The latest medical research on Dentistry
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about dentistry gathered by our medical AI research bot.
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Request AccessPotential predisposing features of external cervical resorption: An observational study.
Endodontic ResearchTo assess the occurrence of external cervical resorption (ECR) in relation to patient characteristics and potential predisposing factors.
In total, 215 ECR lesions (194 patients) referred to the Endodontic postgraduate Unit at King's College London or Specialist Endodontic practice (London, UK) between September 2017 and January 2022. The clinical records were readily accessible for evaluation. At the time of initial presentation, patients diagnosed with ECR were interviewed regarding potential predisposing factors using a checklist based on existing literature of reported predisposing factors. Absolute and relative frequencies for all variables were computed. Inferential analysis was carried out to determine if there was any potential association between the type and location of tooth in the jaw as well as sex, age of the patient and potential predisposing factors.
No identifiable predisposing factor were detected in 22.3% (48/215 teeth) of the cases, 57.7% (124/215 teeth) had a sole, identifiable predisposing factor and 20% (43/215 teeth) had combined (several) factors. The most common (sole or combined) potential predisposing factors were previous/existing history of orthodontic treatment (25.6%, 55/215 teeth), dental trauma injury (DTI) (20.9%, 45/215 teeth), domestic cat ownership (15.8%, 34/215 teeth) and parafunctional habits (10.2%, 22/215 teeth). The highest occurrence of sole predisposing factors was recorded for males (62%, 75/121 teeth), all other ethnic groups combined (non-white) patients (58.5%, 24/41 teeth), incisor teeth (64.4%, 56/87 teeth) and maxillary teeth (62.4%, 68/109 teeth). While the highest occurrence of combined predisposing factors was found in females (22.3%, 21/94 teeth), white patients (20.1%, 35/174 teeth), premolars (29%, 9/31 teeth) and mandibular teeth (21.7%, 23/106 teeth). There were significant associations between tooth type and trauma (p < .001), cat ownership (p = .003) and parafunctional habits (p = .017). The association between trauma (p < .001), cat ownership (p = .002) and jaw location were found to be significant. Concerning parafunctional habits, female patients had significantly (p = .015) more ECR occurrence than male patients.
Most cases had 1 (sole) identified predisposing factor; orthodontic treatment, dental trauma history and (previous) cat ownership were the most identified factors. The information may be helpful in diagnosing early stage ECR.
Endodontic access cavity training using artificial teeth and Simodont® dental trainer: A comparison of student performance and acceptance.
EndodonticsCompetency in endodontic access cavity preparation requires key motor skills, good conceptual understanding, along with an appreciation of 3-dimensional pulp chamber anatomy. These are traditionally learned using natural or artificial teeth (AT) mounted within a phantom head (PH). Simodont® (Nissin Dental Products INC, JPN) is a haptic virtual reality simulator (HVRS) and offers an alternative to AT for training.
This study aimed to (1) evaluate the evolution in the performance of learners trained to prepare access cavities incorporating Simodont (test group) against learners trained on AT mounted within PH (control group), (2) determine learner acceptability of HVRS.
Forty dental students, with no prior endodontic training, were given instruction and video demonstration of access cavity preparation using a mandibular left 1st molar AT (LL6). Thereafter, they prepared an access cavity on PH mounted AT LL6. This provided a baseline record of performance. Participants were randomly assigned to the test or control groups. The test group (n = 22) trained using Simodont: preparing a virtual tooth LL6 for a period of 60 minutes with instructor feedback. The control group (n = 18) trained using AT LL6 on a PH for 60 minutes with instructor feedback. Subsequently, learners from both groups prepared an access cavity on an AT LL6 in a PH. This provided a re-evaluation record. Two calibrated examiners graded the teeth from the baseline and re-evaluation using rubric criteria; assigning scores with a grading range from 0 to 17. The examiners were blinded to which group the teeth belonged. Change in performance was determined by calculating the difference in assessment grade from baseline to re-evaluation. Scores which improved by 3 or more units were labelled improvers, all other scores were described as non-improvers.
Within the test group, the numbers of improvers were 5 (23%) versus 7 (39%) in the control group The difference failed to indicate statistical significance (p = .315). The Cohen kappa values for intra and inter-examiner agreement were 1.00 and 0.73 respectively.
The evolution of skills in learners trained using Simodont is comparable to those trained using AT. It is, therefore, reasonable to use Simodont, which was acceptable to learners, as an adjunct to AT for endodontic access cavity training.
Evaluating the effectiveness of a novel training model in dental preclinical regenerative endodontic education.
EndodonticsRegenerative endodontic procedures (REPs) are tissue engineering-based treatments aimed at regenerating the pulp-dentin complex. However, these procedures are not widely practiced or well-known among dentists due to a lack of training. This study aims to develop a practical hands-on training model for REPs to enhance students' theoretical knowledge and practical skills.
A cost-effective, easy-to-operate, and reusable training model for preclinical training of REPs was developed. A total of 125 undergraduates were divided into an experimental group (REPs model) and a control group (traditional teaching). The students' theoretical knowledge and operational skills were assessed through examinations and practical assessments. Student perceptions were assessed by questionnaires.
The experimental group achieved higher scores in theoretical knowledge and operational skills compared to the control group (p < .001). The process evaluation of the experimental group demonstrated a high level of proficiency in executing root canal disinfection steps, with pass rates ranging from 93.5% to 95.2%. Students in both groups perceived the model as valuable for improving critical thinking, stimulating interest, and enhancing their confidence and proficiency.
The developed REPs training model is a practical and effective tool for teaching and training regenerative endodontics. It bridges the gap between preclinical and clinical education, enhancing students' confidence and clinical competence.
Endodontic treatment modifies circulatory inflammatory mediator levels: A systematic review with meta-analysis.
EndodonticsPROSPERO database (CRD42024559271).
To answer the following research question: in adult healthy patients with AP [Population (P)], is there a difference before [Comparator (C)] and after various endodontic treatments (nonsurgical, surgical or retreatment) [Intervention (I)] on systemic levels of inflammatory biomarkers [Outcome (O)] in the follow-up period [Time (T)]?
An electronic literature search was conducted in the databases Scopus, PubMed, Clarivate Analytics' Web of Science, Cochrane Database of Systematic Reviews and Grey literature from inception to July 2024 with no language restrictions. Observational studies examining changes in serum levels of inflammatory mediators were included. Two independent reviewers selected studies, extracted data and critically appraised the included studies. Qualitative and quantitative (meta-analysis) data synthesis methods were employed. The Newcastle-Ottawa Scale was used to assess the quality of the included studies.
Sixteen studies met the inclusion criteria, of which six were included in the meta-analysis. These studies were published between 1992 and 2024, involving a total of 596 patients (54% females) aged between 16 and 75 years. The meta-analysis of pooled data showed a significant decrease in high-sensitive C-reactive protein (hs-CRP) levels in the serum of patients with AP 6 months after treatment [2.26 ± 1.76 versus 1.28 ± 1.06 mg/L, (Z = 2.03, p = .04)] and a decrease in interleukin-1β (IL-1β) levels 12 months after treatment [13.01 ± 5.95 versus 10.86 ± 3.52 pg/mL, (Z = 3.72, p < .01)]. One study was assessed as poor quality, while all others were considered high quality.
Following effective endodontic treatment in patients with AP, the systemic levels of hs-CRP and IL-1β exhibit a significant reduction at 6 and 12 months, respectively. Further clinical studies should investigate whether effective endodontic treatment and reduced levels of investigated biomarkers may change the clinical presentation of systemic diseases.
Unveiling the power of artificial intelligence for image-based diagnosis and treatment in endodontics: An ally or adversary?
EndodonticsArtificial intelligence (AI), a field within computer science, uses algorithms to replicate human intelligence tasks such as pattern recognition, decision-making and problem-solving through complex datasets. In endodontics, AI is transforming diagnosis and treatment by applying deep learning algorithms, notably convolutional neural networks, which mimic human brain function to analyse two-dimensional (2D) and three-dimensional (3D) data.
This article provides an overview of AI applications in endodontics, evaluating its use in 2D and 3D imaging and examining its role as a beneficial tool or potential challenge.
Through a narrative review, the article explores AI's use in 2D and 3D imaging modalities, discusses their limitations and examines future directions in the field.
AI significantly enhances endodontic practice by improving diagnostic accuracy, workflow efficiency, and treatment planning. In 2D imaging, AI excels at detecting periapical lesions on both periapical and panoramic radiographs, surpassing expert radiologists in accuracy, sensitivity and specificity. AI also accurately detects and classifies radiolucent lesions, such as radicular cysts and periapical granulomas, matching the precision of histopathology analysis. In 3D imaging, AI automates the segmentation of fine structures such as pulp chambers and root canals on cone-beam computed tomography scans, thereby supporting personalized treatment planning. However, a significant limitation highlighted in some studies is the reliance on in vitro or ex vivo datasets for training AI models. These datasets do not replicate the complexities of clinical environments, potentially compromising the reliability of AI applications in endodontics.
Although AI enhances endodontic capabilities through advanced imaging analyses, addressing current limitations and fostering collaboration between AI developers and dental professionals are essential. These efforts will unlock AI's potential to achieve more predictable and personalized treatment outcomes in endodontics, ultimately benefiting both clinicians and patients alike.
Lifestyle, caries, and apical periodontitis: Results from a university-based cross-sectional study.
EndodonticsLifestyle factors significantly influence the development of inflammatory diseases, and emerging evidence suggests they may also impact oral health. However, no studies have explored their role in apical periodontitis (AP) amongst adults. This study aimed to assess the association between adherence to the Mediterranean diet (MD), physical activity, perceived stress, and sleep quality with the periapical and caries status in a university-based cohort.
A total of 149 periodontally healthy patients were included in the study. Clinical assessments and radiographic examinations [Orthopantomography (opt) and periapical radiographs] were conducted to evaluate the periapical status. Data on their periapical index (PAI) score and the decayed, missing and filled teeth (DMFT) index were recorded. Validated questionnaires were used to investigate patient's lifestyles. A final logistic regression model was performed for the multivariable analysis to evaluate the predictive ability of adherence to Mediterranean lifestyle on the presence of AP; other local, systemic and environmental factors were included as independent factors in the model.
Significant associations were observed between AP and high/low adherence to the MD (p = .00), high/low-moderate physical activity (p = .00), high/low sleep quality (p = .00) and high/low perceived stress (p = .00). The final multivariable regression model showed that low adherence to MD (OR = 3.68; 95% confidence interval [CI]: 1.24-10.83; p = . 01) and reduced sleep quality (OR = 3.04; 95% CI: 1.42-6.50; p = .00) were identified as potential risk factors for AP development. On the other hand, the DMFT index showed no significant association with lifestyle factors (OR = 1.0; CI: 1.01-1.14; p = .02) but was correlated with the development of AP (OR = 1.07; CI: 1.01-1.14; p = .02).
Results from the present study suggest a potential association between low adherence to MD and reduced sleep quality with the development of AP. Individuals with low adherence to MD and inadequate sleep quality faced respectively 4-fold and 3-fold increased odds of developing periapical lesions. Further research is essential to elucidate the causal mechanisms underlying these associations and to determine whether lifestyle adjustments could improve endodontic success rate.
A single-cell transcriptomic atlas of human stem cells from apical papilla during the committed differentiation.
EndodonticsHuman stem cells derived from the apical papilla (SCAPs) are recognized for their multilineage differentiation potential and their capacity for functional tooth root regeneration. However, the molecular mechanisms underlying odonto/osteogenic differentiation remain largely unexplored. In this study, we utilized single-cell RNA sequencing (scRNA-seq) to conduct an in-depth analysis of the transcriptional changes associated with chemically induced osteogenesis in SCAPs.
scRNA-seq identified SCAPs as distinct subpopulations. Differentially expressed genes (DEGs) and Gene Ontology (GO) analyses were conducted to evaluate the potential function of each cluster. Pseudotime trajectory analysis was employed to elucidate the potential differentiation processes of the identified SCAP populations. To investigate the osteo/odontogenic potential of Deiodinase Iodothyronine Type 2 (DIO2) on SCAPs, we performed alkaline phosphatase staining, western blot analysis, Alizarin Red S staining and immunofluorescence staining. Additionally, SCAP components were transplanted into mouse calvarial defects to evaluate osteogenesis in vivo.
The analysis of cell clusters derived from our scRNA-seq data revealed a significant shift in cellular composition when cells were cultured in a mineralization induction medium compared to those cultured in a complete medium. Both groups exhibited heterogeneity, with some cells intrinsically predisposed to osteogenesis and others appearing to be primed for proliferative functions. Notably, we identified a subpopulation characterized by high expression of DIO2, which exhibited pronounced osteogenic activity during differentiation.
Our study is the first to reveal a shift in the cellular composition of SCAPs when cultured in a mineralization induction medium compared to a complete medium. Following both in vitro and in vivo validation, the DIO2+ subpopulation exhibited the highest transcriptional similarity to osteogenic function, suggesting its potential utility in tissue regeneration applications.
Attempts to Modify Periodontal Screening Models Based on a Self-Reported Oral Health Questionnaire in the Medical Care Setting.
Clinical PeriodontologyPeriodontal disease (PD) screening models based on a self-reported questionnaire were previously established and externally validated. The aim of the present study is to explore whether the screening models could be modified to improve prediction performance; this methodology is called 'updating'.
Updating the models for 'total' and 'severe' PD was performed using two datasets. One dataset from a previous study (n = 155) was used to explore the updating, and a second (n = 187, built for the current study) was used to validate whether updating improved performance. Updating was based on different statistical approaches, including model recalibration and revision. Discrimination and calibration were assessed after updating.
For 'total' PD, the update based on model revision improved its performance. However, still low AUCs were found: 0.64 (0.56-0.73) and 0.61 (0.53-0.69) with corresponding O:E ratios 1.00 (0.80-1.23) and 0.92 (0.75-1.13) in the update and validation cohorts, respectively. For 'severe' PD, performance of the original model without update performed still the best; AUCs were 0.72 (0.61-0.83) and 0.75 (0.66-0.84) in the update and validation cohorts, respectively, with corresponding O:E ratios 0.60 (0.38-0.84) and 0.62 (0.42-0.87).
The updating methodology did not further improve the performance of the original 'severe' PD screening model; it performed satisfactorily in the medical care setting. Despite updating attempts, the screening model for 'total' PD remained sub-optimal. Screening for 'severe' PD can now be implemented in the medical care setting.
A Study Into Systemic and Oral Levels of Proinflammatory Biomarkers Associated With Endpoints After Active Non-Surgical Periodontal Therapy.
Clinical PeriodontologyTo analyse whether some selected inflammatory biomarkers collected from venous blood and gingival crevicular fluid (GCF) were associated with the outcome of non-surgical periodontal therapy.
Two-hundred and nine patients affected by periodontitis were enrolled in the study, who had undergone steps I and II therapy as well as a non-surgical re-instrumentation (NSRI) of periodontal pockets after 6 months. Serum (SE), plasma (PL) and GCF samples were quantitatively analysed for the following inflammatory biomarkers: active matrix metalloproteinase-8 (aMMP-8), prostaglandin E2 (PGE2) and surfactant protein D (SP-D). Therapy outcomes were evaluated using a 'treat-to-target' endpoint (T2T) at the patient level, defined as ≤ 4 sites with pocket depth ≥ 5 mm.
Patients presented with 23 ± 6 teeth (mean ± SD) at baseline. After steps I and II therapy, 41.6% of the patients reached T2T and after NSRI 47.4%. Univariate analysis identified a potential association between high levels of PL-SP-D and more favourable treatment outcomes. Multivariate binary logistic regression adjusted for sex, mean baseline probing depth, diabetes and current smoking status confirmed an independent relationship between baseline PL-SP-D and the T2T after steps I and II therapy (aOR 0.432, p = 0.011), implying that a higher level PL-SP-D at baseline is associated with a > 50% reduced risk of failing T2T. However, no such association was found for PL-SP-D and NSRI.
Higher baseline PL-SP-D levels might be associated with more favourable treatment outcomes after steps I and II therapy. This may be due to its role in the regulation of neutrophil function. However, further investigation is required to confirm this hypothesis. If proven, PL-SP-D could play a role as a biomarker for identifying individuals who respond differentially to primary therapy.
Identifying Undiagnosed Diabetes and Prediabetes in the Dental Setting in an Asian Population-A Clinical Risk Model.
Clinical PeriodontologyTo assess the glycaemic status of Asian patients in a tertiary care dental setting and develop a risk model for undiagnosed diabetes mellitus (DM).
A total of 1074 participants completed a diabetes risk test questionnaire, full-mouth periodontal examination and a point-of-care HbA1c finger-prick blood test. Univariable logistic regression was performed to assess the effect of potential factors to predict DM, with confirmed diabetes as the outcome. Subsequently, multivariable logistic regression analysis with stepwise variable selection was employed to develop the final models for predicting DM.
Sixty-five (6.1%) and 83 (7.7%) of the 1074 participants were medically confirmed with T2DM and prediabetes, respectively. The 'best' predictive risk model for DM included body mass index (BMI), family history of diabetes, smoking and a diagnosis of Stage III/IV or severe periodontitis with an area under the curve (AUC) of 0.717 (95% confidence interval, CI [0.689-0.744]) and 0.721 (95% CI [0.693-0.748]), respectively. Including the oral health measure marginally increased the AUC.
Dental patients clinically diagnosed with advanced periodontitis in combination with high BMI, positive family history of DM and smoking are potentially at high risk for DM and should be screened for DM and referred for medical confirmation and management.
Proteomic Insights Into Gingival Crevicular Extracellular Vesicles in Periodontitis and Gestational Diabetes: An Exploratory Study.
Clinical PeriodontologyTo characterize the gingival crevicular fluid (GCF) and plasma extracellular vesicles (EVs) and explore their proteomic cargo in healthy pregnant women compared to those with gestational diabetes mellitus (GDM) and periodontitis.
One-hundred and four pregnant women were recruited at 24-30 gestation weeks. GDM was diagnosed by an oral glucose tolerance test. GCF and plasma samples were obtained to isolate EVs and characterized by nanoparticle tracking, immunoassays, electron microscopy and mass spectrometry.
Of the recruits,17.3% women were healthy, 50% had periodontitis and 32.7% had both GDM and periodontitis. Probing depth, clinical attachment loss and bleeding on probing were more severe in GDM and periodontitis pregnancies (p < 0.0001). Additionally, this group showed an increase concentration of total, small and large GCF-EVs (p = 0.0015, p = 0.0011 and p = 0.0008, respectively), with decreased expression of CD9, CD81 and CD81/CD63 ratio (p = 0.0461, p = 0.0164 and p = 0.0005, respectively). No differences were observed in plasmatic EVs concentration or markers expression. Proteomic analysis of GCF-EVs showed peptides of both host and bacterial origin. Gene ontology analysis revealed that proteins of GCF-EVs participate in immune inflammatory responses, glucose metabolism and insulin response mechanisms.
GCF-EVs were increased in both GDM and periodontitis, and their proteomic cargo suggest their involvement in immune inflammatory response, glucose metabolism and insulin pathways during pregnancy.
Being different during treatment: a qualitative study investigating patients' experiences of treatments for missing maxillary lateral incisors.
Acta Odontol ScandaAgenesis of one or more teeth is common among patients who are referred for orthodontic treatment. The most common treatments are orthodontic space closure (SC) and implant replacement (IR), which are widely studied, but the experiences of patients receiving these treatments have received little attention. The aim of this qualitative study is to explore how treatments to address missing maxillary lateral incisors (MMLIs) are experienced by individuals who are treated using either orthodontic SC or IR.
This study is conducted in Sweden and based on semi-structured interviews with 13 individuals who have completed treatment, either orthodontic SC (n = 7) or IR (n = 6), to address the lack of one or two maxillary lateral incisors. Data were analysed in accordance with the grounded theory approach.
Findings were classified into the main category of being different during treatment and into three associated sub-categories. The first category, that is being different due to missing teeth, refers to when a person experiences being different because of the anterior spacing The second category, that is being different due to fixed appliance, refers to when the appliance itself makes a person different. The two first categories exemplify being different in terms of appearance. The third identified category, that is being different due to treatment appointments, refers to the need to spend time differently because of having appointments at the clinic for treatment.
Patients MMLIs consider their treatment to start at the time of diagnosis. They experience feelings of being different irrespective of whether the type of treatment is orthodontic SC or IR. The experience of being different differs in timing and causes depending on the treatment method.
