This study aimed to determine the effect of time span between exposing the enamel to calcium lactate and sodium fluoride and of a demineralized surface on the uptake of alkali-soluble fluorides. A total of 20 non-carious human wisdom teeth, were used. First 10 teeth, were cut into four slabs each and allocated to one of four groups: two treatment groups A) Calcium lactate followed by sodium fluoride with minimal delay (just drying between the two treatments); B) Calcium lactate followed by sodium fluoride with a delay of one hour; one of two control groups C) Sodium fluoride, as the positive control; D) Negative control group without treatment. The other 10 teeth were used for the second part of the research, each tooth was cut into 4 slabs and divided into one of two groups - the first group underwent two weeks of demineralization liquid treatment, the second group, as a control, underwent two weeks in deionized water. After two weeks, all slabs were treated with calcium lactate and followed with sodium fluoride 226ppm F-.Enamel fluoride uptake was determined by the fluoride extraction method by Caslavska and analyzed using a fluoride ion-specific electrode. Enamel fluoride uptake showed no statistical difference regarding various durations of treatment between exposing enamel slabs to calcium lactate and sodium fluoride, as well as demineralization of the surface of the enamel. Time span between exposing enamel to calcium lactate and sodium fluoride and the demineralization process did not significantly affect the enamel uptake of alkali-soluble fluorides.
The purpose of this in vitro study was to evaluate the effect of bioactive glasses containing a small proportion of fluoride and zinc in lower (BAG1) and higher ratios (BAG2) on the Vickers microhardness (VHN), surface morphology and chemical composition of high-viscosity glass ionomer cement and glass hybrid cement. Fuji IX (Fuji) and Equia Forte HT (Equia) were modified with 5 wt% BAG1 and BAG2. Six groups were prepared and stored in distilled water: Fuji, Fuji+ BAG1, Fuji+BAG2, Equia, Equia+ BAG1, and Equia+BAG2. BAG1 and BAG2 were characterized using FTIR. VHN was measured after 24 hours and 7 days. Representative samples from all groups were stored in phosphate buffered solution and analyzed using SEM-EDS. Data were analyzed using ANOVA and paired t-tests (α = 0.05). Fuji and Fuji+BAG1 showed the highest VHN at both time points, whereas BAG2 significantly reduced microhardness compared to original materials Fuji and Equia (p<0.05). All groups exhibited increased VHN over 7 days (p<0.05). FTIR confirmed the amorphous silicate and fluoride content. SEM-EDS confirmed the absence of crystalline precipitates on the material's surface when stored in phosphate containing solution. BAG1 preserved or slightly enhanced microhardness, while BAG2 significantly reduced it. There were no crystalline precipitates on original or on materials modified with 5 wt% bioactive glass. Optimizing BAG composition is essential to balance mechanical stability and bioactivity of glass ionomers.
This in vitro preliminary study investigated how different ozone formulations affect the adhesion, surface topography, and interfacial ion release of two pediatric bioactive restorative materials. Standardized enamel and dentin surfaces (n=96) from extracted human teeth were randomized into 8 groups which differ by the treatment protocol (no treatment, ozone gas, ozonated water, ozonated gel) and restorative material used (Fuji II LC, ACTIVA Bioactive Restorative). Adhesive performance was evaluated after 7 days of storage (HBSS, 37 °C) by shear bond strength (SBS) test and microscopic fracture mode analysis. Surface roughness (Sa) was measured by optical profilometry; interfacial elemental composition was analyzed by Raman spectroscopy and scanning electron microscopy with energy dispersive X-ray detectors (SEM-EDX). Ozone treatment did not significantly affect SBS (mean 3.59±3.23 MPa [min 0.05 MPa; max 11.69 MPa]), fracture modes, or surface roughness (p>0.05 for all domains). Chemical analyses revealed no appreciable difference, with the possible exception of minimal fluoride release. Regardless of the vector agent, ozone treatments showed no significant effect on the short-term adhesion capability of either restorative material, or on the bonding quality with enamel and dentin. Additionally, it seemed that they they neither affected the surface topography nor the possible bioactivity at the interface of the tested materials. However, these preliminary results are restricted to the specific experimental conditions adopted, and further studies are required before any definitive clinical recommendations can be made.
The study aimed to evaluate the effects of multiple sterilization cycles and repeated clinical use on the stability of monoblock titanium and PEEK scanbodies. Ten monoblock titanium and PEEK scanbodies were paired up, thus forming a total of ten study groups. Each pair was scanned using an intraoral scanner to record a reference scan. Study groups underwent 30 cycles of tightening, loosening and sterilization, respectively. Scanning was performed after every five cycles, resulting in six study scans per group. Linear (∆X, ∆Y and ∆Z-axis), angular (∆ANGLE) and three-dimensional (Euclidean distance, ∆EUC) deviations were calculated and compared using two-way ANOVA test. The number of repeated cycles was insignificant on scanbody deviations for both of the scanbody materials (p>0.05). The scanbody material had a significant impact, with titanium scanbodies demonstrating significantly higher deviations in ∆X, ∆Z and ∆EUC compared to PEEK scanbodies (p<0.05). PEEK scanbodies provided more accurate and more consistent digital scans than titanium.
Pre-transplant dental clearance is commonly recommended for kidney transplant candidates, although standardized protocols are lacking and supporting evidence remains limited. The aim of this study was to analyze the dental work-up protocol, treatment needs, complications, and time to clearance in patients undergoing kidney transplantation at a tertiary care center. A retrospective chart review was conducted of patients referred by their attending nephrologist for pre-transplant dental evaluation between 2019 and 2024. Demographic, medical, and dental data were collected, including DMFT index, type and number of procedures performed, complications, and time required to obtain dental clearance. Seventy-four patients (median age 41 years) were included. The median DMFT index was 13.5 (range 0-28). Supragingival instrumentation was performed in 39.2% of patients, and tooth extraction in 27%, with 62 teeth removed overall. Endodontic treatment was completed in 9.5% of patients. Two postoperative complications (2.7%) were recorded and managed conservatively. Most patients (67.6%) achieved dental clearance in a single visit, and the median time to clearance was 1 day (range 1-45). Within the limitations of this single-center retrospective study, pre-transplant dental clearance was feasible, safe, and completed without evidence of clinically meaningful delay in the transplant preparation process.
Statins exhibit pleiotropic effects on bone metabolism, including osteogenic and angiogenic activity. The aim of this pilot study was to evaluate whether local application of simvastatin combined with a bovine-derived xenogeneic bone substitute enhances histomorphometric outcomes of socket preservation compared with the bone substitute alone after a three-month healing period. This prospective split-mouth clinical study included nine patients requiring bilateral tooth extraction. One socket was treated with cerabone® plus alone (control), while the contralateral socket received cerabone® plus combined with locally applied simvastatin (1 mg/0.2 mL saline). Bone core biopsies were harvested three months after grafting and analyzed histomorphometrically. The proportions of newly formed bone (NB/TV), residual bone substitute material (BSM/TV), and connective tissue (CT/TV) were quantified. Paired t-tests and Wilcoxon signed-rank tests were used for statistical analysis. Histomorphometric analysis demonstrated a similar tissue composition in both groups. Connective tissue represented the predominant component in the control and statin-treated sites (59.1 ± 12.0% and 64.3 ± 9.4%, respectively; p = 0.31). Newly formed bone accounted for 31.0 ± 15.5% in the control group and 26.2 ± 11.6% in the statin group (p = 0.45). Residual bone substitute material showed comparable values between groups (9.9 ± 8.5% vs. 9.5 ± 9.7%; p = 0.91). No statistically significant differences were observed. The addition of locally applied simvastatin to a bovine-derived xenogeneic bone substitute did not result in significant histomorphometric differences in socket preservation after three months. At the tested dose and delivery method, simvastatin did not enhance early mineralized tissue formation compared with the bone substitute alone.
Temporomandibular Disorders (TMDs) encompass a set of conditions affecting the masticatory muscles and the temporomandibular joint (TMJ), with an impact on both functionality and individuals' quality of life. Myalgia is a diagnosis of TMD with multifactorial etiology, and treatment strategies aim primarily to relieve pain and restore function. Pharmacological therapy is commonly considered a second-line option, thus complementing conservative measures. Assess the efficacy of pharmacological interventions in the management of myalgia associated with temporomandibular disorders, in adolescents and adults, while exploring differential effects across TMD subtypes through subgroup analyses, using a systematic review and meta-analysis of randomized controlled trials (RCTs). A systematic review with meta-analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported following the PRISMA 2020 statement. Seventeen randomized controlled trials (RCTs) published between 2018 and 2024 were included. Pharmacological interventions such as nonsteroidal anti-inflammatory drugs, corticosteroids, muscle relaxants, antidepressants, and intra-articular injectables-were compared with placebo or other active treatments. The primary outcomes were pain intensity (Visual Analog Scale, VAS) and maximum interincisal opening (MIO) unassisted. A total of 1,128 participants were analyzed across 25 treatment arms. Pharmacological interventions were associated with a significant reduction in pain (SMD = -0.68; 95% CI: -1.09 to -0.26; p < 0.001) and an improvement in MIO (SMD = 0.51; 95% CI: 0.20 to 0.82; p < 0.001). Subgroup analyses indicated that interventions were more consistent and effective in arthralgia-only populations, showing lower heterogeneity and a more predictable therapeutic response, whereas myalgia-only populations exhibited smaller and less consistent benefits. Conservative therapies demonstrated a consistent advantage, thus aligning with international recommendations that prioritize such approaches. Subgroup analyses demonstrated more consistent and homogeneous effects in arthralgia-dominant populations, whereas myalgia-only studies showed greater heterogeneity and less predictable responses. Pharmacological therapy provides a moderate overall beneficial effect in reducing pain and improving mandibular function in TMD, with stronger and more consistent evidence in arthralgia-dominant populations, while myalgia-related outcomes remain more variable, thus indicating the need for tailored treatment strategies. Further high-quality RCTs with standardized protocols are needed.
To compare the quality of recovery between total intravenous anaesthesia (TIVA) with propofol and balanced inhalational anaesthesia with sevoflurane in patients undergoing intraoral surgical procedures. We conducted a prospective randomised controlled clinical trial on 50 patients (25 per group) who underwent intraoral surgical procedures longer than 30 minutes. The primary outcome was the quality of recovery measured by the QoR-40 questionnaire at 1 hour, 24 hours, and 30 days after surgery. Secondary outcomes included bite force, hand grip strength, incidence of postoperative nausea and vomiting (PONV), and postoperative shivering. QoR-40 scores did not differ between groups at any time point (differences from -0.04 to 1.2 points, all p>0.05). Bite force and hand grip strength did not differ between groups. However, TIVA eliminated PONV (0% vs 28%, p=0.010, NNT=4) and shivering (0% vs 36%, p=0.002, NNT=3). TIVA and sevoflurane result in a similar quality of recovery after intraoral procedures. However, TIVA eliminates PONV and shivering, which represents a clinically significant benefit for patients undergoing intraoral surgery.
To evaluate a two-year clinical performance of resin infiltration in anterior teeth affected by Molar Incisor Hypomineralisation (MIH), focusing on esthetic outcomes, hypersensitivity control, and patient-reported satisfaction. This retrospective observational study included 106 MIH-affected permanent incisors from children aged 7-10 years, treated at a university-based pediatric dental clinic. The primary outcome was esthetic improvement (colour match, FDI criteria). Secondary outcomes included patient-reported hypersensitivity (VAS), additional esthetic and biological properties from the FDI index, and patient and guardian satisfaction. Esthetic and biological properties, hypersensitivity, and satisfaction were recorded at 1, 12, and 24 months following resin infiltration of demarcated opacities. Data were analysed using descriptive and comparative statistics. A two-year clinical success rate of resin infiltration was 96.2% based on colour match. Hypersensitivity scores (VAS 0-10) decreased from 8 at baseline to 0 at 24 months. Success rates for esthetic and biological properties, as assessed with the FDI index, all exceeded 90%. Patient and guardian satisfaction was high at 1 and 12 months but declined at 24 months, particularly in cases with yellow-brown demarcated opacities. Resin infiltration showed high effectiveness for improving esthetic integration and colour match in anterior teeth affected by MIH, with high initial satisfaction reported by patients and guardians.
Dental age estimation is a relevant procedure in forensic odontology, but it becomes increasingly challenging as age advances. In such cases, the use of third molars stands out, as they are the last teeth to complete the maturation process. However, it has been observed that these teeth have the highest rate of impaction. The aim of this systematic review was to assess whether dental impaction influences the mineralization process of third molars and whether this condition affects the accuracy of age estimation methods. A search was carried out in the Embase, LILACS, PubMed/MEDLINE, SciELO, Scopus, and Web of Science databases, using terms related to the topic in Portuguese, English, and Spanish. Two independent evaluators applied eligibility criteria to select and evaluate the relevant articles. After selection by title, abstract, and full-text reading, 11 articles were included. The risk of bias was analyzed using the checklist proposed by the Joanna Briggs Institute. Data extraction revealed that the populations studied were from India, Germany, Lebanon, Switzerland, China, Canada, South Africa, and Denmark. All studies were separated by sex, though in different sample sizes, except for one study, which used equal numbers of 260 orthopantomograms for each sex. Furthermore, all studies demonstrated that dental impaction, regardless of its degree, influences tooth mineralization. In conclusion, third molar impaction may delay the process of dental mineralization, raising concerns that these teeth, when impacted, should not be considered the first choice for age estimation methods.
The objective of this randomized-controlled, examiner-blinded parallel-group study was to evaluate the impact of daily oil pulling compared to distilled water on oral health-related quality of life (OHRQoL). Eighty participants from the University Hospital for Conservative Dentistry and Periodontology diagnosed with gingivitis were randomly assigned to either the test group (oil) or the control group (distilled water). Within the test group, participants received either pure sesame oil or sesame-based tooth oil. They were instructed to perform daily oil pulling in the morning for 15 minutes over a period of eight weeks using their assigned fluid, in addition to their daily oral hygiene routine. Oral Health Impact Profile (OHIP-14) scores were recorded at baseline, and after four and eight weeks. The test group (oil) demonstrated a statistically significant reduction in total OHIP-14 scores from baseline to week four (p < 0.001) and week eight (p = 0.002). Similarly, the control group (distilled water) showed a statistically significant decrease in total OHIP-14 scores from baseline to week four (p = 0.005) and week eight (p = 0.003). No statistically significant differences were observed in total OHIP-14 scores between test and control groups at baseline (p = 0.178), week four (p = 0.384) and week eight (p = 0.250). Daily oil pulling can have a positive impact on OHRQoL, regardless of whether oil or distilled water is used. Clinical relevance: Oil pulling may be considered a supportive measure alongside mechanical oral hygiene to improve oral health-related quality of life.
Untreated dental caries is a very widespread childhood disease that can damage the quality of life (QoL), growth, and education, while increasing healthcare costs. This study aimed to determine whether untreated and current dental caries affect both QoL and growth and development. This cross-sectional study included 145 systemically healthy children aged 11-12 who visited the Pediatric Dentistry Department at Marmara University. Body Mass Index (BMI) was calculated using height and weight and categorized as underweight, normal, or overweight. Oral Health-Related Quality of Life (OHRQoL) was evaluated using the Child Oral Impacts on Daily Performances(C-OIDP) scale. Caries severity was assessed with the International Caries Detection and Assessment System (ICDAS)-II system and classified as: no caries (ICDAS 0), initial (1-2), moderate (3-4), or extensive (5-6). Untreated caries were evaluated using the Pulpal involvement, Ulceration, Fistula, and Abscess (PUFA/pufa) index and grouped as PUFA/pufa=0 (none) or PUFA/pufa>0 (present). Of the children, 56.5% were female. The mean score of pufa and PUFA was 0.6 ± 1.2 and 0.1 ± 0.3, with a total C-OIDP score of 10.1 ± 12.3. The distribution of BMI by sex and age showed no significant differences (p=0.451 and p=0.129). Additionally, no significant relationship was found between BMI and clinical complications resulting from untreated caries (p=0.317) or caries severity (p=0.219). This study underscores the role of oral health in children's well-being. Higher ICDAS-II scores were associated with lower OHRQoL, while caries-free children showed better outcomes, possibly due to greater awareness or psychosocial factors. Caries severity negatively affected emotional well-being. These findings highlight the need for comprehensive assessments and early preventive care.
This study investigated the effect of Polymethyl vinyl ether-co-maleic anhydride (PVM/MA) copolymer incorporation and aging with thermocycling on the shear bond strength (SBS) of an etch-and-rinse adhesive (Adper Single Bond Plus-ASB) and two different self-etch adhesive systems (Clearfil SE Bond-CSE and Fluorobond II-FLB) to dentin. Adhesive systems were applied to 240 dentin sections randomly selected from the occlusal surfaces of 60 extracted molar teeth. The test groups were as follows (n=20): (G1) Pure Clearfil SE (CSE) Bond; (G2) CSE with copolymer (50 mg/ml PVM/MA); (G3) Pure FL II Bond (FLB); (G4) FLB with copolymer (50 mg/ml PVM/MA); (G5) Pure Adper Single Bond (ASB); and (G6) ASB with copolymer (50 mg/ml PVM/MA). A resin composite (Clearfil Majesty Posterior) was applied to the dentin surfaces and light-cured. Half of the specimens from each group were tested immediately after preparation (IM) and the other half was tested after exposure to 20,000 thermal cycles (TC; 5-55 °C). SBS values were measured at a crosshead speed of 0.5 mm/min. Data were analyzed with ANOVA and Tukey's HSD. The PVM/MA copolymer incorporation improved the performance of CSE in the IM group and ASB in the TC group, however, it showed no influence in the other adhesive groups. The self-etch adhesive CSE with the PVM/MA copolymer showed the highest bond strength to dentin surfaces in the IM group (22.0±1.7 MPa). However, copolymer corporation did not increase bonding performance of Fluor containing bonding agent FLB. Thermocycling of test specimens significantly decreased bond strengths in all test groups except for ASB resin adhesive with PVM/MA copolymer. Incorporating PVM/MA into ethanol-based, hydrophilic all-in-one bonding agents may offer a valuable strategy to improve the long-term stability of adhesive systems.
To evaluate the acceptance of non-aesthetic treatment approaches for dental caries in children as perceived by parents, children, and dental professionals. A systematic search was conducted across four databases: PubMed, Scopus, Web of Science, and Embase. The included studies comprised cross-sectional or cohort studies, and randomized controlled trials assessing the acceptance of non-aesthetic treatments for dental caries in children, as reported by parents, children, and dental professionals. The risk of bias was assessed using the ROB-2, ROBINS-I, and JBI tools, depending on the study design. A total of 126 studies were included in this systematic review. The acceptance rate of Silver Diamine Fluoride (SDF) treatment for posterior primary molars in children ranged from 71.4% to 100% (median 93.2%). Among parents, it ranged from 3.2% to 91% (median 69.9%), and for dental professionals it ranged from 13.2% to 95% (median 61.6%). The acceptance rate for Stainless-Steel crowns (SSC) or Hall technique (HT) treatment in posterior primary molars for children, ranged from 32% to 100% (median 90%), for parents, it ranged from 14.5% to 100% (median 81.9%), and for dental professionals it ranged from 1% to 96% (median 44%). Parents had higher acceptance of SDF treatment for posterior teeth compared to anterior teeth. Non-aesthetic treatment options are generally accepted by children, parents, and, to a lesser extent, dental professionals, particularly for posterior teeth. However, most of the included studies presented a high risk of bias. The systematic review protocol was registered in OSF platform (doi: 10.17605/OSF.IO/P7CNY).
This study investigated whether toothpastes containing different fluoride compounds influence cytotoxic and genotoxic alterations in buccal mucosal cells, with particular attention to the type of fluoride, the presence of fluoride itself, and the duration of exposure. Eighty-eight participants were randomly assigned to four parallel groups: a control group using fluoride-free toothpaste and three intervention groups using formulations containing sodium fluoride, sodium monofluorophosphate, or amine fluoride. Buccal cell samples were obtained at baseline (T0), after 30 days (T1), and after 45 days (T2), and evaluated using the buccal micronucleus cytome assay to quantify nuclear abnormalities and cytotoxic markers. All fluoride-containing toothpastes led to higher frequencies of micronuclei, nuclear buds, and "broken egg" cells at T1 and T2 compared with the control group (P ≤ 0.001). Amine fluoride and sodium monofluorophosphate produced sustained increases in cytogenetic markers, including nuclear buds (AmF: P = 0.013; NaMFP: P ≤ 0.001) and "broken egg" cells (AmF: P ≤ 0.001; NaMFP: P = 0.004), while sodium fluoride demonstrated a slower, progressive increase in "broken egg" cells (P = 0.036). The findings suggest that fluoride-based toothpastes may modulate cytogenetic responses in buccal epithelial cells, and that these effects differ according to the fluoride compound and exposure duration. The findings should be interpreted with caution due to study limitations, and further research is needed to clarify the long-term biological consequences of repeated fluoride exposure in oral hygiene.
Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a degenerative condition affecting both osseous and soft tissue structures. Cone beam computed tomography (CBCT) offers detailed visualization of osseous changes, while magnetic resonance imaging (MRI) provides superior assessment of soft tissues, particularly the articular disc. The relationship between bony degeneration and disc abnormalities remains poorly defined. This study examined the correlation between CBCT-identified osseous radiological features of TMJ OA and MRI-detected disc displacement patterns. A cross-sectional analysis was performed on 198 TMJs from 99 patients clinically diagnosed with TMJ OA, where both MRI and CBCT imaging were performed in the same patient to enable direct comparative analysis. MRI was used to classify disc position as normal, partial displacement with reduction, complete displacement with reduction (DDR), or complete displacement without reduction (DDWR). CBCT scans were assessed for degenerative bone changes, including subchondral cysts, erosions, generalized sclerosis, osteophytes, and loose calcified bodies. OA severity was graded using the Ahmad and Schiffman criteria. Statistical evaluation was conducted using Fisher's Exact Test. A statistically significant correlation was found between OA severity and disc displacement type (p < 0.001). DDWR was most frequently associated with Grade 2 OA (26.8%). Subchondral cysts (p = 0.004), erosions (p < 0.001), generalized sclerosis (p < 0.001), and osteophytes (p < 0.001) occurred with significantly higher prevalence in patients presenting with DDWR. Loose calcified bodies showed no significant association with disc position (p = 0.191). There is an association between degenerative osseous changes and disc displacement patterns in TMJ OA, and DDWR represents a more advanced stage of internal derangement accompanied by pronounced bone remodeling. These results support the combined use of CBCT and MRI for the comprehensive assessment of TMJ OA.
This retrospective cohort study evaluated the effects of adjunctive povidone-iodine (PVP-I), full-mouth disinfection (FMD), and conventional full-mouth scaling (FMS) following Step 2 of periodontal therapy on clinical outcomes. Patient records from the Department of Conservative Dentistry, University Hospital Tubingen (2004-2016), with complete periodontal data before (T0) and after Step 2 of periodontal therapy (T1), were analyzed. The influence of treatment modality, baseline bleeding on probing (BOP%), proportion of sites with probing pocket depth (PPD) ≥ 5 mm, age, smoking, diabetes, and re-evaluation interval on changes in BOP and PPD, as well as on the clinical endpoints BOP ≤ 20% and ≤ 4 sites with PPD ≥ 5 mm, was assessed using multivariable regression. A total of 227 patients were included (52% female; mean ± SD age: 56.5 ± 11.2 years): 96 FMS, 93 FMD, and 38 PVP-I. Adjunctive PVP-I led to a significantly greater reduction in BOP compared with both FMD and FMS and substantially increased the likelihood of achieving BOP ≤ 20% (adjusted OR = 11.5; p = 0.03), independent of baseline inflammation and re-evaluation period. For the pocket-related endpoint (≤ 4 sites with PPD ≥ 5 mm), regression models were unstable due to the small number of successful cases; baseline PPD % remained the only consistent predictor. Adjunctive PVP-I use was significantly associated with improved bleeding-related outcomes after Step 2 of periodontal therapy, whereas no additional benefit was observed for deep-pocket reduction. PVP-I may therefore enhance the resolution of gingival inflammation but does not substantially affect pocket closure beyond conventional mechanical therapy.
This study evaluated the effects of paper point drying, microsuction, and 70% isopropyl alcohol on the push-out bond strength and interfacial adaptation of a premixed bioceramic sealer. Thirty extracted maxillary central incisors were prepared using NiTi rotary instruments and irrigated with NaOCl and EDTA. Specimens were randomly assigned to three groups (n = 10): paper point drying, microsuction, or 70% isopropyl alcohol. All canals were obturated with a calcium silicate-based bioceramic sealer using the single-cone technique. After one week of incubation, root slices from the coronal, middle, and apical thirds (n = 90) were subjected to push-out bond strength testing. Failure modes were evaluated stereomicroscopically, and selected specimens underwent scanning electron microscopy (SEM) analysis. Statistical analysis was performed using nonparametric tests (α = 0.05). The drying protocol significantly affected bond strength (p < 0.001). The isopropyl alcohol (3.23 MPa) and paper point (2.97 MPa) groups demonstrated significantly higher bond strength than the microsuction group (1.23 MPa). Apical slices showed higher bond strength than coronal and middle slices. Mixed failures predominated, while cohesive failures were more frequent in the alcohol and paper point groups. SEM revealed improved sealer-dentin adaptation with fewer interfacial gaps in these groups. Bioceramic sealer adhesion is strongly influenced by the drying method. Paper point drying and isopropyl alcohol enhance bond strength and interfacial adaptation, whereas microsuction results in inferior performance.
The aim was to analyze current orthodontic retention protocols in Croatia and their trend over a 10-year period. In a repeated cross-sectional survey, questionnaires were distributed to 150 orthodontists in Croatia in 2013 and 185 of them in 2023 (representing 69% and 85% of practicing orthodontists with response rates of 61% and 75%). Significant changes in retainer types across different malocclusions and treatment protocols were observed over a 10-year period. There was an increase in the use of VFR and a decrease in acrylic retention plates in both jaws (p≤0.001). Over the decade, the use of only fixed retention in the mandible declined from 20% to 7% (p=0.007), and the combination of fixed and removable retention in the maxilla dropped from 29% to 17% (p≤0.033). Increased use of removable retainers was noted in cases involving rotations, open bites, and extractions. Conversely, fixed-removable retainers were more frequently used in spacing cases (p≤0.001). There was a trend toward fewer check-ups (p=0.001) and toward increased patient self-monitoring (p=0.021). Personal experience as the primary reason for choosing a retention protocol increased from 39% to 62% (p<0.001). Additionally, the use of written information on retention rose from 39% to 69% (p<0.001). Retention practices in Croatia have evolved over the past decade, characterized by increased use of VFRs, more frequent implementation of dual retention in the mandible, and greater provision of written retention information. Additionally, follow-up protocols have shifted toward fewer scheduled visits, with increased emphasis on patient self-monitoring.
Mandibular fractures, particularly condylar process fractures, are common in maxillofacial surgery and require effective treatment methods that minimize complications while ensuring functional and esthetic recovery. This paper presents two cases of mandibular condylar process fractures treated using a transoral endoscopically assisted technique (EATA), thus marking the first documented application of this approach in Croatia. The aim was to evaluate the efficacy of this minimally invasive method compared to traditional extraoral approaches, which often carry risks such as visible scarring, facial nerve injury, and prolonged postoperative recovery. A 30° rigid endoscope and specialized angled instruments were utilized in both cases to achieve precise visualization, reduction, and fixation of the fractures. The first case involved a young male with a double mandibular fracture, while the second case addressed an isolated condylar fracture in an older female with comorbidities. Both patients were successfully treated without complications, including facial nerve injury, hematomas, or salivary fistulas. Hospitalization periods were shorter compared to traditional approaches, and recovery included restored temporomandibular joint function (TMJ), stable occlusion, and the absence of visible scars. The EATA method proved to be safe and effective, offering numerous advantages such as reduced morbidity, minimal soft tissue trauma, and superior aesthetic outcomes. Despite requiring specialized equipment and additional surgical training, EATA has significant potential to become a standard treatment modality for mandibular fractures. The findings of this study contribute to the growing body of evidence supporting the clinical benefits of this minimally invasive technique.