The aim of this study was to describe the clinical microscopic features of localized juvenile spongiotic gingival hyperplasia (LJSGH) using an operating microscope (OM), a non-invasive technique rarely applied to oral mu...The aim of this study was to describe the clinical microscopic features of localized juvenile spongiotic gingival hyperplasia (LJSGH) using an operating microscope (OM), a non-invasive technique rarely applied to oral mucosal lesions. An 18-year-old female presented with asymptomatic gingival redness and bleeding affecting the buccal gingiva of previously orthodontically treated maxillary canines. Conventional clinical examination revealed gingival recession, erythema, and edema. OM evaluation enabled detailed visualization of gingival surface irregularities, superficial vascular spots, exudation, and friable tissue that bled upon touch and probing. An incisional biopsy was performed. Histopathological analysis showed acanthosis, spongiosis, exocytosis, congested capillaries at the epithelium-connective tissue interface, and a dense inflammatory infiltrate in the lamina propria, confirming the diagnosis of LJSGH. In conclusion, OM allowed the identification of vascularity, exudation, surface irregularity, and tissue friability, features not apparent in conventional clinical examination. These findings suggest that OM is a valuable adjunct for evaluating and documenting gingival lesions.
OBJECTIVE: To develop and validate a multimodal dual-step support vector machine model (SVM-DualNet) for the preoperative three-class classification of salivary gland lesions (SGLs) to support clinical decision-making. M...OBJECTIVE: To develop and validate a multimodal dual-step support vector machine model (SVM-DualNet) for the preoperative three-class classification of salivary gland lesions (SGLs) to support clinical decision-making. METHODS: We retrospectively collected clinical, conventional ultrasound (CUS), shear wave elastography (SWE), and radiomics features from 284 patients with SGLs. For malignancy discrimination and pleomorphic adenoma identification, linear SVM models based on different modality combinations were constructed and compared. The best-performing binary models were sequentially combined to form SVM-DualNet. SHapley Additive exPlanations (SHAP) were applied for global and case-level interpretation and incorporated into diagnostic assistance. Clinical utility was evaluated by comparing the junior radiologist's diagnostic performance before and after SHAP assistance and by comparison with the senior radiologist. RESULTS: In the test cohort, SVM-DualNet achieved a balanced accuracy of 0.76 and a macro F1 score of 0.82 for the three-class classification. The binary models discriminated malignancy and pleomorphic adenoma with AUCs of 0.90 (95% CI: 0.82-0.97) and 0.85 (95% CI: 0.76-0.94), respectively. SHAP-assisted review improved the junior radiologist's balanced accuracy from 0.55 to 0.70 and macro F1 from 0.57 to 0.75, approaching the senior radiologist's performance. CONCLUSIONS: The model provides reliable preoperative classification of SGLs and can assist clinicians in decision-making.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the most effective minimally invasive intra-articular procedure for reducing pain and improving maximum mouth opening (MMO) in individuals diagnosed w...OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the most effective minimally invasive intra-articular procedure for reducing pain and improving maximum mouth opening (MMO) in individuals diagnosed with painful articular TMD, specifically TMJ osteoarthritis and/or internal derangement. MATERIALS AND METHODS: Only randomized clinical trials (RCTs) assessing the efficacy of minimally invasive procedures, such as arthrocentesis and intra-articular injection (IAI), were included. The meta-analysis included seven studies with a 6-month follow-up, while 23 studies with different follow-up periods were evaluated qualitatively. RESULTS: The meta-analysis showed that IAI with tenoxicam was the most effective procedure for pain reduction, with the highest [7.44 mean difference (MD); 6.28-8.60 confidence interval (CI)], followed by opioids (5.93; 5.03-6.83), the combination of hyaluronic acid (HA) with platelet-rich plasma (PRP) (5.10; 4.52-5.68), and PRP alone (4.99; 3.13-6.85). For improvement in MMO, tenoxicam had the highest MD (+11.50 mm; 15.47-7.53), followed by PRP (+10.46 mm; 14.89-6.02) and the HA-PRP combination (+10.10 mm; 11.89-8.31). CONCLUSIONS: Tenoxicam showed promising results for pain reduction and improvement in MMO, although the evidence remains limited, followed by opioids and the combination of HA and PRP with arthrocentesis. Further high-quality studies are needed to confirm their clinical applicability.
PURPOSE: This study aimed to investigate the real-world efficacy of combining Pembrolizumab with Nimotuzumab in patients with Recurrent/Unresectable/Metastatic HNSCC and to analyze the impact of p16 expression on treatme...PURPOSE: This study aimed to investigate the real-world efficacy of combining Pembrolizumab with Nimotuzumab in patients with Recurrent/Unresectable/Metastatic HNSCC and to analyze the impact of p16 expression on treatment outcomes. METHODS: The study included 86 patients: 41 received Pembrolizumab monotherapy, and 45 received Pembrolizumab plus Nimotuzumab. Patients were divided into four groups based on treatment and p16 status, analyzing OS, PFS, and ORR. RESULTS: With a median follow-up of 30.2 months, the combination therapy showed a significantly higher 6-month ORR, longer 1-year PFS and OS compared to monotherapy. Additionally, the combination therapy group notably improved 6-month ORR, 1-year PFS rate, and 1-year OS rate in p16-negative patients when compared to monotherapy. However, there was no significant improvement in ORR, PFS, or OS in p16-positive patients. Adverse events occurred in 61 patients (70.93%), with incidences of 68.29% in the monotherapy and 73.33% in the combination group, showing no statistically significant difference (p > 0.05). CONCLUSION: The combination of Pembrolizumab and Nimotuzumab demonstrates a notable enhancement in ORR and OS, maintaining a dependable safety profile. Differential p16 expression in HNSCC patients may influence the efficacy of immune-combined targeted therapy, highlighting the importance of considering p16 in the formulation of therapeutic strategies.
OBJECTIVES: This study aimed to develop and preliminarily validate a multimodal deep learning model based on two-dimensional maxillofacial imaging for screening temporomandibular joint (TMJ) degenerative joint disease (D...OBJECTIVES: This study aimed to develop and preliminarily validate a multimodal deep learning model based on two-dimensional maxillofacial imaging for screening temporomandibular joint (TMJ) degenerative joint disease (DJD). METHODS: A total of 1000 TMJs from 500 orthodontic patients were retrospectively analyzed. TMJ DJD diagnoses based on cone-beam computed tomography served as the reference standard, with substantial interrater agreement. A fine-tuned YOLOv8 model was used to localize condyles on panoramic radiographs. EfficientNetV2 networks extracted features from panoramic radiographs and lateral cephalograms, which were fused with patient age and sex for final classification. RESULTS: The YOLOv8 model achieved an mAP50 of 0.995 for condylar localization. The multimodal model demonstrated strong screening performance, achieving an AUC of 0.898, with notable sensitivity and specificity on the test set. Grad-CAM analyses indicated attention to clinically relevant structures, and panoramic radiographs and lateral cephalograms provided complementary diagnostic information. Integrating both 2D modalities improved performance compared with panoramic radiographs alone. CONCLUSIONS: This multimodal deep learning model enables effective, low-radiation, and cost-efficient screening for TMJ DJD using widely available 2D radiographs. Combining panoramic and lateral cephalometric imaging represents a promising approach for enhancing clinical screening accuracy. Larger multicenter studies are warranted for further validation.
AIMS: To ascertain the causal relationship between non-surgical periodontal therapy (NSPT) and incident hypertension and to investigate the mediating role of systemic inflammation in this association. METHODS: We conduct...AIMS: To ascertain the causal relationship between non-surgical periodontal therapy (NSPT) and incident hypertension and to investigate the mediating role of systemic inflammation in this association. METHODS: We conducted a retrospective cohort study of patients diagnosed with periodontitis between 2015 and 2021 at our institution. Participants were stratified into two groups: those who received NSPT (treatment group) and those who did not (control group). Elevated systemic inflammation was assessed using composite inflammatory markers measured from initial treatment through 1 year after diagnosis. The primary outcome was the development of hypertension during follow-up. Causal mediation analysis evaluated the mediating role of inflammation in the NSPT-hypertension association. RESULTS: Among 228 included patients (43% male, median age: 50.5 years), 47 (20.6%) developed hypertension during a median follow-up of 4.34 years (IQR 3.41-5.60). The average direct effect of NSPT on hypertension risk was consistent (control: -0.15, p = 0.012; treatment: -0.15, p = 0.012), indicating a stable protective effect. However, the mediation effect of elevated systemic inflammation was nonsignificant (p > 0.05), with a negligible proportion of the total effect. CONCLUSION: NSPT was causally linked to reduced risk of incident hypertension, but not via systemic inflammatory pathways. Alternative mechanisms warrant investigation.
OBJECTIVE: To expand the clinicopathological, immunohistochemical, and molecular spectrums of head and neck NUT carcinoma (HN-NC) of rare sites and explore potential prognostic factors and treatments. MATERIALS AND METHO...OBJECTIVE: To expand the clinicopathological, immunohistochemical, and molecular spectrums of head and neck NUT carcinoma (HN-NC) of rare sites and explore potential prognostic factors and treatments. MATERIALS AND METHODS: HN-NCs were confirmed by NUT immunostaining, fluorescence in situ hybridization and/or next generation sequencing. Immunohistochemistry for therapeutic markers and follow-up were performed. RESULTS: Fifteen HN-NCs were collected. Most involved major salivary gland (n = 7) and oral mucosa (n = 5). Other sites included mandible (n = 1), and maxilla (n = 2). Nine out of 13 harbored BRD4::NUTM1 fusion while the others carrying rare ZNF532::NUTM1, novel CCNT2::NUTM1 and WHSC1L1::NUTM1 fusion respectively. Microscopically, three unusual morphologies were observed, resembling differentiated papillary squamous cell carcinoma, myoepithelial carcinoma and small round cell malignancy, respectively. SOX2, PRAME, c-MYC, EGFR showed positive staining in around half cases. During the average follow-up time of 12.8 months, 3/13 patients suffered recurrence, 5 had distant metastasis and 5 died of disease. Integrating with published reports, Kaplan-Meier method revealed that tumor site was associated with overall survival (p = 0.039), and fusion gene type was associated with disease-free survival (p = 0.039). CONCLUSIONS: HN-NCs had dismal prognosis, especially those originating from oral mucosa. HN-NC should be included in the differential diagnosis when encountering poorly differentiated/undifferentiated malignancies or carcinomas with squamous differentiation.
AIMS: Aging influences susceptibility to periodontitis and modifies wound repair, which favors the development of age-associated periodontal diseases. However, these effects are not well known. Our scoping review aimed t...AIMS: Aging influences susceptibility to periodontitis and modifies wound repair, which favors the development of age-associated periodontal diseases. However, these effects are not well known. Our scoping review aimed to analyze the existing literature on this topic. METHODS: PRISMA guidelines for Scoping Reviews were followed. An exhaustive literature search was conducted on PubMed, Scopus, LILACS, and Dentistry and Oral Sciences Sources. Pairs of reviewers screened study abstracts and full texts, and two reviewers extracted data using a standardized extraction form. Kappa indices were calculated for reviewer calibration. Data analysis was done using RStudio. RESULTS: 4538 records were identified, and 43 were included. Studies reported reduced collagen synthesis during aging, narrowing of the periodontal ligament, widening of cementum, and increased bone resorption. Aged tissues exhibit increases in genes and proteins involved in microbial sensing, tissue remodeling, inflammation, and senescence, and reductions in structural proteins, bone formation, metabolic regulation. Wound healing studies describe impaired connective tissue and bone responses, while preclinical studies indicate drugs and nutritional agents may reduce periodontal tissue destruction, showing potential for new therapeutic avenues. CONCLUSIONS: Our study highlights significant changes in periodontal disease susceptibility along with impaired wound healing during aging, with implications for future research and clinical management.
AIM: The clinical evaluation of patients with oral potentially malignant disorders is primarily based on physical examination and observable clinical features. Clinical photographs play a key role in patient monitoring a...AIM: The clinical evaluation of patients with oral potentially malignant disorders is primarily based on physical examination and observable clinical features. Clinical photographs play a key role in patient monitoring and help identify signs that may indicate malignant transformation. These images can be accessed by artificial intelligence techniques and fractal analysis, and image processing and segmentation are crucial for these tasks. This review discusses image processing techniques applied to clinical photographs of oral potentially malignant disorders, with emphasis on fractal analysis. METHODS: Studies investigating fractal dimension and lacunarity as measures of lesion complexity and homogeneity were reviewed, along with research on segmentation and binarization. RESULTS: A search of scientific databases identified 10 studies reporting the access of texture parameters on clinical images to measure fractal dimension and lacunarity. CONCLUSIONS: The reviewed studies showed that fractal dimension and texture parameters were useful for evaluating lesions and distinguishing normal and pathological tissues; however, there is a lack of methodological standardization. Although fractal dimension was assessed in all articles, lacunarity was examined in just one. Binarization and segmentation impact fractal dimension, lacunarity, and other texture measurements, which can be significantly enhanced by appropriate image processing. In contrast, poorly executed preprocessing may lead to misinterpretation of results.
AIM: To evaluate the dietary profile and concentrations of soluble receptors for advanced glycation end products (sRAGE) and interleukin-6 (IL-6) in overweight or obese individuals with periodontitis. METHODS: Ninety-eig...AIM: To evaluate the dietary profile and concentrations of soluble receptors for advanced glycation end products (sRAGE) and interleukin-6 (IL-6) in overweight or obese individuals with periodontitis. METHODS: Ninety-eight adults aged 18-59 years were classified into four groups: Normal weight no periodontitis (n = 27), normal weight with periodontitis (n = 21), overweight/obesity no periodontitis (n = 26) and overweight/obesity with periodontitis (n = 24). Dietary, clinical, anthropometric, and biochemical data were collected. sRAGE and IL-6 concentrations were measured in serum and gingival crevicular fluid (GCF) using ELISA. RESULTS: Overweight/obesity and periodontitis group showed reduced serum sRAGE concentrations 979 [770-1193] pg/mL and elevated GCF IL-6 levels 11.4 [10.0-13.3] pg/mL (p < 0.05). Serum sRAGE and GCF IL-6 showed significant correlations with periodontal parameters, including probing pocket depth, clinical attachment loss, and number of diseased teeth (r = 0.40; p < 0.001). Despite higher total nutrient intake, overweight/obesity with periodontitis group had the highest energy intake and the highest prevalence of inadequate intake for protein (79%), calcium (92%), vitamin B5 (83%), and cholesterol (83%). CONCLUSIONS: Obesity and periodontitis were associated with lower serum sRAGE, higher GCF IL-6, and more frequent dietary inadequacies, suggesting a potential link between nutritional status, inflammatory biomarkers, and periodontal health.
OBJECTIVE(S): To evaluate naturally occurring cellular senescence in human gingival and periodontal ligament (PDL) tissues by addressing two questions: (1) whether susceptibility to cellular senescence increases with chr...OBJECTIVE(S): To evaluate naturally occurring cellular senescence in human gingival and periodontal ligament (PDL) tissues by addressing two questions: (1) whether susceptibility to cellular senescence increases with chronological aging, and (2) whether periodontitis lesions exhibit senescence-associated features indicative of inflammation-accelerated senescence. MATERIALS AND METHODS: A structured search of PubMed and bioRxiv databases identified 186 articles. After applying the inclusion criteria, 13 studies that investigated senescence markers in gingival and PDL tissues in the context of aging or periodontitis were selected. RESULTS: We observed tissue-specific senescence. Gingival fibroblasts exhibited progressive age-related senescence. In contrast, PDL fibroblasts showed consistently high baseline senescence regardless of age, whereas PDL stem cells exhibited age-related decline in regenerative potential. In periodontitis-affected tissues, senescence markers-such as p16, SA-β-gal, and SASP-related factors-were elevated compared to healthy tissues, even among younger individuals. CONCLUSION(S): Senescence is a key biological feature of periodontal tissues with distinct cell-type-specific dynamics. These findings suggest that aging and inflammation contribute to the accumulation of senescent cells, which may influence periodontal health and disease progression.