Clinical Oral Investigations[JOURNAL]
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200 papers
Calcium silicate cement with phosphate-based glass for enhanced osteogenic activity and mechanical strength.
Ryu JH, Byun SY, Mangal U … +5 more , Kim JH, Yoo J, Kim KW, Kwon JS, Choi SH
Clin Oral Investig · 2026 Apr · PMID 42018191 · Publisher ↗
OBJECTIVES: To investigate the effects of incorporating a phosphate-based glass (PBG) into Endocem MTA, a calcium silicate cement (CSC) material, on its physicochemical, mechanical, and biological properties. MATERIALS A...
OBJECTIVES: To investigate the effects of incorporating a phosphate-based glass (PBG) into Endocem MTA, a calcium silicate cement (CSC) material, on its physicochemical, mechanical, and biological properties. MATERIALS AND METHODS: Physicochemical and mechanical properties, including setting time, compressive strength, X-ray diffraction (XRD), pH, and calcium and phosphorus ions release, were evaluated. Biological responses were assessed using pre-osteoblastic cells, including cell proliferation, osteogenic gene expression, alkaline phosphatase (ALP) staining, and biomineralization (Alizarin Red S staining) for Endocem MTA with 1 or 3 wt% PBG. RESULTS: Incorporation of 3 wt% PBG into CSC (CSP3) resulted in an approximately 15% longer setting time (p < 0.01) and 51.3% less compressive strength after immersion in deionized water (p < 0.001). Brushite was detected in the CSP3 group due to the reaction between calcium and phosphate ions. All three groups maintained an alkaline environment. The CSP3 had significantly higher phosphate ion release (p < 0.001) but 1 wt% PBG into CSC (CSP1) had better cytocompatibility and enhanced osteogenic differentiation, as evidenced by the upregulation of osteogenic markers, increased ALP activity, and greater calcium deposition compared with the CSC group (p < 0.01). CONCLUSION: Incorporation of 1 wt% PBG into a CSC product enhanced osteogenic activity without significantly compromising its physicochemical and mechanical properties. CLINICAL RELEVANCE: The addition of 1 wt% PBG into Endocem MTA may improve osteogenic potential without compromising handling or mechanical performance, supporting its clinical application in endodontic treatments.
Deep caries management: EFCD-ESE-ORCA S3-level clinical practice guideline.
Schwendicke F, Kosan E, Banerjee A … +9 more , Baysan A, Bjørndal L, Ceballos L, Duncan HF, Herbst S, Neuhaus KW, O'Connell AC, Paris S, Dujic H
Clin Oral Investig · 2026 Apr · PMID 42014635 · Full text
OBJECTIVE: To develop an evidence-based S3-level clinical practice guideline for the management of deep and extremely deep caries in vital permanent teeth. METHODS: An evidence-based medical guideline based on systematic...
OBJECTIVE: To develop an evidence-based S3-level clinical practice guideline for the management of deep and extremely deep caries in vital permanent teeth. METHODS: An evidence-based medical guideline based on systematically searched and appraised evidence as well as a structured consensus (S3-level) was jointly developed by the European Federation of Conservative Dentistry (EFCD), the European Society of Endodontology (ESE), the Organization for Caries Research (ORCA) and the German Society of Conservative Dentistry (DGZ), following the methodological framework of the Association of Scientific Medical Societies in Germany (AWMF) and the GRADE approach. Four working groups formulated key clinical questions regarding (1) caries removal strategies, (2) cavity liners, (3) management of exposed pulps and (4) materials for direct pulp capping and pulpotomy. Systematic reviews were conducted for each question and evidence was synthesized and graded for quality. A structured consensus process was used to formulate recommendations. In order to encourage its wide dissemination, this article is freely accessible on Clinical Oral Investigations https://doi.org/10.1007/s00784-025-06727-1 , International Endodontic Journal https://doi.org/10.1111/iej.70132 and Caries Research https://doi.org/10.1159/000551659 journals’ websites. RESULTS: Evidence supports selective (SE) or stepwise caries removal (SW) over non-selective removal (NSE) to reduce the risk of pulp exposure in deep caries. Routine use of cavity liners after caries removal showed no consistent clinical benefit and is not routinely recommended. For vital pulp therapy following pulp exposure, both direct pulp capping and pulpotomy are effective options in teeth without irreversible pulpitis, while pulpotomy is an acceptable alternative to pulpectomy in cases with signs of irreversible pulpitis. Hydraulic calcium silicate cements demonstrated superior clinical outcomes compared to calcium hydroxide and should be preferred for pulp capping and pulpotomy. The certainty of evidence ranged from very low to moderate across questions and outcomes. CONCLUSIONS: For deep caries, maintaining pulp vitality by using less invasive management strategies is supported by current evidence. Implementation of this guideline requires clinician training, patient-centered decision-making and consideration of economic and practical factors. Further research is needed, particularly for extremely deep caries and towards long-term outcomes.
Performance of posterior 3D printed resin-matrix ceramic crowns fabricated in a fully digital workflow: a two-year prospective clinical study.
Del Piñal Pellón M, Tobar C, Díaz P … +2 more , Pelaez J, Suarez MJ
Clin Oral Investig · 2026 Apr · PMID 42012720 · Full text
OBJECTIVES: To evaluate the survival and success rates, as well as mechanical and biological outcomes of posterior 3D-printed resin-matrix ceramic crowns in a fully digital workflow over a 2-year follow-up. MATERIAL AND...
OBJECTIVES: To evaluate the survival and success rates, as well as mechanical and biological outcomes of posterior 3D-printed resin-matrix ceramic crowns in a fully digital workflow over a 2-year follow-up. MATERIAL AND METHODS: A prospective clinical trial was conducting involving 30 posterior crowns fabricated from a resin-matrix ceramic using DLP 3D-printing technology. Dental preparations were performed and scanned with an intraoral scanner by a single operator. All crowns were cemented using the same dual-curing resin cement. Clinical performance was assessed using California Dental Association (CDA) criteria. Periodontal parameters (plaque index, gingival index and probing depth) were evaluated with a periodontal probe at cementation and at 6-month, 1-year, and 2-year recall appointments on abutment teeth and contralateral or antagonistic uncrowned natural teeth used as controls. Data were analyzed using Wilcoxon signed rank test and Kaplan–Meier survival analysis. RESULTS: The 2-year survival rate was 93%, and the success rate was 87%. Two crowns debonded, and no biological complications were observed. All crowns remained within the satisfactory range after 2 years. A slight yellow shift was detected in 4 crowns, resulting in a significant color change at 2 years (p = 0.046), while all other CDA parameters remained unchanged. The margin remained stable throughout the observation period. Plaque index increased after one year in the abutment and control teeth. CONCLUSIONS: Within the limitations of this study, including the absence of a control group, 3D-printed resin-matrix ceramic crowns may represent a viable alternative for posterior teeth. Long-term studies are required to confirm these results. CLINICAL RELEVANCE: Posterior 3D-printed resin–matrix ceramic crowns within a fully digital workflow demonstrated satisfactory performance after two years, supporting their potential as a viable option for posterior restorations.
Dimensional and colorimetric changes of keratinized tissue following free gingival grafts around teeth: a prospective clinical study.
Maury L, Vilarrasa J, Monje A … +3 more , Valles C, Nart J, Blasi G
Clin Oral Investig · 2026 Apr · PMID 42010156 · Publisher ↗
OBJECTIVES: To assess the three-dimensional and colorimetric changes of keratinized tissue following free gingival grafting to widen the band of keratinized gingiva in sites presenting gingival recession over a one-year...
OBJECTIVES: To assess the three-dimensional and colorimetric changes of keratinized tissue following free gingival grafting to widen the band of keratinized gingiva in sites presenting gingival recession over a one-year follow-up period. MATERIAL & METHODS: 20 subjects with insufficient keratinized tissue width (KTW < 2 mm) underwent FGG procedures. Intraoral scans were obtained at preoperatively, intraoperatively, immediately after surgery, and at 6 weeks and 3, 6, and 12 months. Linear and volumetric changes were assessed through the superimposition of standard tessellation language (STL) files. Gingival color was evaluated using spectrophotometry, and color differences (ΔE values) were calculated. Patient-reported outcomes were recorded to assess perceptions of the procedure using a visual analog scale (VAS 0–10). RESULTS: Graft volume decreased by 39.3% at 6 weeks (p < 0.001), primarily due to vertical shrinkage (28.3%). All dimensional parameters decreased reaching stability at 6 weeks. Greater volumetric loss was significantly associated with wider baseline KTW (95%CI: -43.0 to -2.52, p = 0.027) and a greater clinical attachment level (95%CI: -10.2 to -0.44, p = 0.033). While KTW increased significantly from baseline to immediately after surgery, it decreased by 23.9% at 6 weeks (mean difference = 1.33 ± 1.13 mm, p < 0.001) and remained stable through 12 months. Color differences (ΔE) between the graft and adjacent tissue remained above the perceptibility threshold in nearly all cases throughout follow-up; however, improved color match was associated with greater initial root coverage. Patient-reported outcomes indicated low pain (VAS 3.8 ± 2.3) and high satisfaction (VAS 8.7 ± 1.2) at 12 months. CONCLUSIONS: Keratinized tissue undergoes significant dimensional alterations following FGG; however, color mismatch does not interfere with patient satisfaction (Clinical trials.gov Identifier: NCT05729919). CLINICAL RELEVANCE: Free gingival grafts used to augment keratinized tissue around teeth undergo significant dimensional and colorimetric changes. Anticipating graft shrinkage and potential color differences is essential for optimal graft placement and predictable clinical outcomes.
Antibiotic resistance in odontogenic infections: A systematic review of current evidence and implications for guideline-based therapy.
Schmid AI, Werkmeister R, Al-Nawas B … +1 more , Heider J
Clin Oral Investig · 2026 Apr · PMID 42008044 · Full text
OBJECTIVES: This review aims to summarize and evaluate the current evidence on antibiotic resistance in odontogenic infections, with a special focus on empirical therapy, resistance patterns, and guideline-based recommen...
OBJECTIVES: This review aims to summarize and evaluate the current evidence on antibiotic resistance in odontogenic infections, with a special focus on empirical therapy, resistance patterns, and guideline-based recommendations. The update of the German S3 guideline “Odontogenic Infections” provides the clinical and methodological framework for this review. MATERIALS AND METHODS: A systematic literature search was performed to identify studies published between 2016 and 2025 on antibiotic resistance in odontogenic infections. Both retrospective and prospective studies were included. Special attention was given to resistance rates of commonly used antibiotics and the differentiation of therapy in patients with suspected penicillin allergy. The selected studies were integrated into the German guideline development process to ensure relevance and consistency with current clinical practices. RESULTS: The review confirms increasing resistance rates for Penicillin G/V and aminopenicillins, particularly against Staphylococcus spp. In contrast, the combination of an aminopenicillin with a beta-lactamase inhibitor remains effective in most cases. Clindamycin shows notable resistance and is associated with higher rates of adverse effects. Recent studies suggest that certain cephalosporins, such as cefazolin, may be safe alternatives for patients with non-confirmed penicillin allergies. Clinical strategies such as PEN-FAST scoring and de-labeling are gaining increasing importance in managing suspected allergies. CONCLUSIONS: Empirical antibiotic therapy in odontogenic infections should be based on current resistance data and individualized patient risk profiles. Aminopenicillins with beta-lactamase inhibitors remain the first-line choice; clindamycin should be reserved for selected cases with a justified suspicion of penicillin allergy. CLINICAL RELEVANCE: This review supports evidence-based antibiotic selection and promotes individualized therapy decisions to improve outcomes and minimize the development of antibiotic resistance. The findings have been integrated into the updated German S3 guideline, providing practical recommendations for dental and surgical care.
Caries prevention in permanent teeth - basic recommendations of the German S 3 guideline.
Schlueter N, Hellwig E, Geurtsen W … +1 more , Rupf S
Clin Oral Investig · 2026 Apr · PMID 41999496 · Full text
OBJECTIVES: Caries is still one of the most common diseases in Germany and world-wide, and most adults, children and adolescents are affected during their lifetime. The primary goal of oral disease prevention is therefor...
OBJECTIVES: Caries is still one of the most common diseases in Germany and world-wide, and most adults, children and adolescents are affected during their lifetime. The primary goal of oral disease prevention is therefore maintaining healthy teeth that are either free from decay or sufficiently restored without any secondary caries. MATERIALS AND METHODS: This updated S3-guideline is intended to provide scientifically sound information on basic measures and recommendations for caries prevention in the permanent dentition, based on the current state of knowledge on etiology and pathogenesis of caries. This guideline applies to all persons with permanent dentition, provides information for dentists, educators, teachers, parents and other multipliers. Its core messages can be divided into measures to be taken by the population at home, and measures recommended and carried out by staff members in dental practices. RESULTS: The classic caries prevention pillars (tooth brushing, fluoride use, nutritional advice and regular dental consultations) have been expanded to seven recommendations: (I) Oral hygiene, including interdental cleaning; (II) Risk-adapted recommendations for fluoride use as part of daily oral hygiene, plus use of fluoridated table salt; (III) Reducing sugar consumption. In addition, in dental practices (IV) the participation in risk-adapted and structured prevention programs should be recommended, (V) application of further highly concentrated fluoride preparations such as varnishes, (VI) application of chlorhexidine in case of orthodontic treatment or exposed root surfaces, and (VII) fissure sealing in areas at high risk of caries development should be considered. CONCLUSIONS: These measures can help promote lifelong dental health. CLINICAL RELEVANCE: The recommendations of the guideline should be implemented in individual and professional caries prevention.
Quality assessment of anterior composite restorations: clinical examination versus three digital photographic techniques.
Yazicioglu A, Yildiz Telatar G
Clin Oral Investig · 2026 Apr · PMID 41999411 · Full text
OBJECTIVE: The aim of this study was for the first time to evaluate of intraoral digital photography in assessing buccal surface of anterior composite restorations using a smartphone (iPhone 14 Pro), a smartphone with a...
OBJECTIVE: The aim of this study was for the first time to evaluate of intraoral digital photography in assessing buccal surface of anterior composite restorations using a smartphone (iPhone 14 Pro), a smartphone with a lens (2IN1 Phone Macro Lens), and a digital camera with a macro lens (Canon Rebel XTi), compared to clinical examination, based on World Dental Federation (FDI) criteria. METHODS: A total of 185 anterior composite restorations were evaluated by calibrated restorative dentistry specialists. Restorations were scored according to the FDI criteria as intact, requiring repair, or needing replacement. Clinical examination was considered the gold standard. Photographs were taken under standardized conditions, and inter-observer and inter-method agreement were analyzed using Cohen’s Kappa and intraclass correlation coefficient (ICC). RESULTS: High inter-observer agreement was observed across all methods (Kappa = 0.928–1.0). Good to excellent agreement was found between clinical examination and digital photography methods for FDI final scores (Kappa = 0.775–0.973, p < 0.001). Photographs taken with the lens-equipped smartphone and macro camera showed higher agreement with clinical examination (Kappa = 0.973). CONCLUSION: Digital photography, particularly with a lens-equipped smartphone and macro camera, offers effectiveness comparable to clinical examination in evaluating anterior composite restorations. CLINICAL RELEVANCE: This study demonstrates that intraoral digital photography, particularly with a lens-equipped smartphone and macro camera, achieves diagnostic outcomes closely aligned with clinical examination using FDI criteria. While smartphones alone are practical, lens-assisted imaging enhances accuracy, supporting its use as a cost-effective alternative to professional macro cameras.
Oral microbiome profiling of primary oral candidiasis during infection and post-antifungal therapy.
Azizan N, Al-Maleki AR, Karajacob AS … +7 more , Loke MF, Goh JPE, Kallarakkal TG, Ho GF, Khor HM, Ong HC, Tay ST
Clin Oral Investig · 2026 Apr · PMID 41995913 · Full text
OBJECTIVES: Microbial dysbiosis that facilitates Candida proliferation in the oral cavity is a significant factor associated with oral candidiasis. This study aimed to gain insights into microbial dynamics of primary ora...
OBJECTIVES: Microbial dysbiosis that facilitates Candida proliferation in the oral cavity is a significant factor associated with oral candidiasis. This study aimed to gain insights into microbial dynamics of primary oral candidiasis during infection and following antifungal therapy to enhance our understanding of disease pathogenesis and treatment efficacy. MATERIALS AND METHODS: Oral rinse samples were collected from 16 patients with primary oral candidiasis, seven of whom returned for follow-up after antifungal treatment, and from seven healthy controls. Microbiome profiling was performed using 16S rRNA gene sequencing (V3-V4 region), followed by microbial diversity and taxonomic analyses. RESULTS: Twelve bacterial phyla and 138 genera were identified across all samples. Alpha and beta diversity analyses showed no significant differences in microbial richness or overall community structure across both infection and treatment conditions, suggesting a resilient oral microbiome. Compared to controls, oral microbiome of the patients showed a significantly higher abundance of Firmicutes and Campylobacterota, along with a lower abundance of Bacteroidota. At the genus level, Campylobacter, Staphylococcus, and lactobacilli (Lacticaseibacillus, Ligilactobacillus, and Limosilactobacillus) were present at higher abundances during oral candidiasis, while Neisseria, Prevotella, and Alloprevotella were less abundant. Following two weeks of antifungal therapy, alterations in microbial community composition and diversity were observed relative to the control group, suggesting incomplete microbiota restoration. CONCLUSION: Microbiome analysis revealed dysbiosis with significant taxa changes during primary oral candidiasis. Clinical resolution of oral candidiasis did not correspond well with microbiota restoration, suggesting dysbiosis may persist beyond fungal clearance and contribute to delayed ecological recovery and oral homeostasis. CLINICAL RELEVANCE: This study highlights the microbial shift during primary oral candidiasis and post-antifungal treatment. Despite clinical resolution with antifungal therapy, oral microbiome of patients with primary oral candidiasis continues to exhibit residual shifts in composition, underscoring the needs for microbiota-targeted intervention to prevent recurrence and maintain oral health. While our results provide preliminary insights into microbial dysbiosis associated with primary oral candidiasis and the effects of antifungal therapy, further validation in larger cohorts is warranted.
Bioflex crowns in pediatric dentistry: a scoping review of current evidence and clinical applications.
Yadolahi B, Sadri L, Taghian M
Clin Oral Investig · 2026 Apr · PMID 41995751 · Publisher ↗
BACKGROUND: This scoping review critically evaluates the clinical performance, retention, and aesthetic outcomes of Bioflex crowns in pediatric dentistry, addressing the inherent limitations of conventional stainless ste...
BACKGROUND: This scoping review critically evaluates the clinical performance, retention, and aesthetic outcomes of Bioflex crowns in pediatric dentistry, addressing the inherent limitations of conventional stainless steel crowns (SSCs) and zirconia crowns. Conducted in accordance with PRISMA guidelines, the review synthesizes current evidence to determine the clinical viability of Bioflex crowns as an alternative option for full-coverage restorations in primary dentition. METHODS: A total of six studies published between 2015 and 2025 were included following a comprehensive electronic search of PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The PICO framework guided the selection process: the population (P) consisted of children aged 3–8 years with primary teeth requiring restorations due to early childhood caries (ECC), pulpectomy, or aesthetic considerations; the intervention (I) was the use of Bioflex crowns; the comparators (C) were SSCs, zirconia, and strip crowns; and the outcomes (O) comprised clinical performance, retention, gingival health, and parental/child satisfaction. Sample sizes ranged from 1 to 75 participants or teeth, with follow-up durations of 1–12 months. Data were extracted into Microsoft Excel, and clinical assessments were performed using standardized indices such as the United States Public Health Service (USPHS) criteria, Likert scale, and Silness–Löe plaque and gingival indices. RESULTS: The included studies reported favorable clinical outcomes for Bioflex crowns, demonstrating a 100% success rate following pulpectomy procedures and satisfactory retention and aesthetic results compared to control groups. The hybrid composition of Bioflex crowns contributed to improved adaptability and enhanced visual appeal, particularly in posterior molars. Nevertheless, zirconia crowns exhibited superior plaque control and gingival health scores (0.48 vs. 0.64 for SSCs at 12 months). No systemic or mechanical complications, such as hypersensitivity or crown fracture, were observed; however, occasional marginal adaptation discrepancies were documented. Substantial heterogeneity across crown designs, follow-up intervals, and evaluation criteria limited the ability to conduct direct quantitative comparisons. No quantitative comparative conclusions can be drawn due to heterogeneity and the preliminary nature of the evidence. CONCLUSION: This scoping review of six studies (2023–2025) suggests Bioflex crowns are a promising emerging option in pediatric dentistry, offering favorable aesthetics and adaptability in early reports. However, evidence is preliminary, limited by short follow-up (≤ 12 months), small samples, and mostly non-RCT designs, insufficient to establish equivalence or superiority over traditional crowns. Long-term RCTs are needed.
Instrumental assessment of the association between sleep and awake bruxism in a general dental practice.
Schmitter M, Del Hougne M, Karman C … +2 more , Kuwert G, Hopfener K
Clin Oral Investig · 2026 Apr · PMID 41989492 · Publisher ↗
OBJECTIVES: Assessment of the association between sleep bruxism (SB) and awake bruxism (AB) in a general dental practice. METHODS: Thirty patients (aged 20-78 years, mean age 44.3 years, SD 13.3 years) with regular denta...
OBJECTIVES: Assessment of the association between sleep bruxism (SB) and awake bruxism (AB) in a general dental practice. METHODS: Thirty patients (aged 20-78 years, mean age 44.3 years, SD 13.3 years) with regular dental recall appointments at a general dental practice were included.The exclusion criteria were as follows: refusal to participate; trauma; pregnancy/lactation; medication; age below 18 years; edentulism; orthodontic treatment; and patients with untreated dental problems (e.g. caries).SB was assessed by means of self-report and outpatient polygraphy (SOMNOtouch™RESP, Fa. Somnomedics, Randersacker, Germany) over the course of one night. AB in the same patients was assessed using self-report and the 'Bruxapp' self-observation app (Ecological Momentary Assessment, EMA). This assessment was carried out in the same week in which the patients used the polygraphic device. The following parameters were assessed clinically: the presence of temporomandibular disorders, diagnosed in accordance to the Diagnostic Criteria for Temporomandibular Disorders; tooth wear; and tongue/cheek impressions. The null hypothesis was that no significant correlation exists between the frequency of AB and the duration of SB events, as assessed via EMA, anamnesis and polygraphy. Statistical analysis was carried out using the McNemar's change test, the chi-square test, the Mann-Whitney U test and Pearson's correlation (IBM SPSS Statistics version 30.0.0). RESULTS: The duration of all SB events was significantly correlated with teeth clenching, based on the percentage of EMA (p = 0.05, correlation coefficient r = 0.35). The null hypothesis was therefore rejected. Based on the overall duration of SB events, a significant difference was observed for subjects with and without TMD (p=0.03). No significant association was found between the duration of SB events and tooth wear or tongue and cheek impressions. CONCLUSION: Awake clenching was significantly correlated with the overall duration of SB events. These findings suggest that an association may exist between SB and AB. CLINICAL RELEVANCE: In subjects presenting SB, AB should also be assessed, and vice versa, as SB and AB appear to be correlated.
Recognition of giant cell arteritis and calcified carotid artery atheromas in dental practice: systematic review and meta-analysis.
Momen M, Nassrallah WB, Berkache M … +2 more , Jabbour S, Hieawy A
Clin Oral Investig · 2026 Apr · PMID 41984118 · Publisher ↗
OBJECTIVE: Giant cell arteritis (GCA) is a granulomatous vasculitis affecting medium- and large-sized arteries, most commonly the temporal arteries. Delayed recognition can lead to severe complications, including irrever...
OBJECTIVE: Giant cell arteritis (GCA) is a granulomatous vasculitis affecting medium- and large-sized arteries, most commonly the temporal arteries. Delayed recognition can lead to severe complications, including irreversible vision loss and stroke. Dentists routinely obtain panoramic radiographs for dental assessment, where calcified carotid artery atheromas (CCAA) may appear as incidental findings in the cervical region. This study systematically evaluated the incidence of suspected CCAA detected on panoramic radiographs obtained for dental indications and considered the clinical relevance of these findings for dental practitioners. METHODS: A systematic search of MEDLINE, PubMed, and Embase databases was conducted to identify studies reporting calcified carotid artery atheromas detected on panoramic radiographs. Study selection followed PRISMA guidelines. Observational studies reporting CCAA on panoramic radiographs were included. Data extraction was performed independently, and pooled incidence estimates were calculated using a random-effects meta-analysis. RESULTS: Thirty-four cross-sectional studies met the inclusion criteria. The pooled incidence of suspected CCAA detected on panoramic radiographs was approximately 7% (95% CI 5-9%). Substantial heterogeneity was observed among studies. These findings indicate that incidental radiographic detection of cervical calcifications occurs in a measurable proportion of dental patients undergoing panoramic imaging. CONCLUSIONS: Although panoramic radiography is not a screening modality for carotid artery disease, dentists should recognize potential calcified carotid atheromas when interpreting images obtained for dental purposes. Identification of suspicious calcifications and appropriate referral for medical evaluation may support early assessment of patients with possible vascular risk factors. CLINICAL RELEVANCE: Routine dental examinations and panoramic radiography may allow early risk identification, underscoring the importance of interdisciplinary collaboration.
Evaluation of orthodontically induced inflammatory root resorption (OIIRR) in adolescent patients with class II malocclusion undergoing treatment with rigid and hybrid fixed functional appliances: a randomized clinical trial.
Taneja S, Batra P, Talwar A … +2 more , Singla A, Srivastava M
Clin Oral Investig · 2026 Apr · PMID 41981169 · Publisher ↗
OBJECTIVE: To compare volumetric and linear root resorption in mandibular anterior teeth and maxillary first molars following treatment with rigid (Mandibular Protraction Appliance IV, MPA IV) and hybrid (Forsus Fatigue...
OBJECTIVE: To compare volumetric and linear root resorption in mandibular anterior teeth and maxillary first molars following treatment with rigid (Mandibular Protraction Appliance IV, MPA IV) and hybrid (Forsus Fatigue Resistant Device, Forsus FRD) fixed functional appliances, utilizing cone beam computed tomography (CBCT). METHODS: This prospective clinical trial included 32 patients with Skeletal Class II malocclusion (mean age, 15.71±2.62 years), randomized and allocated into two groups: Group 1 (n=16) treated with an MPA IV appliance, and Group 2 (n=16) treated with a Forsus FRD hybrid appliance. CBCT scans were acquired before treatment (T0) and after mandibular advancement with fixed functional appliance (T1). Volumetric measurements were calculated from the cementoenamel junction (CEJ) to the apex for mandibular anterior teeth and from the furcation area to the apex for maxillary first molars. Statistical analysis was performed using paired and unpaired t-tests with significance set at p<0.05. RESULTS: Both appliances produced statistically significant volumetric and linear root resorption in all evaluated teeth (p<0.05). MPA IV group showed a mean volume reduction of 22.15 ± 8.0 mm³ in mandibular canines compared with 14.15 ± 4.23 mm³ in the Forsus group (p=0.001). Similarly, maxillary palatal root showed significantly more root resorption in MPA IV group (18.7 ± 8.52 mm³) as compared to Forsus FRD group (8.92 ± 4.3 mm³). A similar resorption pattern was also observed in the mandibular anterior region, with greater root resorption (both volumetric and linear) in MPA IV group compared with Forsus FRD group. CONCLUSIONS: Both rigid (MPA IV) and hybrid (Forsus FRD) fixed functional mandibular advancement appliances cause statistically significant root resorption. However, the MPA IV appliance demonstrated greater volumetric root resorption in maxillary first molar palatal roots and mandibular canines.
Comparison of injectable platelet-rich fibrin, titanium platelet-rich fibrin, and 0.8% hyaluronic acid applications versus periodontal dressing alone in wound healing after gingivectomy and gingivoplasty operations: randomized controlled clinical study.
Saraç Atagün Ö, Çardakci Bahar Ş, Ceylan Şen S … +4 more , Ustaoğlu G, Özcan E, Güzel ZC, Inceöz M
Clin Oral Investig · 2026 Apr · PMID 41979746 · Full text
OBJECTIVES: The primary objective of this study was to evaluate the effects of injectable platelet-rich fibrin (I-PRF), titanium-prepared platelet-rich fibrin (T-PRF), and 0.8% hyaluronic acid (HA) gel compared with a na...
OBJECTIVES: The primary objective of this study was to evaluate the effects of injectable platelet-rich fibrin (I-PRF), titanium-prepared platelet-rich fibrin (T-PRF), and 0.8% hyaluronic acid (HA) gel compared with a naturally healing control group on gingival wound healing and epithelialization following gingivectomy and gingivoplasty in plaque-induced gingival enlargement. Secondary objectives were to assess clinical periodontal parameters and patient-reported outcomes during a 28-day follow-up period. MATERIALS AND METHODS: The study included four groups: a control group and three test groups treated with I-PRF, T-PRF, and 0.8% HA gel. All patients underwent gingivectomy and gingivoplasty after the first step of periodontal therapy. Pain and burning were recorded using VAS during the first postoperative week, and analgesic consumption and bleeding were also recorded. Oral health–related quality of life was assessed using OHIP-14. Wound healing was evaluated using Mira-2 Tone staining with digital image analysis, the Landry, Turnbull, and Howley (LTH) wound-healing index, and the H₂O₂ foaming test at days 7, 14, 21, and 28, while clinical periodontal parameters were reassessed at day 28. RESULTS: A total of 60 systemically healthy patients were included in the study: I-PRF (n = 15), T-PRF (n = 15), 0.8% HA (n = 15), and control (n = 15). Significant intergroup differences were observed in several clinical and wound-healing parameters. At day 28, the HA group showed significantly lower gingival inflammation and bleeding compared with the I-PRF, T-PRF, and control groups (p < 0.05). All intervention groups demonstrated improved wound healing compared with the control group. On day 7, the control group exhibited a significantly larger non-epithelialized area (169,440 ± 23,583) than the HA group (122,262 ± 18,363), representing a mean reduction difference of 47,178. LTH wound-healing scores were significantly higher in the intervention groups than in the control group across all time points (all p ≤ 0.005). Pain, burning, and oral health–related quality of life improved significantly over time in all groups (p < 0.001), with the HA and I-PRF groups reporting lower discomfort scores. CONCLUSIONS: I-PRF, T-PRF, and HA enhanced epithelial wound healing and patient comfort compared with control, with HA providing superior reductions in gingival inflammation and bleeding. However, due to the subjective nature of some measures and the lack of histological/molecular analyses, further long-term studies are necessary to confirm these clinical outcomes and understand the underlying biological mechanisms. CLINICAL RELEVANCE: Adjunctive use of HA, I-PRF, and T-PRF may improve soft-tissue healing and patient comfort after gingivectomy. HA may be particularly practical in routine clinical settings because it does not require blood collection or centrifugation. Therefore, the choice of adjunctive treatment may depend on clinical logistics and cost considerations.
Effect of diode laser biostimulation on implant stability, post-surgical inflammation, and bone healing in immediate implant in the maxillary premolars. A randomized double-blind trial.
Kassem BA, Osman SM, El-Mahallawy Y
Clin Oral Investig · 2026 Apr · PMID 41979685 · Full text
INTRODUCTION: The stimulatory effects of laser Biostimulation on immediate implant clinical wound healing and radiographic bone quality analysis is with insufficient evidence. AIM: To evaluate the effect of low-level dio...
INTRODUCTION: The stimulatory effects of laser Biostimulation on immediate implant clinical wound healing and radiographic bone quality analysis is with insufficient evidence. AIM: To evaluate the effect of low-level diode laser as a biostimulatory bolster for immediate implants in maxillary premolars. MATERIALS AND METHODS: The study was conducted as a double-blinded randomized clinical trial on 20 patients with unrestorable maxillary premolars with a Type I socket. Patients were divided into two groups, where those who received immediate implant with laser biostimulation were assigned to the study group, while a sham laser application was used in the control group. Implant stability was appraised using radiofrequency analysis. Radiographic evaluation was conducted using an immediate post-operative and after 4-months tomographic scans. RESULTS: Implant stability analysis showed a significant difference in the reported secondary stability values in the irradiated group. The healing index quantitative assessment of wound healing, reported significantly higher scores compared to the control group at all follow-up points. Radiographic bone density and labial plate thickness showed statistically insignificant differences. CONCLUSION: The overall success rate, secondary implant stability, and radiographic performance were comparable to those of the control group. These findings suggest that the biostimulatory effects of the laser are limited in the long term, offering no significant additional benefits over conventional methods.
Correction to: The association of self-reported awake bruxism and sleep bruxism with temporomandibular pain and dysfunction in adult patients with temporomandibular disorders.
Chattrattrai T, Aarab G, Su N … +3 more , Blanken TF, Mitrirattanakul S, Lobbezoo F
Clin Oral Investig · 2026 Apr · PMID 41979678 · Publisher ↗
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A two-year randomized clinical trial of bulk-fill and ion-releasing composites with universal adhesives in class V carious lesions.
Ismail HS, Soliman HAN, Ali AI … +2 more , Raghip AG, Albelasy EH
Clin Oral Investig · 2026 Apr · PMID 41964796 · Full text
OBJECTIVES: To evaluate the two-year clinical performance of Class V restorations in carious cervical lesions placed with bulk-fill resin composite or ion-releasing composite, combined with either fluoride-free or fluori...
OBJECTIVES: To evaluate the two-year clinical performance of Class V restorations in carious cervical lesions placed with bulk-fill resin composite or ion-releasing composite, combined with either fluoride-free or fluoride-releasing universal adhesives. MATERIALS AND METHODS: In this double-blind, randomized clinical trial, 140 Class V restorations were placed using four restorative systems: bulk-fill composite with fluoride-free adhesive, bulk-fill composite with fluoride-releasing adhesive, ion-releasing composite with fluoride-free adhesive, and ion-releasing composite with fluoride-releasing adhesive. Restorations were placed under rubber-dam isolation using selective enamel etching. Clinical evaluations were performed at baseline, 6 months, one year, and two years using periodontal indices and FDI criteria. Data were analyzed using Kruskal–Wallis, Friedman, Mann–Whitney U, and Wilcoxon signed-rank tests (α = 0.05). RESULTS: Recall rates were 96.4% at 6 months, 89.3% at 1 year, and 83.5% at 2 years. Periodontal parameters showed no significant differences among groups. No significant differences were observed between restorative systems for any FDI functional, biological, or esthetic criteria at any evaluation point. All restorations remained clinically acceptable, with no loss of retention, fractures, or secondary caries throughout the two-year follow-up. Marginal adaptation scores remained stable and comparable among all groups. CONCLUSIONS: All four restorative systems demonstrated comparable and favorable clinical performance over two years. The use of fluoride-releasing adhesives or ion-releasing composites did not confer additional clinical benefits under the conditions of this trial. CLINICAL RELEVANCE: Both the tested bulk-fill resin composite and ion-releasing composite deliver predictable short-term performance in Class V restorations, without additional benefit from fluoride-releasing components.
Impact of smoking on gremlin-1, syndecan-4, and IL-1β responses to non-surgical periodontal therapy in stage 3 periodontitis: a comparative study with periodontally healthy controls.
Bayrakdar YE, Aydın T, Laloğlu E
Clin Oral Investig · 2026 Apr · PMID 41964715 · Full text
OBJECTIVES: This study aimed to compare the periodontal status of periodontally healthy individuals with those of smokers and non-smokers with stage 3 periodontitis before and after treatment, as well as to investigate t...
OBJECTIVES: This study aimed to compare the periodontal status of periodontally healthy individuals with those of smokers and non-smokers with stage 3 periodontitis before and after treatment, as well as to investigate the levels of Gremlin-1, Syndecan-4, and IL-1β in GCF samples. Another objective of the study was to evaluate the relationship between these biomarkers and periodontitis and to assess the effects of smoking on their levels. MATERIALS AND METHODS: A total of 45 volunteers, 15 smokers (Group SP) and 15 non-smokers (Group NP) diagnosed with stage 3 periodontitis between the ages of 18 and 60, and 15 healthy individuals (Group H) were included in the study. RESULTS: All clinical parameters of the SP and NP groups were found to be significantly higher than those of the H group before NSPT (p<0.001), and a significant reduction was observed in all clinical parameters after phase I treatment (p<0.001). Following NSPT, significant improvement was observed in all periodontal parameters in both periodontitis groups (p<0.001). Gremlin-1 levels in the SP and NP groups were statistically significantly lower after treatment compared to pre-treatment levels (p<0.05). While there was no statistically significant difference in IL-1β levels before and after treatment in the SP group (p>0.05), a statistically significant reduction was observed in the NP group after treatment (p<0.05). Similarly, no statistically significant difference was found in Syndecan-4 levels before and after treatment in the SP group (p>0.05), whereas the post-treatment measurements of the NP group were statistically significantly lower (p<0.05). CONCLUSIONS: After NSPT, Gremlin-1 levels in GCF decreased in both groups, whereas significant reductions in Syndecan-4 and IL-1β levels were observed only in non-smokers. These findings suggest that the regulatory effect of smoking on biomarkers may negatively influence the periodontal treatment response. CLINICAL RELEVANCE: Smoking is a major risk factor for periodontitis and may impair healing following nonsurgical periodontal therapy. While similar clinical improvements were observed, reductions in IL-1β and Syndecan-4 occurred only in non-smokers, whereas Gremlin-1 decreased in both groups. These findings suggest that smoking may influence molecular healing responses, and biomarker monitoring may support personalized periodontal management.
Color improvement and stability of orthodontic clear aligners following different cleaning protocols.
Aşık A, Lena Sezici Y, Yetkiner E … +2 more , Aykut Yetkiner A, Ersin N
Clin Oral Investig · 2026 Apr · PMID 41957259 · Full text
OBJECTIVES: To evaluate the color improvement and stability of clear aligners after applying different hydrogen peroxide-containing and hydrogen peroxide-free cleaning protocols under simulated in-vitro conditions. MATER...
OBJECTIVES: To evaluate the color improvement and stability of clear aligners after applying different hydrogen peroxide-containing and hydrogen peroxide-free cleaning protocols under simulated in-vitro conditions. MATERIALS AND METHODS: Clear aligners (Invisalign, Align Technology, San Jose, CA, USA) were immersed in coffee for 7 days (n = 24). They were then subjected to cleaning with four different chemical solutions: hydrogen peroxide-free – Group 1: Invisalign Cleaning Crystals (Align Technology, San Jose, CA, USA) and Group 2: Aktident gel (Rego X-ray GmbH, Augsburg, Germany); hydrogen peroxide-containing – Group 3: Corega Proguard (Stafford-Miller Limited, Waterford, Ireland) and Group 4: Steradent Blancheur Pro (Reckitt Benckiser Healthcare Limited, Hull, UK). Specimens were exposed to the different solutions according to manufacturer’s instructions, followed by a second 7-day discoloration cycle. Color (ΔE*, L*, a*, b*) were assessed at baseline, after a 7-day coffee exposure, after cleaning, and after the second discoloration using a spectrophotometer (Vita Easyshade Compact Advance, VITA Zahnfabrik, Bad Säckingen, Germany). Surface alterations were qualitatively analyzed using a scanning electron microscope (SEM). RESULTS: After the initial discoloration, ΔE values significantly increased in all groups and decreased following cleaning (p < 0.01), indicating partial color recovery. However, a subsequent restaining cycle caused a renewed increase in ΔE (p < 0.05). Although no significant intergroup differences were detected (p > 0.05), a significant intragroup difference between the first and second discoloration cycles was found in the peroxide-containing groups (Corega Proguard and Steradent Blancheur Pro) (p < 0.05). A negative correlation between pH and ΔE₂ was observed in the peroxide-free group (r = − 0.64, p < 0.05). CONCLUSION: Although both hydrogen peroxide-containing and peroxide-free cleaning agents effectively reduce discoloration, variations in their pH and chemical composition influenced their efficacy. The differences in surface alterations among the cleaning agents highlight the need for a comprehensive assessment before recommending specific products to patients for aligner maintenance. CLINICAL RELEVANCE: Clinicians should consider the chemical composition and pH of cleaning agents when advising patients on aligner maintenance to avoid unwanted surface or color alterations.
Oral status and dental treatment needs in patients with Epidermolysis Bullosa - a cross-sectional study.
Véliz S, Diz-Dios P, Besa-Witto C … +1 more , Krämer S
Clin Oral Investig · 2026 Apr · PMID 41957243 · Full text
OBJECTIVE: To determine the oral health status and dental treatment needs in a cohort of children and adults with different types of Epidermolysis Bullosa (EB). MATERIALS AND METHODS: A cross-sectional study was designed...
OBJECTIVE: To determine the oral health status and dental treatment needs in a cohort of children and adults with different types of Epidermolysis Bullosa (EB). MATERIALS AND METHODS: A cross-sectional study was designed. 101 participants with EB (EB Simplex n = 26, Junctional EB = 6, Dominant Dystrophic EB (DDEB) = 20, Recessive Dystrophic EB (RDEB) = 47, Kindler EB = 2) were assessed including simplified debris index (DI-S), Basic Periodontal Examination (BPE), Decay/Missing/Filled Teeth index (DMFT/deft index) and Orthodontic index of complexity, outcome and need (ICON). Treatment needs were classified into preventive, periodontics, restorative, endodontics, orthodontics, prosthodontics, oral surgery, oral pathology, oral radiology, speech therapy and others. Descriptive and statistical analyses were performed. RESULTS: The sample showed a Debris Index of 2.04 ± 0.8, with higher levels in participants with recessive dystrophic EB (2.34 ± 0.7). 15.1% of the total sample (n = 15) showed a BPE value of 3 or 4. DMFT was 11.2 ± 0.1, while 30.1% (n = 28/93) showed an ICON value of 43 or higher. Treatment needs were high, with a median of 3 referrals per patient, with the highest needs in restorative dentistry (n=55, 54.5%), prosthodontics (n=52, 51.5%), and speech/oral function therapy (n=43, 42.6%). By EB type, junctional EB (3.67±0.52) and recessive dystrophic EB (3.34±1.03) showed the highest need for referrals. CONCLUSION: Oral health status among people living with EB differed across major types. Patients with recessive dystrophic EB were associated with poorer oral hygiene, a higher caries experience and more missing teeth, whereas those with junctional EB were associated with a higher number of restored teeth. On the opposite, those with simplex EB and dominant dystrophic EB were associated with more favourable oral health indicator. The greatest referral needs were for restorative dentistry, prosthodontics and speech therapy, with higher referral needs observed among EB subtypes with high risk of oral disease (recessive dystrophic EB, junctional EB and Kindler EB). Older age was associated with periodontics and prosthodontics referral needs, while male participants were associated with a higher need for speech therapy. CLINICAL RELEVANCE: This research seems to indicate that patients with recessive dystrophic EB and junctional EB are at high risk of oral disease, requiring referrals to at least 3 different dental specialities. In addition to paediatric dentists, special care dentists and orthodontists, dental teams caring for patients with EB should include specialists in restorative dentistry and prosthodontics, with access to consultants in speech and language therapy, endodontics and periodontics.
Hydrophilicity, wettability, and elemental analysis of zirconia implant ceramic after surface conditioning methods as a function of storage time.
Luterbach DP, Souza LFB, Eyüboğlu TF … +1 more , Özcan M
Clin Oral Investig · 2026 Apr · PMID 41940972 · Publisher ↗
OBJECTIVES: This study evaluated how distinct surface-modification protocols and storage time affect the wettability, surface free energy (SFE), and elemental composition of zirconia. MATERIALS AND METHODS: Zirconia spec...
OBJECTIVES: This study evaluated how distinct surface-modification protocols and storage time affect the wettability, surface free energy (SFE), and elemental composition of zirconia. MATERIALS AND METHODS: Zirconia specimens were subjected to six surface conditioning methods: Control (CT), alumina airborne-particle abrasion (110 μm) (AL), tribochemical silica coating (30 μm) (SI), chemical etching (ET), alumina+etching (AL-ET), and laser treatment (LS). Measurements were taken at baseline and after 1, 3, 6, and 12 months. Wettability was evaluated with water and diiodomethane contact angles to calculate work of adhesion (WoA) and surface free energy (SFE) via the Owens-Wendt-Rabel-Kaelble method. Elemental composition was assessed by energy-dispersive X-ray spectroscopy. Data analysis involved one-way ANOVA with Tukey`s post-hoc tests for treatment comparison and two-way ANOVA for storage-time effects. RESULTS: Surface conditioning significantly affected contact angle, WoA, and SFE (p < 0.05), compared to storage. SI had the lowest water contact angles, highest WoA, and highest SFE, with a strong polar component. AL improved wettability and SFE, but less than SI. While ET showed the least hydrophilic properties at baseline but improved over time, LS was intermediate and stable. CT became more hydrophilic after 6–12 months and SI remained best. EDS confirmed these trends, with persistent silica, low aluminum after alumina treatment, and treatment-dependent elemental changes. The CT and LS spectra resembled those of the substrate. CONCLUSIONS: Both the surface-modification strategy and storage time affected zirconia wettability, with surface modification playing a greater role. While tribochemical silica coating created a durable, hydrophilic surface, Al2O3 was less effective. Etching needed time to remove residues and laser treatment offered intermediate stability. CLINICAL RELEVANCE: Tribochemical silica coating provided the best zirconia implant surface by maintaining a durable, hydrophilic, high surface-free energy state that may promote early protein interaction and predictable osseointegration.
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