Severe asthma affects a minority of patients with asthma; however, it substantially impacts morbidity, health-care use, and systemic corticosteroid-related harm. Despite the increasing use of biological treatments, achievement of severe asthma remission remains elusive. Notably, real-world data on the disease burden and remission potential of severe asthma in Europe remain limited. We aimed to close this knowledge gap, offering insights with global relevance. Using data from 13 455 adults with severe asthma enrolled in the European Severe Heterogeneous Asthma Registry, Patient-centred Clinical Research Collaboration (SHARP CRC), this cross-sectional observational study evaluated the burden of severe asthma and remission-related clinical domains (exacerbations, asthma control, airflow limitation, and maintenance oral corticosteroid use) across Europe and examined their relationship with disease duration, biological therapy, and type 2 biomarkers (blood eosinophils, fractional exhaled nitric oxide [FeNO], and total IgE). Patients with severe asthma had been enrolled in national registries according to local principles and guidelines and in accordance with the European Respiratory Society/American Thoracic Society guidelines; 3% (430 of 13 885) of patients were excluded due to no consent for the international study and/or missing medication data. Patients were predominantly female (59%; 7999 of 13 453), with adult-onset asthma (82%; 8751 of 10 711), and a median disease duration of 23 years (95% CI 20-26 years). 59% (4148 of 7006) of patients had FEV1/FVC of 0·7 or less, 62% (4680 of 7568) had FEV1 lower than 80% predicted, and 89% (3519 of 3968) had at least one active disease domain. Despite 79% (10 632 of 13 453) receiving biological therapy, more than 66% (2621 of 3968) still had at least two active domains. Elevation of type 2 biomarkers persisted (89% [2806 of 3153] with at least one elevated biomarker) despite widespread biological and maintenance oral corticosteroid treatment. A subset of biologic-naive patients (35%; 1069 of 3018) exhibited a rapid accumulation of disease burden within less than 10 years, suggesting a potentially accelerated progression trajectory. This pan-European analysis of severe asthma revealed significant clinical heterogeneity and a substantial disease burden despite advanced therapies, highlighting the enduring nature of type 2 inflammation, the potential inadequacy of current remission strategies with available therapeutic approaches, and the necessity for early identification of high-risk patients. SHARP Clinical Research Collaboration and consortium partners: European Respiratory Society, GlaxoSmithKline Research and Development, Chiesi Farmaceutici Società per Azioni, Novartis Pharma Aktiengesellschaft, Sanofi-Genzyme Corporation, and Teva Branded Pharmaceutical Products R&D.
Oxidative stress, collagen synthesis, and inflammatory processes have a role in orthodontic movement of teeth. Vitamins C and E play supportive roles, but awareness among dental professionals might not be sufficient. This article aims to compare awareness of the role of vitamins C and E in orthodontic preventive care among Iraqi dental students and practitioners. This article aims to compare awareness of the role of vitamins C and E in orthodontic preventive care among Iraqi dental students and practitioners. A cross-sectional survey was conducted among a sample population of 490 respondents (234 undergraduates, 146 general and non-orthodontic practitioners, and 110 orthodontic practitioners). The survey questions covered the topics of awareness, behavior, perception, and attitudes. Data were analyzed using Chi-square and Kruskal-Wallis tests, with the level of statistical significance set at p = 0.05. The level of awareness was greatest in orthodontic practitioners (58.2%), followed by undergraduates (42.3%) and general practitioners (28.8%). Use of nutritional supplements was also not very common, and intake of vitamin C-rich foods was more often than vitamin E-rich foods. The most preferred method for vitamin administration was systemic supplementation; however, the lack of strong evidence remained the main concern regarding the administration of vitamins C and E. The attitudes of all groups were positive toward the incorporation of nutritional adjuncts in patient care and education. Orthodontic practitioners were the most aware of vitamins C and E in prevention care in orthodontics; students, general, and non-orthodontic dentists had significant gaps in their knowledge. Although there were positive attitudes toward the use of nutrition in education and patient care, there was limited use of supplements, and more robust evidence and improvement of the curriculum is necessary.
Silicone elastomers are widely used in prosthodontics and maxillofacial prosthetics for prosthetic rehabilitation. This study aimed to analyze the adhesion of Candida albicans on silicone elastomers at various concentrations of titanium dioxide (TiO2) nanoparticles. A total of 96 silicone elastomer specimens (N = 96) were prepared and divided into 6 groups (n = 16), incorporating TiO2 nanoparticles at concentrations of 0, 2, 2.5, 3, 3.5, and 4% by weight. 0% TiO2 nanoparticles served as a control. The specimens were submerged in artificial saliva and artificial nasal solutions. Candida albicans were incubated for 2 hours, after which the silicone specimens were rinsed to eliminate any nonadherent C. albicans. Subsequently, the stains were analyzed using scanning electron microscopy, and the adherence of C. albicans was calculated and compared among various groups. The results were compared using one-way ANOVA (analysis of variance) and multiple comparisons using one-way ANOVA with Tukey's Honestly Significant Difference post-hoc test. A p-value of 0.05 was considered a significant difference. The porosity and density of silicone elastomer materials, both with and without TiO2 nanoparticles, exhibited significant differences. In the samples immersed in artificial saliva, those with 0 and 3% concentrations of TiO2 nanoparticles exhibited the highest and lowest mean numbers of C. albicans, respectively. The samples immersed in artificial nasal secretion with the 0% concentration of TiO2 nanoparticles exhibited the highest number of C. albicans. The samples immersed in artificial nasal secretion with the concentrations of 4% TiO2 nanoparticles exhibited the lowest number of C. albicans. Within the limitations of this study, the incorporation of TiO2 nanoparticles influenced the surface characteristics and microbial adhesion of silicone elastomers. Silicone specimens containing TiO2 nanoparticles demonstrated reduced adherence of C. albicans compared with the control group, with the 4% TiO2 concentration showing the lowest fungal colonization in both artificial saliva and artificial nasal secretion. These findings suggest that TiO2 nanoparticle incorporation may enhance the antifungal properties of silicone elastomers used in prosthodontic and maxillofacial prosthetic applications.
This study aims to assess the opinions, attitudes, and perceptions of Thai dental students toward teledentistry; analyze the barriers to teledentistry adoption; and suggest the possibilities for strengthening the integration of teledentistry in undergraduate dental education in Thailand. A cross-sectional electronic study comprising 531 Thai dental students from 16 dental schools assessed four categories of teledentistry: opinions, practices, attitudes, and barriers. The students were categorized by their training stage: preclinical (years 2-3) and clinical (years 4-6), to analyze differences in perspective. Data were collected through a 35-item questionnaire with a binary response format. Chi-square tests and Cramer's V were utilized to examine relationships between binary and key variables, respectively, while binary logistic regression was employed to identify predictors of positive attitudes toward the use of teledentistry. Statistical significance was set at p < 0.05, and the analysis was conducted using SPSS. Students generally demonstrated positive perceptions of teledentistry, particularly regarding its role in improving access to oral healthcare and facilitating patient monitoring (p < 0.001). Factors significantly associated with the intention to use teledentistry included prior familiarity with the concept (Cramer's V = 0.162, p < 0.001), perceived cost-effectiveness (Cramer's V = 0.118, p = 0.006), interest in digital dental examinations (OR = 2.17, p < 0.001), belief in teledentistry as a future standard of oral healthcare delivery (OR = 2.01, p = 0.001), and the perception that it could increase the availability of dental services in underserved areas (OR = 1.83, p = 0.004). This first-time study offers a comprehensive overview of Thai dental students' perception toward teledentistry. While attitudes were generally positive, important barriers remain, including knowledge deficits, concerns about diagnostic accuracy, and data security. The findings highlighted the need for targeted educational strategies within undergraduate dental curricula to improve student preparedness for teledentistry, which in turn will support its broader integration into future dental practice in Thailand.
Oral mucositis is a frequent and debilitating adverse event observed in patients undergoing chemotherapy or radiotherapy. Current management strategies are limited in duration, require frequent application, and fail to address the mechanical irritation from teeth. A novel device, Soft Protector CPC, was developed to overcome these limitations. This multicenter, randomized, two-arm, open-label, confirmatory trial aims to evaluate the efficacy and safety of Soft Protector CPC in patients with breast cancer undergoing chemotherapy. A total of 154 participants will be randomly assigned in a 1:1 ratio to receive either oral care with Soft Protector CPC or oral care alone. The primary endpoint will be oral mucositis as assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 during the comparative treatment period. The secondary endpoints will include CTCAE v3.0 during the continuous treatment period, oral mucositis, pain (CTCAE v5.0), quality of life (Patient Reported Outcomes-CTCAE version 1.0 [PRO-CTCAE v1.0], the 15-item oral health questionnaire of the European Organization For Research And Treatment Of Cancer [EORTC QLQ-OH15], and the pain Numeric Rating Scale), onset and site of mucositis, completion of chemotherapy, use of rescue medications, technical feasibility, and patient preference. The safety endpoints will include adverse events, device malfunction, and laboratory tests. This trial is expected to establish the clinical utility of the Soft Protector CPC for the prevention and management of oral mucositis, with the potential to improve the patients' quality of life and adherence to cancer therapy. This study was approved by the Clinical Research Review Board and registered with the Japan Registry of Clinical Trials, jRCTs062250005, on April 18, 2025.
The nuclear protein Ki-67 and caspase-3 regulate cell proliferation and apoptosis as well as the preservation of tissue homeostasis in response to genetic and inflammatory signals that have a role in the pathogenesis of different conditions such as gingival overgrowth. Yet, the distinct pathogenesis of these lesions could be determined by variations in cellular homeostasis mechanisms. The aim of this study was to assess and compare the immunohistochemical expression of Ki-67 and caspase-3 in hereditary gingival fibromatosis (HGF) and inflammatory gingival hyperplasia (IGH), measure quantitative histopathological parameters, and investigate their association with the balance of proliferation and apoptosis underlying these different gingival overgrowth forms. An observational cross-sectional study involved 31 gingival biopsies collected from subjects with a history of recurrent gingival enlargement, 15 subjects (9 females and 6 males, 11-46 years) with moderate/severe IGH and 16 subjects with HGF (12 females and 4 males, 16-59 years) during gingivectomy and flap procedures. Anti-caspase-3 antibody and anti-Ki-67 antibody were utilized for immunohistochemistry staining. Imaging was performed at 400× magnification using a light microscope (Olympus BX51 model) equipped with an Olympus XC10-IR color camera; digital images were taken and saved in Joint Photographic Experts Group (JPEG) format. Computer-assisted image analysis was conducted using Q Path software version 0.5.1, an open-source software for digital pathology, to quantify marker expression in tissue sections. Mann-Whitney U-test evaluated expression levels; Spearman's correlation assessed biomarker association. Significance was set at p <0.05. The present finding revealed that the percentage of caspase-3-positive cells was higher in HGF (mean rank: 21.44) compared with IGH (mean rank: 10.20), with a statistically significant difference (U = 33.000, p < 0.001). Similarly, the H-score for caspase-3 expression was markedly elevated in HGF (mean rank: 21.25) compared with IGH (mean rank: 10.40), with a statistically significant difference (U = 36.000, p < 0.001). However, the proportion of Ki-67-positive cells was significantly greater in HGF (mean rank: 21.31) than in IGH (mean rank: 10.33), with a statistically significant difference (U = 35.000, p < 0.001). In contrast, the evaluation of optical density revealed higher values in IGH (mean rank: 20.07) compared with HGF (mean rank: 12.19); this difference was statistically significant (U = 59.000, p = 0.016). The findings of this study indicate that both groups reflect divergent pathobiological mechanisms. Specifically, HGF appears to involve genetically mediated tissue remodeling accompanied by compensatory apoptotic activity, while IGH is correlated with inflammation-driven, focally increased proliferation. Our results suggest that HGF and IGH should be regarded as biologically distinct entities.
To evaluate surface microhardness of three thermoplastic retainer materials (Essix PLUS Plastic, Zendura A, and Iconic Original) and to compare the effects of the thermoforming method (vacuum versus pressure) and subsequent thermocycling. This in vitro study tested 180 sheets (1.02 mm; n = 60/material). For each material, specimens were allocated to five conditions (n = 12/group): before thermoforming (BT), after vacuum thermoforming (AVT), after pressure thermoforming (APT), after vacuum thermoforming plus thermocycling (AVTT), and after pressure thermoforming plus thermocycling (APTT). Sheets were formed on a three-dimensionally printed maxillary cast using a vacuum former (Plast Vac P7) or a pressure-molding machine (Biostar), following the manufacturer's protocols. Formed sheets were cut into 9 × 13 mm specimens. For thermocycling, specimens were immersed in distilled water for 24 hours and thermocycled 1,500 cycles between 5°C and 55°C (20 s dwell per bath). STATISTICAL ANALYSIS:  Surface hardness was measured with a Vickers microhardness tester (100 g load for 15 s), and three indentations per specimen were averaged (VHN). SPSS v26 and GraphPad prism V11 were used. Normality and homogeneity were assessed (Shapiro-Wilk, Levene). Comparisons used one-way ANOVA with Tukey HSD, Dunnett's two-sided test versus BT, and independent samples t-tests. Zendura A showed the highest hardness, followed by Iconic Original and Essix Plus. Essix Plus showed no significant changes after thermoforming or thermocycling (p > 0.05). In Zendura A, pressure thermoforming increased hardness versus BT (p = 0.001); thermocycling increased hardness in the vacuum pathway (AVT→AVTT, p = 0.001). In Iconic Original, thermoforming reduced hardness versus BT (AVT and APT, p < 0.001), whereas thermocycling increased hardness within both, forming pathways (AVT→AVTT and APT→APTT, both p < 0.001). Vacuum versus pressure forming did not differ significantly before thermocycling for any material (p > 0.05). After thermocycling, differences were significant for Zendura A (AVTT > APTT, p = 0.030) and Iconic Original (APTT > AVTT, p = 0.031). Hardness is material-dependent and is influenced by thermoforming and thermal aging. Essix Plus was the most stable, while Zendura A and Iconic Original were more sensitive, with method-related differences becoming evident after thermocycling.
One of the causes of congenital cleft lip/palate abnormalities is maternal folic acid deficiency. A common issue during the first trimester is nausea, vomiting, and, in some cases, hyperemesis gravidarum, which can hinder optimal folic acid intake. The application of transdermal patches represents a significant advancement in systemic drug delivery through intact skin. This study aimed to formulate and evaluate a folic acid nanoparticle transdermal patch that effectively bypasses gastrointestinal absorption, addressing a critical need during the first trimester of pregnancy. The ionic gelation technique was utilized to produce folic acid nanoparticles derived from chitosan extracted from shrimp shells. Nanochitosan from shells is a natural polymer used in the encapsulation of the target active ingredient, folic acid. Characterization of nanoparticles was assessed with particle size analysis (PSA) and zeta sizing techniques, transmission electron microscope (TEM), Fourier transform infrared (FTIR), to examine a specific molecular structure and chemical bonding of the folic acid nanoparticles, and scanning electron microscope to assess its morphology. The transdermal patch was assessed for its organoleptic characteristics and various physicochemical properties. In vivo studies were conducted to evaluate skin permeation and potential irritation. The study successfully created a patch containing folic acid nanoparticles with an average size of 290.7 nm and a zeta potential of -18.7 mV. Organoleptic testing revealed that the patch was odorless, exhibited a clear yellow color, was flexible, was free of cracks, and maintained a moist texture. The physicochemical analyses indicated a pH of 6, an average weight variance of 0.280233 ± SD (0.0428345), a thickness of 0.0330 ± SD (0.01264), a moisture content of 37.1067% ± SD (4.20015%), and a folding resistance of up to 500 folds. Cumulative permeation results showed ∼30% absorption over 480 minutes. It is noteworthy that significant irritation was observed in four of the six animal test groups. This study has led to the development of an innovative folate-nanoparticle transdermal patch that exhibits promising morphological characteristics. However, additional research focusing on formulation and dosage optimization is required to achieve enhanced permeation and to minimize skin irritation before initiating clinical studies.
This pilot trial was designed to investigate the efficacy of propolis-based gel in the treatment of primary herpetic gingivostomatitis in children and assessed salivary IFN-γ levels before and after treatment to reflect the anti-inflammatory action of propolis, as IFN-γ is one of the principle cytokines involved in the disease pathogenesis. A total of 60 patients were randomized using a computer-generated sequence and allocated into the two study groups: intervention group treated with 5% propolis gel and placebo group treated with placebo mucoadhesive gel. Both were applied on the oral lesion two to three times daily for 1 week. At follow-up visit after 7 days, the following parameters were measured; severity of clinical lesions, pain assessment using visual analog scale, salivary IFN-γ levels using ELISA, as well as eating and drinking ability. Results revealed a statistically significant difference in pain scores, clinical severity scores, and the ability to eat and drink between the propolis and placebo groups on the 7th day of treatment (p ≤ 0.001, each). Furthermore, values for salivary IFN-γ showed statistically significant differences between the propolis and placebo groups on the 7th day of treatment (p ≤ 0.001). Moreover, in the propolis group, there were statistically significant differences in all clinical parameters, including pain scores, clinical severity scores, and the ability to eat and drink, as well as IFN-γ levels before and after treatment (p ≤ 0.001, p ≤ 0.001, 0.014, and p ≤ 0.001, respectively). In the placebo group, although there was a statistically significant reduction in pain scores, the ability to eat and drink, and salivary IFN-γ level before and after treatment (p ≤0.001 and p = 0.033 and 0.013, respectively), but there was no statistically significant difference in scores of clinical severities before and after treatment (p = 0.099). Propolis showed promising therapeutic effects that could avoid the mishaps of the currently used medications for the management of primary herpetic gingivostomatitis in children.
The current study aimed to evaluate and compare the microtensile bond strength (µTBS), nanoleakage, and micromorphological characteristics of six universal adhesives (UAs) applied in self-etch (SE) mode to dentin. The occlusal one-third of 60 freshly extracted intact human molars was removed, and the exposed surfaces were treated with one of the six UAs (Gluma Bond [GB], Zipbond Universal [ZB], Scotchbond Universal Plus [SB + ], Single Bond Universal [SB], Futurabond U [FB], or OptiBond eXTRa Universal [OB]) in SE mode (n = 10). After resin composite build-up (Tetric N Ceram Bulk-Fill), specimens were subjected to 5,000 thremocycles and stored in artificial saliva in an incubator for 24 h. For each group, composite resin-dentin beams were prepared (n = 56) from seven specimens and the µTBS test was performed. The failure patterns of the debonded specimens were investigated using a stereo binuclear microscope (x = 30). Data were analyzed using one-way ANOVA and Tukey's significant difference (HSD) tests at a significance level of p < 0.05. The remaining specimens from each group (n = 3) were sectioned in mesio-distal direction. Buccal sections were immersed into ammoniacal silver nitrate followed by a photodeveloper under a fluorescent light and then investigated using scanning electron microscope (SEM) in backscattered mode. Lingual sections were used for assessing the micromorphological pattern of adhesive-dentin interface using SEM in secondary electron mode. One-way ANOVA test indicated a significant difference in the microtensile bond strength among the types of the tested adhesives (p < 0.05). SB+ demonstrated the highest bond strength among all tested adhesives (p < 0.05). SB also showed significantly higher bond strength compared with the other tested adhesives, except for OB (p = 0.317). No statistically significant differences were observed among FB, GB, ZB, and OB (p > 0.05). Regarding nanoleakage patterns, GB showed the highest degree while the lowest nanoleakage pattern was exhibited in OB. Resin-dentin interface exhibited the highest massive amount of resin tags in SB+ and the least amount of resin tags in FB followed by ZB. Based on the extracted results, UA bonding performance was material dependent. The number and depth of resin tags were found to correlate with bond strength, whereas nanoleakage patterns showed no such correlation.
To evaluate the short-term effects of professional scaling and polishing on nine oral health and dental aesthetic outcomes in current smokers and never smokers. A total of 371 participants from the SMILE Study Cohort (305 smokers and 66 never smokers) were assessed at baseline (V0) and 14 days after scaling and polishing (V1). Outcomes included Modified Gingival Index (MGI), quantitative light-induced fluorescence parameters (ΔR30, reflecting the percentage of tooth surface covered by mature plaque, and ΔR120, reflecting the percentage covered by thicker deposits including calculus), MacPherson-modified Lobene Stain Index (MLSI) for buccal and lingual surfaces, Whitening Index for Dentistry (WID), Simple Oral Hygiene score (SOH), oral health-related quality of life (OHQoL), and general health perception (EQ-VAS). Linear mixed model analysis was used for between-group comparisons of V0-V1 changes. At baseline, smokers exhibited significantly worse values across all objective indices. Following intervention, significant improvements were observed in MGI, ΔR30, ΔR120, MLSI, and SOH in both groups (p<0.0001). MGI improved by a median of -0.5 units in smokers (IQR: -0.8/-0.2) and -0.08 units in never smokers (IQR: -0.3/-0.02); the magnitude of improvement was significantly greater in smokers (p<0.0001). Similarly, greater reductions in ΔR120 (p=0.010), buccal MLSI (p<0.0001), and lingual MLSI (p<0.0001) were observed in smokers compared to never smokers. WID showed no significant changes in either group. OHQoL improved slightly without between-group differences; EQ-VAS did not change significantly. Professional scaling and polishing produced consistent short-term improvements in objective oral health indicators in both smokers and never smokers, with greater gains among smokers reflecting their higher baseline burden. Regular professional mechanical plaque removal is clinically beneficial for smokers, producing measurable short-term improvements in gingival and aesthetic parameters even in the presence of ongoing tobacco exposure, although smoking cessation remains essential for long-term oral health.
Airway-centric orthodontics has been proposed as a conceptual framework that extends the traditional understanding of craniofacial development, functional disturbances, and orthodontic treatment outcomes beyond a purely dental perspective. This approach focuses on the potential interplay among upper airway characteristics, breathing patterns, and orofacial muscle function in influencing facial growth and occlusal relationships. This narrative review aims to outline the theoretical foundations of airway-centric orthodontics and to synthesize current evidence regarding the associations among upper airway characteristics, craniofacial morphology, and orthodontic interventions. A comprehensive search was conducted across major scientific databases, including PubMed, Scopus, Web of Science, ScienceDirect, SpringerLink, and the Cochrane Library, with additional relevant publications identified through Google Scholar to ensure broader coverage of the available literature. Current evidence suggests associations among variations in nasal airflow, breathing patterns, pharyngeal airway constriction, and maxillofacial growth, which would result in class II patterns, vertical disproportions, and various developmental anomalies. Current evidence primarily supports morphologic airway changes following orthodontic and orthopedic interventions, particularly on CBCT-based assessment, whereas consistent functional respiratory improvements remain less clearly established. Although increasing evidence highlights the potential relevance of airway considerations in orthodontic diagnosis, existing findings are characterized by methodological heterogeneity and limited long-term data. Therefore, airway-related treatment effects should be interpreted with caution. Incorporating airway assessment into clinical evaluation may provide additional diagnostic insight; however, further well-designed longitudinal and three-dimensional studies are required to clarify the clinical significance and functional implications of these observations.
This study aimed to evaluate the influence of printing orientation and surface treatment on the surface roughness, shear bond strength (SBS), and flexural strength of 3D-printed provisional resin materials under laboratory conditions. Four printing orientations (0, 45, 60, and 90°) and four surface treatments (no treatment, airborne particle abrasion, tetrahydrofuran, and HC primer) were investigated. A total of 320 specimens were fabricated and tested according to ISO standards. Of these, 240 disk-shaped specimens were used for surface roughness assessment, conducted using a non-contact profilometer, and for SBS evaluation through a notched-edge shear test. Additionally, 80 rectangular bar specimens were subjected to three-point bending for flexural strength assessment. Fracture morphology was examined using scanning electron microscopy (SEM). Normality and homogeneity of variance were verified using the Kolmogorov-Smirnov and Levene's tests. Surface roughness and SBS were analyzed using two-way ANOVA with Tukey's post hoc test, while flexural strength was analyzed using one-way ANOVA (α = 0.05). Printing orientation and surface treatment significantly affected the tested properties. Surface roughness varied according to orientation and treatment, with the 45° orientation exhibiting higher Ra values compared with other orientations. SBS values differed significantly among surface treatments and orientations, with higher bond strength observed in specimens treated with HC primer at 60°. Flexural strength was significantly greater at 60° compared with 90°. SEM analysis revealed more homogeneous interlayer integration at 60° and evident interlayer separation at 90°. Within the limitations of this in vitro study, printing orientation and surface treatment significantly affected the surface and mechanical properties of the tested 3D-printed provisional resin. A 60° printing orientation combined with chemical surface conditioning demonstrated favorable laboratory performance. Further studies incorporating aging and fatigue protocols are required to confirm these findings.
The aim of the study is to assess the effectiveness of web-based pathology modules and virtual slides in teaching oral pathology to third-year undergraduate dental students at the College of Dental Medicine, Rangsit University. Virtual slides and web-based learning modules of selected oral and maxillofacial diseases were created. Students were randomly allocated into three study groups based on their pretest scores. After completing each module, post-test was administered. Pre-test and post-test scores were compared between groups. In addition, all students completed a satisfaction survey. A total of 119 dental students participated in the study. Significant improvement between pre-test and post-test scores was observed in all groups. The majority of the participants preferred virtual slides over conventional glass slides. High satisfaction with the virtual slides and the oral pathology modules was observed. The incorporation of virtual slides and web-based learning modules for oral pathology learning in undergraduate study is effective and well accepted. This development could be utilized to improve the efficacy of oral pathology teaching, ultimately leading to more understanding, enhanced basic knowledge, and improved clinical skills for dental students and future dentists.
The objective of this systematic review with individual participant data (IPD) meta-analysis evaluated treatment outcomes of intraosseous odontogenic myxoma (OM) across different surgical modalities, focusing on recurrence rate associated with each approach. Secondary objectives included synthesizing epidemiological, clinical, radiographic, and histopathologic variables of prognostic significance to provide an evidence base for optimizing surgical decision-making and postoperative surveillance strategies. This study was conducted per PRISMA guidelines, and registered in the PROSPERO. A systematic search was conducted across MEDLINE, Embase, Scopus, and Web of Science databases for English-language articles published from January 1950 to present. Eligibility criteria included human subjects with a confirmed diagnosis of intraosseous OM, odontogenic myxofibroma, or odontogenic fibromyxoma. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute tools. This study utilized IPD analysis rather than aggregate effect-size meta-analysis. Statistical analyses involved descriptive statistics, comparative tests, and logistic regression to estimate odds ratios (OR) for potential prognostic factors. Eighty-three studies comprising 187 patients were included. The population predominantly consisted of OM, followed by odontogenic myxofibroma and odontogenic fibromyxoma. The overall recurrence rate was 14.4%. The analysis showed a significant difference in outcomes between treatment modalities. Surgical resection demonstrated a 5.5% recurrence rate, while conservative management with and without additional modalities (peripheral ostectomy and/or chemical cauterization) showed 14.3 and 25.3% recurrence, respectively (p = 0.001, OR [95% CI] = 0.17 [0.06 - 0.48]). Age, sex, tumor location, and histopathologic subtype did not show statistically significant associations with recurrence. However, age less than 15 years, tumor size larger than 6 cm, and multilocular radiographic patterns demonstrated a trend toward higher recurrence risk (OR [95% CI] = 1.90 [0.76-4.77], 1.70 [0.14-20.42], and 1.42 [0.58-3.45], respectively). Surgical resection provides significantly superior disease control for intraosseous OM compared to conservative management. While histopathological subtypes do not influence prognosis, clinical features such as large tumor size and multilocular presentation, suggest a need for more aggressive intervention. Due to potential confounding by indication, results are associative rather than casual. Nevertheless, the high recurrence risk in conservative therapies necessitates rigorous, extended, long-term radiographic surveillance for non-radical approaches.
This study aimed to evaluate the accuracy, consistency, and scientific reliability of two AI-powered chatbots-ChatGPT-3.5 and ChatGPT-4o-in clinical endodontic decision-making, using the recently published European Society of Endodontology (ESE) S3-level Clinical Practice Guideline as the gold standard reference. Twenty-five dichotomous (yes/no) questions were developed based on the ESE guideline and presented to both chatbots across three time intervals, yielding 300 total responses. Each response was evaluated for accuracy and consistency, and the quality of the supporting references was assessed according to their journal ranking (Q1, Q2, others). Both ChatGPT versions demonstrated high internal consistency across repeated measurements. ChatGPT-3.5 showed 94.4% agreement (κ = 0.824; 95% confidence interval [CI]: 0.786-0.898; p < 0.001), whereas ChatGPT-4o demonstrated 98.9% agreement (κ = 0.937; 95% CI: 0.893-0.965; p < 0.001). The accuracy of ChatGPT-3.5 relative to the guideline-based answers was 81.4%, 88.9%, and 82.2% in the morning, afternoon, and evening sessions, respectively, while ChatGPT-4o achieved 82.9%, 83.3%, and 85.4%, respectively. No statistically significant differences were observed between the models across the three time intervals (p > 0.05). The proportion of Q1/Q2-ranked references was high and comparable between ChatGPT-3.5 (74-82%) and ChatGPT-4o (76-84%). Both ChatGPT-3.5 and ChatGPT-4o demonstrated substantial alignment with the ESE S3-level clinical practice guideline. However, these findings should not be interpreted as definitive assessments of current clinical conversational AI systems, and further evaluation of evolving models is required.
Disinfection protocols are essential for maintaining hygiene in occlusal devices, yet they may compromise material properties, affecting clinical performance. The influence of different disinfectants across various material types remains insufficiently understood. In this study, we aimed to evaluate the effects of disinfectants, material types, and their interactions on changes in color stability (∆E), Vickers microhardness (∆VHN), and surface roughness (∆Ra) of occlusal devices, with the goal of informing evidence-based disinfection protocols for long-term maintenance. A total of 168 specimens were fabricated from six occlusal device materials: self-cured (SC), heat-cured (HC), two milled (ML-A, ML-B), and two 3D-printed (3D-A, 3D-B) types. Specimens were aged in distilled water at 37 °C for 45 days and assigned to daily 15-minute conditions of dry storage (control) or immersion in liquid soap (LS), chlorhexidine (CHX), or denture cleanser (DC). Color stability, Vickers microhardness, and surface roughness were measured before and after immersion, and ΔE, ΔVHN, and ΔRa were calculated to determine the changes. Two-way ANOVA evaluated the effects of disinfectant type, material type, and their interaction. One-way ANOVA with Tukey's post hoc test compared disinfectants within each material group. Significance was set at p < 0.05. Disinfectants and material types significantly affected ΔE, ΔVHN, and ΔRa (p < 0.05). ML-A, 3D-A, and 3D-B showed greater discoloration (higher ∆E), particularly after immersion in LS and CHX. SC, 3D-A, and 3D-B materials immersed in CHX and DC demonstrated increased microhardness (higher ΔVHN), while HC, ML-A, and ML-B materials showed minimal change or slight softening. Surface roughness alterations were minimal (low ΔRa) and remained within clinically acceptable limits. Certain disinfectants increased discoloration and microhardness in a material-dependent manner, whereas surface roughness showed no clinically relevant change. Clinicians should tailor disinfection protocols according to material type to preserve long-term performance.
To systematically investigate the comprehensive spectrum of dental features across a well-characterized cohort of individuals harboring pathogenic CHD7 variants, and to explore the spatial expression pattern of CHD7 in craniofacial tissues using an in situ hybridization model to support the biological relevance of the observed phenotypes. We performed a multi-case analysis (n = 9 pediatric patients; 7 M, 2 F; 1-18 years) with confirmed pathogenic/likely pathogenic CHD7 variants recruited. Genetic analysis utilized whole genome or exome sequencing. In situ hybridization in embryonic mouse models mapped CHD7 expression in craniofacial and dental primordia. All patients presented with systemic CHD7-related features. Dental anomalies were frequent and diverse: cleft lip/palate (n = 2), tooth agenesis (n = 2), microdontia (n = 1), and malocclusion (n = 6). Notably, novel findings included the identification of odontoma or unexplained radiopaque lesions in two distinct cases. Genetic analysis identified seven novel CHD7 variants (two de novo). Murine in situ hybridization confirmed CHD7 expression in mandibular and dental primordia, supporting its role in odontogenesis. We suggest that CHD7-related disorders may be associated with a broader spectrum of dental anomalies, including potentially underrecognized features. Dental assessments, including oral and radiographic examinations, may serve as adjunctive indicators and support further clinical and genetic investigation.
Pain is the most prevalent adverse experience among orthodontic patients, especially following stainless steel (SS) archwire placement. This randomized controlled trial aims to evaluate the short-term effects of chewing gum on self-reported pain, analgesic medication usage, and appliance breakages associated with the use of SS archwires. Forty-four female participants aged 20 to 40 years undergoing fixed appliance therapy were allocated in equal numbers to either the chewing gum (CG) or the control (NC) group. Participants in the CG group were instructed to chew sugar-free gum for a standardized duration of 5 minutes immediately after SS archwire placement, and to repeat this at 12-hour intervals over the subsequent 3 days. Self-reported pain was documented using a visual analogue scale at eight predefined time points: baseline (prior to SS archwire placement), immediately after placement (0 hours), and at 12, 24, 36, 48, 60, and 72 hours. Analgesic consumption and orthodontic appliance breakages were recorded during the 3-day period. Changes in pain intensity across time and between groups were analyzed using one-way repeated-measures ANOVA (analysis of variance). Participants in the NC arm reported significantly greater pain levels than those allocated to the CG arm at 0, 12, and 24 hours following archwire placement. A significant main effect of group was observed (p = 0.023), with lower overall mean pain scores in the CG group (0.83 [standard error, SE: 0.31]) compared with the NC group (1.86 [SE: 0.30]), corresponding to a mean difference of -1.03 (95% confidence: -1.90 to -0.15). Pain levels in both groups peaked within the first 24 hours and declined thereafter over the 3-day period. Analgesic use and appliance-related breakages did not differ between groups during the study period. Sugar-free CG may offer a modest analgesic benefit during the early post-placement period following SS archwire placement in female adult orthodontic patients, without influencing analgesic consumption or increasing the risk of appliance-related breakages.
The increasing demand for aesthetic dental treatments has led to widespread use of resin composites and in-office bleaching procedures. This study evaluated the effect of 35% hydrogen peroxide bleaching on the surface roughness, microhardness, wear, and color stability of three commercially available resin composites representing distinct material categories: short fiber-reinforced (everX Posterior), zirconium silicate-reinforced nanohybrid (Vittra APS), and shade-adaptive nanohybrid (Harvard MultiChrome). A total of 240 disc-shaped specimens were prepared (n = 80 per material) and divided into bleached and non-bleached groups. The bleaching protocol consisted of three 20-minute applications of 35% hydrogen peroxide gel in a single session. Surface roughness (Ra, μm), Vickers microhardness (VHN), and wear (μm) were assessed using optical and mechanical testing methods. Color changes (ΔE00) were measured using an intraoral spectrophotometer. Independent t-tests and ANOVA with Tukey's HSD post-hoc test were used for statistical analysis (α = 0.05). Bleaching significantly increased surface roughness only in Vittra APS (0.245 ± 0.01 to 0.266 ± 0.03 μm, +8.6%, p = 0.015), while everX Posterior (+3.1%, p = 0.09) and Harvard MultiChrome (+2.9%, p = 0.38) remained unchanged. Microhardness significantly decreased in everX Posterior (84.3 ± 1.42 to 78.6 ± 2.32 VHN, -6.8%, p = 0.0001) and Vittra APS (81.2 ± 2.22 to 77.0 ± 5.69 VHN, -5.2%, p = 0.003), whereas Harvard MultiChrome showed no significant change (-3.2%, p = 0.18). Wear significantly increased in Vittra APS (+30.0%, p = 0.02) and Harvard MultiChrome (+25.9%, p = 0.03), while everX Posterior remained unaffected (+3.1%, p = 0.47). All materials exceeded the clinical acceptability threshold for color change (ΔE00 > 1.8): Harvard MultiChrome (3.8 ± 1.4), Vittra APS (10.6 ± 1.0), and everX Posterior (10.9 ± 4.6) (p ≤ 0.05). Harvard MultiChrome demonstrated relatively less degradation, while everX Posterior showed superior wear resistance. However, none maintained clinically acceptable color stability after bleaching. Mechanical alterations were modest; color changes were clinically unacceptable for all materials. Shade-adaptive composites remain underrepresented, and findings require cautious interpretation pending further studies.