Abstract in English:

Background This comparative analysis aims to deepen our understanding of catechol-O-methyltransferase (COMT) gene variations and their potential role in Temporomandibular Joint (TMJ) pain mechanisms. Methods To analyze COMT protein sequences relevant to TMJ pain, UniProt IDs P21964 and Q8WZ04 were utilized, identifying proteins with 90% and 50% sequence similarity. These sequences were processed using the Deepbio tool, a deep-learning platform for biological sequence analysis. FASTA sequences were downloaded, validated, and divided into training and test datasets through Deepbio. The datasets were partitioned into 80 percent training and 20 percent test to optimize hyperparameters and evaluate performance. Three sequence prediction models—GAT (graph attention networks), transformer, and BiLSTM—were trained and tested to assess their predictive accuracy for TMJ pain-related COMT sequences, employing a structured approach to fine-tune parameters. Results The sequence prediction models demonstrated promising results in identifying functional COMT sequences associated with TMJ pain.GAT has the highest accuracy (0.885), followed by BiLSTM (0.855) and Transformer (0.830). BiLSTM achieves the highest sensitivity (0.870), indicating better performance in identifying positive cases. These models exhibited strong sensitivity and specificity in identifying TMJ pain-associated sequences, indicating their potential utility in pinpointing genetic risk factors for TMJ pain. Conclusion This study demonstrates that GAT and BiLSTM models, in particular, can effectively predict COMT sequence variants associated with TMJ pain, providing valuable insights into the genetic basis of TMD. As these computational approaches continue to evolve, they hold promise for improving diagnostic and therapeutic strategies for TMJ pain, underscoring the role of computational tools in molecular biology research.

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Aim The aim of this study was to evaluate the variables that can influence dentists on choosing pre- and postoperative drug protocols for impacted and semi-impacted third molar surgeries. Methods A study carried out by collecting data using a questionnaire set up on the “Google Forms” and sent online to dentists. The questionnaire contained questions about general characteristics and training, professional practice, surgical and pharmacological procedures and postoperative procedures. All Brazilian dentists were eligible to participate. A descriptive analysis of the data was performed, according to the outcomes class of pre- and postoperative medication, and form of administration, and the absolute and relative frequencies of the variables were calculated. Results A total of 310 forms were answered by professionals, most of them over 40 years old; 53% were male, most were specialists working in private practice, and 50.8% had some training in oral surgery. This was evidenced in the wide range of responses obtained in our study that is a lack of relationship between the dentist’s profile and drug prescriptions. Antibiotics were primarily used postoperatively by more than half of the participants, and few prescribed them preoperatively. The antibiotic prophylaxis was not widely prescribed for this surgery, and amoxicillin proved to be the antibiotic of choice pre- and postoperatively by almost all surveyed dentists. Non-steroidal anti-inflammatory drugs were rarely used preoperatively, although 71.9% of the professionals reported using them postoperatively. Corticosteroids were responsible for 37.7% of preoperative prescriptions, and the preference was for oral administration. Almost all professionals prescribed analgesics in the postoperative period. Conclusions There was great variability of responses of drug prescriptions in the pre- and postoperative period of third molar surgeries, and no relationship between the dentist’s profile and drug protocols was found.

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Aim To compare the patterns of diagnosis for oral lesions and the number of biopsies performed in children aged 0 to 12 years before and during the COVID-19 pandemic in a Brazilian Oral Pathology Service. Methods In this retrospective cross-sectional study, data were collected from patient records and biopsy forms, including demographic information, clinical diagnosis, lesion duration, localization, and symptomatology of oral lesions. Data were categorized into three periods: prepandemic, first pandemic, and second pandemic. Results A total of 99 cases (43 boys and 56 girls) were included, with the highest mean age recorded during the first and second pandemic periods. Salivary gland pathology (n = 28, 28.1%), reactive lesions (n = 20, 20.2%), and developmental and inflammatory cysts (n = 18, 18.2%) were the most frequent diagnoses. Lesions presenting as bullae and vesicles were significantly associated with a duration of 1 to 6 months. A significant decrease in the number of oral biopsies performed was observed across the prepandemic (n = 46, 46.5%), first pandemic (n = 28, 28.3%), and second pandemic (n = 25, 25.3%) periods. Conclusions Despite the disruption of healthcare services caused by the COVID-19 pandemic, there was no significant increase in the frequency of oral lesions in pediatric patients. However, the mean age of the patients increased during the pandemic periods, suggesting potential delays in diagnosis. Additionally, the total number of oral biopsies in children substantially decreased.

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Aim This study aimed to evaluate the two-year clinical performance of class II restorations using bulk-fill resin composites. Methods Thirty-five patients received 70 class II restorations (n=70) with conventional composite resin Filtek Supreme (3M-ESPE, group FS) and bulk-fill Surefill SRD (Smart Dentine Replacement-Dentsply, group SDR) composites using a split-mouth design. The restorations were assessed based on modified USPHS and FDI criteria for proximal contact at baseline, 6, 12, and 24 months after placement. Results After 6 months, 31 patients were assessed and two FS restorations failed due to dentin sensitivity. After 12 months, each group had one restoration failure for fracture/loss of retention of the material. After 24 months, 58 restorations were assessed, and the following was observed: three FS restorations needed to be replaced due to fracture/loss of retention, marginal adaptation, and proximal contact; and three SDR restorations needed to be replaced due to secondary caries, fracture/loss of retention, and proximal contact defect. For each score in the 24 months, an increase in the surface roughness of FS (p=0.013) and SDR (p=0.0006) restorations was observed as well as a decrease in dentin sensitivity, respectively, p=0.0015 and p=0.00021. The highest number of failures occurred due to fracture/loss of retention for both restorations. The chi-square test showed no statistically significant difference between FS and SDR restorations regarding all parameters assessed (p>0.05). After two years of clinical assessment, no statistically significant differences were found between FS and SDR restorations for the parameters assessed. Conclusion Both materials were shown to have similar clinical performance.

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Objective The aim of this study was to assess the impact of xerostomia, the subjective perception of dry mouth, on the oral health-related quality of life of older adults. Methods This study involved 131 individuals who participated in the AcampaVida extension project between 2015 and 2018 in the city of Santa Maria, Rio Grande do Sul, Brazil. A structured questionnaire obtained demographic, socioeconomic, behavioral, and self-reported information about xerostomia. Also, the Brazilian version of the Oral Health Impact Profile-14 (OHIP-14) was used to assess oral health-related quality of life. Data were analyzed in STATA 14.0, and the association of xerostomia with predictive quality of life variables was performed using unadjusted and adjusted Poisson regression. Results OHIP-14 scores were 28% higher in individuals with xerostomia. Regarding the questionnaire domains, the highest scores comprised physical pain and psychological discomfort in individuals with xerostomia. Conclusion The results indicate that xerostomia had a negative impact on the oral health-related quality of life of the assessed older adults.

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The purpose of this in vitro study was to evaluate the three-dimensional positioning of dental implants in casts obtained using conventional and digital impressions. A printed typodont with three digital mini-abutment analogues (Neodent, Curitiba, Brazil) and a scan body for mini-abutments (EFF – Dental Components, São Paulo, Brazil) was scanned five times (n=5) with two different scanners (Omnicam, CEREC, Dentsply Sirona and TRIOS 3, 3Shape) Five stone casts were fabricated from conventional impressions of the primary cast and then scanned using a laboratory scanner. Dental implant angulation and displacement were calculated. One cobalt-chrome metal framework was fabricated over the primary cast and seated over each obtained cast, and the misfit was assessed using scanning electron microscopy (SEM) For precision and trueness, data distribution and variance equality were analyzed using the Shapiro-Wilk and Levene’s tests, respectively. Precision was assessed using one-way ANOVA; trueness was assessed using two-way ANOVA. Both analyses were followed by Tukey’s test (α=0.05).The buccal-lingual angle showed no statistically significant differences, and the mesio-distal angle also showed no significant differences between cast types, although worse results were found for the distal implant. Implant displacement showed better results (lower values) for stone casts in all directions (P=.001). The prosthetic interface region showed better outcomes compared to the bevel feature of the scan body in all directions (P=.001). SEM evaluation showed no statistically significant differences in vertical misfit when all implant prosthetic screws were tightened in all groups. Printed casts present greater variability in 3D positioning and misfit of dental implants compared to conventional casts.

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Aim Obstructive Sleep Apnea (OSA) is a common, yet underdiagnosed disorder linked to cardiovascular disease, hypertension, diabetes, and other systemic risks. The Mallampati score, a simple clinical tool for assessing airway anatomy, has been suggested as a cost-effective screening method. This study evaluates the association between Mallampati score and OSA severity in an Oral Medicine clinic setting. Methods In this prospective observational study, 92 adults attending the Oral Medicine OPD were screened using the Epworth Sleepiness Questionnaire. Mallampati scores were recorded during oral examination and categorized into Classes I–IV. OSA severity was assessed by clinical evaluation and polysomnography. Associations between Mallampati score, OSA severity, BMI, age, systemic diseases, and gender were analyzed. Results Higher Mallampati classes were associated with increased OSA severity. Each increase in class raised the odds of OSA diagnosis by 7.14% (p = 0.02). Mallampati Class III and IV showed strong correlation with severe OSA. Significant associations were noted with Type 2 diabetes (p = 0.03), hypertension (p = 0.01), asthma (p = 0.04), and heart disease (p = 0.03). Age and BMI positively correlated with Mallampati class, while no significant association was found with gender. Mild systemic conditions such as gastrointestinal or thyroid disorders showed no meaningful relationship (p = 0.90). Conclusion Mallampati scoring is a reliable, non-invasive, and inexpensive tool to screen high-risk patients for OSA, particularly those with elevated BMI and diabetes. Its routine use in Oral Medicine clinics can aid early identification and referral for confirmatory sleep studies.

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Aim This in vitro study evaluated the effects of different mouth rinses in combination with 10% carbamide peroxide bleaching gel on the properties of resin composite. Methods Cylindrical specimens of a nanofilled resin composite (n = 12) were allocated to four groups: distilled water (control, C), mouth rinse with essential oils (EO), mouth rinse with essential oils and alcohol (EO+A), and mouth rinse with essential oils, alcohol, and hydrogen peroxide (EO+A+HP). Samples were bleached daily for 14 days with 10% carbamide peroxide gel for 4 hours and immersed in 5 mL of the assigned mouth rinse before and after bleaching. Surface microhardness (SMH), surface roughness (Ra), and color changes (ΔL*, Δa*, Δb*, ΔEab, and ΔE00) were assessed at baseline (T1) and post-treatment (T2). Data were analyzed using generalized linear mixed models and Kruskal–Wallis/Dunn tests. Results All groups exhibited decreased SMH and increased Ra at T2. No significant differences in SMH were observed among groups, whereas Ra was highest in the EO+A+HP group. The EO+A and EO+A+HP groups showed greater Δa* and ΔE00 values compared with the control. Conclusion Mouth rinses used during 10% carbamide peroxide bleaching increase roughness, reduce microhardness, and alter resin composite color, depending on their active ingredients.

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Aim Evaluate changes in and the complexity of the bone trabeculae in individuals with cancer using or not using antiresorptive drugs through the panoramic morphometric indices and fractal dimension. Methods Clinical records and panoramic radiographs of individuals with cancer were analyzed. The risk group (RG) consisted of 22 individuals using zoledronic acid or denosumab for a minimum period of 12 months. The control group (CG) consisted of 26 individuals without any antiresorptive drugs. Linear measurements were performed for the panoramic radiomorphometric indices and the fractal dimension in four different regions of interest (ROI). Results In RG it was observed that 72.7% of the patients were using zoledronic acid, while 27.3% were using denosumab. In the fractal dimension analysis, the ROIs of the mandibular angle (p = 0.000) and premolar region (p = 0.005) of the RG showed significant changes in bone complexity when compared to the CG. In the analysis of panoramic radiomorphometric indices, the mental index showed a significant increase in linear measurements of the RG compared to the CG (p = 0.008). Conclusion The fractal dimension analysis of the mandibular angle and premolar regions in the RG indicated greater bone complexity compared to the CG.

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Aim Coronectomy is an alternative technique for the removal of lower third molars in close proximity to the inferior alveolar nerve (IAN), minimizing the risk of nerve damage by retaining the roots in situ. This study aimed to evaluate the long-term outcomes and complications of coronectomy in four clinical cases. Methods Three healthy male patients (aged 28, 36, and 57 years) underwent four coronectomy procedures between 2010 and 2016. Preoperative panoramic radiographs and, in two cases, cone-beam computed tomography (CBCT) confirmed the proximity of the third molar roots to the IAN. Surgical protocols included standardized techniques, antibiotic prophylaxis, and postoperative follow-up with radiographic assessments at intervals ranging from 6 months to 10 years. Results Root migration was observed primarily within the first postoperative year, stabilizing thereafter. No cases exhibited root exposure, infection, or neurosensory deficits. The 28-year-old patient demonstrated the highest migration rate (5.65 mm), consistent with age-related trends reported in the literature. Conclusion Coronectomy is a viable and safe alternative for high-risk lower third molar extractions, significantly reducing the risk of IAN injury. Long-term follow-up confirmed minimal complications, though root migration remains a predictable occurrence, particularly in younger patients.

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Bruxism is a masticatory muscle activity that can occur during sleep and/or wakefulness, characterized by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible. Aim Evaluate the prevalence of probable awake bruxism (PAB) and its association with signs and symptoms of temporomandibular disorders (TMD) in psychiatric patients. Methods The sample was comprised of 123 participants of both genders, between 18 and 65 years old. Of these 73 were inpatients at 3 psychiatric hospitals (experimental group) and 50 healthy individuals (control group). All of them were evaluated through a clinical inspection, to observe the presence of clinical signs of bruxism (tooth wear, buccal and labial mucosa and/or tongue indentations, masseter muscle hypertrophy) and a questionnaire to assess the presence of TMD signs and symptoms. Information about current use of medication and reason for hospitalization were also collected. Results There was no statistical difference regarding the prevalence of probable awake bruxism between experimental (85%) and control (74%) groups. However, a higher prevalence of clinical signs of bruxism and TMD signs and symptoms was observed in psychiatric patients diagnosed with probable awake bruxism. For the experimental group, the association of PAB with the reason for hospitalization and the use of psychotropic drugs were not statistically significant. The presence of masseter hypertrophy, tongue indentation, buccal mucosa indentation, tooth wear and TMD signs and symptoms appears to be associated with the presence of PAB and psychiatric disorders. Conclusions The prevalence of awake bruxism in psychiatric patients about 85%. The presence of TMD signs and symptoms appears to be associated with the presence of PAB in psychiatric patients.

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Aim This study aimed to evaluate the effect of six-month water aging on surface roughness and color stability of resin composites with color adjustment potential. Methods Disc specimens from Omnichroma (OMNI), Vittra Unique (UNI), Harmonize (HAR), Filtek Universal (FIL), and Filtek Z350XT (Z350) (n=5) were prepared and immersed in water. Color was assessed at baseline, 7 days, 1, 2, 3, and 6 months. CIEDE2000 color differences were calculated between baseline and each time point. Surface roughness was measured at baseline and 6 months. One-way ANOVA with Tukey’s post-hoc test analyzed differences among the composites, while repeated measures ANOVA with Bonferroni’s post-hoc test evaluated differences over time. Color differences were interpreted based on perceptibility and acceptability thresholds, and roughness based on the plaque retention threshold. Pearson correlation assessed the relationship between ΔE00 and surface roughness. Results Water aging significantly affected CIELab color coordinates for all composites except HAR. All composites exhibited color differences within the acceptable threshold for three months. After 6 months, surface roughness was different among the resins (p = 0.043), only the FIL maintained mean values below Ra=0.2μm. Over the 6-month evaluation period, no correlation between color difference and surface roughness (R=0.057, P=0.788) was demonstrated. Conclusions All resin composites presented color stability for three months. However, after six months, color changes for Filtek Universal and Vittra Unique were above the acceptability threshold, demonstrating moderately unacceptable discoloration. Surface roughness was affected by six months of water aging, exceeding the plaque retention threshold for all resin composites except Filtek Universal.

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Aim This study evaluated the accuracy and reliability of semi-automated mandibular condyle segmentation using conventional and ultra-low-dose (ULD) cone-beam computed tomography (CBCT) protocols, with dry skull measurements as the reference standard. Methods Twenty-nine dry human mandibles with intact condyles and glenoid fossae were scanned with two CBCT protocols: conventional (0.2 mm voxel size, 90 kV, 8 mA) and ULD (0.4 mm voxel size, 90 kV, 4 mA, ~50% dose reduction). Semi-automated segmentation was performed in 3D Slicer software. Linear condylar measurements (width, length, height) were obtained by two blinded evaluators, and their averages were analyzed against the reference standard. Descriptive statistics (mean, SD, CI), agreement analysis (ICC), and intergroup comparisons (ANOVA with Bonferroni correction) were performed. Results Real measurements showed a mean condylar size of 12.08±0.99 mm. Conventional CBCT produced 11.88±0.91 mm, and ULD CBCT yielded 11.67±0.89 mm, with differences <0.5 mm. Both protocols demonstrated excellent agreement with the reference standard (ICC >0.8, p<0.001). Measurement errors remained <1 mm for both groups, though ULD errors were slightly higher and reached significance only when pooled collectively (p=0.029). Inter- and intra-observer reliability was excellent (ICC >0.9). Conclusion ULD CBCT protocols, despite using a larger voxel size, maintained clinically acceptable accuracy (<1 mm error) while reducing radiation dose by ~50%. Semi-automated segmentation provided reproducible results, supporting ULD CBCT for safer condylar assessment, particularly in pediatric or longitudinal cases where dose reduction is critical.

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Aim Microbially induced oral diseases are highly prevalent worldwide. As a result, antimicrobial agents are widely used in clinical practice, and concerns about antimicrobial resistance have become a significant issue. However, there is limited information regarding the overall knowledge of antimicrobial use in dentistry at different stages of career progression, which was evaluated in this study. Methods Cross-sectional study evaluating the knowledge and behaviors of dental students and practicing dentists regarding the use of antimicrobials. Students from the basic sciences, preclinical and clinical years of dental school (n=50 per level, for a total of 150 students), as well as dentists with 2-5 years of clinical practice (n=50), were included. Questionnaires were administered, and descriptive, bivariate, and logistic regression analyses were conducted. Results There is a clear improvement in knowledge levels as professional levels increase when comparing students at different stages and clinicians. However, most dentists accessed scientific evidence more than one year prior to the survey (43.9%) and still prescribing antibiotics for oral conditions that typically do not require. The negative self-perception of knowledge regarding antimicrobial was associated with career level (p=0.05), a lack of confidence in prescribing antimicrobials (p=0.001), a lack of interest in receiving educational information (p=0.007), and among individuals who do not recommend systemic antibiotics for treating implant-related infections (p=0.002) or for patients with heart diseases (p=0.002). Conclusion Although there is a clear trend toward improved knowledge and attitudes regarding antimicrobial use throughout a dental career, the findings highlight an urgent need for educational programs with up-to-date information.

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Aims To evaluate the influence of different endodontic sealer activation methods on the bond strength and sealer filling quality. Methods Sixty bovine incisors with similar root anatomy were instrumented using a crown-down technique and randomly distributed into five groups (n = 12) according to the sealer activation protocol: No Activation; Activation using Easy Clean (EC) file attached to a handpiece – EC / Handpiece; EC in endodontic motor in rotary movement – EC / Rotatory; EC in endodontic motor in reciprocating movement – EC / Reciprocating; or Ultrasonic activation. The roots were filled using the lateral condensation technique with gutta-percha and AH Plus sealer, which was activated for 40 seconds, 2 mm short of the working length. Two slices were obtained from each root third: one for push-out and another to assess sealer filling quality using a stereomicroscope. Kruskal-Wallis with Dunn’s post hoc tests were used to compare the different sealer activation methods. Friedman tests were applied for repeated measurements within the same group, comparing root thirds (α = 0.05). Results Significantly lower values of bond strength and a higher occurrence of voids in the middle and apical thirds were observed when the sealer was not activated (p < 0.05). No significant differences were observed among the activation methods (ultrasonic activation vs. EC activation in different kinematics) for bond strength and sealer filling quality (p > 0.05). Conclusions Sealer activation, regardless of the method, improve the bond strength of the sealer for root dentin and a result in fewer voids on filling material.

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Glass ionomer cement (GIC) is a widely used material in Dentistry that has some limitations. Silk fibroin (SF) is a natural polymer with potential benefits. Thus, this study has incorporated SF into two GICs. Aims Evaluate the influence of this modification on shear bond strength (SBS) and characterize the materials with scanning electron microscopy (SEM). Methods Two types of GICs, Maxxion R (M) and Ketac Molar (KM), were used. For each GIC, four formulations were prepared: a control (0% SF) and three experimental concentrations (1%, 3%, and 5% SF nanoparticles). A total of 160 bovine tooth specimens were prepared for SBS analysis, with 20 specimens allocated to each of the 8 experimental groups (2 GIC types x 4 SF concentrations). Subsequently, each group was subdivided into two subgroups of 10 specimens each: one subjected to thermocycling and the other serving as a non-thermocycled control. Additionally, 8 specimens (one from each GIC/SF concentration group) were prepared for SEM analysis. Results were analyzed using the Shapiro-Wilk test, followed by two-way ANOVA and Duncan’s complementary test, at a significance level of 5%. Results Concentrations showed statistically significant differences after thermocycling (p = 0.01) for M, revealing an increase in SBS (G1M = 0.69±0.18; G2M = 1.95±0.17; G3M = 1.96±0.17; G4M = 1.54±0.15). KM showed SBS values significantly higher with the addition of SF, with no differences between concentrations (p = 0.001) (G1KM = 1.19±0.21; G2KM = 4.47±0.75; G3KM = 4.31±0.68; G4KM = 3.62±0.54). SEM analysis revealed an increase in cracks with higher concentrations of SF. Conclusions Finally, the incorporation of 1% SF nanoparticles into GICs resulted in a significant increase in SBS, particularly following thermocycling.

Abstract in English:

Orofacial clefts are anomalies arising from defects during the fusion of the craniofacial processes. Non-syndromic orofacial cleft (NSOC) is the most frequent malformation in the craniofacial region. Understanding their etiology is a challenge requiring a multidisciplinary approach and deep understanding of environmental and genetic factors. Polymorphic variants in genes linked to craniofacial development emerge as key pieces in this puzzle. Aim This research aimed to deepen the understanding of the genetic mechanisms of the WNT5A gene in the development of NSOC. Methods To this end, a broad, comprehensive and updated synthesis of existing literature was carried out, through a narrative literature review. Results The WNT5A gene plays a crucial role in regulating cellular functions, significantly contributing to the formation and development of labial and palatal structures. It interacts with multiple gene signaling pathways also strongly linked to craniofacial development. Specifically, the SNP rs566926 has been associated with the occurrence of NSOC in various populations. Conclusions This study reinforces the importance of the WNT5A gene and its polymorphic variant in craniofacial development. Understanding these genetic mechanisms may pave the way for new diagnostic strategies, treatment, and improvement in the quality of life of affected individuals and their families.

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Aim Selection of prosthetic attachment height and implant number can influence the supporting structures of implant mandibular overdentures (IMOs), including peri-implant tissue and prosthetic components. This study evaluated the biomechanical effects of single IMO (SIMO) or two IMO (TIMO) systems with different stud transmucosal heights (2, 3, or 4 mm) on cortical bone, mucosal tissue, implants, and prosthetic elements. Methods Twelve three-dimensional finite element models were created using McNeel Rhinoceros 3D v7.0®, representing scenarios with 2 mm (SIMO-2mm, TIMO-2mm), 3 mm (SIMO-3mm, TIMO-3mm), and 4 mm (SIMO-4mm, TIMO-4mm) heights. Simulations included 100 N oblique loading (30º) on lower central incisors and 150 N axial loading on the first molars. Von Mises stress (implant, housing, stud), maximum and minimal principal stress (bone, tissue, prosthesis, nylon), and displacement were analyzed through numerical data and color-coded images. Results Oblique loading resulted in higher stress, particularly in SIMO-4mm and TIMO-4mm. Nylon inserts in SIMO configurations experienced high compressive stress, especially in SIMO-4mm. TIMO configurations under oblique loading caused critical stress in peri-implant bone. Prosthetic tensile stress and displacement were greatest in SIMO-4mm under anterior loading. High transmucosal heights increased stress on housing, attachment, and prosthesis, particularly in systems with thin soft tissue. Conclusion SIMO and TIMO rehabilitations under oblique loading showed high stress in ductile structures, with significant implications for SIMO-4mm due to stress concentration in nylon, prosthesis base, and displacement. Elevated transmucosal heights should be used cautiously in cases of limited soft tissue thickness.

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Aim To evaluate if whitening dentifrices change enamel color and if their use induces alteration over the enamel and dentin roughness. Methods Forty enamel and forty dentin bovine samples (4 mm x 4 mm, n=80) were divided into four groups following the dentifrice tested: Char - activated charcoal (3D White Therapy Charcoal); HP - low concentration of hydrogen peroxide (Colgate Luminous White Advanced); Cov – blue covarine (Close Up White Now); and Cont – control (Colgate Total 12). Initial enamel color coordinates (L*a*b*) were obtained, followed by enamel and dentin Ra measurements. Specimens were submitted to an abrasive cycle (20 s abrasion, 3x/day, 14 days). After, the final Ra and color were obtained, and the delta E was calculated. Roughness data were submitted to repeated measures ANOVA, and color alterations were assessed by one-way ANOVA, followed by the Tukey test. Results The dentifrice Char reduced the enamel Ra and presented lower values than the Cont and Cov, while Cont increased the Ra and HP reduced it for dentin. Regarding enamel color, there was no significant difference between the dentifrices. Conclusion The dentifrices could not promote enamel whitening, and their use shall be cautiously indicated as they can induce surface harm, mainly over dentin.

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Aim This study aims to assess the level of knowledge of healthcare professionals about first aid procedures in cases of dental trauma. Methods A questionnaire was administered to students enrolled in the first aid course at the Catholic University of Brasília. This questionnaire covered a variety of topics, including the students’ profile, hypothetical scenarios that required first aid approaches and the degree of knowledge in preventive methods. Results The survey findings highlighted a worrying trend. The results obtained from the students’ responses indicated that their knowledge about dental trauma is, in general, limited. Data revealed that most students had a level of knowledge below what was desirable, with a considerably low average number of correct answers on items related to the topic. This finding raises significant concerns, suggesting that students may not be fully prepared to effectively deal with emergencies related to dental injuries. The questionnaires were processed and analyzed using Microsoft Office Excel 2007 software. Data were presented as percentages, offering a simplified way to understand the distribution and trend of results. Conclusion The results indicated that students demonstrated that they were aware of the importance of acquiring more knowledge and skills in this specific area. Furthermore, it is notable to highlight the importance of using mouthguards as a preventive measure in sporting environments. This conclusion highlights the need for proactive measures to prevent dental injuries, reinforcing the importance of raising awareness about preventive practices in risk situations.

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Objective To verify the association between the use of preventive dental services and tooth loss in adolescents aged 15-19 years. Methods This cross-sectional study utilized data from the National Health Survey (NHS) 2019. The outcome of interest was “tooth loss of one or more teeth.” The principal predictor was the use of preventive dental services in the past year. The predictor was dichotomized into two groups: those who sought dental services on a preventive basis (e.g., cleaning, check-ups) and those who did not seek preventive care but rather attended for non-routine reasons. Multivariate analysis was conducted using Poisson regression with robust variance to estimate both crude and adjusted prevalence ratios (PR), with adjustment for socioeconomic and demographic factors. Results A total of 4,336 adolescents (15-19 years) from all Brazilian regions participated in this study. The adjusted analysis revealed that individuals who used preventive dental services in the past 12 months had a 62% lower prevalence of tooth loss (PR: 0.38 [95% CI: 0.30-0.49]) compared to those who did not use preventive services. Conclusion This study highlights the importance of public policies that promote equity in access to preventive oral health services for adolescents in Brazil. The use of these services is associated with a lower occurrence of tooth loss, indicating that investing in prevention can reduce inequalities and improve the oral health of this population. To ensure fairer access to healthcare, it is essential that public strategies address risk factors, such as socioeconomic inequalities, and strengthen primary care services, promoting better overall health conditions. The study objective was achieved, as the use of preventive dental services was shown to be associated with lower prevalence of tooth loss among adolescents.

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Aim To characterize the quality of dental care services and validate the Quality of Care in Dental Services from the Perspective of Adolescents (QASO-A - Qualidade da Assistência nos Serviços Odontológicos na perspectiva de Adolescentes) instrument. Methods A quantitative cross-sectional epidemiological study, part of an epidemiological survey on oral health conditions among schoolchildren. The tested sample consisted of 350 subjects. Trained academics used software developed for data collection and database construction. Data were descriptively analyzed using JASP 1.8.2. Results The quality of dental care was positively evaluated among schoolchildren aged 12 and 15 years. However, there was limited access to information about oral cancer and diet, along with dissatisfaction related to the physical structure of the clinic, the comfort of the dental chair, and waiting time. The QASO-A instrument provided evidence of validity and reliability. Conclusion The quality of dental care among adolescents aged 12 and 15 years was well evaluated in terms of service satisfaction, indicating that good-quality services were offered. The QASO-A instrument was considered valid and reliable for application to individuals with similar characteristics to those evaluated in this study.

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Objective To evaluate the serological response to hepatitis B vaccination among health care workers (HCWs) in a dental teaching institution in South India and to assess factors influencing seroprotection. Methods This observational cohort study included 217 HCWs from a dental teaching hospital. Participants received the recombinant hepatitis B vaccine according to the standard three-dose schedule (0, 1, and 6 months). Anti-hepatitis B surface antibody (anti-HBs) titers were measured two months after completion of vaccination using enzyme-linked immunosorbent assay. Seroprotection was defined as anti-HBs ≥10 mIU/mL. Associations between seroprotection and demographic variables, including age, gender, ethnicity, and number of vaccine doses, were analyzed using chi-square and independent t-tests. Results Among the participants, 203 (93.5%) completed the three-dose vaccination schedule. The overall seroprotection rate was 89.2% in the three-dose group and 85.7% in the two-dose group, with no statistically significant difference (p=0.691). Younger participants (≤30 years) demonstrated significantly higher seroprotection rates (p=0.034) and higher mean anti-HBs titers (p=0.049). No significant differences were observed between males and females (p=0.501). Seroprotection varied significantly across ethnic groups, with Malaysian participants showing the highest response rates (p=0.05). Conclusion Although hepatitis B vaccination provides substantial protection among HCWs, a proportion of individuals remain non-seroprotected despite completing the recommended vaccination schedule. Age and ethnicity significantly influence vaccine response. These findings highlight the importance of post-vaccination antibody monitoring and the need for targeted revaccination strategies in high-risk populations.

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Casado (2017) described a low-cost and practical method for sex estimation of adult skulls using precision calipers to evaluate anatomical landmarks. Aim This study aimed to validate this method in Brazilian skulls. Methods: Measurements of 202 skulls (118 male and 84 female) were collected, according to Casado (2017). Results The results were very promising. Except for the external occipital protuberance, the anatomical landmarks were related to sex (p < 0.0001). The anatomical landmarks from both sexes were included, and 72.16% of the skulls were correctly classified. The individual percentage per sex was similar, with 71.40% accuracy in male skulls and 72.92% in female skulls. Conclusion The method efficiently identified sex differences in anatomical landmarks of Brazilian skulls regardless of age and ancestry.

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Aim To evaluate anxiety, sleep quality, and associated variables among Brazilian postgraduate (stricto sensu) Dentistry professors during the COVID-19 pandemic. Methods A cross-sectional study was conducted through an online questionnaire distributed to 1,973 professors between January and March 2021. The instrument included sociodemographic variables, teaching activity, State-Trait Anxiety Inventory (State component – STAI-S) and Sleep Assessment Questionnaire (SAQ). Univariable and multivariable linear regression analyses were performed using SPSS® version 29.0.2. Statistical significance was set at p < 0.05. Results 322 professors participated (189 females and 133 males), with a mean age of 49 (± 9.3) years. Female gender, difficulties in performing remote activities, total change in routine due to social distancing, and increased time spent on teaching activities were significantly associated (p < 0.05) with higher STAI-S and SAQ values in both univariable and multivariable analyses. In the multivariable analysis for STAI-S (cutoff > 40), women were more than twice as likely to report anxiety than men [OR = 2.23; 95% CI: 1.32–3.75; p = 0.003], as those who reported difficulties with remote activities [OR = 4.13 (95% CI: 2.25 – 6.96); p < 0.001], and those who perceived a “total” change in routine [OR = 1.60 (95% CI: 1.01 – 2.54); p = 0.047]. For the SAQ (cutoff > 40), the “reduced” category remained statistically significant [OR = 1.85; 95% CI: 1.01–3.41; p = 0.049]. Conclusion Anxiety and poor sleep quality were associated with gender, remote work challenges, and disrupted routines during the pandemic in this sample.

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Aim This study compared the expression of virulence genes and the ability to form biofilm in Enterococcus faecalis isolated from patients undergoing different endodontic clinical cases. Methods For the biofilm-forming capacity, a reference strain (E. faecalis ATCC 29212) and four clinically isolated E. faecalis strains were analyzed by counting the colony-forming units, scanning electron microscopy, and optical density measurement. The gene expression of the collagen-binding protein (ace), aggregation substance (asa), endocarditis antigen (efaA), cytolysin (cylA), protein surface (esp), gelatinase (gelE), and histidine kinase (fsrC) was evaluated by a real-time polymerase chain reaction. Results All strains were capable of forming biofilms in vitro; however, the reference strain exhibited significantly lower biofilm formation than the clinical isolates. The majority of virulence genes were expressed across all strains, with no significant differences between the clinical groups. Notably, expression of the asa gene was detected only in isolates obtained from root canals associated with apical periodontitis. Conclusion In conclusion, all E. faecalis strains showed biofilm-forming capacity, but analysis of virulence genes showed the expression of asa only in strains isolated from patients with apical periodontitis.

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Aim This study investigated the impact of toothpaste abrasiveness on the surface roughness, gloss, and microhardness of resin composite and CAD/CAM hybrid materials. Methods A 4x3 factorial design was utilized. The substrate was divided into 4 groups: Vita Enamic Hybrid Ceramic (VE), SHOFU Block HC Hybrid Ceramics (SH), Grandio Blocs CAD/CAM Nano-Hybrid Resin Block (GB), and dental enamel (ESM). The factor abrasiveness of toothpaste presented 3 levels: Low-36 (L), Medium-78 (M), and extra-high-175 (EH). Before and after brushing represented the repetition factor. Specimens (n=15 per group) measuring 6mm X 2mm were prepared and submitted to brushing aging. Surface gloss, roughness, and microhardness were evaluated before and after the brushing simulation. Three-way repeated measures ANOVA and the Tukey’s test (p<0.05) were used for statistical analysis. Results Gloss measurements indicated a significant increase after brushing ESM with the M toothpaste, while GB material significantly reduced gloss overall. The use of EH increased the roughness of the ESM group only. An increase in microhardness was detected using L and M for VE, while a decrease was observed in ESM specimens. Conclusion The tested protocols influenced the surface gloss, and the roughness was similar in the groups, except in the ESM group. The EH abrasive dentifrice was the only one that did not demonstrate statistical differences for microhardness in brushing protocols for these materials.

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Aim To assess the impact of brushing using 5 different toothpastes on the roughness and microhardness of CAD-CAM materials. Methods A total of 400 specimens (14 × 5 × 2.5 mm) were fabricated using four different materials: 2 resin composites (Lava Ultimate, LU; Cerasmart, CE), 1 polymer-infiltrated ceramic (Vita Enamic, VE), and 1 lithium disilicate glass-ceramic (IPS e.max CAD, EM). Twenty specimens of each material were brushed (100,000 cycles) using three types of toothpastes: 1 regular (Colgate Total 12, CT), 2 sensitivity (Sensodyne Pro-Enamel, SP; Colgate Sensitive Pro-Relief, CS), and 2 whitening (Oral-B 3D White, OB; Colgate Luminous White, LW). Surface roughness (Ra) and microhardness (KHN) were measured before and after brushing. The data were submitted to the Kruskal-Wallis test followed by the Bonferroni-Dunn multiple comparison and Wilcoxon tests (α=.05). Results For CE, the post-brushing Ra using SP was significantly lower (P=.017) than the other toothpastes. For EM, the post-brushing Ra using SP was significantly higher than CS (P=.017). In general, the toothpastes increased the material Ra (P<.02), except for SP, which decreased the Ra of LU and CE (P<.007) and had no effect on VE (P>.05). Only CE brushed using LW showed an Ra higher than 0.2 µm. KHN did not differ among toothpastes within each material before or after brushing. The sensitivity toothpastes significantly increased KHN values of all materials after brushing, while a significant reduction was observed with the other toothpastes (P<.05). Conclusions Sensitivity toothpastes decreased surface roughness of the resin composites LU and CE and increased hardness of all other materials. Regular and whitening toothpastes increased surface roughness and decreased hardness of most restorative materials.

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Aim: This study aimed to report the use of high-viscosity glass ionomer cement for functional and esthetical rehabilitation of a 6-year-old boy with DGI-II. Methods: Using a working cast, templates for all teeth requiring restoration were made and used to make an addition silicon replica. With the aid of the silicone templates, all primary teeth with weariness and the permanent molars newly erupted were respectively restored and covered with high-viscosity glass ionomer cement (GIC). Results: Following-up of 12 months were made. The early diagnosis and treatment of teeth with DGI-II play an essential role in the dental preservation and child's functional, esthetical and psychological aspects. Conclusion: In this case report, the boy changed his shy behavior to a more communicative one, came back to smile besides being able to eat normally again, impacting his quality of life. The rehabilitation with replica technique and high-viscosity glass ionomer cement can save chair time, because DGI-II is a condition that needs continuous return to the dentist regarding challenging adherence of any adhesive restoration materials.

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Addressing hyperpigmentation in exposed areas of the body can be challenging in general practice and can raise a variety of questions, from possible serious illnesses to aesthetic concerns. Reviewing the case of a 21- year-old female, this study investigates concurrent benign hyperpigmentation of the tongue and conjunctiva while exploring potential links to iron and vitamin D deficiencies. The diagnostic journey involves a comprehensive evaluation, ruling out extrinsic causes and systemic illnesses for tongue hyperpigmentation, and discusses the approach leading to the diagnosis of Pigmented Fungiform Papillae (PFP) on the tongue and Complexion Associated Melanosis (CAM) in the conjunctiva. The article advocates for a cost-effective, minimally invasive approach in managing such cases in general medical practice.

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Aim Older adults are an increasingly significant group of consumers of cosmetic procedures, particularly minimally invasive aesthetic treatments. However, scientific data of these procedures in older populations remain limited. This study evaluated the self-perception of facial aesthetics and quality of life among older adults who have undergone minimally invasive facial rejuvenation procedures. Methods Older adults who seek aesthetic treatment at a Dental School were recruited. They underwent treatments such as botulinum toxin injections, dermal fillers, microneedling, collagen biostimulators, chemical peels, and facial threads (experimental group, n = 61). Older adults who had not undergone any aesthetic procedures were also recruited (controls, n = 61) Satisfaction with facial appearance and health-related quality of life were assessed using the Brazilian version of the Satisfaction with Facial Appearance Overall Scale (FACE-Q) and the Portuguese version of World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) questionnaire, respectively. Data were analyzed using exploratory methods and independent t-tests (α = 0.05). Results Older adults who had undergone aesthetic procedures reported significantly lower satisfaction with their facial appearance (P < .001). However, they demonstrated a significantly higher overall quality of life (P = .024). Conclusion Although minimally invasive aesthetic procedures may enhance the overall quality of life in older adults treated in a Dental School, they do not necessarily increase satisfaction with facial appearance. Results should be interpreted with caution, as they may not be generalized to all older adults, particularly those who do not wear dentures.

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Aim To evaluate whitening toothpastes by analyzing labels, active ingredients, prices, commercial appeal, pH, and characteristics of abrasives. Methods 18 whitening toothpastes and 4 regular toothpastes sold by different manufacturers were assessed. The pH of the slurry was determined in triplicate, and the percentage of solid weight by desiccation. The abrasive particles were sieved and analyzed using scanning electron microscopy (SEM). The average price (BRL, USD) was established, the labels were analyzed for advertising approach, type of abrasive, and presence of fluoride, and the whitening active ingredients were categorized as abrasive, chemical, or optical agents. The data were analyzed using the Mann-Whitney test to compare regular and whitening toothpastes (α=0.05), and the categorical data were analyzed by absolute and relative frequencies. Results The toothpastes had a pH close to neutral or > 7, with no difference between whitening and regular toothpastes (p=0.173). Whitening toothpastes had solids between 26.70% and 66.46% and did not differ statistically from regular ones (p=0.394). The average price of regular toothpastes is lower than that of whitening toothpastes (p=0.033). Concerning whitening toothpastes, the most common abrasive was silica, the chemical agent was sodium pyrophosphate, and the optical agent was blue covarine. SEM analysis revealed that some whitening toothpastes presented amorphous particles of different sizes, unlike the composition of regular toothpastes. In addition, three whitening toothpastes did not contain fluoride in their composition. Conclusion The whitening toothpastes can differ from regular toothpastes in terms of price, advertising, and the shape and size of the abrasive.

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Aim This cross sectional in situ study aimed to evaluate the physical properties and color stability of polymethylmethacrylate (PMMA)-based resins used in provisional crowns. Methods Twelve cubic specimens with 5mm edges of conventional self-, heat-polymerized acrylic resins, 3D-printed, and CAD-CAM milled PMMA resin were fabricated. Surface roughness, Knoop microhardness, wettability, and color stability were evaluated. Utilizing a split-mouth design, 8 cubes were randomly placed in a palatal intraoral appliance worn by 12 volunteers. Specimens were exposed to erosion extra-orally with 15 mL of cola-based soft drink (Coca-Cola®) three times daily for 5 minutes over 7 days. Statistical analysis was performed using one-way repeated measures ANOVA and Bonferroni multiple comparison analysis (α = 0.05). Results PMMA resins exhibit comparable surface roughness and wettability under non-erosive and erosive conditions (p>0.05). However, self-polymerized and 3D-printed acrylic resins exhibited significant differences in microhardness after exposure to the erosive environment (p<0.05). CAD-CAM milled acrylic resins showed superior color stability compared to the other resins (p <0.05). The simulated erosive environment significantly alters the physical properties and color of provisional crown resins. Conclusions These findings demonstrate that heat-polymerized and CAD-CAM acrylic resins exhibit superior behavior under non-erosive and erosive conditions, which may indicate better clinical performance, especially when indicated for longer-term use.

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Odontogenic keratocyst is an intraosseous lesion with aggressive potential and infiltrative behavior, presenting high recurrence rates. The occurrence of multiple odontogenic keratocysts in the same patient may be associated with Gorlin–Goltz syndrome, a condition characterized by a predisposition to neoplasms and other developmental abnormalities. There is no consensus regarding the best treatment modality. In cases of multiple or large lesions, surgical management may be associated with significant morbidity, resulting in aesthetic and functional impairment. Conservative approaches, such as decompression, represent an effective treatment option due to their simplicity and low morbidity. Aim This study aims to describe the case of a 13-year-old female patient diagnosed with Gorlin–Goltz syndrome and multiple odontogenic keratocysts in the mandible. Methods The patient was treated using surgical decompression techniques and posterior enucleation. Decompression devices were fabricated from surgical suction tips or needle cap tips and were placed under local anesthesia in five mandibular lesions. After 17–21 months following the decompression procedures, a significant volumetric reduction was observed in four out of five lesions. Subsequently, the patient underwent enucleation surgery. The patient has been under long-term postoperative follow-up for six years after decompression and approximately five years after enucleation, demonstrating satisfactory postoperative recovery, bone neoformation, and absence of aesthetic or functional sequelae. Conclusion Conservative techniques such as surgical decompression for the treatment of odontogenic keratocysts are simple, low-cost, and effective options, reducing surgical morbidity and ensuring favorable aesthetic and functional outcomes. However, continuous follow-up and patient compliance are essential for optimal results.

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Aim To assess Libyan undergraduate dentistry students’ familiarity, comfort, attitudes towards treating patients with special healthcare needs (PSHCN), their opinions on instruction quality, and their perceptions of treatment needs and challenges in providing dental care to children with special needs. Methods A self-administered questionnaire on special need dentistry (SND) was given to 239 fourth-year undergraduate dental students at the Faculty of Dentistry in Benghazi, Libya, as part of a cross-sectional, questionnaire-based study that took place between February and August 2022. Results Most students lacked a comprehensive understanding of SND definitions and expressed discomfort in managing patients with such conditions, 59.4% of dental students lack knowledge about intellectual disabilities. The highest rate of dental students who never exposed themselves to intellectual disabilities and visual and hearing impairment were 60.3% and 54.8%, respectively. Most students agreed that they should have received didactic and clinical training at the undergraduate level, and they felt their undergraduate training in SND was insufficient. Respondents were less motivated regarding clinical and behavioral management, facilities, didactic training, and degree of collaboration, but more motivated to treat PSHCN if they were compensated, had more time, had experience with oral sedation, and had hospital privileges. Conclusions The study suggests that dental practitioners and students should enhance their understanding and awareness of the oral health requirements of PSHCN. In addition, a significant portion of students indicated a desire to pursue graduate study in this field of dentistry, even though they had little exposure to it during their undergraduate studies.

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Aim To determine the prevalence, location, shape, size and base length of maxillary sinus septa using cone beam computed tomography, in order to provide critical anatomical information for safe and accurate surgical planning, particularly in procedures such as sinus lift surgeries. Methods CT images of 198 patients were selected. The images were analyzed using XoranCat® software. All patients were classified according to sex, age and type of dentition. The existence and number of septa were investigated. If septa were present, their locations were determined and the height and length of their base were measured. The septa were classified as buccopalatal, sagittal or transverse. Statistical analysis was performed to evaluate the prevalence, location and morphology of the septum within the maxillary sinus according to the different variables. The Pearson Chi-square, Mann-Whitney and Kruskal-Wallis statistical tests were used, adopting a significance level of 5% (p<0.05). Results Septa were found in 99 patients studied, thus indicating a prevalence of 50%. No significant differences (p<0.05) were found in the frequency of septa according to dentition type, gender and different age groups. Most of the septa found were in the middle region, with a prevalence of 52.5%, and the buccopalatal orientation was the most frequent (75.5%). The mean height and base length found in this study were 6.12 ± 3.32 and 6.61 ± 2.38 mm, respectively, with the highest measurements found in the middle region. Conclusion Making a detailed anatomical study by tomographic images essential before sinus floor elevation surgeries and other maxillary procedures, including diagnosis and treatment planning in implantology and sinus pathology.

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Aim This study aimed to compare total working time, active instrumentation time, instrument fracture, and preservation of canal morphology in curved mesiobuccal canals of mandibular molars prepared with ProTaper Ultimate (PTU) or WaveOne Gold (WOG). Methods Twenty-eight extracted human mandibular molars were randomly assigned to the PTU or WOG groups (n = 14). The canals were prepared by a single calibrated undergraduate operator using an X-Smart Plus motor and the manufacturers’ protocols, with 2.5% NaOCl irrigation. Two independent observers timed total working time (including instrument changes and irrigation) and active instrumentation time using digital stopwatches. In each group, a single instrument kit was reused across all specimens; if an instrument fractured, the corresponding specimen was excluded from the analysis. Pre- and postoperative cone-beam computed tomography enabled qualitative assessment of canal morphology, considering apical transportation, ledges, and canal axis deviation. Shapiro–Wilk, Mann–Whitney test, and Student’s t-test were performed. Results The WOG group exhibited shorter total working time than PTU (median = 6.310 min; 95% CI: 5.775–7.311 vs median = 10.115 min; 95% CI: 8.241–11.535; p < 0.001), as well as shorter active instrumentation time (2.05 ± 0.576 min vs 3.01 ± 0.765 min; p = 0.001). One fracture occurred in the WOG group (Small 20/.07), and none in PTU. No specimens showed clinically relevant postoperative apical transportation, ledges, or canal deviation; both systems preserved canal morphology, and WOG was more time-efficient despite an isolated instrument fracture. Conclusion Overall performance was considered safe, and the clinical choice should balance reduced working time against instrument durability.

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Aim To evaluate the effects of different doses of avocado and soybean unsaponifiable extract (ASU) on the progression of induced periodontitis in rats. Methods Thirty-five rats underwent induction of periodontitis by inserting ligatures around the upper second molar of one hemiarch, while the second molar of the other hemiarch was left without the ligature. The animals were subsequently randomly distributed into 5 groups according to the administered solution: CTR: Saline solution (SS); ASU1: ASU at a concentration of 0.3 g/kg/day; ASU2: ASU at a concentration of 0.6 g/kg/day; ASU3: ASU at a concentration of 1.2 g/kg/day; ASU4: ASU at a concentration of 2.4 g/kg/day. The solutions were administered daily, by gavage, from the day of insertion of the ligatures until the day of euthanasia of the animals, which was performed 15 days after the periodontitis induction. The analysis of the distance from the cemento-enamel junction (CEJ) to the top of the bone crest (BC) and the % bone volume was performed using micro-CT. The inflammatory infiltrate was evaluated by stereometric analysis. One-way ANOVA complemented by Tukey test was used to compare the different groups with the significance level of 5%. Results ASU groups presented smaller JCE-BC distances than the CTR group (p<0.05). The CTR group had a lower number of fibroblasts and extracellular matrix and a higher amount of inflammatory cells than the ASU groups (p<0.05). Conclusion ASU promoted reduction against bone tissue resorption and in the inflammatory pattern, mainly at concentrations of 0.3 g/kg/day to 1.2 g/kg/day.

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Aim to evaluate advances in dental pulp regeneration and challenges for regenerative endodontic therapies, particularly nervous tissues and their components. Methodology for the analysis of this narrative review, a search for relevant articles was conducted across various scientific databases, including PubMed, Scopus, Web of Science, and Embase, covering the period from 2000 to 2023. The inclusion criteria were set to primarily encompass original research articles, systematic reviews, and meta-analyses that demonstrated relevance to the topics of interest. Results neurogenesis occurs during pulp repair but is impaired by ongoing lesions due to reduced vascular supply. The results suggest that while various therapeutic approaches using biomaterials are being explored, efficient neural regeneration though achieved in some studies remains a significant challenge. Conclusion Several studies have demonstrated the return of pulp sensitivity and the formation of neural tissue. However, despite growing interest and promising results, challenges remain to be addressed, the variability in individual responses and the complexity of tissue revitalization mechanisms, which are not yet fully understood.

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Background Ameloblastomas (AM) and Odontogenic Keratocysts (OKC) are benign odontogenic lesions with potential for growth and local expansion and are considered aggressive in many cases. Despite being histologically distinct, they exhibit similar imaging characteristics, complicating radiographic diagnosis. Aim This is an exploratory and descriptive case series study which aims to reevaluate and detail six cases diagnosed as AM and OKC, focusing on the trabecular characterization of the lesions through fractal dimension (FD) and pixel intensity (PI) analyses on panoramic radiographs (PR). Results Radiographic features were reassessed, and diagnoses were confirmed for each case. Additionally, two analyses were conducted to characterize the bone pattern of the lesions. FD and PI were calculated using Image J® software. All cases were located in the mandible. The mean age for the AM patients (n=3) was 35.33 years, with a sex distribution of 2 females and 1 male. In one case, the lesion appeared as a radiolucent-unilocular image. The mean FD and PI values were 1.24 and 74.67, respectively. The mean age for OKC patients (n=3) was 32.33 years, with a predominance of males (2:1). The mean FD and PI values were 1.33 and 98.75, respectively. Conclusion The results indicate that the FD values in this sample were most similar between the two pathologies, preventing differentiation based on FD alone. However, the PI values suggested that the AM lesions were less dense than the OKC lesions.

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Trigeminal neuralgia (TN) is a debilitating neuropathic pain condition characterized by brief, recurrent paroxysms of intense, electric shock-like pain, triggered by light stimuli within the distribution of the trigeminal nerve. Although the symptoms are distinctive, TN is frequently misinterpreted as odontogenic pain, leading to inappropriate dental interventions before the correct diagnosis is made. Aim to identify the first healthcare professional consulted by patients with TN, evaluate the number of unnecessary dental procedures performed, and determine the time elapsed between symptom onset and correct diagnosis among patients referred to a tertiary public university center. Methods Seventy-eight patients fulfilling clinical criteria for TN were included. Data were collected using a standardized questionnaire administered during consultation. Results The mean patient age was 66 ± 10.9 years. The maxillary (V2) and/or mandibular (V3) branches were affected in 82% of cases, with dentists being the first professionals consulted. In contrast, when the ophthalmic (V1) or combined V1–V2 branches were involved, patients more frequently sought physicians. This difference was statistically significant (p=0.019). Overall, 52 patients (87%) underwent unnecessary dental treatments, mainly extractions. A positive correlation was observed between diagnostic delay and the number of extractions performed (r=0.309; p=0.040). No significant associations were found between diagnostic timing and age, sex, pain characteristics, or first professional consulted. Nevertheless, patients diagnosed within 12 months were 80% less likely to have undergone dental extractions. Conclusions These results highlight the persistent underdiagnosis of TN and the urgent need for ongoing education and awareness among dental and primary healthcare professionals.

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Aim This retrospective case series aims to describe different stabilization methods for a volume-stable collagen matrix (VCMX) in multiple root coverage (RC) cases. Methods Four patients with RT1 multiple gingival recessions presenting with aesthetic or sensitivity complaints were treated with a coronally advanced flap using a VCMX. The biomaterial was handled and sutured using different techniques, including interproximal interrupted sutures and horizontal mattress sutures. Follow-up periods ranged from 1 to 3 years, with clinical measurements taken at both baseline and the last follow-up visit. Results A total of 10 gingival recessions were treated, with 6 receiving VCMX. Recession reduction at VCMX-treated sites ranged from 1 to 2.5 mm, with RC percentages ranging from 67% to 100%. Complete RC was achieved in 50% of the treated sites, with only one of these involving the use of the biomaterial. Conclusion The addition of a VCMX to root coverage procedures yielded favorable clinical outcomes, and the method of biomaterial handling and stabilization via sutures appeared to correlate with postoperative outcomes. However, further studies are needed to assess the true impact of VCMX stabilization techniques on clinical outcomes.

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Introduction Failures in orthodontic treatments using bands may be related to deficient properties of GICs. Incorporating graphene into GICs for cementation is an option to improve this material and reduce failures. Aim The purpose is to evaluate the effect of adding reduced graphene oxide (rGO) on the mechanical and optical properties of glass ionomer cements (GICs) for luting. Methods Samples of 6 different GICs (Meron, GC Gold Label, GC Fuji Plus, Riva Luting, Vitro Cem, and Vidrion) with and without graphene incorporation at concentrations of 0.25%, 0.5%, and 1% were prepared. Cohesive strength (CoheS), compressive strength (CompS) and Shear Bond Strength (SBS) tests were conducted using a universal testing machine (EMIC). Color change was assessed using the CIELAB system and particle dispersion was observed with Optical Microscopy (OM). Data was tabulated and analyzed with Jamovi software (p<0.05) using descriptive and correlation analyses with One-way ANOVA and Kruskal-Wallis tests, based on the Shapiro-Wilk normality test. Results The incorporation of rGO significantly increased the compressive strength of Vidrion (0.5%) and the cohesive strength of GC Gold Label and GC Fuji Plus, although it caused perceptible chromatic changes in all tested cements. Conclusion The addition of rGO to GICs enhanced the mechanical properties of some GICs and altered the color of all GICs.

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Background Nosocomial infections pose a significant risk to pediatric cardiac patients, often linked to alterations in the oral microbiota during hospitalization. Objective To identify microorganisms responsible for nosocomial infections in the saliva of children and adolescents with congenital heart disease admitted to a tertiary care hospital. Methods This prospective study included patients aged 0–18 years who underwent cardiac surgery. Unstimulated saliva samples were collected at three time points: (1) within 24 hours of admission to the hospital ward; (2) within 24 hours after surgery in the Pediatric Intensive Care Unit (PICU); and (3) 48 hours postoperatively in the PICU. Oral hygiene status was assessed using the Visible Plaque Index (VPI). Samples were analyzed to identify the presence of microorganisms associated with nosocomial infections. Results Among 50 participants, 44% exhibited alterations in their salivary microbiota, with Klebsiella pneumoniae (25%) being the most prevalent pathogen, followed by Acinetobacter baumannii (24%) and Enterobacter cloacae (20%). Nosocomial infections occurred in 10% of patients. Microbiota alterations were significantly associated with younger age (<12 months), systemic inflammatory response syndrome (SIRS), prolonged mechanical ventilation (≥72 hours), and extended cardiopulmonary bypass time (≥60 minutes) (p<0.05). No significant association was found between VPI and microbiota changes. Conclusion Significant shifts in the oral microbiota, particularly involving pathogens with nosocomial potential, occur after 24 hours in the PICU. These findings underscore the importance of monitoring oral health and implementing preventative oral hygiene protocols to reduce systemic infections in pediatric cardiac patients.

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Objective The aim of this scoping review was to comprehensively search the literature to identify and present available published information regarding the addition of zirconium compounds into glass ionomer cements (GICs), the incorporation methodologies, and the impact of zirconium on the properties of GICs. Methods The protocol was registered in the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/BWVJK). The search was conducted across eight databases in June 2023. Selected journals were screened for potential predatory status. Data regarding study design, classification of dental materials, zirconium incorporation, and property assessments were extracted and synthesized. Results A total of 72 studies, mostly in vitro, were included. Zirconomer, commercially modified GICs, and experimental GICs were identified. Zirconia 10% was the most common added zirconium compound, and nanometric particles resulted in superior mechanical performance. Regarding compressive strength and microhardness, Zirconomer exhibited superior results, while modified or experimental GICs demonstrated lower values compared to commercial GICs lacking zirconium compounds. Zirconomer is the sole commercially available zirconium-based GIC. Among the experimental materials, zirconia nanoparticles at 5% and 10% incorporation ratios presented the most favorable mechanical properties, especially microhardness and compressive strength. Conclusion These findings suggest a favorable scenario for the clinical application of glass ionomer cements modified with zirconium compounds. Glass ionomer cements modified with zirconium compounds showed enhanced mechanical properties relevant for restorative dentistry.

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Aim In this study, we aimed to draw attention to the mismanagement of a rare complication that develops during root canal treatment. The report follows the guidelines of the Case Report Guide (CARE) and focuses on steps to eliminate the complication that has occurred. Methods The widespread acute infection of a 51-year-old female patient who applied to our clinic with an extraoral abscess was first brought under control. Afterward, during the root canal treatment performed on the lower third molar tooth, which was the source of the infection, endodontic paste residues that penetrated the mandibular canal were surgically removed, and the patient was followed up. Results It was understood that the source of the patient’s widespread infection was the medicament-impregnated cotton that the endodontic treatment physician placed into the tooth extraction socket for analgesia. It was observed that the patient’s paresthesia, which occurred due to nerve damage, did not regress during long-term follow-up. Conclusion This case report shows that while it is essential to avoid complications in dentistry, the knowledge and ability to manage them are truly remarkable.

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Aim To determine the prevalence of persistent pain in endodontic patients. Methods Six electronic databases (EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, and Web of Science) were searched, along with the gray literature (Google Scholar, ProQuest Dissertations and Theses). The review used a random-effects model for meta-analysis of proportions and assessed the risk of bias based on the Joanna Briggs Institute Critical Appraisal tool. Results The review included 16 articles (seven cohort studies and nine cross-sectional studies) published in English from 1994 to 2022. Fifteen of them were selected for meta-analysis. The combined prevalence estimate was 5% (95% CI = 0.01 – 0.10). The risk of bias was moderate in four studies and low in the others. Conclusion The estimated prevalence of persistent pain after endodontic treatment was approximately one in every 25 patients.

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Aim This cross-sectional study aimed to evaluate the knowledge, acceptance, and use of irrigant activation techniques during root canal treatment (RCT) among Brazilian endodontists. Methods Participants received an electronic questionnaire consisting of 16 questions regarding sociodemographic characteristics, professional profile, and irrigation protocols. Responses were collected from June 2022 to October 2023. Data were analyzed descriptively and using Chi-square tests at a 5% significance level. Results A total of 282 endodontists responded to the survey. Most were female (61.3%), with an average of 14.5 years since dental school graduation and 10.2 years of specialized training in endodontics. Most respondents were from the southern (49.6%) and southeastern (32.3%) regions. Of them, 44.3% worked exclusively in private practice and 31.6% combined private practice with academic roles. Sodium hypochlorite (75.9%) and EDTA (92.9%) were the predominant irrigants used during RCT. When asked to rank the reasons for their primary irrigant selection, antimicrobial capability was considered the most important and to clean isthmuses and ramifications, the main reason to use activation methods. In total, 78.3% of respondents consistently used irrigant activation, with 69.5% employing it after chemomechanical preparation. Passive ultrasonic irrigation was the most popular technique, followed by the Easy Clean instrument. Workplace setting significantly influenced the frequency of irrigant activation usage (p<0.05). Conclusion In conclusion, most Brazilian endodontists employ irrigant activation techniques and prefer sodium hypochlorite and EDTA as irrigating solutions, aligning their practices with global standards. This web-based survey highlights the integration of contemporary scientific knowledge into endodontic practice.

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Aim This systematic review and meta-analysis aimed to assess the short term skeletal and dental effects of clear aligners with mandibular advancement feature (CAMA) in class II malocclusion due to mandibular retrognathism. Methods An electronic data search was performed without any restriction in the year of publication in five search engines. Data were extracted and Newcastle–Ottawa Scale for observational studies was used to assess the risk of bias. As necessary, statistical heterogeneity was examined, random effects model was used in meta-analyses and parameters assessed by meta-analysis across studies were graded for quality of evidence. Results Seven retrospective and five prospective studies were included. Five studies had low risk, two had moderate and five had high risk of bias. There was a significant increase in mandibular length following CAMA therapy. There was no significant difference in the skeletal changes brought about by twin block and CAMA. There was no significant change in maxillary and mandibular incisor inclination after twin block or CAMA therapy. Conclusion It can be concluded that CAMA promoted mandibular growth, but it was not significantly greater than twin block. There was no difference in the maxillary and mandibular incisor inclination with twin block or CAMA therapy.

Abstract in English:

The use of fixed orthodontic appliances by conventional technique favors biofilm accumulation in adjacent brackets areas and, consequently, white spot lesions (WSL) development, diagnosed as active tooth enamel caries. Clinically, these lesions appear whitish and opaque, without superficial shine, and can affect aesthetics and self-esteem. Aim The present study aimed to present and discuss the preventive and aesthetic treatment approach for a young patient with multiple WSL diagnosed as dental caries lesions, developed during orthodontic treatment with fixed appliance. Methods An 18-year-old female patient was referred to the University Dental Clinic of the State University of Londrina for management of WSL located on the buccal enamel surfaces of the upper and lower teeth. Clinical and radiographic examinations revealed generalized active WSL on the buccal surfaces of both arches. After diagnosis and treatment planning, a combined approach was implemented, including mechanical biofilm control, remineralization therapy, tooth whitening, and enamel microabrasion. Results The proposed therapeutic sequence yielded favorable outcomes, demonstrating that a conservative and effective clinical approach can be successfully applied for managing WSL in young patients after orthodontic treatment. Conclusion The combined use of remineralization techniques, bleaching, and enamel microabrasion proved to be a viable, safe, minimally invasive, and cost-effective strategy to reestablish oral health and dental esthetics.

Abstract in English:

The aging process induces morphophysiological changes that significantly impact oral health, necessitating specialized endodontic care in older adults. Systemic diseases common in this population, such as diabetes and cardiovascular conditions, further complicate treatment outcomes by influencing pulp and periradicular structures. Key age-related alterations include pulp chamber reduction, dentin sclerosis, and bone loss, which challenge conventional endodontic techniques. Aim To address these issues, this review conducted a search in PubMed, Scopus, and Web of Science for articles published between 2010 and 2024, using keywords related to endodontics and aging, and selecting studies relevant to clinical practice. Results This review highlights the interplay between systemic health and oral pathophysiology, emphasizing the need for tailored clinical strategies to enhance treatment predictability. Evidence indicates failure rates of approximately 26% in geriatric endodontics, frequently associated with suboptimal treatment quality, comorbidities, and microbial persistence. A comprehensive preoperative assessment, integrating medical, pharmacological, and dental histories, is critical to mitigate risks and optimize outcomes. Specific considerations include anesthesia modifications, calcified canal management (using microscopy or ultrasonics), and drug interactions (NSAIDs with antihypertensives). Successful treatment hinges on addressing both technical and systemic factors: precise canal preparation, antimicrobial protocols, and thermoplastic obturation improve longevity, while interdisciplinary collaboration ensures patient safety. Sedation may benefit anxious individuals, and postoperative monitoring is advised for high-risk cases. In conclusion, endodontic success in older adults relies on adapting techniques to age-related anatomical changes while managing systemic complexities. Conclusion This review synthesizes evidence-based recommendations to guide clinicians in delivering effective, safe care for aging populations.