss polishing system. CLINICAL RELEVANCE: Polishing significantly improved the surface properties of CAD/CAM reinforced resin composites; however, the results were material- and protocol-dependent. The findings highlight the importance of selecting appropriate polishing systems to optimize the surface properties of different reinforced resin composites.
Three-dimensional stability during orthodontic retention: A comparative analysis of conventional, CAD/CAM-fabricated, and robotically bent fixed retainers versus removable appliances.
Köck J, Lang F, Niederau C … +5 more , Rizk M, Al-Sakati H, Lang N, Wolf M, Knaup I
Clin Oral Investig · 2026 May · PMID 42174193 · Full text
OBJECTIVES: To evaluate three-dimensional anterior tooth position changes during orthodontic retention and to compare the effectiveness of three distinct fixed retainer fabrication designs including robotically bent reta...
OBJECTIVES: To evaluate three-dimensional anterior tooth position changes during orthodontic retention and to compare the effectiveness of three distinct fixed retainer fabrication designs including robotically bent retainers alongside with removable retainers. MATERIALS AND METHODS: This retrospective cohort study included 113 patients (226 dental arches; mean retention period 1.3 ± 0.6 years). Combined fixed lingual plus removable retention (group 1, n = 148 arches) comprised CAD/CAM Memotain, conventional multistranded stainless-steel (Twistflex), and robotically bent retainers; group 2 (n = 78 arches) received removable retention only. Digital model superimposition using a three-dimensional tooth-specific coordinate system quantified rotational and translational tooth movements, Little's Irregularity Index (LII), transverse arch widths, and bonding failures. RESULTS: Combined fixed and removable retention showed higher stability than removable-only retention (55% vs. 33% stable arches). Removable retention increased the odds of moderate-to-severe instability (maxilla OR 4.37, 95% CI 1.74-10.98; mandible OR 14.35, 95% CI 3.24-63.56), whereas fixed lingual retention was protective (maxilla OR 0.23, 95% CI 0.09-0.58; mandible OR 0.07, 95% CI 0.02-0.31). Instability mainly involved canine rotations and vertical translations. Robotically bent and CAD/CAM Memotain retainers showed the lowest movement magnitudes and variability, with minimal LII increases. Intercanine and intermolar widths remained stable across fixed retainers. Bonding failures (25%) strongly predicted severe instability. CONCLUSIONS: Three-dimensional tooth movements during retention mainly involve canine rotations and vertical translations. All fixed retainer designs (Twistflex, CAD/CAM-fabricated, and robotically bent) provided greater stability than removable-only retention. CLINICAL RELEVANCE: All fixed retainer designs require regular monitoring of bonding integrity; digitally fabricated and robotically bent retainers demonstrated marginally lower dimensional variability, which may be clinically relevant over longer observation periods.
The morphologies and aerodynamic characteristics of the upper airway in class II adolescents with different minimum cross-sectional area.
Wang C, Hu J, Qu Q … +2 more , Ni X, Li Q
Clin Oral Investig · 2026 May · PMID 42174188 · Publisher ↗
OBJECTIVES: To investigate whether different upper airway minimum cross-sectional area (CSAmin) in Class II adolescents correspond to distinct upper-airway morphology and aerodynamic characteristics. MATERIALS AND METHOD...
OBJECTIVES: To investigate whether different upper airway minimum cross-sectional area (CSAmin) in Class II adolescents correspond to distinct upper-airway morphology and aerodynamic characteristics. MATERIALS AND METHODS: One hundred and fifty-nine Class II adolescents were enrolled in this cross-sectional observational study and stratified into three groups according to the upper airway CSAmin, Group 1(40 ≤ CSAmin < 80 mm²), Group 2 (80 ≤ CSAmin ≤ 120 mm²), and Group 3(CSAmin > 120 mm²). Cone-beam computed tomography (CBCT) data were used to measure upper-airway morphological characteristics and to reconstruct three-dimensional models of the upper airway. Computational fluid dynamics (CFD) simulations were performed to calculate velocity, pressure, wall shear stress and resistance of upper airway during inspiration and expiration. RESULTS: The three groups exhibited significant differences in upper airway volume (P < 0.01). Upper airway airflow velocity, wall shear stress and resistance of Group 1 were significantly higher than those of the other two groups. Nasopharyngeal volume and aerodynamic variables differed only between Group 1 and Group 3; Group 1 and Group 2 were statistically indistinguishable. At the level of the palatopharynx and glossopharynx, significant differences in most measured variables were observed across all three groups. CONCLUSIONS: Smaller CSAmin was consistently associated with reduced total volume, greater negative intraluminal pressure, higher peak velocity, wall shear stress, and airway resistance. Class II adolescents with CSAmin < 80 mm² should be flagged for closer airway surveillance before initiating any treatment that could further narrow the airway.
Correction to: Effects of body mass index on mandibular bone architecture: a retrospective fractal dimension and radiomorphometric analysis.
İspir NG, Akay G, Gungor K
Clin Oral Investig · 2026 May · PMID 42168677 · Full text
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NECKCHECK project: development and validation of a digital checklist for radiologic assessment of oral cavity squamous cell carcinoma.
Ferrero-Coloma SM, Quesada JA, Izquierdo-Luzón J … +5 more , Ferrero-Coloma C, Sancho-Mestre M, Garcia-Garrigós E, Pereira-Expósito A, Gil-Guillen V
Clin Oral Investig · 2026 May · PMID 42168667 · Full text
OBJECTIVES: Oral cavity squamous cell carcinoma (OCSCC) is one of the most common malignancies affecting the oral region and requires accurate imaging assessment for staging and treatment planning. However, variability i...
OBJECTIVES: Oral cavity squamous cell carcinoma (OCSCC) is one of the most common malignancies affecting the oral region and requires accurate imaging assessment for staging and treatment planning. However, variability in radiologic interpretation may lead to inconsistencies in clinical decision-making. The aim of this study was to develop and evaluate a structured radiologic checklist (NECKCHECK) to improve diagnostic accuracy and interobserver agreement in the imaging assessment of OCSCC. MATERIALS AND METHODS: NECKCHECK was developed following a comprehensive narrative review of the literature focusing on relevant staging features of OCSCC using computed tomography (CT) and magnetic resonance imaging (MRI). Key radiologic parameters were organized into a digital checklist designed to guide systematic image interpretation. A concordance study was performed in which otolaryngologists independently evaluated anonymized CT and MRI examinations of patients with OCSCC, both with and without checklist support. Expert radiologist assessment served as the reference standard. Interobserver agreement was assessed using Cohen's kappa coefficient, and diagnostic accuracy was measured as the proportion of correct responses. RESULTS: Use of the checklist significantly improved interobserver agreement, with mean Cohen's kappa increasing from 0.44 to 0.72. Diagnostic accuracy also improved significantly, with correct responses increasing from 67.1% to 84.7% (p < 0.001). Perfect agreement was achieved for key parameters such as tumor size and depth of invasion. CONCLUSIONS: Implementation of a structured radiologic checklist improves both diagnostic accuracy and interobserver agreement in the imaging evaluation of OCSCC. CLINICAL RELEVANCE: NECKCHECK may support more standardized radiologic assessment of oral cavity squamous cell carcinoma and improve multidisciplinary clinical decision-making in oral cancer management.
The influence of different skeletal patterns on TMJ anatomy: a comprehensive CBCT study across various sagittal and vertical skeletal patterns in adults.
Eslami S, Sayahpour B, Tashakor A … +4 more , Tavazozadeh E, Harsoputranto A, Marya A, Jamilian A
Clin Oral Investig · 2026 May · PMID 42168666 · Full text
OBJECTIVE: This study aimed to evaluate the impact of sagittal and vertical skeletal patterns as well as gender on temporomandibular joint (TMJ) morphology using Cone Beam Computed Tomography (CBCT). METHODS: A cross-sec...
OBJECTIVE: This study aimed to evaluate the impact of sagittal and vertical skeletal patterns as well as gender on temporomandibular joint (TMJ) morphology using Cone Beam Computed Tomography (CBCT). METHODS: A cross-sectional analysis was conducted on CBCT scans of 126 adult patients (63 females, 63 males) aged 20 to 40 years, stratified into Class I, II and III sagittal classifications and further divided by vertical patterns: horizontal, normal and vertical. Measurements included condylar dimensions (length, height, and width) and glenoid fossa dimensions (depth and width). Left and right TMJs were assessed and average values were used due to the absence of significant side differences. A multiple linear regression model was used to examine the effects of sagittal and vertical patterns and Gender on the parameter. Gender was included as a covariate in all models. Both an interaction model (vertical × sagittal pattern) and a main-effects-only model were considered with interaction effects accounted for where present. Model selection was based on statistical significance and model fit criteria. Pairwise comparisons were conducted using Tukey's Honest Significant Difference (HSD) test and estimated marginal means (EMMs) were calculated where applicable. Statistical significance was set at p < 0.05 with adjustments for multiple comparisons. RESULTS: For Condyle Height, a significant difference was found between Class III and Class I within the vertical pattern (VP) subgroup (p = 0.011). In contrast, Gender significantly influenced Condyle Length (p = 0.009) and a significant difference was found between Class II and Class I (p = 0.01). Subgroup analysis revealed a significant difference between Class II and Class I in the VP group (p = 0.023). For Condyle Width, a significant interaction between VP and Class III was found (p = 0.029). Significant pairwise differences were observed between HP-Class II and VP-Class III (p = 0.023), NP-Class II and VP-Class III (p = 0.007), and HP-Class III and VP-Class III (p = 0.013). Within the NP subgroup, Class II differed significantly from Class I (p = 0.044). Analysis of Glenoid Fossa Width revealed a significant interaction between NP and Class III (p = 0.048). Multiple significant pairwise differences were identified, including NP-Class I versus HP-Class II (p = 0.002), NP-Class I versus NP-Class II (p = 0.004), and VP-Class II versus HP-Class III (p = 0.004). Regarding glenoid fossa depth, a significant interaction between VP and Class III was found (p = 0.037), but no pairwise subgroup differences reached statistical significance (all p > 0.05). CONCLUSIONS: This study demonstrates that TMJ morphology is variably influenced by vertical and sagittal skeletal patterns and gender. Significant differences in condyle length and width as well as glenoid fossa width were primarily observed in individuals with vertical patterns and Class II or III skeletal relationships. Gender significantly affected condyle length. While glenoid fossa depth showed a high interaction between vertical pattern and sagittal skeletal relationships, no individual comparisons reached statistical significance. These findings underscore the nuanced interplay of sagittal and vertical skeletal patterns in shaping TMJ morphology.
Ultrasonographic measurement of masseter muscle thickness and elasticity in patients with symptomatic apical periodontitis.
Çelik N, Dogan ME
Clin Oral Investig · 2026 May · PMID 42168434 · Full text
OBJECTIVE: The purpose of current study was to evaluate changes in masseter muscle thickness (MMT) and elasticity in patients with symptomatic apical periodontitis (SAP) using ultrasonography before and after endodontic...
OBJECTIVE: The purpose of current study was to evaluate changes in masseter muscle thickness (MMT) and elasticity in patients with symptomatic apical periodontitis (SAP) using ultrasonography before and after endodontic treatment. METHODS: This prospective controlled clinical study inclusive 30 patients diagnosed with SAP and 30 systemically and orally healthy individuals. MMT was assessed using B-mode ultrasonography, and tissue stiffness was measured with shear wave elastography (SWE). Measurements were obtained bilaterally at rest and during maximum clenching. In the case group, the second measurement was performed 1-month after the completion of root canal treatment and without the observation of symptoms. Data were investigated using independent and paired samples t-tests, statistical importance level of P < 0.05 was accepted. RESULTS: Intra-observer agreement was good (κ = 0.83). At baseline, the right MMT was importantly lower in the case group compared with the control group, both at rest and during clenching (p = 0.003 and p = 0.020, respectively). Similarly, right-sided SWE values obtained during clenching were significantly reduced in the case group (p = 0.003), whereas no significant difference was found for resting SWE measurements. On the left side, resting measurements did not diverge importantly between groups. However, during clenching, both muscle thickness and SWE values were significantly lower in the case group (p = 0.024 and p = 0.001). CONCLUSION: SAP may cause alterations in MMT and stiffness. The improvement observed in ultrasonographic parameters after root canal treatment suggests that these changes may represent a reversible functional adaptation to acute periapical inflammation. CLINICAL RELEVANCE: The clinical significance of this study focuses on elucidating how SAP and associated pain can lead to secondary adaptations in the masseter muscle, such as protective co-contraction or muscle protection.
Ectopic eruption of permanent first molars: a cross-sectional study in the mixed dentition.
Aguiar MVS, Santos LG, da Silva CBBM … +3 more , Degrazia FW, Cançado RH, Neves LS
Clin Oral Investig · 2026 May · PMID 42168390 · Full text
INTRODUCTION: Ectopic eruption of permanent first molars can compromise arch development and lead to malocclusion if undetected. Identifying associated occlusal traits may enable early intervention and prevent complicati...
INTRODUCTION: Ectopic eruption of permanent first molars can compromise arch development and lead to malocclusion if undetected. Identifying associated occlusal traits may enable early intervention and prevent complications. OBJECTIVE: To determine the frequency and occlusal characteristics associated with ectopic eruption of permanent first molars in children. MATERIALS AND METHODS: A cross-sectional study analyzed 901 orthodontic files of children aged 5-9 years. Twenty-four patients with ectopic eruption of permanent first molars were included as the experimental group, while 23 age- and sex-matched children comprised the control group. Panoramic radiographs were used to assess molar angulation and digital dental models were used to assess arch length, arch perimeter, intercanine and intermolar distances. Data reliability was assessed using paired t-tests and Dahlberg's formula. Statistical analysis included Shapiro-Wilk tests, independent t-tests or Mann-Whitney tests, Chi-square tests, and logistic regression to evaluate predictors of ectopic eruption. RESULTS: Ectopic eruption was observed in 2.66% of children, predominantly in the maxilla. Children with ectopic eruption exhibited significantly shorter and narrower arches compared with control, with maxillary intermolar width emerging as a significant predictor (p < 0.05). Molar angulations and deciduous molar crown size were not significantly associated. CONCLUSION: Ectopic eruption of first permanent molars is associated with reduced arch dimensions, particularly maxillary intermolar width. Early recognition of these occlusal patterns may facilitate timely orthodontic management and prevent space loss and secondary crowding.
Novel salivary biomarkers of Alzheimer's disease identified by integrated metabolomics and microbiomics analysis.
Chen H, Chen H, Xie L … +8 more , Jiang K, Xia E, Mao J, Liu Z, Li X, Xiao Y, Qian X, Jin Z
Clin Oral Investig · 2026 May · PMID 42165911 · Publisher ↗
OBJECTIVES: Alzheimer's disease (AD) and mild cognitive impairment (MCI) represent significant health challenges, with identification of biomarkers from non-invasive biofluid critical for large-scale screening and effect...
OBJECTIVES: Alzheimer's disease (AD) and mild cognitive impairment (MCI) represent significant health challenges, with identification of biomarkers from non-invasive biofluid critical for large-scale screening and effective intervention. MATERIAL AND METHODS: In this study, we performed a comprehensive analysis integrating non-targeted metabolomics and 16S rDNA sequencing of saliva samples from 3 age and sex-matched groups containing 18 AD patients, 15 MCI individuals and 19 healthy controls (HC). RESULTS: Salivary metabolites including histamine (biogenic amine), carveol (monoterpene), and 2-phosphoglycerate (glycolytic intermediate) were significantly altered in AD patients. In addition, L-glutamic acid (excitatory neurotransmitter) levels were notably reduced in MCI patients, suggesting its potential as a biomarker for MCI. Microbial analysis revealed a decrease in the abundance of Actinomyces and Stomatobaculum in AD patients. In contrast, MCI patients exhibited a reduction in Atopobium and Actinomyces, along with an increase in Gemella and Peptostreptococcus compared to HC. An integrated analysis of microbiota and metabolites uncovered significant correlations, such as a positive correlation between Lactobacillus crispatus and GABA in AD patients, and an association between Klebsiella pneumoniae and multiple metabolites in AD patients. Additionally, MCI patients exhibited a higher abundance of "potentially pathogenic" microbiota species, highlighting a distinct microbiome profile. CONCLUSIONS: Our findings revealed distinct metabolic and microbiomic alterations across the groups. CLINICAL RELEVANCE: These findings suggest that saliva may harbor valuable biomarkers for the early diagnosis of AD and MCI. Moreover, our results underscore the involvement of the "oral-brain axis" in the pathogenesis of neurodegenerative diseases, offering new insights into potential therapeutic targets.
Evaluation of a novel dual-headed toothbrush design for periodontal health: split- mouth randomized blind clinical trial.
ElHaddad SA, Zahid MN, Dimashkieh RM … +7 more , Demachkia AM, Al Khalifa FI, Ayami RA, ElShall AM, Kahil N, Algohar A, Dimashkieh MR
Clin Oral Investig · 2026 May · PMID 42154306 · Publisher ↗
BACKGROUND: Optimal oral health largely depends on the successful removal of plaque through effective brushing, but success typically relies on user technique, time, and adherence. The aim was to compare the effectivenes...
BACKGROUND: Optimal oral health largely depends on the successful removal of plaque through effective brushing, but success typically relies on user technique, time, and adherence. The aim was to compare the effectiveness of a newly introduced dual-headed toothbrush with a conventional single-headed toothbrush in control of plaque and gingival health using a split-mouth design. METHODS: In the study, 37 dental professionals used two types of toothbrushes: a dual-headed toothbrush on one side of the mouth (Test side) and a conventional single-headed toothbrush on the other side (Control side). The study compared plaque removal, gingival status, and brushing time, assessing clinical outcomes using plaque index (PI), gingival index (GI), and modified sulcus bleeding index (mSBI) at baseline, 2 weeks, and 4 weeks. At the end, participants completed a Likert scale questionnaire. RESULTS: Both types of toothbrushes were effective in enhancing oral hygiene over time; however, dual-headed toothbrush group showed significant short-term reductions in plaque accumulation, gingival inflammation, and bleeding, particularly at the 2-week interval. A significant majority of participants (89.2%) rated dual-headed brush as "very easy" to use. Using a dual-headed toothbrush significantly reduces the brushing time (0.54 ± 0.17 vs. 0.99 ± 0.05 min for a conventional single-headed toothbrush), suggesting enhanced time efficiency. CONCLUSION: A dual-headed toothbrush would be more effective, faster, and easier to use than a single-headed brush. It would be a convenient alternative, especially for individuals with time constraints.
The effect of bite planes on deepbite correction with clear aligners.
Kou B, Xu Y, Liu Q … +6 more , Yang Z, Hui Y, Lan S, Ye W, Liu Q, Gu Z
Clin Oral Investig · 2026 May · PMID 42141153 · Full text
OBJECTIVES: Deep overbite correction with clear aligners faces challenges including decreased anterior intrusion efficiency and spontaneous molar intrusion. Bite planes are often incorporated to address these issues, but...
OBJECTIVES: Deep overbite correction with clear aligners faces challenges including decreased anterior intrusion efficiency and spontaneous molar intrusion. Bite planes are often incorporated to address these issues, but their effects remain debated. This study aimed to investigate the impact of bite planes on anterior intrusion efficiency and posterior displacement during a specific deep overbite correction phase using clear aligners. MATERIALS AND METHODS: This retrospective study included 36 adult patients with deep overbite who were treated with the clear aligner (Smartee system) divided into a bite plane group (n = 15) and a control group (n = 21). Pre- (T1) and post-intrusion (T2) digital models were superimposed to measure tooth displacement and subsequently calculate intrusion accuracy of anterior teeth. Comparisons of tooth displacement and intrusion accuracy between the two groups were performed using an independent t-test or a Mann-Whitney U test, intragroup vertical changes of posterior teeth were analyzed by one-way analysis of variance, and Pearson correlation was used to assess the relationship between molar intrusion and treatment duration. RESULTS: No significant difference was found in anterior intrusion accuracy between the bite plane group (18.8% ± 24.7%) and the control group (18.4% ± 21.6%). The bucco-lingual movement of teeth where bite planes were designed was not significantly affected. Premolars in both groups exhibited extrusion ranging from 0.0 to 0.5 mm, with no significant intergroup difference. Molars in the control group exhibited 0.1-0.2 mm of spontaneous intrusion (P<0.01), which showed a positive correlation with treatment duration. The maxillary molar intrusion correlated moderately with the number of aligners (r = 0.49, P<0.0001), while the correlation was weaker in the mandible (r = 0.33, P = 0.0031). In contrast, the bite plane group showed no spontaneous molar intrusion but rather slight extrusion of 0.1-0.2 mm, with no correlation with treatment duration. CONCLUSION: Bite planes in clear aligners do not enhance anterior intrusion efficiency or affect labiolingual movement but effectively prevent spontaneous molar intrusion caused by the "posterior bite-block effect," thereby helping maintain vertical molar position during deep overbite correction. CLINICAL RELEVANCE: The bite planes in clear aligners are less effective in inducing posterior teeth extrusion and the associated increase in vertical facial height compared to those in fixed appliances. However, they do not affect the intrusion and labiolingual movement of anterior teeth, and prevent spontaneous intrusion of molars, making them a recommended design for deepbite correction in both normodivergent and hypodivergent patients.
Cytotoxicity assessment of LuxCreo and Nylon direct-printed photopolymers for orthodontic applications: An in vitro study.
T AJ, S W, D M LR … +3 more , R M, A C, M B V
Clin Oral Investig · 2026 May · PMID 42133117 · Full text
OBJECTIVES: The aim of this in vitro study was to evaluate the cytotoxicity of two direct-printed photopolymers, LuxCreo and Nylon, intended for orthodontic applications. METHODS: LuxCreo (LuxCreo Inc., Chicago, IL) and...
OBJECTIVES: The aim of this in vitro study was to evaluate the cytotoxicity of two direct-printed photopolymers, LuxCreo and Nylon, intended for orthodontic applications. METHODS: LuxCreo (LuxCreo Inc., Chicago, IL) and Nylon (EOS, Munich, Germany) direct-printed materials were compared to conventionally used orthodontic materials including polyethylene terephthalate glycol (PETG) and polymethyl methacrylate (PMMA). Human gingival fibroblasts (hGFB) were cultured in 12-well plates on sterilized material discs for 24-h, 72-h or 7-day intervals (n = 3). Following co-incubation of hGFB with the materials, an MTT assay was conducted to evaluate cell viability, an LDH assay was used to evaluate cell death, and ELISA was used to measure IL-6, IL-8, and IL-1β production. RESULTS: Nylon significantly reduced cell metabolic activity at 24 h, 72 h, and 7 days, while LuxCreo showed a reduction only at 72 h and 7 days, compared to conventional materials. None of the materials induced a significant increase in cell death in hGFB. Elevated levels of IL-6 and IL-8 were observed only in the Nylon group. IL-1β levels were not significantly different between groups. CONCLUSION: Direct-printed materials reduced cell viability. While none of the materials induced cell death, Nylon did increase the pro-inflammatory cytokine response. Future studies should investigate the underlying mechanisms of cytotoxicity and pro-inflammatory responses to improve the safety and biocompatibility of orthodontic materials. CLINICAL RELEVANCE: The elevated pro-inflammatory cytokine response observed with direct-printed photopolymers highlight the need for clinical studies to investigate the mechanisms underlying cytotoxic and inflammatory responses. Future research should also evaluate the effects of long-term intraoral exposure and monitor relevant biomarkers during orthodontic treatment to better assess the safety and biocompatibility of these materials.
Immunotherapies based on macrophage reprogramming in periodontitis and apical periodontitis.
González-Quintanilla D, Castro-Saavedra S, Bordagaray MJ … +5 more , Lucero-Mora J, Vernal R, Paula-Lima A, Fernández A, Hernández M
Clin Oral Investig · 2026 May · PMID 42133106 · Publisher ↗
INTRODUCTION: Periodontitis and apical periodontitis (AP) are characterized by biofilm-driven, immune-mediated bone destruction. Macrophages orchestrate the immune imbalance, where the M1/M2 polarization axis is critical...
INTRODUCTION: Periodontitis and apical periodontitis (AP) are characterized by biofilm-driven, immune-mediated bone destruction. Macrophages orchestrate the immune imbalance, where the M1/M2 polarization axis is critical for tissue homeostasis. AIM: To review preclinical strategies for macrophage reprogramming-based immunotherapies in periodontitis and AP. METHODS: A literature search in Web of Science (last 10 years) identified original in vivo and complementary in vitro studies evaluating interventions targeting macrophage polarization. Eligible studies reported M1 markers (CD80, CD8, and/or iNOS) and M2 markers (CD163, CD206, and/or Arg-1) in relation to inflammatory modulation and regenerative outcomes. RESULTS: Fifteen studies met the criteria. In periodontitis, local therapeutic strategies such as bioactive cytokines (CCL2, IL-37), inhibition of extracellular matrix proteins (FBLN3), functionalized biomaterials (Se-nHA/PC microspheres, Q@MPDA nanoparticles), MSC-derived exosomes, regulatory miRNAs (miR-126), pharmacological agents (glipizide, apabetalone), and adoptive M2 transfer demonstrated M2 polarization. In AP, systemically administered M2-derived extracellular vesicles, pharmacological agents (DMOG, Stattic, azithromycin), and blockade of Gremlin-1 are associated with M2 phenotypes. All reduced alveolar bone loss, osteoclast activity, and pro-inflammatory mediators, while favoring reparative responses. Mechanistically, effects were mediated through MAPKs, PI3K/Akt/HIF-1α, STAT3, and NF-κB pathways. CONCLUSIONS: Current evidence highlights macrophage reprogramming toward an M2 phenotype as a promising adjunctive strategy for periodontitis and AP. Delivered locally or systemically, these interventions dampen M1-driven inflammation and enhance regeneration, though validation in orthotopic models and translational studies remains necessary. CLINICAL RELEVANCE: Immunotherapeutic approaches targeting macrophage polarization could complement conventional biofilm control with emphasis on regenerative periodontics and endodontic procedures, opening new avenues for biologically driven, patient-centered therapies.
Classification of occlusal caries severity using spectrophotometric CIELAB measurements and machine learning algorithms.
Rashid F, Dudley J
Clin Oral Investig · 2026 May · PMID 42133094 · Full text
OBJECTIVES: This study evaluated whether spectrophotometric CIELAB color measurements can support machine-learning (ML) classification of occlusal caries severity based on ICDAS categories. METHODS: Three hundred extract...
OBJECTIVES: This study evaluated whether spectrophotometric CIELAB color measurements can support machine-learning (ML) classification of occlusal caries severity based on ICDAS categories. METHODS: Three hundred extracted human teeth were visually classified using ICDAS (0-4) and served as labels for supervised learning. Five occlusal sites per tooth were measured using a spectrophotometer under standardized conditions. Site-level CIELAB values were transformed into engineered color features and aggregated at the tooth level. Teeth were categorised as sound (ICDAS 0), initial carious lesions (1-2), and moderate carious lesions (3-4). Five ML models: Random Forest (RF), XGBoost, CatBoost, Multilayer Perceptron (MLP), and a Deep Sets architecture were trained. Performance was evaluated using accuracy, balanced accuracy (BA), and macro-F1, with additional binary analyses for early (ICDAS 1-4 vs. 0) and operative lesion detection (ICDAS 3-4 vs. 0-2), based on the included ICDAS range. Learning curve analysis was performed to evaluate the effect of training data size on model performance. RESULTS: Deep Sets achieved the highest multiclass performance (BA = 0.89) followed by the MLP (BA = 0.72). Tree-based models demonstrated lower performance overall. For early lesion detection, all models showed high sensitivity (SE) but reduced specificity (SP). At the operative level, the MLP achieved 100% SE and moderate SP. Learning-curve analysis showed that neural models benefited most from increased training data, whereas tree-based models showed limited improvement. CONCLUSION: Under controlled in-vitro conditions, spectrophotometric CIELAB measurements enabled machine-learning classification of occlusal caries severity. Deep sets achieved the highest overall performance, supporting the potential of color-based approaches as adjunctive tools for caries assessment. CLINICAL RELEVANCE: Spectrophotometric tooth color measurements may support machine learning classification of occlusal caries severity under controlled conditions, using an image-independent approach. Such color-based methods may complement visual assessment by providing a more standardized and reproducible evaluation of enamel changes following further validation.
Evaluating upper airway in orthodontics via 3D UX-Net model on CBCT scans.
Liu Y, Zhan J, Zhang J … +7 more , Hong W, Fan W, Shihabi R, Lan Z, Gu S, Pan L, Hu L
Clin Oral Investig · 2026 May · PMID 42128967 · Publisher ↗
INTRODUCTION AND AIMS: The relationship between orthodontic treatment and upper airway morphology is increasingly recognized. Artificial intelligence (AI) now supports airway analysis, but traditional 3D U-Net models sho...
INTRODUCTION AND AIMS: The relationship between orthodontic treatment and upper airway morphology is increasingly recognized. Artificial intelligence (AI) now supports airway analysis, but traditional 3D U-Net models show limited accuracy, particularly in the laryngopharynx. This study proposes a deep learning model to accurately and efficiently extract 3D upper airway structures from CBCT scans, facilitating improved orthodontic monitoring. METHODS: The 3D UX-Net was employed for airway segmentation. Biased pharyngeal interface information from the network output enabled precise localization of boundary landmarks on the midsagittal plane, enhancing interface delineation. RESULTS: On internal 5-fold cross-validation, 3D UX-Net achieved a mean Dice similarity coefficient (DSC) of 0.953 ± 0.007 for total airway segmentation, outperforming existing methods. External validation across three geographic datasets confirmed strong generalization. After refining the pharyngeal interface via midsagittal landmarks, mean DSC improved to 0.963 ± 0.006. CONCLUSION: The proposed model enables high-precision upper airway segmentation, supporting more efficient and comprehensive clinical image analysis. CLINICAL RELEVANCE: This study addresses the insufficient segmentation accuracy of prior 3D U-Net models, especially in the laryngeal region, offering enhanced reliability for orthodontic airway assessment.
Efficacy of subgingival irrigation with chemical agents as adjuvants to non-surgical periodontal therapy: systematic review and meta-analysis.
da Silveira MI, Maciel CCM, Grant MM … +3 more , Chapple ILC, De Marco AC, Rovai EDS
Clin Oral Investig · 2026 May · PMID 42126682 · Full text
OBJECTIVE: This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. METHODS: Searc...
OBJECTIVE: This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. METHODS: Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). RESULTS: From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. CONCLUSION: Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CLINICAL RELEVANCE: CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.
Transfusion rates in oral and maxillofacial surgery and their influencing factors in the context of patient blood management.
Mönnikes N, Fenske J, Steffen C … +5 more , Wu V, Treskatsch S, Heiland M, Rendenbach C, Pruß A
Clin Oral Investig · 2026 May · PMID 42126656 · Full text
OBJECTIVES: Existing evidence on transfusion requirements in oral and maxillofacial surgery (OMFS) is limited to selected indications. This study aimed to provide an overview of transfusion rates across the full diagnost...
OBJECTIVES: Existing evidence on transfusion requirements in oral and maxillofacial surgery (OMFS) is limited to selected indications. This study aimed to provide an overview of transfusion rates across the full diagnostic spectrum and to identify factors influencing transfusion rates with relevance for patient blood management (PBM). MATERIALS AND METHODS: All operated OMFS patients from a five-year period (n = 13,239) were retrospectively analyzed. Diagnosis-specific transfusion rates were determined, followed by a subgroup analysis of free flap surgeries. Logistic regressions identified factors influencing transfusion rates. ROC analysis in the free flap subgroup determined preoperative hemoglobin cut-off values for increased transfusion risk. Differences in treatment course associated with preoperative anemia were assessed. RESULTS: Overall transfusion rate was 5.1%. Microvascular free flap surgery was the primary driver of transfusion with a rate of 58.8%, independent of underlying pathologies. Non-oncologic indications requiring free flap reconstruction showed high transfusion rates similar to oncologic indications, whereas the same diagnoses without free flaps had rates < 5%. Free flap reconstruction (OR 5.21) and preoperative anemia (OR 6.25) were the strongest factors influencing transfusion rates. ROC analysis identified preoperative hemoglobin of 12.25 g/dl as risk threshold for intraoperative transfusion. Preoperative anemia was associated with a less favorable course regarding intensive care unit treatment, in-hospital mortality and hospital length of stay. CONCLUSIONS: Transfusion rates in OMFS are generally low but increased in reconstructive free flap surgery. CLINICAL RELEVANCE: These findings offer an evidence base for targeted PBM strategies, including early identification and treatment of preoperative anemia, like intravenous iron therapy in free flap patients, and transfusion rate-adapted blood product preparation to improve perioperative management.
Partially demineralized allogeneic cancellous bone plug versus deproteinized bovine bone mineral for guided bone regeneration: a pilot randomized controlled clinical trial.
Rao S, Zhou J, Niu W … +3 more , Dong C, Pan S, Sun W
Clin Oral Investig · 2026 May · PMID 42126621 · Full text
OBJECTIVES: To compare a partially demineralized allogeneic cancellous bone plug (ACBP) with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR), focusing on CBCT-based dimensional outcomes and hi...
OBJECTIVES: To compare a partially demineralized allogeneic cancellous bone plug (ACBP) with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR), focusing on CBCT-based dimensional outcomes and histomorphometric tissue composition at implant placement. MATERIALS AND METHODS: In this prospective randomized controlled clinical trial, 25 adults requiring GBR for two common indications-posterior maxillary sinus floor elevation or mandibular posterior extraction socket preservation-were randomized to ACBP (n = 12) or DBBM (n = 13), with collagen membrane coverage in both groups. Radiographic endpoints were indication-specific and were reported separately for sinus and socket sites. CBCT was obtained at baseline and 6 months to assess augmented height (sinus sites) and ridge dimensions at standardized levels (socket sites). At 6 months (implant placement), a 3-mm trephine core was harvested for H&E staining and histomorphometric quantification of vital bone (VB, %) and residual graft material (RG, %). Between-group comparisons used independent-samples t tests (two-sided P < 0.05). RESULTS: All participants completed the 6-month follow-up. VB did not differ significantly between ACBP and DBBM (38.84 ± 8.37% vs. 32.18 ± 11.04%, P = 0.105), whereas RG was significantly lower with ACBP (11.18 ± 5.48% vs. 19.80 ± 8.23%, P = 0.006). CBCT outcomes were comparable between groups, with no significant differences in sinus height gain (7.82 ± 1.52 mm vs. 8.21 ± 4.30 mm, P = 0.852) or socket-related ridge dimensional changes (all P > 0.05). CONCLUSION: Within a 6-month healing interval, ACBP showed CBCT-based dimensional outcomes comparable to DBBM and a lower residual graft fraction with a similar vital bone fraction at implant placement, suggesting that the observed difference was more related to graft turnover than to greater bone formation. CLINICAL RELEVANCE: At routine implant timing (~ 6 months), use of ACBP was associated with a lower residual graft fraction at re-entry while maintaining short-term CBCT-based dimensional stability.
Ankylosis and external root resorption following intentional replantation using intermittent oxygenation technique: a Bayesian observational study.
Abdellatif D, Iandolo A, Ipci TS … +5 more , De Fontaine S, Mancino S, Cernera M, Spagnuolo G, Mancino D
Clin Oral Investig · 2026 May · PMID 42126472 · Publisher ↗
OBJECTIVE: To evaluate the clinical outcomes, periodontal ligament (PDL) healing, and complication rates associated with Intermittent Oxygenation Technique (IOT), a staged reoxygenation protocol designed to preserve PDL...
OBJECTIVE: To evaluate the clinical outcomes, periodontal ligament (PDL) healing, and complication rates associated with Intermittent Oxygenation Technique (IOT), a staged reoxygenation protocol designed to preserve PDL vitality on the root surface during intentional replantation (IR). MATERIALS AND METHODS: Forty mature permanent teeth from 39 patients underwent intentional replantation using IOT between 2020 and 2024. The protocol introduces intermittent replantation periods during extraoral procedures to restore oxygenation and nutrient diffusion to PDL cells on the root surface. Clinical and radiographic follow-up was performed for at least 12 months (mean: 2.7 years). Primary outcomes included the incidence of ankylosis and replacement resorption. Frequentist binomial statistics and Bayesian Beta-Binomial models were applied to estimate the true complication rate. RESULTS: No cases of ankylosis or replacement resorption were detected (0/40). The Clopper-Pearson 95% CI yielded an upper bound of 9.5%. Bayesian analysis demonstrated substantially lower credible upper bounds: 5.5% (Jeffreys prior), 6.6% (conservative prior), and 6.3% (literature-informed prior). Subgroup analysis (< 15 min vs. ≥ 15 min extraoral time) revealed identical outcomes. CONCLUSION: IOT may significantly reduce the risk of ankylosis and replacement resorption by mitigating PDL hypoxia through staged reoxygenation. Bayesian modelling strongly suggests that the true complication rate lies in the low single digits, substantially below historical values for traditional IR.
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