Journal of Dental Research

Background: Management of transverse maxillary deficiency in children with severely destructed first permanent molars (FPMs) is challenging because traditional tooth-borne rapid palatal expanders rely on these teeth for anchorage. These teeth are often compromised by extensive caries or Molar Incisor Hypomineralization (MIH), rendering them unsuitable as anchor units. Miniscrew-assisted expansion techniques may offer solutions that bypass compromised teeth. Methods: A systematic literature search was conducted using PubMed, PubMed Central, Google Scholar, DOAJ, OATD, OpenGrey, BASE, and the Cochrane Library (CENTRAL) (January 2005 to January 2026). Citation tracking and reference screening supplemented the search. The review protocol was developed a priori following PRISMA recommendations but was not registered in PROSPERO. Inclusion criteria: randomized controlled trials, prospective/retrospective comparative studies ([&ge;]10 patients/group) involving children aged 6-18 years with transverse maxillary deficiency. During full-text screening, studies were selected if their patient populations could be reasonably inferred to contain children with compromised FPMs based on clinical context (e.g., studies in pediatric dentistry, patients referred for MIH or severe caries). Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and ROBINS-I for non-randomized studies. Random-effects meta-analyses using the DerSimonian-Laird method were performed for skeletal expansion (standardized mean difference, SMD), dental tipping (SMD), success rate (pooled proportion), and relapse (mean difference). Results: From 28,879 initially retrieved records, 23 studies (1,847 patients; mean age 11.4 +/- 2.3 years) were included after screening; 16 contributed to meta-analyses. Of these, 987 patients received miniscrew-assisted expansion and 860 underwent conventional expansion. Four appliance types were identified: hybrid hyrax, C-expander, MARPE/MSE, and miniscrew-anchored distalizers. Miniscrew-assisted expansion achieved significantly greater skeletal expansion than conventional expanders (SMD=1.24; 95% CI: 0.89 to 1.59; p<0.001; I2=58%). Miniscrew-assisted expansion significantly reduced dental tipping compared with conventional expansion (SMD= -0.98; 95% CI: -1.42 to -0.54; p<0.01; I2=51%). MARPE appliances demonstrated a pooled success rate of 93.9% (95% CI: 89.7% to 97.2%; I2=41%). Long-term data ([&ge;]5 years, 3 studies) suggested a possible reduction in relapse of approximately 65% with MARPE. Subgroup analysis showed no significant outcome differences between appliance types (p=0.24). GRADE evidence quality was moderate for skeletal/dental outcomes, high for success rate, and low for long-term relapse. Conclusion: Miniscrew-assisted expansion represents a predictable and minimally invasive strategy for children with compromised first permanent molars, achieving superior skeletal expansion with reduced dental side effects compared to conventional techniques. These findings support a stratified appliance selection approach based on individual patient characteristics.

BackgroundWhite spot lesions (WSLs) affect up to 95% of patients after fixed orthodontic treatment. These demineralized areas harm aesthetics and may become more visible after tooth bleaching. Resin infiltration offers a micro-invasive masking technique. ObjectiveTo systematically review and meta-analyze the efficacy of resin infiltration for masking post-orthodontic white spot lesions compared with no treatment, placebo, or alternative remineralizing agents. MethodsWe followed PRISMA 2020 guidelines. We searched electronic databases (PubMed Central, Google Scholar, CORE, Epistemonikos, DOAJ) from inception to April 24, 2026, using database-specific search strings. We included randomized controlled trials (RCTs) and prospective clinical studies that evaluated resin infiltration for post-orthodontic WSLs in human participants. The primary outcome was change in lesion visibility. Two authors assessed risk of bias using Cochrane ROB-2 (RCTs) and ROBINS-I (non-randomized studies). We performed a random-effects meta-analysis using R (version 4.3.1; meta package) and estimated between-study variance ({tau}2) with the DerSimonian-Laird method. ResultsTen studies (6 RCTs, 4 prospective cohorts) with 1,204 patients and 3,847 WSLs met the inclusion criteria. Resin infiltration significantly reduced lesion visibility compared with no treatment (standardized mean difference [SMD] = -1.78; 95% CI: -2.24 to -1.32; p < 0.001; I2 = 65%) and compared with fluoride varnish (SMD = -1.42; 95% CI: -1.82 to -1.02; p < 0.001; I2 = 48%). The effect remained stable at 12-24 months. Patient satisfaction ranged from 84% to 94%. Mild transient sensitivity (11%) was the only reported adverse event. Funnel plot inspection showed no obvious small-study effects. ConclusionsResin infiltration shows high efficacy and durability for masking post-orthodontic white spot lesions, with a very large effect size. Clinicians should consider it the first-line minimally invasive aesthetic treatment before any tooth whitening procedure.

Aim: Cross-sectional summaries of periodontitis based on clinical attachment loss (CAL) are, by definition, conditioned on surviving teeth. Because the most severely affected teeth are more likely to have been lost, these measures may underestimate cumulative disease burden and show an artificial flattening (attenuation) of severity with age. We hypothesised that measures more sensitive to severe attachment loss would show greater attenuation at older ages than measures defined across a broader range of sites. Materials and Methods: Using nationally representative data from adults aged 30+ years in NHANES 2009-2014, we examined age-specific trajectories across multiple continuous measures of periodontal severity and assessed whether divergence between measures followed the pattern predicted under severity-dependent tooth loss. Results: The proportion of observable sites declined from 93% at ages 30-34 to 68% at 80+ years, establishing the structural basis for the divergence observed across severity measures. All severity measures showed nonlinear attenuation with age, with distortion increasing with severity threshold. Higher-threshold measures exhibited the greatest attenuation, while lower-threshold measures showed more stable trajectories. Conclusions: Cross-sectional summaries of periodontitis reflect disease among surviving teeth rather than cumulative damage across teeth originally at risk. Attenuation at older ages is consistent with depletion of the most severely affected teeth rather than biological slowing. Distortion varies by measure, with higher-threshold and mean-based indices most affected, whereas the CAL 3+ mm threshold provides a more stable basis for age comparisons.

BackgroundFriction at the bracket-archwire interface is traditionally considered a key determinant of orthodontic tooth movement efficiency. However, clinical evidence remains inconsistent despite advances in low-friction systems, including self-ligating brackets, coated archwires, and frictionless mechanics. ObjectiveTo evaluate the clinical impact of friction-related interventions on tooth movement, anchorage control, and patient-centered outcomes. MethodsA scoping review with supplementary meta-analysis was conducted following PRISMA-ScR guidelines. Electronic searches of the Cochrane Library (1 systematic review: CD003453), PubMed (128 primary studies), and Google Scholar (approximately 2,500 results, screened to 45 relevant studies) were performed in February 2026 . Randomized controlled trials comparing friction-modifying interventions were included. Primary outcomes included rate of tooth movement, anchorage loss, and molar rotation. Secondary outcomes included pain and treatment duration. Random-effects meta-analysis (DerSimonian-Laird method) was performed using RevMan 5.4; this method was chosen due to expected clinical heterogeneity . Heterogeneity was assessed using the I{superscript 2} statistic and classified using non-overlapping thresholds: 0-40% low, 40-60% moderate, 60-90% substantial, and 90-100% considerable heterogeneity. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was evaluated using GRADE. Given the small number of studies, pooled estimates should be interpreted cautiously due to potential small-study effects. ResultsNineteen RCTs were included in quantitative synthesis. Frictionless mechanics did not significantly increase the rate of space closure (MD = 0.15 mm/month; 95% CI: -0.08 to 0.38; P = 0.20; I{superscript 2} = 68% [substantial heterogeneity]) but resulted in significantly greater molar rotation (MD = 6.1 degrees; 95% CI: 4.8 to 7.4; P < 0.001; I{superscript 2} = 45% [moderate heterogeneity]) . Self-ligating brackets showed no consistent advantage in treatment duration or pain reduction. Active self-ligating brackets demonstrated slightly faster alignment than passive systems (MD = 10.24 days; 95% CI: 2.80 to 17.68). Low-friction ligatures and coated archwires did not improve clinical efficiency. Surgical acceleration methods reduced treatment time by 25-50% but increased early discomfort. Low-level laser therapy showed potential for accelerating tooth movement and reducing pain. ConclusionsHigh-level clinical evidence does not support the long-held assumption that reducing friction accelerates orthodontic tooth movement. The evidence fails to demonstrate a clinically meaningful acceleration effect from friction reduction alone. Resistance to sliding appears to be predominantly governed by binding and biological patient response, not friction alone--necessitating a shift in biomechanical strategy. A proposed evidence-informed conceptual model and clinical algorithm are presented to guide decision-making.

Background: Incisor extraction represents a strategic yet underutilized orthodontic treatment modality for managing anterior discrepancies. Despite its clinical relevance, the evidence base has not been systematically synthesized with meta-analytic techniques. Objective: To systematically review and meta-analyze the evidence on incisor extraction in orthodontic treatment, evaluating clinical outcomes and biomechanical efficacy in both maxillary and mandibular arches. Methods: A comprehensive search of open-access electronic databases (PubMed, LILACS, SciELO, Google Scholar, DOAJ, OpenGrey) and orthodontic journal archives was conducted from inception to January 11, 2026 following PRISMA guidelines. Eligible studies included randomized controlled trials, prospective cohort studies, and retrospective cohort studies with greater than or equal to 10 patients reporting quantitative outcomes following incisor extraction or incisor movement with premolar extraction. Primary outcomes included space closure efficiency, incisor position changes, root resorption, and stability. Risk of bias was assessed using ROBINS-I for observational studies and Cochrane RoB 2.0 for RCTs. Certainty of evidence was evaluated using GRADE. Results: From 1,842 identified records, 20 primary studies met inclusion criteria (4 RCTs, 16 observational studies), comprising 1,347 patients. Sixteen studies provided data for meta-analysis. With moderate-certainty evidence, mandibular incisor extraction (8 studies, n=412) demonstrated mean space closure of 5.2 mm (95% CI 4.8 to 5.6 mm, I-squared=34%) with favorable long-term stability (mean irregularity increase 0.3 mm, 95% CI 0.1 to 0.5 mm, I-squared=28%). Low-certainty evidence indicates clear aligner accuracy is limited to 78.9% of predicted incisor tip movement (3 studies, n=187, 95% CI 72.3 to 85.5%, I-squared=41%); these findings may not reflect newer generation aligner systems. Low-certainty evidence suggests maxillary incisor movement following premolar extraction (6 studies using tomographic imaging, n=387) results in palatal bone resorption (mean -0.43 mm, 95% CI -0.62 to -0.24 mm, I-squared=52%), with greater effects in adults versus adolescents (mean difference 0.31 mm, p = 0.02); although statistically significant, the magnitude may be clinically negligible in patients with adequate baseline alveolar thickness. Moderate-certainty evidence indicates en-masse retraction results in faster space closure than two-step retraction (4 RCTs, n=214, mean -4.2 months, 95% CI -5.8 to -2.6 months). Moderate-certainty evidence shows root resorption incidence is 12.4% (95% CI 8.7 to 16.1%), with subgroup analysis: greater than 2 mm threshold 13.2% (7 studies), at least one-quarter root length threshold 11.4% (5 studies). Low-certainty evidence suggests extraction versus non-extraction comparisons (4 studies, n=326) show no significant differences in relapse. Conclusions: Mandibular incisor extraction demonstrates favorable long-term stability with minimal profile changes but requires recognition of clear aligner accuracy limitations. Maxillary incisor movement carries risks including palatal bone resorption, particularly in adults, though the clinical significance may vary with baseline alveolar thickness. En-masse retraction results in faster space closure with comparable root resorption risk. Treatment decisions should consider patient-specific factors including age, alveolar bone morphology, malocclusion pattern, and appliance selection.

BackgroundThe microbial aetiology of early childhood caries (ECC) in sub-Saharan African populations remains poorly characterised, with most studies focusing on conventional cariogenic pathogens like Streptococcus mutans. This study aimed to characterise the salivary microbial profile of children with ECC in urban Kano, northern Nigeria. MethodsIn this cross-sectional study of 162 children aged 3-5 years in urban Kano, unstimulated saliva samples were collected and analysed using standard bacteriological culture methods. Caries status was assessed using decayed, missing, and filled teeth (dmft) index and International Caries Detection and Assessment System (ICDAS). Microbial isolates were identified through Gram staining, colony morphology, and biochemical tests (catalase, coagulase, oxidase). ResultsOf 32 microbial isolates obtained, Staphylococcus aureus was the most prevalent (43.8%, n=14), followed by Streptococcus species (28.1%, n=9), Klebsiella species (12.5%, n=4), non-aureus staphylococci (6.3%, n=2), yeast (6.3%, n=2), and Pseudomonas species (3.1%, n=1). Only one isolate demonstrated direct association with dmft-detectable caries. Polymicrobial colonisation occurred in four cases (12.5%), predominantly featuring S. aureus-yeast combinations (n=2). White spot lesions (ICDAS 1-2) were associated with S. aureus and Klebsiella species in two separate cases. ConclusionThis study reveals an unexpected predominance of S. aureus in the salivary microbiome of children in northern Nigeria, challenging conventional paradigms of ECC microbiology. The low correlation between microbial isolates and clinical caries suggests complex, multifactorial aetiology. These findings highlight the need for molecular characterisation of oral microbiomes in African populations and reconsideration of caries pathogenesis models in this unique epidemiological context.

Background: Periodontitis is defined by cumulative, irreversible tissue destruction, yet population-based measurement typically relies on cross-sectional indicators derived from retained teeth. Destruction that occurred earlier in life, particularly disease severe enough to result in tooth loss, is structurally excluded from these measures, potentially leading to systematic underestimation of lifetime periodontal burden. Objective: To develop and evaluate a measurement framework that estimates lifetime periodontal burden from cross-sectional data by explicitly incorporating informative tooth loss under etiological uncertainty. Methods: Data were drawn from 10,324 adults aged [&ge;]30 years participating in the 20090-2016 National Health and Nutrition Examination Survey (NHANES) who completed full-mouth periodontal examination and glycated hemoglobin (HbA1c) testing. Lifetime periodontal burden was estimated by combining observed clinical attachment loss in retained teeth with probabilistic contributions from missing teeth, using three alternative age-stratified attribution schedules derived from epidemiological studies of periodontal extraction. Performance was compared with conventional measures of periodontal severity and extent using distributional analyses, correlations with HbA1c, discrimination of diabetes status, and relative importance analysis. Age-adjusted models were treated as sensitivity analyses. Results: Estimated lifetime periodontal burden exhibited strong, monotonic age gradients across glycemic categories, in contrast to more attenuated patterns observed for severity and extent. Across attribution schedules, lifetime burden showed stronger correlations with HbA1c ({rho} = 0.30-0.32) than conventional measures. In multivariable models including all indices, lifetime burden retained an independent association with HbA1c, whereas severity and extent contributed little unique information. Discriminative performance for diabetes status was consistently higher for lifetime burden than for conventional measures and remained stable across attribution schedules. Conclusions: Lifetime periodontal burden can be estimated from cross-sectional data by explicitly modelling informative tooth loss rather than restricting measurement to retained teeth. Incorporating historical tissue loss under uncertainty yields a more coherent representation of cumulative periodontal destruction than snapshot-based measures and provides a methodological basis for life-course-oriented periodontal epidemiology.

BackgroundGingival inflammation is associated with dysbiotic oral biofilms characterized by reduced nitrate-reducing capacity and diminished nitric oxide (NO) bioavailability. While dietary nitrate has been shown to influence oral microbial activity, the effects of sustained, localized nitrate delivery on oral biofilm ecology and gingival inflammation remain incompletely defined. Methods and findingsIn this randomized, double-blind, placebo-controlled trial, 30 adults with gingival bleeding were assigned to receive localized prebiotic nitrate ([~]0.989 mmol per dose) or placebo for 21 days. The primary outcome was mean bleeding on probing (mBOP). Secondary outcomes included modified Gingival Index (mGI), Quigley-Hein plaque index (QHPI), salivary nitrite (as a proxy for NO bioavailability), oral pH, and microbiome composition assessed by 16S rRNA gene sequencing. Nitrate supplementation significantly reduced mBOP (25.7% to 15.3%; p = 0.0002) compared to placebo. Salivary nitrite levels and oral pH increased, indicating enhanced nitrate metabolism. Microbiome analysis demonstrated enrichment of nitrate-reducing taxa, including Rothia mucilaginosa and Neisseria spp., and a relative reduction in inflammation-associated genera such as Prevotella and Porphyromonas. No significant differences were observed in plaque index, consistent with functional modulation of the biofilm rather than reduction in plaque accumulation. ConclusionsLocalized prebiotic nitrate supplementation was associated with reduced gingival inflammation and shifts in oral microbiome composition consistent with enhanced nitrate-reducing capacity critical in nitric oxide formation. These findings support a role for biofilm-directed nutritional modulation as a non-antimicrobial approach for managing gingival inflammation and improving nitric oxide bioavailability.

Background: Impacted maxillary incisors present significant clinical challenges requiring interdisciplinary management. To date, no meta-analysis has quantitatively synthesized success rates specifically for impacted maxillary incisors. This systematic review and meta-analysis aimed to determine the pooled success rate of orthodontic traction for impacted maxillary incisors and identify factors influencing outcomes. Methods: A systematic review and meta-analysis of observational studies was conducted following PRISMA 2020 guidelines. A systematic search was performed in PubMed, Epistemonikos, Cochrane Library, and Google Scholar (January 2011 - March 5, 2026). Primary studies reporting success rates of orthodontic traction for impacted maxillary incisors were included. The primary outcome was successful eruption and alignment into the dental arch. Although the protocol was not registered in PROSPERO, the methodology was predefined, documented, and strictly followed to minimize risk of bias. Pooled success rates were calculated using a random-effects model (DerSimonian-Laird method) with R software (meta package). Heterogeneity was assessed using I2 statistics. Publication bias was evaluated using funnel plots and Egger's test. Quality assessment employed ROBINS-I. Results: Eleven studies with 2,847 patients were included in the systematic review; 2,149 patients from 11 studies provided sufficient data for quantitative synthesis. The pooled success rate was 82.3% (95% CI: 78.6-86.0%), with a prediction interval ranging from 70% to 91%. Considerable heterogeneity was observed (I2 = 78%, p < 0.001). Subgroup analysis showed that younger age (<14 years) was associated with significantly higher success rates (88.4% vs. 78.2%, p = 0.01). Mild impaction depth (<5mm) was associated with higher success rates (89.2% vs. 76.5%, p = 0.02). No significant publication bias was detected (Egger's test, p = 0.18); however, the power to detect publication bias is limited with fewer than 15 studies. Certainty of evidence was moderate due to heterogeneity and observational study designs. Conclusions: Orthodontic traction is an effective, though not universally successful, treatment modality, with a pooled success rate of 82.3% for impacted maxillary incisors, and success significantly associated with patient age and impaction severity. Early intervention and favorable impaction characteristics are associated with better outcomes

IntroductionDiscrimination within oral health care settings is increasingly recognized as a contributor to oral health inequities, shaping patient trust, care-seeking behaviors, and health outcomes. While prior research has documented discriminatory experiences among racially and ethnically minoritized populations, nationally representative evidence on discrimination and dignity in dental care among LGBTQ+ adults remains limited. This study examines differences in discrimination and microaggressions in dental settings by LGBTQ+ status, sexual orientation, and gender identity. MethodsThis study analyzed pooled data from the 2022-2025 waves of the State of Oral Health Equity in America (SOHEA) survey, a nationally representative survey of U.S. adults aged 18 and older. Discrimination was measured using the Everyday Discrimination Scale-Oral Care (EDSOC), and microaggressions were assessed using the Dignity in Oral Care Scale (DOCS). Descriptive and bivariate analyses compared mean scores across identity groups. Multivariable linear regression models estimated associations between LGBTQ+ status, sexual orientation, and gender identity with EDSOC and DOCS scores, adjusting for sociodemographic characteristics and dental insurance status. Analyses focused on group differences and associations and were conducted without applying survey weights. ResultsThe analytic sample included 15,591 adults from the 2022-2025 SOHEA surveys with complete data (52.5% of the total N=29,679); 12% identified as LGBTQ+. Overall, LGBTQ+ individuals in the analytic sample reported significantly higher mean discrimination (EDSOC: 2.97, SD=4.99) and microaggression (DOCS: 2.19, SD=3.22) scores than non-LGBTQ+ individuals (EDSOC: 1.72, SD=3.79; DOCS: 1.62, SD=2.80; p<0.001). Questioning individuals and those with gender identities categorized as "other" had the highest mean EDSOC and DOCS scores (p<0.001). In adjusted models controlling for sociodemographic and insurance factors, LGBTQ+ identity remained significantly associated with higher EDSOC ({beta}=0.16, 95% CI=0.11-0.21) and DOCS ({beta}=0.08, 95% CI=0.03-0.13) scores. Sexual orientation and gender identity differences persisted, with questioning and gender-diverse individuals experiencing significantly higher levels of discrimination and microaggressions in dental settings. DiscussionFindings demonstrate that LGBTQ+ adults, particularly adults identifying as questioning and those with nonbinary or other gender identities, experience disproportionate discrimination and microaggressions in dental care settings. Addressing interpersonal and structural sources of bias in oral health care is critical to advancing equity and improving access to respectful, high-quality care for LGBTQ+ populations.

Background: Peak height velocity (PHV) is a critical indicator of pubertal growth timing and is widely used in orthodontics to determine optimal timing for growth modification interventions. Secular trends toward earlier maturation have been reported, but a quantitative synthesis of PHV age reduction across generations is lacking. Objective: To systematically review and quantitatively synthesize evidence for secular trends in age at PHV and to estimate the pooled mean difference in PHV age between historical and contemporary cohorts. Methods: A systematic search was conducted in PubMed and Google Scholar from January 1990 to December 2021. The Directory of Open Access Journals (DOAJ) was also searched but yielded no eligible studies due to the specificity of the search string. Studies were included if they reported age at PHV in two or more birth cohorts separated by at least 20 years, used objective methods to determine PHV (longitudinal growth data with curve fitting), and reported means with standard deviations or standard errors. Risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects quantitative synthesis (meta-analytic approach) was performed to calculate the pooled mean difference in PHV age between historical and contemporary cohorts. Between-study variance (tau-squared) was estimated using the restricted maximum likelihood (REML) method. Heterogeneity was assessed using I-squared statistics. Given the limited number of eligible studies, findings should be interpreted as preliminary. Results: Two high-quality longitudinal studies met inclusion criteria, comprising 171 participants from historical cohorts (1969-1973) and 71 participants from contemporary cohorts (1996-2000). The pooled mean difference in PHV age was -0.48 years (95% CI: -0.72 to -0.24, P < 0.001), indicating that contemporary children reach PHV approximately 0.5 years earlier than their historical counterparts. PHV velocity showed a pooled increase of 0.71 cm/year (95% CI: 0.48 to 0.94, P < 0.001). Heterogeneity was low (I-squared = 0% for both analyses). Both studies were rated as low risk of bias. These findings are based on a limited number of studies and should be interpreted as preliminary. Conclusions: This preliminary quantitative synthesis provides evidence of a secular decline in age at peak height velocity of approximately 0.5 years in contemporary children compared to historical cohorts, accompanied by an increase in growth velocity. These findings suggest that orthodontic growth modification strategies may need to be initiated earlier than traditionally recommended. However, given the limited evidence base, results should be interpreted with caution and require confirmation in large-scale longitudinal studies.

BackgroundTrauma from occlusion (TFO) is a frequently under-recognized clinical entity. While narrative reviews exist, no prior systematic review has quantitatively synthesized the prevalence of TFO signs in orthodontic patients, the distribution of the Akerly classification for deep traumatic overbite, the efficacy of orthodontic intrusion, or the outcomes of immediate orthodontic repositioning of traumatized incisors. Furthermore, the knowledge-practice gap among orthodontists regarding trauma management has not been meta-analyzed. MethodsSystematic review and meta-analysis of observational and interventional studies, including cross-sectional studies, randomized controlled trials, and before-after studies. We searched PubMed (n=57), PubMed Central (n=538), the Cochrane Library (n=11: 2 reviews, 9 trials), and Google Scholar (~3,930) up to December 2025. Studies reporting prevalence of TFO signs, Akerly classification distribution, overbite reduction following orthodontic intrusion, success of immediate orthodontic repositioning, or orthodontist knowledge/practice were included. Random-effects meta-analyses were performed using the meta package in R (DerSimonian-Laird estimation for {tau}2). The protocol was not registered due to the exploratory nature of this multi-domain synthesis; however, the methodology strictly adhered to PRISMA 2020 guidelines. ResultsTwenty-seven studies (n=8,432 participants) were included. The pooled prevalence of any TFO sign was 34% (95%CI:27-42%, I2=86%), with wide prediction intervals indicating substantial between-study variability. TFO was variably defined across studies as the presence of [&ge;]1 of the following: fremitus, increased mobility, occlusal interference, soft tissue trauma, or CR-CO discrepancy. Higher prevalence was observed in Class II malocclusion (46% vs. 22%). Among deep traumatic overbite cases classified using the Akerly system, Type II was most common (52%, 95%CI:44-60%), followed by Type I (31%) and Type III (17%). Orthodontic intrusion reduced overbite by a mean of 2.8 mm (95%CI:2.1-3.5, I2=72%); TAD-assisted intrusion produced greater reduction (3.4 mm) than conventional archwires (2.1 mm, p<0.001). Immediate orthodontic repositioning of traumatized incisors with light forces ([&le;]50 g) achieved 91% success (95%CI:84-96%) at 12 months, comparable to splinting (84%), with no statistically significant difference between groups. The orthodontic group required fewer visits and reported better comfort. Meta-analysis of orthodontist knowledge showed correct awareness of specific trauma management protocols was below 40% in most domains, indicating a substantial evidence-practice gap. ConclusionThis first systematic review and meta-analysis on TFO in orthodontics provides preliminary quantitative benchmarks. One-third of orthodontic patients exhibit TFO signs; Akerly Type II is the dominant deep overbite pattern; orthodontic intrusion effectively reduces overbite by approximately 3 mm; immediate light-force repositioning is comparable to splinting in success and superior in efficiency. However, the disconnect between high clinical efficacy (e.g., 91% success of repositioning) and low practitioner awareness (<40%) represents a substantial translational gap in clinical practice. Assessment of publication bias was limited due to the small number of studies in several analyses (<10), precluding reliable funnel plot interpretation.

BackgroundRadiographic detection of caries lesions adjacent to restorations is challenging due to limitations of two-dimensional imaging and difficulties distinguishing true lesions from restorative or anatomical radiolucencies. Artificial intelligence (AI)-based clinical decision support systems (CDSSs) have been introduced to assist radiographic interpretation; however, different AI tools may yield variable diagnostic outputs, and their comparative performance remains unclear. ObjectiveTo compare the diagnostic performance of commercial and experimental AI algorithms for detecting secondary caries lesions on bitewings. MethodsThis cross-sectional diagnostic accuracy study included 200 anonymized bitewings comprising 885 restored tooth surfaces. A consensus group reference standard identified all surfaces with a caries lesion and classified each lesion by type (primary/secondary) and depth (enamel-only/dentin-involved). Five commercial (Second Opinion(R), CranioCatch, Diagnocat, DIO Inteligencia, and Align X-ray Insights) and three experimental (Mask R-CNN-based and Mask DINO-based) systems were tested. Diagnostic performance was expressed through sensitivity, specificity, and overall accuracy (95% CI). Comparisons used generalized estimating equations, adjusted for clustered data. ResultsSpecificity was high across all systems (0.957-0.986), confirming accurate recognition of non-carious surfaces, whereas sensitivity was moderate (0.327-0.487), reflecting frequent missed detections of enamel and dentin lesions. Accuracy ranged from 0.882 to 0.917, with no significant differences among models (p [&ge;] 0.05). Confounding factors, such as radiographic overlapping, marginal restoration defects, and cervical artifacts, were the main sources of misclassification. ConclusionsAI algorithms, regardless of architecture or commercial status, showed similar diagnostic capabilities and a conservative detection profile, favoring specificity over sensitivity. Improvements in dataset diversity, labeling precision, and explainability may further enhance reliability for secondary caries detection. Clinical SignificanceAI-based CDSSs assist clinicians by providing consistent detection. Their high specificity is particularly valuable in minimizing unnecessary invasive treatments (overtreatment), though they should be used as adjuncts rather than a replacement for expert judgment.

The in vitro study aimed to evaluate linear dimensional shifts in intraoral photographs of the esthetic zone captured using two smartphone cameras--the iPhone 15 Pro Max and the Samsung Galaxy S23 Ultra--compared to a digital single-lens reflex (DSLR) camera, which is regarded as the gold standard for dental photography. Imaging was performed under controlled conditions using a custom-designed stand and stabilizer to maintain a consistent distance and angle between the dental model and the photographic devices. Standardized frontal and occlusal images of the anterior maxillary region were acquired, and point-to-point linear measurements between specified dental landmarks were performed using calibrated digital imaging software. Each measurement was conducted triple and then averaged across various samples per image to guarantee precision and dependability. Friedmans test with Bonferroni correction was applied for statistical analysis to evaluate differences among the imaging devices. The results indicated no statistically significant variations in linear measures between the DSLR and the Samsung Galaxy S23 Ultra (p > 0.05), however minor inconsistencies were noted between the DSLR and the iPhone 15 Pro Max. It is important to acknowledge that all images were obtained utilizing the stabilization system, which contrasts with the conventional handheld approach applied in clinical environments and could impact the external validity of the results. The Samsung Galaxy S23 Ultra, in telephoto mode, demonstrated measurement precision similar to that of a DSLR camera, potentially serving as a reliable choice for clinical intraoral photography. The iPhone 15 Pro Max demonstrated potential, although minor measurement discrepancies.

BackgroundDental caries and periodontal disease represent the most prevalent global oral health conditions, collectively affecting several billion people. The diagnostic interpretation of dental radiographs, a cornerstone of modern dentistry, is associated with considerable inter-observer variability. In routine clinical practice, clinicians are required to evaluate a high volume of radiographic images daily, a cognitively demanding task in which diagnostic fatigue, time constraints, and the inherent complexity of overlapping anatomical structures can lead to the inadvertent oversight of early-stage pathologies. Artificial intelligence (AI) offers a transformative opportunity to augment clinical decision-making by providing rapid, objective, and consistent radiographic analysis, thereby serving as a tireless adjunct capable of flagging findings that may be missed during routine human inspection. MethodsThis study developed and validated a deep learning system for the automated detection of dental caries and alveolar bone loss using a dataset of 1,063 periapical and bitewing radiographs. Two separate YOLOv8s object detection models were trained and evaluated using a rigorous 5-fold cross-validation methodology. To align with the clinical use-case of a screening tool where high sensitivity is paramount, a custom image-level evaluation criterion was employed: a true positive was recorded if any predicted bounding box had a Jaccard Index (IoU) > 0 with any ground truth annotation. Model performance was systematically evaluated at confidence thresholds of 0.10 and 0.05. ResultsAt a confidence threshold of 0.05, the caries detection model achieved a mean precision of 84.41% ({+/-}0.72%), recall of 85.97% ({+/-}4.72%), and an F1-score of 85.13% ({+/-}2.61%). The alveolar bone loss model demonstrated exceptionally high performance, with a mean precision of 95.47% ({+/-}0.94%), recall of 98.60% ({+/-}0.49%), and an F1-score of 97.00% ({+/-}0.46%). ConclusionThe YOLOv8-based models demonstrated high accuracy and high sensitivity for detecting dental caries and alveolar bone loss on periapical radiographs. The system shows significant potential as a reliable automated assistant for dental practitioners, helping to improve diagnostic consistency, reduce the risk of missed pathology, and ultimately enhance the standard of patient care.

ObjectiveX-linked Hypophosphatemia is associated with dental complications, including spontaneous endodontic infections (abscesses) in non-carious teeth and severe periodontal loss. Previous studies have mainly focused on dentin Hypomineralization; however, the structural basis underlying periodontal tissue failure remains unclear. We aimed to investigate histoanatomical abnormalities in the dentin and periodontium of Hyp mice to clarify structural consequences of Phex deficiency in adult molars. MethodsWe performed detailed histological and scanning electron microscopy analyses on the molar regions of untreated adult Hyp mice and wild-type littermates, with particular attention to the structural integrity of the root and periodontal ligament. Additionally, odontoblast process morphology and periodontal attachment abnormalities were evaluated. ResultsHyp molars exhibited marked root abnormalities, including radicular shunt-like defects and disorganized odontoblast processes, particularly in furcation and radicular dentin. Periodontal attachment showed characteristic asymmetry: detachment from the cementum surface was frequently observed, whereas attachment to the alveolar bone surface was relatively preserved. These changes were accompanied by thinning and discontinuity of Sharpeys fibers and increased vascularity in the periodontal ligament. ConclusionsThese findings provide a histoanatomical framework for understanding refractory dental complications in X-linked hypophosphatemia and support the importance of intervention during root development.

IntroductionDigital technologies are reshaping how health professionals are trained, and extended reality (XR) has gained attention as a tool for skills development in dental education. Yet, successful integration depends largely on educators perceptions, readiness, and working conditions. This study aimed to explore dental educators views of the educational value of XR, what barriers they experience, and how familiarity with immersive technologies relates to their use in teaching. Materials and MethodsA cross-sectional, web-based survey was conducted among dental educators. The questionnaire included items on demographics, familiarity and frequency of XR use, and perceptions of educational value, barriers, and curricular integration. Descriptive statistics were calculated, and Spearman correlation analyses were performed to explore associations between familiarity, use, and perceived benefits of XR. ResultsRespondents reported positive attitudes toward XR, particularly for improving students understanding of complex anatomy (mean = 6.02/7), skill development (5.68/7), and confidence and preparedness for clinical practice (5.08-5.20/7). XR was mainly viewed as a complement to traditional teaching rather than a replacement (mean = 3.77/7). Strong correlations were observed between perceived improvements in confidence, skills, and clinical readiness (r = 0.71 - 0.89, P < 0.0001). High costs, limited technical support, and time constraints were the most prominent barriers to usage. ConclusionOverall, dental educators appear open to XR but constrained by structural and organizational factors rather than a lack of interest. Faculty development, hands-on training opportunities, and institutional support may therefore be essential to translating positive perceptions into meaningful and sustained integration of immersive technologies in dental curricula.

Acidification of the oral environment has been implicated in the initiation and progression of oral pathologies including oral cancer, but how acidic environments modulate normal oral epithelial cell (OEC) responses to microbial ligands is not understood. This study examined the impact of acidic stress on OEC morphological, molecular, and functional responses to toll-like-receptor ligand engagement in vitro. OEC cultures were exposed to either normal (pH:=:8.0) or acidified growth media (pH:=:3.0) for 24 hours prior to machine-learning-guided morphological analysis and exposure to either toll-like receptor (TLR)5 (flagellin) or TLR2/TLR1 (Pam3CSK4) agonists. Multiplex gene expression technology was used to quantify the transcriptional responses of metabolic-and immune-related genes at 6 hours post-TLR agonist exposure. OEC-mediated production of transforming growth factor-beta (TGF-{beta}) was assessed by enzyme-linked immunosorbent assay at 2-, 6-, and 24-hours post-agonist exposure. Results showed that acid exposure induced significant changes to OEC morphology resembling epithelial-mesenchymal transition, the differential expression of n=197 metabolic-and n=43 immune-related genes and significantly increased OEC TGF-{beta}1 production. The results demonstrate that acid stress skews normal OECs towards pro-inflammatory and pro-oncogenic phenotypes when faced with concomitant microbial ligand challenge and provide key molecular clues to OEC survival strategies with potential implications for elucidating the early molecular events in the development of epithelial dysplasia. Article HighlightsO_LIAcute acid exposure reduces survival of OECs C_LIO_LIA subpopulation of OECs is resistant to acid-mediated cell loss and undergo morphometric changes consistent with epithelial-mesenchymal transition C_LIO_LIConcurrent acid stress and TLR stimulation modulates transcription of immune and metabolic genes in OECs C_LIO_LIAcid stress increases TGF-{beta}1 protein production of OECs following TLR agonist stimulation C_LI

BackgroundConventional clinical indicators of periodontitis progression detect disease after irreversible tissue destruction has occurred. Molecular biomarkers in gingival crevicular fluid (GCF) offer potential for earlier detection, but existing analytical approaches rely on cross-sectional snapshots that fail to capture the temporal dynamics of disease evolution. AimTo develop and validate a temporal deep learning framework leveraging longitudinal GCF protein profiles for (1) regression-based prediction of clinical attachment level (CAL) and probing depth (PD) changes, (2) current-visit classification of periodontitis progression, (3) next-visit prediction of progression with a 2-month clinical lead time, and (4) identification of the most informative biomarkers through systematic multi-method feature importance analysis. Materials and MethodsThis study utilized longitudinal GCF data from a prospective cohort of 413 participants (501 periodontal sites, 3,792 time-series observations) with 64 protein biomarkers measured at 2-month intervals over 12 months. A compact encoder-gated recurrent unit (GRU)-decoder architecture was developed through systematic experimentation across four phases, benchmarking temporal deep learning against cross-sectional machine learning baselines. Task-specific decoders addressed continuous regression (CAL and PD prediction) and binary classification (progression detection). Model development and reporting followed the TRIPOD+AI guidelines. ResultsThe temporal GRU achieved 47.7% CAL mean absolute error (MAE) reduction (1.139 to 0.596 mm) and 41.0% PD MAE reduction (0.902 to 0.532 mm) over linear regression baselines through the systematic model development progression. For binary classification, the model achieved AUC-ROC of 0.886 for current-visit classification and 0.867 for next-visit prediction with a 2-month lead time. Per-visit analysis revealed progressive improvement in both regression and classification accuracy as longitudinal data accumulated. Cross-method feature importance analysis identified Periostin, VEGF, MMP-2, IL-1RA, and MCP-4 as core predictive biomarkers, with divergent profiles between diagnostic and prognostic tasks suggesting distinct molecular signatures for concurrent versus incipient progression. ConclusionsTemporal deep learning applied to longitudinal GCF protein profiles enables both accurate regression prediction of clinical parameters and reliable classification of progression status, including 2-month-ahead forecasting suitable for clinical intervention planning. The compact architecture and non-invasive sampling approach make this framework suitable for integration into point-of-care periodontal monitoring workflows. Clinical RelevanceConventional clinical indicators of periodontitis progression, including probing depth changes, attachment loss, and radiographic bone loss, inherently detect disease after irreversible damage has occurred. This study shows that a compact deep learning model analyzing temporal GCF protein profiles can first accurately predict continuous changes in pocket depth and attachment loss, then classify progression status 2 months in advance, enabling proactive intervention before clinical manifestation of tissue destruction.

Diet is an important ecological modulator of the oral microbiome, yet population-level evidence on a broader spectrum of food components remains limited. This cross-sectional study investigated associations among dietary intake, oral rinse microbiome, and oral disease conditions in a nationally representative sample of United States adults from the National Health and Nutrition Examination Survey. A total of 3,254 participants with oral rinse microbiome sequencing data were included, with oral conditions classified as oral health, caries-only, periodontitis-only, or co-existing disease. Dietary intake was assessed using 24-hour dietary recalls and summarized as dietary indices and energy-adjusted food components. Associations between diet and the oral microbiome were evaluated using community-level analyses, regression models, mediation analyses, and unsupervised clustering, while accounting for oral conditions. This study found that dietary intake, as a combined variable set, explained 3.6% of the variance in oral rinse microbial community structure; this was comparable to oral disease status or smoking and larger than sociodemographic factors. Healthier dietary profiles, including higher health-associated dietary index scores and greater vegetable and fruit intake, were associated with taxa commonly linked to oral health (e.g., Neisseria, Cardiobacterium and Lautropia). In contrast, added sugars, alcoholic drinks, cured meat, potatoes, dairy products, and higher dietary inflammatory index scores showed opposite association patterns. Mediation analyses suggested that coordinated microbial groups may partly link dietary exposures with oral disease outcomes, particularly for vegetables and added sugars. Additionally, three population-level dietary patterns were identified, among which the plant-rich pattern was associated with more favorable oral health and microbial profiles enriched in nitrate-reducing commensals, including Neisseria and Haemophilus. Overall, dietary intake was associated with oral microbiota composition and oral health conditions, supporting ecological influences of dietary components beyond sugar on oral bacteria and dental diseases. Longitudinal studies are needed to clarify the direction and causality of these relationships.