Clinical Oral Investigations[JOURNAL]
Sun
200 papers
Assessing the diagnostic performance of MediXpar texture analysis for C-shaped canal morphology on panoramic radiographs: a pilot study.
Uzun S, Satir S, Felek T … +1 more , Magat G
Clin Oral Investig · 2026 Apr · PMID 41940904 · Full text
OBJECTIVES: This study evaluated whether panoramic radiographs could help identify C-shaped canal configurations in mandibular first premolars and offer preliminary diagnostic indicators using the MediXpar bioinformatic...
OBJECTIVES: This study evaluated whether panoramic radiographs could help identify C-shaped canal configurations in mandibular first premolars and offer preliminary diagnostic indicators using the MediXpar bioinformatic platform by examining pixel density and grayscale depth, in a way that approaches the diagnostic value of cone-beam computed tomography (CBCT) while minimizing radiation exposure. METHODS: Panoramic radiographs were retrospectively analyzed with the MediXpar system, a pixel-based quantitative image analysis platform that extracts grayscale density and texture-related parameters from digital radiographs. Three quantitative measures—Xpar, Power Xpar, and Pixel Count—were recorded under zoomed and non-zoomed conditions at two-pixel resolutions (1023 × 496 and 1023 × 593). Logistic regression and receiver operating characteristic (ROC) analyses were used to assess the diagnostic performance of each parameter in identifying C-shaped canals C-shaped canals, with statistical significance set at p < 0.05. RESULTS: Teeth with C-shaped canals showed a significantly larger dentin–pulp complex volume (p = 0.001), whereas pulp length did not differ (p = 0.653). Digital zoom produced higher pixel-based values (p ≤ 0.01), reflecting resampling effects rather than added anatomy. Among all metrics, Power Xpar demonstrated the strongest diagnostic performance (AUC = 0.917 in zoomed and 0.950 in non-zoomed images), showing consistent discrimination across resolutions. CONCLUSIONS: Digital magnification alters the appearance of panoramic images but does not improve diagnostic accuracy. Power Xpar performed best at higher native resolution and remained highly discriminative despite on-screen zoom, indicating that its usefulness depends on true image resolution rather than digital enlargement. CLINICAL RELEVANCE: Although zooming enhances visual comfort, it may distort quantitative interpretation. MediXpar-based analysis, especially using Power Xpar—offers a practical and reproducible option when CBCT is unavailable.
Assessment of the effect of photodynamic therapy on the reduction of bacteria in deep dental caries lesions of primary teeth.
Kuderewska S, Korczak Ł, Majewski P … +6 more , Chludzińska D, Sacha P, Kuźmiuk J, Kochańska A, Tryniszewska E, Marczuk-Kolada G
Clin Oral Investig · 2026 Apr · PMID 41920262 · Publisher ↗
OBJECTIVE: The aim of the present study was to evaluate the effect of photodynamic therapy on the reduction of bacteria in deep carious lesions of primary teeth. MATERIALS AND METHODS: Thirty-six children presenting with...
OBJECTIVE: The aim of the present study was to evaluate the effect of photodynamic therapy on the reduction of bacteria in deep carious lesions of primary teeth. MATERIALS AND METHODS: Thirty-six children presenting with deep carious lesions in primary molars were included in this randomized clinical study. After selective caries excavation, dentin samples were collected. Participants were randomly assigned to two groups according to the photosensitizer applied: 0.1% toluidine blue gel (FotoSan Agent® High) or curcumin QroxB2®. In both groups, aPDT was performed using the same diode lamp (FotoSan® 630; 630 nm) to ensure standardized clinical conditions. Dentin samples were collected before and after aPDT. Microbiological analysis was performed using conventional culture methods, and colony-forming units (CFU/ml) were quantified. Strain identification was performed using the VITEK® MS system (bioMérieux SSC, France). RESULTS: A statistically significant reduction in the total number of microorganisms was noted after therapy. A decrease in bacterial counts was also observed on selective media for total Streptococci and Streptococcus mutans. The degree of microbial reduction did not significantly differ depending on the photosensitizer used. CONCLUSIONS: Within the limitations of this study, antimicrobial photodynamic therapy significantly reduced bacterial counts in deep carious lesions of primary teeth and may serve as an adjunctive method in selective caries excavation. CLINICAL SIGNIFICANCE: Photodynamic therapy may be used as an adjunct in selective caries excavation.
Shaping efficiency versus dentin conservation: a micro-CT taper-based analysis.
da Silva EJNL, E Silva TMS, Barbosa AFA … +3 more , Massa GDS, de Lima CO, Versiani MA
Clin Oral Investig · 2026 Apr · PMID 41917289 · Full text
OBJECTIVES: To evaluate the influence of instruments with identical tip diameters but increasing taper on shaping efficiency and dentin preservation in the root canals of mandibular molars using micro-CT. MATERIALS AND M...
OBJECTIVES: To evaluate the influence of instruments with identical tip diameters but increasing taper on shaping efficiency and dentin preservation in the root canals of mandibular molars using micro-CT. MATERIALS AND METHODS: Twelve extracted mandibular molars with Vertucci Type III mesial canals and Type I distal canals were scanned using micro-CT before and after each instrumentation step. Mesial canals were sequentially prepared with 25/0.03, 25/0.05, 25/0.06, and 25/.08v instruments, whereas distal canals were prepared with 40/0.03, 40/0.05, and 40/.06v instruments. Co-registered datasets were used to quantify canal volume, surface area, percentage of unprepared canal surface, dentin removal, and minimum dentin thickness. In addition, dentin thickness values were categorized according to clinically relevant thresholds (< 0.5 mm, 0.5-1.0 mm, and > 1.0 mm). Data were analyzed using generalized linear and mixed-effects models (α = 0.05). RESULTS: In mesial canals, unprepared area decreased significantly with larger tapers; reductions were significant with 25/0.06 (-21.9%) and 25/.08v (-37.9%), but not with 25/0.05. Dentin removal increased markedly and progressively with taper, reaching ~ 350% with 25/.08v compared with 25/0.03 (p < 0.001). In distal canals, taper did not significantly affect the unprepared area; however, dentin removal increased significantly with 40/0.05 and 40/.06v. Directional analyses confirmed a stepwise increase in dentin reduction, following the pattern mesiobuccal > mesiolingual > distal at all levels. Threshold analysis showed that the proportion of dentin thickness measurements within the 0.5-1.0 mm range increased with larger tapers, particularly on the distal aspect of the mesial roots. CONCLUSIONS: Increasing instrument taper improves shaping efficiency in mesial canals but substantially increases dentin removal and shifts dentin thickness toward potentially vulnerable ranges. Conservative taper selection may therefore better balance shaping effectiveness and structural preservation in mandibular molars. CLINICAL RELEVANCE: Larger tapers may improve canal wall contact but can substantially reduce dentin thickness in anatomically vulnerable regions, emphasizing the importance of anatomy-guided taper selection during root canal preparation.
Evaluation of enamel wear after the use of whitening toothpastes.
Neto AJT, Guimarães RP, do Nascimento ABL … +1 more , Teixeira HM
Clin Oral Investig · 2026 Mar · PMID 41915234 · Full text
OBJECTIVES: The aim of this study was to evaluate by optical coherence tomography (OCT), the wear of tooth enamel after using different toothpastes for whitening. MATERIALS AND METHODS: Specimens of bovine teeth, divided...
OBJECTIVES: The aim of this study was to evaluate by optical coherence tomography (OCT), the wear of tooth enamel after using different toothpastes for whitening. MATERIALS AND METHODS: Specimens of bovine teeth, divided into 5 groups (n = 10) according to the toothpaste were made: G1 / Oral-B 3D White; G2 / Colgate Total 12 Whitening Gel; G3 / Colgate Luminous White; G4 / White Closeup Now; G5 (control) / distilled water. The OCT images were taken before brushing cycling, with a system operating in the spectral domain, with a center wavelength of 930 nm. The simulated toothbrushing (5000 cycles) was performed with linear movements, under static axial load of 200 g and speed of 4.5 cycles per second, understanding how to cycle the full movement back-and-forth of the toothbrush. New OCT analysis was then performed, and the images were compared for surface changes. RESULTS: Through qualitative analysis of the images, there was wear on the enamel surface and all groups, but the G5 worn with smaller specimens equivalent to 22.2%. G2 specimens showed the most wear surface with about 90%. CONCLUSION: All evaluated toothpastes showed potential for abrasive wear, but the G2 group showed a higher percentage of worn specimens. CLINICAL RELEVANCE: The use of whitening toothpaste can cause significant enamel wear, which varies according to the formulation. Therefore, the dentist should guide product selection to balance aesthetics and preservation of tooth structure.
Effectiveness of fissure sealants following different silver fluoride application protocols in MIH-affected molars: randomized clinical study.
Cayiroglu N, Ballikaya E, Unverdi GE … +1 more , Cehreli ZC
Clin Oral Investig · 2026 Mar · PMID 41915094 · Full text
OBJECTIVES: To compare the clinical efficacy of glass ionomer sealants (GIS) and resin-based sealants (RBS) applied immediately or one week after silver fluoride (SF) application to permanent molars affected by molar inc...
OBJECTIVES: To compare the clinical efficacy of glass ionomer sealants (GIS) and resin-based sealants (RBS) applied immediately or one week after silver fluoride (SF) application to permanent molars affected by molar incisor hypomineralization (MIH) in children at high risk for caries. METHODS: A total of 216 MIH-affected molars (ICDAS 1–2) from 102 children aged 6–14 years were randomly allocated to six groups: Resin- or glass ionomer–based fissure sealants were placed either one week after the application of silver fluoride or during the same clinical session. In the same-visit protocols, sealants were applied immediately after silver fluoride treatment, either following gentle blot drying with cotton or after immediate rinsing. Hypersensitivity, caries progression, and sealant retention were assessed at 1, 6, and 12 months. Hypersensitivity was evaluated using the Schiff Cold Sensitivity Scale (SCASS). Sealant performance was analyzed using modified USPHS criteria. Statistical analyses included Fisher’s Exact Test and the Friedman test. RESULTS: Full retention was achieved in all resin-based sealant groups, while the lowest retention rate (88.9%) was recorded in the glass ionomer sealant group applied one week after silver fluoride. Caries occurred in 2.8% of teeth and was confined to three groups: glass ionomer sealants placed one week after silver fluoride, resin-based sealants applied immediately following blot drying, and glass ionomer sealants applied immediately after rinsing. All other groups showed complete clinical success. No statistically significant differences were found among groups regarding caries prevention (p = 1.000) or sealant retention (p = 0.062). Hypersensitivity decreased significantly over time in all groups. CONCLUSION: Resin-based and glass ionomer fissure sealants placed either one week after silver fluoride application or immediately following treatment, using rinsing or blot-drying protocols, showed similar outcomes over a 12-month follow-up period in terms of caries prevention and reduction of hypersensitivity. Nonetheless, within the limitations of this study, sealants placed immediately following silver fluoride application demonstrated a greater frequency of discoloration. CLINICAL SIGNIFICANCE: Both glass ionomer and resin-based fissure sealants can be successfully applied either immediately or one week following silver fluoride treatment to provide protection for MIH-affected permanent molars. CLINICAL TRIALS REGISTRATION NUMBER: NCT06641011.
Preventive exercise intervention for trismus in head and neck cancer - a randomized study : Preventive exercise intervention for trismus.
Pauli N, Tuomi L, Lindell E … +2 more , Larsson H, Finizia C
Clin Oral Investig · 2026 Mar · PMID 41915079 · Full text
OBJECTIVES: The aim of the study was to investigate the effect of preventive exercise therapy on radiation-induced trismus in head and neck cancer. MATERIALS AND METHODS: Eighty-nine patients (n = 89) with newly diagnose...
OBJECTIVES: The aim of the study was to investigate the effect of preventive exercise therapy on radiation-induced trismus in head and neck cancer. MATERIALS AND METHODS: Eighty-nine patients (n = 89) with newly diagnosed head and neck cancer were included and randomized to either the preventive exercise intervention group (n = 45) or the control group. (n = 44). The intervention group was instructed to perform jaw opening exercises once daily. RESULTS: No differences were found in mouth opening capacity between the intervention and the control groups in the first year after oncological treatment. At the 6-month follow-up, the prevalence of trismus was 7% and 19% in the intervention and the control groups, respectively, and at the 12-month follow-up, 7% and 3%, respectively; these differences were not statistically significant. CONCLUSION: Preventive exercise was not effective in improving trismus and mouth opening-related outcomes in this randomized study. A surprisingly low prevalence of trismus was seen in both groups in the first year after radiotherapy. CLINICAL RELEVANCE: There is reason to believe that newer radiotherapy regimens have reduced radiation trismus in HNC. Although prophylactic intervention does not appear to influence mouth opening capacity, it is important to carefully monitor mouth opening in patients undergoing radiotherapy for HNC. Early detection of a reduction in MIO can permit early initiation of exercise interventions for trismus.
Cellular senescence in the dental pulp and its implications for endodontics: a scoping review.
da Silva JC, Ramos RF, de Melo MEF … +4 more , da Silva MJA, Neelakantan P, Franco OL, Rezende TMB
Clin Oral Investig · 2026 Mar · PMID 41912747 · Full text
INTRODUCTION: Cellular senescence compromises pulp vitality and may negatively affect vital pulp therapy and regenerative endodontics. Exposure to dental materials may accelerate this process, highlighting the need for s...
INTRODUCTION: Cellular senescence compromises pulp vitality and may negatively affect vital pulp therapy and regenerative endodontics. Exposure to dental materials may accelerate this process, highlighting the need for safer biomaterials and novel therapeutic strategies. OBJECTIVES: To map and analyze the scientific evidence on cellular senescence in dental pulp, focusing on triggers, biological consequences, and implications for endodontic therapies. MATERIALS AND METHODS: This scoping review was conducted following PRISMA-ScR guidelines (OSF registration: https://doi.org/10.17605/OSF.IO/5ARJH ). PubMed, EMBASE, Scopus, Web of Science, SciELO, and Cochrane Library were searched (1999–2026). RESULTS: From 1,391 records, 94 studies met the inclusion criteria. Most were in vitro (78%) and conducted in Asia (77.7%), mainly using human dental pulp stem cells. Senescence was primarily induced by oxidative stress (hydrogen peroxide), replicative exhaustion, and inflammatory stimuli like lipopolysaccharide. The most consistent markers were SA-β-gal activity and increased p16, p21, and p53 expression. Resin-based monomers, particularly TEGDMA, were associated with senescence induction via oxidative stress and DNA damage. Antioxidants and senolytic compounds reduced senescence markers and improved cell viability and proliferation in vitro. CONCLUSIONS: Oxidative stress and inflammation are key drivers of dental pulp senescence, and resin monomers may contribute to this process. Senescence assessment should be incorporated into biomaterial testing, and senotherapeutics represent potential adjuncts to improve regenerative endodontic outcomes. CLINICAL RELEVANCE: Identifying senescence-inducing factors may support safer material selection and biologically guided strategies to preserve pulp vitality and improve long-term outcomes.
The effect of the injectable platelet-rich fibrin on peri-implant soft tissue phenotype: a preliminary, prospective, 12-month follow-up clinical study.
Ayyildiz BG, Eken S, Terzioglu B
Clin Oral Investig · 2026 Mar · PMID 41910803 · Full text
OBJECTIVE: The aim of this study was to assess the effectiveness of submucosal injectable platelet-rich fibrin(i-PRF) application on the peri-implant soft tissue phenotype and pink esthetic outcomes in thin and thick phe...
OBJECTIVE: The aim of this study was to assess the effectiveness of submucosal injectable platelet-rich fibrin(i-PRF) application on the peri-implant soft tissue phenotype and pink esthetic outcomes in thin and thick phenotypes. MATERIALS AND METHODS: The present study comprised 36 implants from 10 patients. Based on the probe visibility method, implants were classified into Group I (thin phenotype) or Group II (thick phenotype). i-PRF applications were performed three times at one-month intervals into the peri-implant keratinized submucosal and mucogingival junction region. Keratinized mucosal width (KMW), mucosal thickness (MT), and marginal soft tissue recession height (REC-H) and width (REC-W) were measured at baseline (T0), 1 (T1), 3(T3), 6 (T6), and 12 months (T12). Modified plaque index (mPI), modified gingival index (mGI), probing depth (PD), and pink esthetic score (PES) were recorded at T0 and T12. Statistical analyses were conducted utilizing Generalized Estimating Equations (GEE) in conjunction with Type III Wald Chi-square tests. RESULTS: Intragroup evaluations revealed that PD increased significantly between T0 and T12 in Group I (p = 0.02). Intra-group and inter-group post hoc analyses demonstrated that Group I exhibited statistically significant alterations in MT at all evaluated time points, with the exception of the interval between T6 and T12 (p < 0.05). In contrast, no statistically significant changes were observed in either MT or KTW in Group II (p > 0.05). Furthermore, significant intergroup differences in MT were identified at T0, T1, and T3 (p < 0.001, p < 0.001, and p = 0.005, respectively). Evaluation of the PES across all implants revealed statistically significant enhancements in the total PES, as well as in the soft-tissue colour and contour subcomponents (p = 0.00, p = 0.04, and p = 0.04, respectively). CONCLUSIONS: Multiple applications of peri-implant i-PRF may alter the mucosal phenotype, particularly in thin phenotype cases, and consequently may lead to changes in the pink aesthetic score. Further research with larger samples is required. CLINICAL RELEVANCE: Multiple i-PRF injections applied to peri-implant sites may modify the particularly thin phenotype and may offer a new approach for clinical applications in limited cases.
3D assessment of root resorption and soft tissue adaptations in surgery-first vs. early orthognathic surgery: a randomized clinical trial.
Saraç Kale H, Çoban G, Demirbaş AE … +1 more , Soylu E
Clin Oral Investig · 2026 Mar · PMID 41910789 · Full text
OBJECTIVE: This study evaluated the effects of two orthognathic surgery-timing approaches on hard and soft tissues in skeletal Class III patients undergoing bimaxillary orthognathic surgery using cone beam computed tomog...
OBJECTIVE: This study evaluated the effects of two orthognathic surgery-timing approaches on hard and soft tissues in skeletal Class III patients undergoing bimaxillary orthognathic surgery using cone beam computed tomography (CBCT) and stereophotogrammetry. METHODS: Patients undergoing non-extraction surgery were randomly assigned to either a surgery-first (SF) group (n = 12; 19.91 ± 2.60 years) or a surgery-early (SE) group (n = 12; 22.50 ± 2.90 years) for a total of 24 patients. Maxillary advancement was 3.64 ± 1.50 mm in the SF group and 3.47 ± 2.77 mm in the SE group, and mandibular setback was 2.25 ± 1.32 mm and 1.20 ± 1.75 mm, respectively. Millimetric (length, dehiscence, and fenestration), volumetric measurements, and soft tissue anthropometric assessments were collected using three-dimensional (3D) records obtained before treatment and after debonding. RESULTS: Following orthognathic surgery, a significant reduction in root length and volume measurements, and a significant increase in dehiscence were observed within the groups. Additionally, incisor teeth exhibited greater root resorption compared to other teeth. However, no significant differences were found between the groups regarding changes in hard or soft tissues. CONCLUSIONS: These findings suggest that changes in root length, alveolar bone, and soft tissues are similar in the SF and SE approaches, indicating that these changes occur independently of the surgical timing in comparable patients. THE TRIAL REGISTRATION NUMBER (TRN): is NCT06873451 (Date of registration: 13.02.2025; retrospectively registered).
Alterations in condylar position and bite force distribution following clear aligner use: a single-arm clinical trial.
Liu Y, Wei M, Yue S … +2 more , Yang F, Xiong H
Clin Oral Investig · 2026 Mar · PMID 41910782 · Publisher ↗
OBJECTIVES: This single-arm clinical trial investigated changes in condylar displacement, total of force (TOF), and force distribution during the initial phase of passive clear-aligner wear. MATERIALS AND METHODS: The ma...
OBJECTIVES: This single-arm clinical trial investigated changes in condylar displacement, total of force (TOF), and force distribution during the initial phase of passive clear-aligner wear. MATERIALS AND METHODS: The mandibular condylar displacement (MCD) instrument was employed to measure sagittal, vertical, and horizontal condylar displacement. Simultaneously, the T-Scan system was used to analyze the total of force (TOF), force distribution and occlusal balance. The study comprised twelve healthy adult participants (nine females and three males; mean age: 25.6 years). These individuals consecutively wore two pairs of passive clear aligners for a duration of ten days each. Assessments were conducted on baseline (Day 0), Day 10, and Day 20. RESULTS: TOF significantly decreased over time (P < 0.05), whereas no notable alterations were observed in other evaluated parameters. In Group CHANGED, TOF markedly decreased on Day 10 and showed partial recovery on Day 20. Statistically significant differences in the anterior/posterior (A/P) bite force ratio between the groups were identified on day 10 and day 20 (P < 0.05). Condylar displacement demonstrated significant increases in both vertical and sagittal dimensions (P < 0.05), predominantly in the distal and downward directions. CONCLUSIONS: Passive clear‑aligner wear transiently decreases TOF and occlusal balance during the initial 20 days. The anterior–posterior force ratio may act as a clinical marker for upcoming shifts in mandibular position. Although the average MCD remained stable, some participants exhibited distal‑downward condylar drift. CLINICAL RELEVANCE: Clear aligners have the potential to alter mandibular position downward and distally while somewhat reducing bite forces.
Pulp transplantation in necrotic mature teeth with periapical radiolucency.
Tatar EÜ, Balkanlioglu E, Kamalak A
Clin Oral Investig · 2026 Mar · PMID 41902965 · Full text
OBJECTIVES: This exploratory randomized clinical trial evaluated the regenerative potential of autologous dental pulp transplantation, with or without concentrated growth factor (CGF), compared with conventional root can...
OBJECTIVES: This exploratory randomized clinical trial evaluated the regenerative potential of autologous dental pulp transplantation, with or without concentrated growth factor (CGF), compared with conventional root canal therapy (RCT). The aim was to assess sensibility recovery and periapical healing in necrotic mature teeth with periapical radiolucency. MATERIALS AND METHODS: Twenty-one patients were randomly allocated into three groups (n = 7): autologous pulp transplantation, pulp transplantation with CGF, and conventional RCT. Donor pulp tissues were obtained from non-carious third molars. Follow-up examinations were performed at 3, 6, and 12 months. Sensibility was assessed using electrical pulp testing, and periapical healing was evaluated by periapical radiographs and cone-beam computed tomography. Statistical analyses included non-parametric tests (Kruskal–Wallis and Wilcoxon) and categorical comparisons (chi-square/Fisher’s exact) (α = 0.05). RESULTS: Positive sensibility response was observed in 71.4% of teeth in the pulp transplantation group and 42.9% in the CGF group, while no sensibility recovery occurred in the RCT group. All groups showed periapical healing, with the greatest lesion reduction in the pulp transplantation group (p < 0.01). No adverse events were reported. CONCLUSIONS: Autologous dental pulp transplantation appears to be a safe and promising approach for necrotic mature teeth, whereas the addition of CGF did not provide additional clinical benefit in this cohort. CLINICAL RELEVANCE: Autologous dental pulp transplantation may represent a viable regenerative alternative to conventional RCT in necrotic mature teeth, with the potential to promote periapical healing and partial sensibility recovery without additional biological adjuncts.
Oral health and oral health-related quality of life in community-dwelling older adults: associations with geriatric syndromes in a retrospective study.
Auerbacher M, Beck MC, Schluessel S … +4 more , Huth KC, Schwendicke F, Pitchika V, Drey M
Clin Oral Investig · 2026 Mar · PMID 41896485 · Full text
OBJECTIVE: This study characterises the oral and general health of community-dwelling older adults and examines the relationship between geriatric syndromes, oral health, and oral health-related quality of life (OHRQoL)....
OBJECTIVE: This study characterises the oral and general health of community-dwelling older adults and examines the relationship between geriatric syndromes, oral health, and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: The study included 138 patients (mean age 81 years, 73% women) from the MUnich SArcopenia Registry (MUSAR) database, divided into three age groups (< 80, 80–85, > 85 years). Oral health was assessed, for example, with decayed, missing, and filled teeth (DMFT), the Periodontal Screening Index (PSI), and the Plaque Index (PI). Geriatric parameters included the Charlson Comorbidity Index (CCI), probable sarcopenia, frailty, and the Mini Nutritional Assessment (MNA). OHRQoL was evaluated using two patient-reported outcome measures (PROMs). Alongside statistical tests comparing age groups, linear regression analyses were performed to examine associations between various parameters. RESULTS: Oral health was generally at a moderate level with a mean DMFT of 19.3 ± 6.4, with hardly any variation across age groups. OHRQoL was significantly influenced, among others, by Activities of Daily Living (ADL) (β = -0.202, 95%CI -0.313 to -0.092) and MNA (β = -0.594, 95%CI -1.054 to -0.133), whereas frailty was strongly associated with dental health measured by DMFT Index (β = 4.118, 95%CI 1.445 to 6.790). CONCLUSIONS: We confirm associations between general and oral health in older individuals. CLINICAL RELEVANCE: Links between oral and general health in community-dwelling older adults highlight the need for interdisciplinary collaboration. Recognising the factors affecting both health and quality of life enables comprehensive care and may be highly beneficial for older patients.
Deep margin elevation in permanent incisors with crown-root fractures: A laboratory study.
Liechti L, Hildebrand H, Zitzmann NU … +6 more , Blatz MB, Weiger R, Krastl G, Connert T, Filippi A, Eggmann F
Clin Oral Investig · 2026 Mar · PMID 41896435 · Publisher ↗
OBJECTIVES: This laboratory study evaluated the effect of deep margin elevation (DME) on the marginal integrity and fracture resistance of anterior teeth with crown-root fractures. MATERIALS AND METHODS: Fifty-two extrac...
OBJECTIVES: This laboratory study evaluated the effect of deep margin elevation (DME) on the marginal integrity and fracture resistance of anterior teeth with crown-root fractures. MATERIALS AND METHODS: Fifty-two extracted permanent human maxillary central incisors were randomly divided into four groups. All teeth received a standardized simulated crown-root fracture, selective enamel etching followed by universal adhesive application, resin-based composite (RBC) build-up (conventional or bulk-fill), root canal treatment, and glass fiber post placement. Crown preparations were performed either entirely in natural tooth structure with subgingival finish lines (DME absent) or partially on the RBC build-up, yielding supragingival finish lines (DME present). Marginal integrity was assessed microscopically at baseline, after initial thermomechanical loading (TML), and after extended TML. Fracture resistance was determined by load-to-fracture testing. Statistical analyses included Kruskal-Wallis, Dunn’s post hoc, and Fisher’s exact tests (α = 0.05). RESULTS: Median marginal continuity remained 100% across all groups. Fracture resistance (1,305-1,595 N) showed no significant differences between groups. Fractures during TML occurred exclusively in groups without DME. CONCLUSIONS: Within the limitations of this in vitro study, DME did not adversely affect marginal integrity or fracture resistance of restored anterior teeth. In contrast to non-DME groups, specimens with DME did not exhibit failures during TML. CLINICAL RELEVANCE: DME restorations can maintain high marginal integrity and load-bearing capacity in anterior teeth with crown-root fractures. These findings provide preliminary evidence supporting DME as a conservative approach for managing anterior crown-root fractures in select cases, with confirmation needed from clinical studies.
Postoperative healing and recurrence in osteonecrosis of the jaw: influence of risk factors and surgical approach.
Mohr J, Pippich K, Cherdron C … +7 more , Ketschau J, Erben P, Kram H, Krautkremer N, Deppe H, Wolff KD, Ritschl LM
Clin Oral Investig · 2026 Mar · PMID 41896363 · Full text
OBJECTIVES: The aim of this study was to evaluate the outcomes of surgical and adjunctive treatments for osteonecrosis of the jaw (ONJ) and to analyze the influence of specific risk factors on postoperative wound healing...
OBJECTIVES: The aim of this study was to evaluate the outcomes of surgical and adjunctive treatments for osteonecrosis of the jaw (ONJ) and to analyze the influence of specific risk factors on postoperative wound healing and recurrence rates. MATERIALS AND METHODS: We retrospectively analyzed surgically treated ARONJ and ORN patients from 2012 to 2017. Demographics, comorbidities, etiology, treatments, and healing outcomes were analyzed using descriptive statistics and multivariate regression analyses. RESULTS: N = 194 patients met inclusion criteria. The overall postoperative healing rate was 78.4%, with wound healing disturbances occurring in 44% of cases. Healing rates were comparable between entities, with 79.4% in ORN and 77.3% in ARONJ patients achieving complete mucosal healing. Neither classical risk factors (smoking, obesity, diabetes) nor treatment regimens predicted wound healing disturbances (WHD). Risk factors for the development of ONJ were not consistently predictive of postoperative complications. CONCLUSIONS: Thorough resection with tension-free closure is central to ARONJ and ORN treatment. Close postoperative monitoring - especially within the first 100 days - is crucial, given the high early recurrence rate. CLINICAL RELEVANCE: The findings underscore the importance of surgical intervention - particularly complete necrotic bone resection with tension-free wound closure - as the cornerstone of effective treatment for osteonecrosis of the jaw, irrespective of its origin (ARONJ or ORN). Traditional risk factors did not predict wound-healing complications. Within the limitations of this retrospective study, common adjunctive measures did not appear to influence healing outcomes. Given the high rate of early recurrence, vigilant postoperative follow-up-especially within the first 100 days-is essential for optimal patient management.
Uncovering jaw-specific radiographic differences in medication related osteonecrosis of the jaws (MRONJ): a case-control study.
Masri D, Chaushu G, Rosenfeld E … +4 more , Muchnik D, Adut S, Avishai G, Ghanaiem O
Clin Oral Investig · 2026 Mar · PMID 41888501 · Full text
OBJECTIVE: To compare the radiographic manifestations of medication-related osteonecrosis of the jaw (MRONJ) between the maxilla and the mandible using a matched case-control design, and to identify jaw-specific imaging...
OBJECTIVE: To compare the radiographic manifestations of medication-related osteonecrosis of the jaw (MRONJ) between the maxilla and the mandible using a matched case-control design, and to identify jaw-specific imaging features that may support early diagnosis. MATERIALS AND METHODS: A retrospective analysis was conducted on 109 MRONJ patients treated between 2013 and 2024 at a tertiary care center. A matched cohort of 45 patients (15 maxillary, 30 mandibular) was created based on age (± 2 years), gender, and underlying condition (osteoporosis vs. malignancy). Demographic, clinical, and radiographic data using cone-beam computed tomography (CBCT) or multidetector computed tomography (MDCT), were extracted and analyzed. Radiographic features evaluated included osteolysis, sclerosis, periosteal bone formation, and sequestration. RESULTS: Demographic and clinical variables were similar between the groups. Radiographically, osteolysis was significantly more common in maxillary MRONJ (93.3% vs. 63%, P = 0.0319), while the mandible showed higher frequencies of periosteal reaction (50% vs. 6.6%, P = 0.0042) and sequestration (80% vs. 33.3%, p = 0.0021). Sclerosis was more common in mandibular cases (90% vs. 73.3%) but did not reach statistical significance (P = 0.1458). No significant differences were observed in MRONJ staging or comorbidities (P > 0.05 respectively). CONCLUSION: Maxillary and mandibular MRONJ demonstrate distinct radiographic patterns, likely reflecting anatomical and vascular differences. The predominance of osteolysis in the maxilla, which often presents with less specific symptoms, may contribute to delayed diagnosis. Recognizing these jaw-specific imaging features can improve diagnostic accuracy and promote earlier intervention, particularly for maxillary MRONJ. CLINICAL RELEVANCE: By uniquely applying a matched case-control design, this study uncovers a jaw-specific radiographic signatures of MRONJ-highlighting the overlooked dominance of osteolysis in the maxilla and the aggressive periosteal and sequestration changes in the mandible-offering a powerful diagnostic lens for earlier, site-specific intervention.
Development of multifunctional dental adhesive with 4-formylphenyl acrylate and nano-silver.
Lin Q, Lin L, Chen H … +3 more , Yang Z, He X, Zhu S
Clin Oral Investig · 2026 Mar · PMID 41886118 · Publisher ↗
OBJECTIVES: This study synthesized 4-formylphenyl acrylate (FA), capable of chemically binding to dentin collagen, and incorporated in-situ-synthesized antibacterial silver nanoparticles (NAg) to develop an experimental...
OBJECTIVES: This study synthesized 4-formylphenyl acrylate (FA), capable of chemically binding to dentin collagen, and incorporated in-situ-synthesized antibacterial silver nanoparticles (NAg) to develop an experimental adhesive. The aim was to evaluate its antibacterial efficacy, bonding performance, and inhibitory effects on MMPs, offering a novel strategy to enhance dentin bonding stability. MATERIALS AND METHODS: Silver nanoparticle dispersion was analyzed via scanning electron microscopy (SEM). Antibacterial activity was tested against Streptococcus mutans biofilm using MTT assay, colony forming units counting, live/dead staining, and SEM. Bonding performance was examined through micro-tensile bond strength tests (immediate and aged), failure mode analysis, and nanoleakage evaluation. Resin-dentin bonding interface was observed via SEM, and collagenase activity in the hybrid layer was quantified using in situ zymography. RESULTS: The FA-Ag adhesive group significantly inhibited the metabolic activity of S. mutans biofilm, reduced colony-forming units, improved micro-tensile bond strength, minimized nanoleakage, demonstrated well-formed bonding interface, and suppressed MMPs activity. CONCLUSIONS: The FA-Ag-modified adhesive exhibits potent antibacterial properties, enhanced bond strength, and suppressed MMPs activity, making it a promising candidate for durable resin-dentin adhesion. CLINICAL RELEVANCE: This FA-NAg adhesive system offers a multifunctional solution to enhance restoration longevity. It concurrently combats bacterial biofilm, strengthens dentin bonding, and inhibits enzymatic degradation, thereby addressing major causes of restoration failure such as secondary caries and interface deterioration.
Postoperative radiotherapy and external carotid artery diameter: is there a link to osseous free flap osteoradionecrosis risk?
Fenske J, Wollenberger E, Nikolaidou E … +4 more , Zips D, Heiland M, Beck M, Rendenbach C
Clin Oral Investig · 2026 Mar · PMID 41886002 · Full text
OBJECTIVES: Postoperative radiotherapy (PORT) is a cornerstone in the multimodal treatment of head and neck malignancies but may lead to osteoradionecrosis (ORN) inside healthy osseous free flaps. This study analyzes the...
OBJECTIVES: Postoperative radiotherapy (PORT) is a cornerstone in the multimodal treatment of head and neck malignancies but may lead to osteoradionecrosis (ORN) inside healthy osseous free flaps. This study analyzes the role of external carotid artery (ECA) narrowing as a potential contributor to flap ORN, as prior evidence in this regard remains unclear. MATERIALS AND METHODS: This retrospective study analyzed 89 patients who received osseous free flaps and PORT between April 2017 and December 2024. ECA diameters were measured on pre- and post-radiotherapy computed tomographies. Applied radiation doses to the ECA and flaps were extracted from treatment plans. A Cox-proportional-hazard model was developed to identify free flap ORN predictors. RESULTS: PORT led to a significant reduction in ECA diameter (-1.06 ± 1.05 mm, p < 0.001). No significant difference in ECA narrowing between patients with and without free flap ORN was found (p = 0.41). Multivariate analysis confirmed nicotine abuse (hazard ratio (HR) 6.66 [1.95;22.78], p = 0.003) as an independent free flap ORN predictor. Conversely, no significant association was found between ECA dose, flap dose, ECA narrowing, or plate exposure and ORN occurrence. CONCLUSIONS: Although PORT results in measurable ECA narrowing, this vascular change does not significantly influence free flap ORN risk. Future prevention strategies should instead prioritize known modifiable risk factors and further. aim to consider osseous free flaps as structures at risk during radiotherapy planning. CLINICAL RELEVANCE: While ECA irradiation leads to arterial narrowing, it was not identified as a predictor for free flap ORN formation.
Salivary microbiota composition and caries status in children with hearing impairment: a cross-sectional comparative study.
Peng B, Feng Q, Wang S … +9 more , Zhao X, Sheng T, Wang S, Liu W, Liu W, Huang W, Meng S, Zeng S, Lin R
Clin Oral Investig · 2026 Mar · PMID 41885972 · Publisher ↗
OBJECTIVES: To characterize the salivary microbiota structure in children with hearing impairment using 16 S rRNA gene sequencing and explore its potential association with caries burden. METHODS: A total of 114 hearing-...
OBJECTIVES: To characterize the salivary microbiota structure in children with hearing impairment using 16 S rRNA gene sequencing and explore its potential association with caries burden. METHODS: A total of 114 hearing-impaired children aged 6–16 years underwent oral clinical examination and completed a questionnaire. From this cohort, 20 children (HI group) and 20 age- and sex-matched healthy children (HS group) were randomly selected for salivary microbiome sequencing. Analyses included alpha and beta diversity, LEfSe, and caries-stratified subgroup comparisons. RESULTS: Hearing-impaired children carried a heavy caries burden (overall prevalence: 93.9%; mean DMFT/dmft: 6.4 ± 3.9). Oral hygiene practices were generally suboptimal, with only 54.5% brushing twice daily and 41.6% using fluoride toothpaste. Beta diversity analysis significantly differed between groups (ANOSIM, R² = 0.057, P < 0.05). The HI group exhibited trends of increased Proteobacteria, Neisseria, and Gemella and decreased Veillonella and Capnocytophaga (all P > 0.05). LEFSe analysis revealed richer signature taxa in controls (e.g., Selenomonas, Tannerella), whereas hearing-impaired children showed limited enriched taxa, especially in the low-caries subgroup, indicating microbiota simplification. CONCLUSIONS: The oral microbiome of hearing-impaired children displays alterations in overall community structure, characterized by reduced diversity of signature microbial taxa and a trend toward ecological simplification. CLINICAL RELEVANCE: These findings identify oral microbial trends associated with hearing impairment, providing potential insights for early caries risk assessment and tailored preventive interventions in this vulnerable population.
Exploring the relationship between insulin resistance, wrist circumference, dental age, and skeletal maturation in growing patients with overweight and obesity: a pilot study.
Grenga C, Guarnieri R, Di Giorgio R … +5 more , Veroi G, Curreli M, Masi D, Lubrano C, Barbato E
Clin Oral Investig · 2026 Mar · PMID 41882437 · Publisher ↗
OBJECTIVES: The global prevalence of childhood obesity has surged in recent years. Children who are overweight or obese frequently exhibit accelerated dental development, skeletal maturation, and earlier onset of puberty...
OBJECTIVES: The global prevalence of childhood obesity has surged in recent years. Children who are overweight or obese frequently exhibit accelerated dental development, skeletal maturation, and earlier onset of puberty. This study explores the relationship between insulin resistance and the advancement of dental and skeletal maturation in growing individuals. Additionally, it evaluates wrist circumference—an easily measurable clinical marker associated with insulin resistance—as a potential independent predictor of dental advancement in orthodontic patients. MATERIALS AND METHODS: Assessed parameters included chronological age (7–14 years), anthropometric measurements (weight, height, body mass index [BMI], waist and wrist circumference, waist-to-height ratio [WHtR]), glucose profile, insulin resistance markers, cervical vertebrae maturation stage (CVMS), and dental age advancement (calculated as dental age minus chronological age). Eighteen patients were stratified into three BMI-based groups: normal-weight subjects, patients who are overweight, and patients who are obese. RESULTS: Statistical analysis showed a strong association between BMI and dental age advancement. Wrist circumference and WHtR were stronger and more reliable predictors of skeletal maturation than BMI. Insulin resistance was significantly correlated with dental age advancement, emphasizing the influence of metabolic health on dental development. Multivariate analysis identified wrist circumference and WHtR as key predictors of dental age advancement. CONCLUSIONS: This pilot study suggests a potential association between BMI, insulin resistance, anthropometric measures, and the advancement of dental and skeletal maturation in children who are overweight or obese. These preliminary findings highlight the possible influence of metabolic health on growth patterns. CLINICAL RELEVANCE: Considering metabolic indicators such as wrist circumference and waist-to-height ratio in growing patients may help orthodontists identify those at risk of accelerated dental development and optimize the timing of individualized treatment.
Smartphone-based patient-driven teledentistry for postoperative monitoring: a pilot study.
Pasztor B, Strauss FJ, Jung RE … +3 more , Balmer M, Joda T, Kraus RD
Clin Oral Investig · 2026 Mar · PMID 41882427 · Publisher ↗
PURPOSE: This pilot study evaluated whether the use of an intraoral camera improves the accuracy of remote postoperative wound-healing assessment after oral surgery compared to a phone consultation alone. The primary out...
PURPOSE: This pilot study evaluated whether the use of an intraoral camera improves the accuracy of remote postoperative wound-healing assessment after oral surgery compared to a phone consultation alone. The primary outcome was the correct identification of cases requiring further intervention such as a medication change or an in-person visit. METHODS: Eleven patients undergoing oral surgery were assessed 4–6 days postoperatively using four remote modalities: phone consultation (PC), patient-generated snapshots (SS), patient-generated video footage (VF) and clinician-guided live video call (LC). For each method, assessments were performed independently by the operating clinician and by a second independent dentist, who had no prior knowledge of the patient, using standardized questionnaires developed for this study. A physical visit (PV) served as the reference standard. Accuracy, rates of non-assessable outcomes and inter-examiner agreement (Cohen’s kappa, or prevalence-adjusted bias-adjusted κ when required) were calculated. Performance across modalities was compared using McNemar tests. Clinicians also rated the perceived usefulness and preference and image quality was assessed for smartphone-based intraoral camera (IOC) modalities. RESULTS: No patient required an intervention at the PV. Remote assessments incorrectly suggested the need for intervention in three instances, all occurring during phone-based or live video call evaluations. Accuracy varied across modalities. Correct identification of cases needing intervention was highest for SS and VF (21/22; 95.5%), followed by PC and LC (19/22; 86.4%). Snapshots showed the lowest overall accuracy across wound-healing parameters, largely due to poor image quality (47% diagnostically sufficient). Live video calls yielded the highest proportion of diagnostically adequate images (72.7%) and were the most preferred modality among clinicians. Across all modalities, assessments by the operating clinician more closely matched PV findings than those made by the independent dentist. CONCLUSIONS: In this pilot study, smartphone-based intraoral camera methods did not outperform simple phone consultations in identifying postoperative cases requiring intervention after oral surgery. This finding likely reflects the limited statistical power rather than a true absence of differences between methods. However, live video calls were preferred by clinicians and provided the most clinically useful images. CLINICAL RELEVANCE: Remote postoperative assessment in oral surgery is feasible but reliability depends largely on image quality and clinician’s familiarity with the patient. Live video-guided assessements may offer practical advantages and represent a promising approach for future teledentistry applications
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