Clinical Oral Investigations[JOURNAL]
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200 papers
The potential of bioactive compounds in functional foods for caries disease prevention an updated scoping review of clinical studies.
Babalola AE, Adinnu CM, Oyediran T … +7 more , Entonu AI, Lawal MO, Babalola DO, Ukpong BS, Chidera Bob-Ume N, Olaore AK, Ogieuhi IJ
Clin Oral Investig · 2026 Mar · PMID 41882160 · Publisher ↗
BACKGROUND: Oral diseases are among the most prevalent health issues worldwide, with dental caries contributing a substantial burden. The role of bioactive compounds in functional foods has recently gained attention due...
BACKGROUND: Oral diseases are among the most prevalent health issues worldwide, with dental caries contributing a substantial burden. The role of bioactive compounds in functional foods has recently gained attention due to their ability to slow and delay oral diseases by interacting with oral microbiota and pH. This scoping review aims to map and update the existing evidence on the potential of bioactive compounds in functional foods for oral disease prevention. METHODS: This review synthesized literature from peer-reviewed articles published over the past 20 years (2005-September, 2025), sourced from six databases including ScienceDirect, PubMed, Google Scholar, DOAJ (Directory of Open Access Journals), AJOL (African Journals Online), and the Cochrane Library. Data on study information, functional food, bioactive compounds, and the mechanism of dental caries prevention were extracted and analysed. RESULTS: A total of 21 studies and 3,504 participants were included. The main bioactive compounds included polyphenols, prebiotics, propolis, calcium, phosphate, and other dairy phosphopeptides. Naturally derived bioactive extracts, essential oils containing candices, and marine-based foods were also studied. Overall, these bioactive compounds measurably reduced oral microbiota, especially Streptococcus mutans, increased oral pH, supported remineralization, and slowed the progression or delayed the onset of dental caries. However, study duration and methodology differed among the studies. CONCLUSION: Bioactive compounds in functional foods have the potential to prevent or slow dental caries and improve overall oral health. However, further studies are necessary to elucidate their molecular mechanisms, determine their actual scale of impact, and identify other bioactive compounds in regional foods. CLINICAL RELEVANCE: Functional foods could be integrated into population health prevention strategies and used as adjuncts to routine public/clinical caries management.
Periodontal inflammation and tryptophan-kynurenine metabolism in Parkinson's disease.
Yilmaz M, Bakici A, Parlat R … +7 more , Akpinar İN, Karaaslan R, Balci N, Toygar H, Kurgan Ş, Serdar MA, Kantarcı A
Clin Oral Investig · 2026 Mar · PMID 41876924 · Full text
OBJECTIVE: The kynurenine pathway(KP) of tryptophan catabolism is a major regulator of the immune response. Metabolites of this pathway may have protective or degenerative effects on the nervous system. Based on our rece...
OBJECTIVE: The kynurenine pathway(KP) of tryptophan catabolism is a major regulator of the immune response. Metabolites of this pathway may have protective or degenerative effects on the nervous system. Based on our recent studies, we tested the hypothesis that KP metabolites play a role in the pathogenesis of the link between Parkinson’s disease (PAD) and Periodontitis (PD). MATERIALS AND METHODS: Saliva and serum samples were collected from Stage III, Grade B periodontitis patients with PAD (Parkinson+periodontitis group, n = 20) and without PAD (periodontitis group, n = 24), and 24 periodontally and systemically healthy individuals (control group). Salivary and serum concentrations of tryptophan-kynurenine pathway metabolites, including tryptophan, kynurenine, kynurenine/tryptophan ratio, kynurenic acid, 3-hydroxykynurenine, picolinic acid, and quinolinic acid, were quantified using liquid chromatography–mass spectrometry. Periodontal status was assessed by recording plaque index, probing pocket depth, clinical attachment loss, and bleeding on probing according to standard clinical procedures. RESULTS: Clinical parameters were significantly higher in the PD groups than in the control group (p < 0.001). The control group had the lowest BOP (3.54 ± 2.52), followed by the Parkinson+periodontitis (52.00 ± 14.91) and the periodontitis groups (70.46 ± 25.09). Salivary TRP, KYN, KYNA, PA, and QA levels were significantly higher in the Parkinson+periodontitis group than in the control. The salivary KYN/TRP ratio was significantly higher in the Parkinson+periodontitis group than in the other groups (p < 0.05). Serum TRP levels were significantly higher in the periodontitis group compared to the other groups. The serum KYN/TRP ratio was significantly higher in the Parkinson+ periodontitis group than in the control group (p < 0.05). CONCLUSIONS: The data suggest that the metabolic regulation of immune responses via the tryptophan-kynurenine pathway may play a pathogenetic role in the link between Parkinson’s disease and periodontitis. CLINICAL RELEVANCE: Altered tryptophan–kynurenine metabolism in patients with both Parkinson’s disease and periodontitis suggests a shared inflammatory pathway linking the two conditions. Clinical Trials ID: NCT07272564.
Response to the letter to the editor.
Bonilla M, Mesa F
Clin Oral Investig · 2026 Mar · PMID 41876904 · Full text
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Efficacy of topical application of simvastatin gel combined with a collagen sponge carrier in preserving alveolar ridge dimensions: a triple-blind randomized clinical trial.
López-Andrade E, Manzano-Moreno FJ, Taboada V … +3 more , Vallecillo C, Jiménez-Andújar L, Vallecillo-Rivas M
Clin Oral Investig · 2026 Mar · PMID 41876793 · Full text
BACKGROUND: Alveolar ridge atrophy is an inevitable consequence following tooth extraction, leading to substantial vertical and horizontal bone loss and frequently complicating subsequent prosthetic rehabilitation. Simva...
BACKGROUND: Alveolar ridge atrophy is an inevitable consequence following tooth extraction, leading to substantial vertical and horizontal bone loss and frequently complicating subsequent prosthetic rehabilitation. Simvastatin (SIM), known for its osteoinductive and anti-inflammatory properties, has shown promise in promoting local bone regeneration. This study aimed to evaluate the efficacy of topical application of a novel 1.2% SIM gel in preserving alveolar ridge dimensions following the surgical extraction of mandibular third molars, compared with a placebo. METHODS: A randomized, triple-blind clinical trial (RCT) was conducted involving 40 patients (n = 20 per group) requiring mandibular third molar extraction. Patients were randomly assigned to receive either the active 1.2% SIM gel (test group) or a placebo gel (control group). In both groups, the assigned gel was delivered using a collagen sponge as a carrier scaffold placed directly into the extraction socket. Cone Beam Computed Tomography (CBCT) scans were obtained pre-extraction (T0) and 12 weeks postoperatively (T1). The primary outcome was the dimensional change in vertical alveolar bone height (ΔH). Secondary and exploratory outcomes included changes in bone width (ΔW), bone density (Mean Gray Value), postoperative pain, and swelling. RESULTS: The primary outcome analysis included 38 sockets (n = 19 per group). The Test Group (SIM) showed significantly greater vertical bone preservation, with a mean change in height of − 0.30 ± 1.79 mm (indicating preservation/gain), compared to the Control Group’s mean loss of 1.28 ± 1.50 mm (p = 0.006). No statistically significant difference was observed in exploratory bone width preservation (p > 0.05). The SIM gel demonstrated an excellent safety profile, with no significant differences regarding postoperative pain or swelling compared to the placebo. CLINICAL SIGNIFICANCE: The topical application of 1.2% SIM gel significantly improved vertical alveolar bone height preservation at 12 weeks compared to the placebo. This primary finding confirms the clinical benefit of local simvastatin delivery in maintaining the vertical dimension required for successful prosthetic treatment, while exploratory densitometric data also suggested an improvement in coronal bone mineralization. This simple, low-cost pharmacological approach is highly effective in mitigating post-extraction vertical bone loss.
Effect of ultrasonic power settings on intracanal biofilm reduction.
Louzada VG, Oliveira-Silva M, Goulart RS … +2 more , Pitondo-Silva A, Leoni GB
Clin Oral Investig · 2026 Mar · PMID 41870810 · Full text
OBJECTIVE: This study evaluated the effect of different power settings in ultrasonic activation, combined with antimicrobial and non-antimicrobial irrigants, on Enterococcus faecalis biofilm reduction and cell viability....
OBJECTIVE: This study evaluated the effect of different power settings in ultrasonic activation, combined with antimicrobial and non-antimicrobial irrigants, on Enterococcus faecalis biofilm reduction and cell viability. MATERIALS AND METHODS: A total of 150 root canals of human uniradicular teeth were prepared to size #50.05 and inoculated with E. faecalis for 21 days. Specimens were assigned to groups according to ultrasonic activation protocols (activation at lower or intermediate power and no activation) and irrigant (2.5% NaOCl or phosphate-buffered saline) used in ultrasonically activated irrigation. Biofilm reduction was assessed by colony-forming unit (CFU) counts and data were analyzed using two-way ANOVA and Tukey’s post hoc test (p < 0.05). Biofilm structure and bacterial cell viability were qualitatively evaluated by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). RESULTS: Significant differences in CFU counts were observed between irrigants, ultrasonic power settings, and their interaction (p < 0.001). NaOCl 2.5% promoted greater microbial reduction regardless of the activation protocol (p < 0.05). Intermediate power resulted in the lowest CFU counts (p < 0.05), and showed greater qualitative biofilm disruption and reduced cell viability with both irrigants, particularly in the middle and apical thirds. CONCLUSIONS: Intermediate ultrasonic power improves root canal cleaning by enhancing biofilm disruption and reducing bacterial cell viability, even without antimicrobial irrigants. Precise adjustment of ultrasonic power should be regarded as a critical parameter to maximize cleaning and disinfection efficacy. CLINICAL RELEVANCE: Adjusting ultrasonic power to an intermediate level improves biofilm removal and reduces bacterial viability, enhancing root canal cleaning even when non-antimicrobial irrigants are used.
Plasma rich in growth factors in alveolar ridge preservation: randomized, controlled clinical trial.
Anitua E, Murias-Freijo A, Loroño J … +4 more , Loroño M, González-Mosquera A, Anitua L, Alkhraisat MH
Clin Oral Investig · 2026 Mar · PMID 41870787 · Full text
PURPOSE: The objective of this study is to evaluate the efficacy of Plasma rich in growth factors (PRGF) compared to spontaneous healing in alveolar ridge preservation of the aesthetic zone. METHODS: This randomized and...
PURPOSE: The objective of this study is to evaluate the efficacy of Plasma rich in growth factors (PRGF) compared to spontaneous healing in alveolar ridge preservation of the aesthetic zone. METHODS: This randomized and controlled clinical trial included 46 patients requiring simple-tooth extraction in the aesthetic zone and subsequent implant placement. The extraction sockets were treated either with PRGF or allowed to heal spontaneously. Postoperative healing was assessed by pain, Landry's soft tissue healing index, and inflammation index at 3, 7, and 15 days after tooth extraction. Histomorphometric bone regeneration was evaluated in biopsies harvested after 12 weeks of healing. Dimensional alveolar ridge measurements were performed at baseline and 12 weeks. Any postoperative complications and adverse effects were registered. Statistical analysis was performed to assess the differences between the study groups. RESULTS: PRGF significantly enhanced postoperative healing, as evidenced by statistically significant reductions in pain on day 3 (p = 0.036) and improved soft tissue healing on days 3 (p = 0.047), 5 (p = 0.012), and 7 (p = 0.027). No significant differences were observed between groups regarding postoperative inflammation. The new bone formation was significantly improved with PRGF treatment (p = 0.024), with a median of 36.1% (range: 15.8% to 58.9%) in the control group compared to 48.7% (range: 31.9% to 92.3%) in the PRGF group. PRGF contributed to improved dimensional stability of the alveolar ridge at 12 weeks. CONCLUSION: PRGF improved healing following tooth extraction by promoting soft tissue healing and reducing postoperative pain. Additionally, it enhanced bone regeneration and contributed to better preservation of the alveolar ridge.
Determinants and therapeutic outcomes of maxillary sinus mucosal thickening in periodontitis: a retrospective cohort study.
Bian Z, Chen Y, Yang Y … +4 more , Chen X, Lin Q, Wu Y, Tan J
Clin Oral Investig · 2026 Mar · PMID 41870737 · Publisher ↗
AIM: To investigate the clinical effects of periodontal therapy and tooth extraction on patients with periodontitis-associated maxillary sinus mucosal thickening. METHODS: This retrospective study included 120 maxillary...
AIM: To investigate the clinical effects of periodontal therapy and tooth extraction on patients with periodontitis-associated maxillary sinus mucosal thickening. METHODS: This retrospective study included 120 maxillary sinuses from 73 patients with periodontitis-associated mucosal thickening. Of these, 99 received periodontal therapy and 21 underwent tooth extraction. Cone-beam computed tomography was used to evaluate mucosal thickness before and 3 months after treatment. Analyses were performed both in patients with severe alveolar bone loss and after propensity score matching to balance baseline characteristics between treatment groups. Mixed-effects models were performed to identify factors associated with treatment outcomes, accounting for patient-level clustering. RESULTS: Both periodontal therapy and tooth extraction resulted in a significant reduction in periodontitis-associated maxillary sinus mucosal thickness (mean change: 2.77 ± 3.73 mm and 2.83 ± 3.34 mm, respectively; P < 0.05). In subgroup analysis, periodontal therapy significantly reduced mucosal thickness in patients with ≥ 1/3 alveolar bone resorption (Grade II: 2.63 ± 3.67 mm, Grade III: 3.34 ± 3.84 mm, P < 0.05), whereas no significant change was observed in those with < 1/3 bone resorption (Grade I: 0.01 ± 0.97 mm, P > 0.05). No clear superiority was observed between extraction and periodontal therapy after accounting for baseline disease severity. Pre-treatment mucosal thickness, age and root-to-sinus distance were also independently associated with treatment outcomes. CONCLUSIONS: Periodontal therapy and tooth extraction both mitigate periodontitis-associated maxillary sinus mucosal thickening, with different applicability. CLINICAL RELEVANCE: This study provides clinical evidence for managing periodontitis-associated maxillary sinus mucosal thickening: it confirms treatment can reduce thickening, clarifies indications (periodontal therapy for ≥ 1/3 alveolar bone resorption, extraction for unsalvageable teeth), and identifies prognostic factors to guide efficacy prediction and individualized strategies.
Impact of menopause on clinical periodontal outcomes: a systematic review.
Martín FC, Rus MJ, de la Cruz Gándara Alvarez A … +2 more , Simon-Soro A, Cantiga-Silva C
Clin Oral Investig · 2026 Mar · PMID 41870718 · Full text
OBJECTIVES: To investigate whether menopause is associated with adverse clinical periodontal outcomes by systematically comparing postmenopausal and premenopausal women. MATERIALS AND METHODS: A systematic review of obse...
OBJECTIVES: To investigate whether menopause is associated with adverse clinical periodontal outcomes by systematically comparing postmenopausal and premenopausal women. MATERIALS AND METHODS: A systematic review of observational studies was conducted following PRISMA guidelines. Electronic databases were searched up to March 2025 March 2025 for observational studies reporting clinical periodontal parameters in postmenopausal women not undergoing hormone replacement therapy. Risks of bias and certainty of evidence were assessed using ROBINS-I and GRADE frameworks. RESULTS: Nine studies met inclusion criteria. Postmenopausal women showed greater clinical attachment loss, increased probing depths, and more pronounced signs of inflammation. However, the certainty of evidence was rated as moderate to low, mainly due to methodological variability. CONCLUSIONS: While the observed trends suggest that menopause is a clinically relevant factor in periodontal health, the current evidence base is weak. High-quality prospective studies are urgently needed to confirm these findings before informing clinical practice or developing new guidelines. CLINICAL RELEVANCE: Findings contribute to the current understanding of systemic influences on periodontal disease, with relevance to aging, women’s health, and menopause as a physiological stage of life.
Clinical effects of two ozone therapy administration methods following mandibular third molar extraction: a parallel-group randomized clinical trial with exploratory salivary biomarker assessment.
da Costa MG, Dallazen E, Pavelski MD … +4 more , Delamura IF, Sampaio LV, Chaves-Neto AH, Faverani LP
Clin Oral Investig · 2026 Mar · PMID 41870681 · Full text
INTRODUCTION: Some non-drug methods have been used as adjuncts to minimize tissue damage after third molar extractions, including ozone therapy, although there is no consensus on the most efficient protocol. OBJECTIVES:...
INTRODUCTION: Some non-drug methods have been used as adjuncts to minimize tissue damage after third molar extractions, including ozone therapy, although there is no consensus on the most efficient protocol. OBJECTIVES: to compare two ozone therapy administration protocols regarding clinical parameters (edema, pain, maximum mouth opening) and salivary biomarkers of tissue injury and redox state. MATERIALS AND METHODS: This randomized, parallel-group clinical trial with blinded outcome assessment included thirty-five volunteers (45 mandibular third molars; 15 teeth per group). Participants were allocated to OZO-GAS (0.1 mL of subperiosteal ozonized gas), OZO-OIL (600 mEq of topical ozonized oil), or PLACEBO, administered immediately postoperatively and after 2 days. Outcome evaluation was performed by an examiner blinded to group allocation. Clinical outcomes were recorded at 24 h, 48 h, and 7 days, and unstimulated saliva was collected at the same time for spectrophotometric analyses. RESULTS: The OZO-OIL group showed greater efficacy in reducing postoperative pain compared with PLACEBO (p < 0.05; Holm–Sidak). At 48 h postoperatively, OZO-OIL was associated with reduced salivary protein carbonyls and TBARS, alongside increased uric acid levels, compared with the PLACEBO group (p < 0.05). No consistent clinical or biochemical benefits were observed for the OZO-GAS protocol, and salivary related enzymes (AST, ALT, and ALP) suggested a less favorable biochemical profile in this group . CONCLUSIONS: Topical ozonized oil improved postoperative pain following mandibular third molar extraction and was associated with trends toward reduced oxidative damage and enhanced antioxidant defense compared with placebo, while gas administration showed no comparable benefits. The observed biochemical effects should be considered exploratory and correlated with the clinical findings. CLINICAL RELEVANCE: Ozonized oil represents a simple, non-pharmacological adjuvant capable of enhancing postoperative recovery after third molar extraction.
Supragingival dental biofilm microbiomes of tobacco heating system smokers, cigarette smokers and non-smokers.
Božac E, Žučko J, Braut A … +5 more , Špalj S, Peršić Bukmir R, Toplak N, Hladnik M, Vitezić BM
Clin Oral Investig · 2026 Mar · PMID 41870676 · Publisher ↗
OBJECTIVES: The study compared the bacterial composition of supragingival dental biofilm (SDB) among smokers and non-smokers (NS). MATERIALS AND METHODS: This cross-sectional study included 60 subjects allocated into thr...
OBJECTIVES: The study compared the bacterial composition of supragingival dental biofilm (SDB) among smokers and non-smokers (NS). MATERIALS AND METHODS: This cross-sectional study included 60 subjects allocated into three groups: tobacco heating system smokers (THSS), cigarette smokers (CS) and NS. SDB samples were collected, and bacterial DNA was extracted and prepared for next generation sequencing of the 16s rRNA gene hypervariable regions. Bioinformatic pipelines were applied to assess microbial diversity and taxonomic composition. RESULTS: No significant differences were observed in alpha diversity (Observed taxa and Shannon index) or beta diversity (Bray-Curtis index) among groups. In contrast, significant differences in microbiome bacterial composition were identified across multiple taxonomic levels. At the genus level, Alysiella (p = 0.016) and Propionibacterium (p = 0.025) were most abundant in THSS, whereas Actinobaculum (p = 0.004), Avibacterium (p = 0.015) and Haemophilus (p = 0.030) predominated in NS. At the species level: Alysiella filiformis (p = 0.006) and Streptococcus thermophilus (p = 0.025) were most abundant in THSS, Streptococcus lactarius (p = 0.05) in CS, and Prevotella multiformis (p = 0.016) and Lactobacillus salivarius (p = 0.018) in NS group. CONCLUSIONS: Distinct differences in bacterial composition of SDB were observed among THSS, CS and NS. The increased abundance of anaerobic bacteria with cariogenic potential in THSS and CS suggests a more dysbiotic profile and increased pathogenic potential compared to NS. CLINICAL RELEVANCE: Variations in SDB bacterial composition may influence the pathological potential of dental biofilms in smokers and non-smokers.
Do CAD/CAM restorative materials respond differently to coffee thermocycling and simulated toothbrushing?
Sozen Yanik I, Sahin Hazir D, Aktas G … +1 more , Guncu MB
Clin Oral Investig · 2026 Mar · PMID 41870650 · Full text
OBJECTIVES: This laboratory study aimed to investigate the effects of toothbrushing with different toothpaste formulations on the color stability and surface roughness of CAD/CAM restorative materials following coffee-st...
OBJECTIVES: This laboratory study aimed to investigate the effects of toothbrushing with different toothpaste formulations on the color stability and surface roughness of CAD/CAM restorative materials following coffee-staining thermocycling. MATERIALS AND METHODS: A total of 160 specimens were prepared from four restorative materials: IPS e.max CAD, CEREC Tessera, Shofu Block HC, and VITA Enamic (n = 40 each). Following initial measurements, specimens underwent thermocycling in a coffee solution (5000 cycles) to simulate staining. Each group was subsequently divided and brushed with either a whitening toothpaste containing hydrated silica and hydrogen peroxide or a non-whitening toothpaste containing hydrated silica only. A total of 10,000 brushing cycles were performed under standardized conditions. Color stability was assessed using ΔE₀₀ values, and surface roughness was quantified using the Ra parameter at baseline, after thermocycling, and after brushing. Data were analyzed using Kruskal–Wallis and Mann–Whitney U tests with the significance threshold set at p < 0.05. SEM analysis was conducted on one randomly selected specimen per group (x1000). RESULTS: Statistically significant differences in color stability, as assessed by ΔE₀₀ values, were observed among the tested materials (p < 0.001). Resin-based groups, particularly Shofu Block HC, exhibited the greatest reduction in color stability after coffee thermocycling and subsequent brushing (ΔE₀₀ = 1.069, p < 0.001), whereas glass-ceramics (IPS e.max CAD and CEREC Tessera) demonstrated superior color stability (ΔE₀₀ ≤ 0.520). Surface roughness increased significantly in resin-containing materials (VITA Enamic ΔRa = 0.036; Shofu Block HC ΔRa = 0.020) compared with glass-ceramics (p < 0.001). No significant differences were detected between whitening and non-whitening toothpastes for either parameter across all groups (p > 0.05). Ra changes were also concluded by SEM. CONCLUSION: The performance of restorative materials under staining and mechanical aging stressors is material-dependent. Glass-ceramics displayed superior color stability after coffee exposure and greater resistance to brushing-related surface degradation, whereas resin-containing materials were more vulnerable. The choice of toothpaste formulation did not significantly affect color stability or surface characteristics, suggesting that intrinsic material properties play a more critical role in long-term esthetic outcomes. CLINICAL RELEVANCE: Selection of restorative materials plays a decisive role in ensuring the long-term esthetic success of dental restorations. Since intrinsic material properties strongly influence color stability and resistance to surface degradation, clinicians should carefully consider material choice during treatment planning to achieve durable and predictable outcomes.
Sex-specific differences in salivary microbiota composition and their associations with metabolic health in adults with excess body weight: a secondary cross-sectional analysis.
da Costa JP, Fraiz GM, Bonifácio DB … +2 more , Milagro FI, Bressan J
Clin Oral Investig · 2026 Mar · PMID 41870630 · Full text
OBJECTIVES: Growing evidence links the oral microbiome to obesity-related outcomes, yet the influence of sex-related biological differences on salivary microbial profiles remains insufficiently explored. This exploratory...
OBJECTIVES: Growing evidence links the oral microbiome to obesity-related outcomes, yet the influence of sex-related biological differences on salivary microbial profiles remains insufficiently explored. This exploratory study aimed to characterize the composition, abundance, and diversity of the salivary microbiota in Brazilian men and women with excess body weight and to examine its associations with cardiometabolic markers. MATERIALS AND METHODS: This cross-sectional secondary analysis of a randomized controlled trial (REBEC: RBR-9832wsx) included 59 adults with excess body weight. Salivary microbiota was profiled through amplification of the 16 S rRNA V4 region, and bioinformatics analyses were performed using the Microbiome Analyst (v2.0). Associations between microbial taxa and clinical variables were assessed using Spearman’s correlation. RESULTS: Men exhibited greater alpha diversity at the family level by higher Shannon (p = 0.015, rrb = 0.4) and Simpson (p = 0.003, rrb = 0.5) indices. Sex-specific microbial differences were identified: men showed higher levels of genera Tannerella, Lachnoanaerobaculum, and Actinomyces, as well as the putative species-level taxons Tannerella serpentiformis and Lachnoanaerobaculum umeaense, whereas women demonstrated greater abundance of genera Campylobacter, Granulicatella, Moryella, and Scardovia. Among women, Granulicatella genera was positively associated with triglycerides and the TyG index. CONCLUSION: Men and women with excess body weight exhibited distinct salivary microbiota profiles, with differences in both diversity and taxonomic composition. CLINICAL RELEVANCE: Sex-specific differences in salivary microbiota composition may be associated with variations in metabolic markers. These findings are exploratory and hypothesis-generating, providing insight into sex-related patterns in the oral microbiome and may help inform future research exploring personalized approaches to cardiometabolic risk assessment.
Five-year results evaluating the healing of intrabony defects following treatment with A-PRF+ or EMD: a randomized controlled trial.
Csifó-Nagy BK, Czufor B, Sólyom E … +1 more , Dőri F
Clin Oral Investig · 2026 Mar · PMID 41870619 · Full text
OBJECTIVES: The aim of the study was to clinically evaluate the long-term healing of intrabony periodontal defects treated with a new-generation platelet-rich fibrin (A-PRF+) compared with enamel matrix derivative (EMD)....
OBJECTIVES: The aim of the study was to clinically evaluate the long-term healing of intrabony periodontal defects treated with a new-generation platelet-rich fibrin (A-PRF+) compared with enamel matrix derivative (EMD). MATERIALS AND METHODS: Thirty intrabony defects in 18 patients were randomly assigned to treatment with A-PRF+ (test, n = 15) or EMD (control, n = 15). Clinical parameters were assessed at baseline, 6 months, 1 year, and 5 years post-surgery. Clinical attachment level (CAL) was the primary outcome variable. Following full-thickness flap elevation, defect debridement, scaling, and root planning were performed. Defects were filled with A-PRF + or EMD according to group allocation and stabilized with sutures. At the 5-year follow-up, 26 defects in 14 patients were available for evaluation. RESULTS: Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains after 6 months, and the results were maintained 5 years post-operatively. At 5 years no statistically significant differences were found between the two groups as the mean CAL gain was 2.92 ± 1.65 mm in the test group, and 3.84 ± 1.81 mm in the control group, respectively (p < 0.05). CONCLUSION: Within the limitations of this study, A-PRF+ demonstrated clinical outcomes comparable to EMD in the surgical treatment of intrabony periodontal defects, with stable long-term results. CLINICAL RELEVANCE: A-PRF + may represent a reliable autologous alternative for periodontal regeneration, offering favorable and stable clinical outcomes over a five-year period.
Effect of ammonia-free silver fluoride application on the resin-dentin interface subjected to an in situ cariogenic challenge.
Muniz LP, de Aguiar Moreira PH, Soares GLO … +6 more , Cantanhede LG, Wendlinger M, Carvalho TS, Loguercio AD, Cardenas AFM, de Siqueira FSF
Clin Oral Investig · 2026 Mar · PMID 41866591 · Full text
OBJECTIVE: This study aimed to evaluate whether an ammonia-free silver diamine fluoride solution can prevent adhesive interface degradation when subjected to an in situ cariogenic challenge (CC). MATERIALS AND METHODS: F...
OBJECTIVE: This study aimed to evaluate whether an ammonia-free silver diamine fluoride solution can prevent adhesive interface degradation when subjected to an in situ cariogenic challenge (CC). MATERIALS AND METHODS: Fifty-six sound human molars were sectioned to obtain flat mid-coronal dentin surfaces, and half of the specimens received ammonia-free silver diamine fluoride pretreatment. Specimens were then restored using two universal adhesives (Single Bond Universal, SBU; and Zipbond, ZIP) applied with either the etch-and-rinse (ER) or self-etch (SE) strategy. Composite buildups were constructed, sectioned into resin–dentin bonded sticks, and allocated for immediate testing or after an in situ cariogenic challenge. Twenty volunteers wore (14 days) palatal devices containing eight resin–dentin sticks from different groups. CC were induced (20% sucrose solution; 4×/day). Microtensile bond strength (µTBS) was assessed, and failure modes were classified. Adhesive interfaces were analyzed by scanning electron microscopy with energy-dispersive X-ray spectroscopy (EDX-SEM). Data were analyzed using four-way repeated measures ANOVA and Tukey’s post hoc test (α = 0.05). RESULTS: At immediate evaluation, no significant differences were observed between groups, while after the CC, µTBS values significantly decreased in groups without Riva Star Aqua. Ammonia-free silver diamine fluoride solution treatment maintained µTBS, showing higher µTBS compared to untreated groups (p < 0.05). EDX-SEM confirmed silver and calcium deposition within the hybrid layer and dentinal tubules after ammonia-free silver diamine fluoride treatment. CONCLUSION: Pretreatment with ammonia-free silver diamine fluoride solution preserved resin–dentin bond strength under cariogenic conditions. CLINICAL SIGNIFICANCE: ammonia-free silver diamine fluoride solution pretreatment may protect adhesive interfaces in high-caries-risk patients by enhancing hybrid layer stability and reducing biofilm-related degradation.
Shallow vestibular depth as a risk indicator for peri-implantitis: a retrospective analysis of 336 implants.
Ulaştan B, Dağ A, Ortaç H
Clin Oral Investig · 2026 Mar · PMID 41851493 · Full text
OBJECTIVE: This retrospective cross-sectional study aimed to evaluate the relationship between vestibular depth (VD) and peri-implant soft tissue parameters, marginal bone loss (MBL), and peri-implant disease status. MAT...
OBJECTIVE: This retrospective cross-sectional study aimed to evaluate the relationship between vestibular depth (VD) and peri-implant soft tissue parameters, marginal bone loss (MBL), and peri-implant disease status. MATERIALS AND METHODS: A total of 336 implants from 65 patients (27 males, 38 females) who had at least one implant restored prosthetically and whose implants had been in function for at least 1 year were examined at the Department of Periodontology, Faculty of Dentistry, Dicle University. Demographic and clinical data (age, gender, smoking, oral hygiene, implant function duration) were recorded. In the clinical evaluation, VD, keratinized mucosa (KM) width and phenotype, and periodontal/peri-implant parameters (modified plaque index (mPI), modified gingival index (mGI), probing pocket depth (PD), bleeding on probing (BOP), gingival recession, and suppuration) were recorded. Implants were divided into two groups based on VD: shallow VD (≤ 4 mm) and adequate VD (> 4 mm). The primary endpoint was the presence (yes/no) of peri-implantitis at the implant level according to clinical and radiographic criteria, reported as prevalence in the study population. Radiographic bone loss was measured on panoramic radiographs. The VD groups were compared using the Mann–Whitney U and χ² tests; within-patient clustering was accounted for using GEE logistic regression. FINDINGS: A total of 336 implants from 65 patients were evaluated. VD ≤ 4 mm was detected in 26.5% of implants, and > 4 mm in 73.5%. According to clinical diagnosis, 39.9% of implants (n = 134) had peri-implant health, 34.5% (n = 116) had peri-implant mucositis, and 25.6% (n = 86) had peri-implantitis. In the shallow VD group, mPI, mGI, BOP, PD, gingival recession, radiographic bone loss, and suppuration were found to be higher than in the adequate VD group in exploratory bivariate analyses (all p < 0.05). In the multivariate GEE analysis, VD ≤ 4 mm was independently associated with peri-implantitis (OR = 2.405; 95% CI: 1.233–4.690; p = 0.010). Additionally, the odds of peri-implantitis were increased in those with implant duration of 5–10 years (OR = 4.026; p = 0.044), and the maxillary anterior region showed a lower likelihood of peri-implantitis compared to the mandibular posterior region (OR = 0.409; p = 0.026). CONCLUSION: Shallow VD was associated with gingival recession, MBL, and the presence of peri-implantitis, along with higher plaque accumulation and soft tissue inflammation. The findings suggest that adequate VD, as a component of the peri-implant phenotype, may be associated with the maintenance of peri-implant health. In particular, in shallow vestibules with a KM width < 2 mm and a thin mucosal phenotype, approaches such as vestibuloplasty and/or soft tissue augmentation may be considered in selected cases to support plaque control. CLINICAL SIGNIFICANCE: Our findings suggest that evaluating VD as part of the peri-implant phenotype may help identify conditions that make maintaining hygiene difficult in areas with shallow vestibules and facilitate discussion of mucogingival approach options in selected cases.
Proliferative verrucous leukoplakia management requires x-ray surveillance. A retrospective study of 78 cases.
Molnarova N, Liskova V, Malkus T … +5 more , Hauerova P, Andrle P, Hauer L, Topolcan O, Liska J
Clin Oral Investig · 2026 Mar · PMID 41851450 · Full text
BACKGROUND: Proliferative verrucous leukoplakia (PVL) is a very rare lesion of the oral mucosa with frequent development of oral epithelial dysplasia and a very high ratio of malignant transformation (MT). The aim of thi...
BACKGROUND: Proliferative verrucous leukoplakia (PVL) is a very rare lesion of the oral mucosa with frequent development of oral epithelial dysplasia and a very high ratio of malignant transformation (MT). The aim of this study is to correlate radiographic assessment of alveolar bone resorption with the clinical manifestations and course of PVL in order to improve therapy. MATERIALS AND METHODS: The study evaluates the resorptive changes on alveolar ridges in 78 cases of PVL, confirmed by clinical and pathological criteria. All patients were treated at the Oral Medicine Department, Dentistry Clinic, University Hospital Pilsen. Each case was examined for bone defects using imaging methods such as X-ray intraoral scans, orthopantomograms, or cone beam computed tomography (CBCT). The location and extent of the resorption were correlated with the distribution of PVL lesions in the oral cavity and the course of the mucosal disease. Cases with MT underwent whole-body examination using hybrid imaging techniques, including positron emission tomography (PET) combined with either magnetic resonance imaging (MRI) or computed tomography (CT). RESULTS: A correlation between the alveolar resorptive process and the development of PVL lesions was found in 66.7% of PVL cases (52/78). In one-sixth of cases (13/78), progressive bone loss paralleled worsening mucosal status and increased tooth mobility. Radiographic follow-ups delineated areas indicated for antimicrobial and anti-inflammatory therapy to address aggressive local cofactors in PVL. Oral squamous cell carcinoma developed in 37% of cases (29/78). Combined clinical and radiologic surveillance enabled early detection of malignant transformation (MT) in 5 cases (17% of MTs). CONCLUSION: Routine radiologic assessment is an essential component of PVL management. Radiography and CT improve detection of local cofactors, help define the scope of therapy, and may indicate the onset of MT before overt clinical manifestations.
Evaluation of shear bond strength of orthodontic ceramic and metal brackets with zirconia: effects of adhesive systems and storage conditions.
Salama AA, Shehab KA, Naguib AM
Clin Oral Investig · 2026 Mar · PMID 41844922 · Full text
OBJECTIVE: The current study assessed the shear bond strength of two orthodontic bracket materials to zirconia using two bonding approaches and two storage settings. METHODS: Two bonding strategies were selected to bond...
OBJECTIVE: The current study assessed the shear bond strength of two orthodontic bracket materials to zirconia using two bonding approaches and two storage settings. METHODS: Two bonding strategies were selected to bond metal and ceramic brackets to zirconia samples. Before being tested for Shear Bond Strength [SBS], samples were either subjected to 5,000 thermocycles or kept in water for 24 h. Samples were divided into 8 Groups [n = 10] represented as Group 1: Ceramic Brackets + HEMA-Free Bonding System + Water Storage, Group 2: Ceramic Brackets + HEMA-Containing Bonding System + Water Storage, Group 3: Metal Brackets + HEMA-Free Bonding System + Water Storage, Group 4: Metal Brackets + HEMA-Containing Bonding System + Water Storage, Group 5: Ceramic Brackets + HEMA-Free Bonding System + Thermocycling, Group 6: Ceramic Brackets + HEMA-Containing Bonding System + Thermocycling, Group 7: Metal Brackets + HEMA-Free Bonding System + Thermocycling, Group 8: Metal Brackets + HEMA-Containing Bonding System + Thermocycling. Several independent groups were compared using the Kruskal-Wallis test, and two independent groups were assessed using the Mann-Whitney U test. A P-value < 0.05 was deemed significant. RESULTS: Shear bond strength was significantly greater in ceramic than in metal [5.9 ± 2.6 vs. 4.9 ± 2.3, p = .026] and in 2-Hydroxyethyl methacrylate HEMA-containing systems compared to HEMA-free systems [6.1 ± 2.3 vs. 4.8 ± 2.4, p = .034]. Water storage settings also yielded higher bond strength than thermocycling conditions [6.9 ± 1.8 vs. 3.9 ± 2.2, p < .001]. CONCLUSION: The findings indicate that shear bond strength was significantly influenced by bracket material and adhesive system to zirconia. Additionally, storage settings play a crucial part in shear bond strength. CLINICAL RELEVANCE: Developing effective bonding techniques for orthodontic brackets and zirconia ceramic materials remains a major clinical obstacle.
Planimetric quantification of plaque in patients with multibracket appliances using an intraoral scanner - proof-of-concept.
Jung K, Ganss C, Korbmacher-Steiner H … +1 more , Jablonski-Momeni A
Clin Oral Investig · 2026 Mar · PMID 41844885 · Full text
OBJECTIVES: This proof-of-concept study aimed to evaluate whether disclosed dental plaque can be reliably visualized and quantified using an intraoral scanner in patients with multibracket (MB) appliances, despite potent...
OBJECTIVES: This proof-of-concept study aimed to evaluate whether disclosed dental plaque can be reliably visualized and quantified using an intraoral scanner in patients with multibracket (MB) appliances, despite potential imaging artefacts caused by metallic brackets. MATERIALS AND METHODS: Twenty patients (mean age: 17.0 ± 2.1 years) with fixed MB (Mini Sprint® II or SPEED brackets) underwent 3D-intraoral scans before (T1) and after (T2) bracket debonding. Plaque was visualized using a disclosing agent and quantified planimetrically on selected Ramfjord teeth (FDI 16, 21, 24, 36, 41, 44) using standardized image processing. Five image sets per tooth were analysed to compare plaque coverage (P%) under various conditions: with brackets, after debonding, with masked bracket areas and with the masked areas transferred onto surfaces after debonding, and with only the exposed surface considered. Statistical analyses included t-tests and Bland-Altman plots. RESULTS: Highest P% values were found with brackets in situ (49.4 ± 8.9 P%), followed by values obtained after bracket debonding (34.0 ± 7.1 P%). After masking bracket areas, plaque levels approximated those seen after debonding (29.8 ± 7.0 vs. 34.0 ± 7.1 P%; p < .001). No significant difference was observed between bracket types. Reliable plaque quantification was achieved when bracket areas were masked in both scan sets. CONCLUSIONS: Intraoral scans enable valid planimetric plaque quantification in patients with MB, especially when metallic bracket areas are masked during analysis. CLINICAL RELEVANCE: Digital intraoral scans, combined with plaque disclosing agents, offer a reproducible and objective method for assessing plaque levels in orthodontic patients. This approach may support individualized hygiene monitoring and patient education during fixed appliance therapy.
Evaluating the feasibility of intraoral scanning technology for removable partial dentures: ai-assisted measurement analysis and clinical investigation.
Yang X, Wu Y, Qian M … +3 more , Wu R, Xie H, Chen C
Clin Oral Investig · 2026 Mar · PMID 41843229 · Publisher ↗
OBJECTIVES: To evaluate the feasibility of intraoral scanning (IOS) for the digital design and fabrication of removable partial dentures (RPDs) across different Kennedy classes, and to compare IOS-based models with conve...
OBJECTIVES: To evaluate the feasibility of intraoral scanning (IOS) for the digital design and fabrication of removable partial dentures (RPDs) across different Kennedy classes, and to compare IOS-based models with conventional final impressions using reverse engineering and artificial intelligence (AI)-assisted analyses. The null hypothesis was that no statistically significant differences exist in 3D deviations between IOS and conventional impression models among Kennedy classes. A secondary hypothesis was that AI-assisted analysis could serve as a reliable supplement to conventional reverse engineering. MATERIALS AND METHODS: Fifty partially edentulous patients underwent two methods. 3D deviations between corresponding maxillary and mandibular models were quantified using reverse engineering software. Subgroup analyses were performed according to Kennedy classification, patient-related factors, and anatomical regions. A PointNet++-based deep learning model was used exclusively for automated segmentation and alignment. Data normality was assessed using Shapiro-Wilk test. One-way or two-way ANOVA with Tukey’s post hoc test was applied. Clinical follow-up was conducted at 3, 6, and 12 months. RESULTS: Smaller deviations were observed in Kennedy Class III and IV cases, whereas larger deviations occurred in Class I and II cases, particularly in soft tissue regions such as the palate, gingival margins, and retromolar pads. Age and sex showed minimal influence, while higher Body Mass Index (BMI) was associated with increased soft tissue deviation. AI-assisted analysis produced results consistent with conventional reverse engineering. CONCLUSIONS: IOS demonstrates stable performance in Kennedy Class III and IV cases and acceptable outcomes in selected Class I and II cases with appropriate clinical adjustment. CLINICAL RELEVANCE: IOS may be applied for RPD fabrication in carefully selected cases; however, free-end extension RPDs still require cautious case selection and post-insertion adjustment.
Effectiveness of virtual reality-based toothbrushing instruction on oral health outcomes: A randomized controlled trial.
Kwon HJ, Ryu SH, Choi EJ … +3 more , Lee JA, Kim SJ, Cho HJ
Clin Oral Investig · 2026 Mar · PMID 41843223 · Full text
BACKGROUND: Oral diseases, significantly driven by dental plaque, remain a major global health concern. Traditional toothbrushing instruction (TBI) methods are often limited in interactivity and long-term skill retention...
BACKGROUND: Oral diseases, significantly driven by dental plaque, remain a major global health concern. Traditional toothbrushing instruction (TBI) methods are often limited in interactivity and long-term skill retention. Recent digital innovations, particularly virtual reality (VR) offer highly interactive educational experiences. This randomized controlled trial (RCT), therefore, aimed to evaluate the effectiveness of VR-based TBI compared to traditional instruction using plaque-disclosing agents. METHODS: This single-blind, two-arm RCT was conducted at a school of dentistry. Healthy adults aged 20–39 years were recruited and randomly allocated using a computer-generated randomization sequence to either a VR group or control group. The VR group received a structured toothbrushing curriculum delivered through immersive VR (Meta Quest 3), whereas the control group received one-on-one instruction from a dental hygienist using plaque-disclosing agents. The primary outcome was the change in plaque index (PI) from baseline to the two weeks follow-up, and secondary outcomes was oral health knowledge-attitude-behavior (KAB) scores. Participants were blinded to group assignment; however, the investigators who performed the assessments were not. RESULTS: 30 participants were randomized (15 in each group), and all participants were included in the final analysis. The VR group demonstrated a significantly greater mean reduction in PI compared with the control group (0.44 ± 0.48 vs. 0.07 ± 0.26; p = 0.012). Both groups showed improvements in KAB scores. Notably, the VR group achieved significantly greater gain in oral health attitude (39.06 ± 4.80 vs. 38.30 ± 3.66; p = 0.008) and behavior (4.73 ± 1.39 vs. 4.53 ± 1.30; p = 0.004). No harms or unintended events such as dizziness or discomfort was reported. CONCLUSION: Immersive VR toothbrushing education improved plaque control and enhanced oral health attitudes and behaviors compared with traditional instruction. This approach may also address the limitations of conventional education, including reliance on professionals and restrictions of time and place, and holds promise for broader public health applications. Further research should examine long-term effects and scalability. TRIAL REGISTRATION: : KCT0010914 (Clinical Research Information Service [CRIS]); retrospectively registered on August 19, 2025.
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