Optimal oral health largely depends on the successful removal of plaque through effective brushing, but success typically relies on user technique, time, and adherence. The aim was to compare the effectiveness of a newly introduced dual-headed toothbrush with a conventional single-headed toothbrush in control of plaque and gingival health using a split-mouth design. In the study, 37 dental professionals used two types of toothbrushes: a dual-headed toothbrush on one side of the mouth (Test side) and a conventional single-headed toothbrush on the other side (Control side). The study compared plaque removal, gingival status, and brushing time, assessing clinical outcomes using plaque index (PI), gingival index (GI), and modified sulcus bleeding index (mSBI) at baseline, 2 weeks, and 4 weeks. At the end, participants completed a Likert scale questionnaire. Both types of toothbrushes were effective in enhancing oral hygiene over time; however, dual-headed toothbrush group showed significant short-term reductions in plaque accumulation, gingival inflammation, and bleeding, particularly at the 2-week interval. A significant majority of participants (89.2%) rated dual-headed brush as "very easy" to use. Using a dual-headed toothbrush significantly reduces the brushing time (0.54 ± 0.17 vs. 0.99 ± 0.05min for a conventional single-headed toothbrush), suggesting enhanced time efficiency. A dual-headed toothbrush would be more effective, faster, and easier to use than a single-headed brush. It would be a convenient alternative, especially for individuals with time constraints.

Periodontitis and apical periodontitis (AP) are characterized by biofilm-driven, immune-mediated bone destruction. Macrophages orchestrate the immune imbalance, where the M1/M2 polarization axis is critical for tissue homeostasis. To review preclinical strategies for macrophage reprogramming-based immunotherapies in periodontitis and AP. A literature search in Web of Science (last 10 years) identified original in vivo and complementary in vitro studies evaluating interventions targeting macrophage polarization. Eligible studies reported M1 markers (CD80, CD8, and/or iNOS) and M2 markers (CD163, CD206, and/or Arg-1) in relation to inflammatory modulation and regenerative outcomes. Fifteen studies met the criteria. In periodontitis, local therapeutic strategies such as bioactive cytokines (CCL2, IL-37), inhibition of extracellular matrix proteins (FBLN3), functionalized biomaterials (Se-nHA/PC microspheres, Q@MPDA nanoparticles), MSC-derived exosomes, regulatory miRNAs (miR-126), pharmacological agents (glipizide, apabetalone), and adoptive M2 transfer demonstrated M2 polarization. In AP, systemically administered M2-derived extracellular vesicles, pharmacological agents (DMOG, Stattic, azithromycin), and blockade of Gremlin-1 are associated with M2 phenotypes. All reduced alveolar bone loss, osteoclast activity, and pro-inflammatory mediators, while favoring reparative responses. Mechanistically, effects were mediated through MAPKs, PI3K/Akt/HIF-1α, STAT3, and NF-κB pathways. Current evidence highlights macrophage reprogramming toward an M2 phenotype as a promising adjunctive strategy for periodontitis and AP. Delivered locally or systemically, these interventions dampen M1-driven inflammation and enhance regeneration, though validation in orthotopic models and translational studies remains necessary. Immunotherapeutic approaches targeting macrophage polarization could complement conventional biofilm control with emphasis on regenerative periodontics and endodontic procedures, opening new avenues for biologically driven, patient-centered therapies.

To evaluate the clinical outcomes, periodontal ligament (PDL) healing, and complication rates associated with Intermittent Oxygenation Technique (IOT), a staged reoxygenation protocol designed to preserve PDL vitality on the root surface during intentional replantation (IR). Forty mature permanent teeth from 39 patients underwent intentional replantation using IOT between 2020 and 2024. The protocol introduces intermittent replantation periods during extraoral procedures to restore oxygenation and nutrient diffusion to PDL cells on the root surface. Clinical and radiographic follow-up was performed for at least 12 months (mean: 2.7 years). Primary outcomes included the incidence of ankylosis and replacement resorption. Frequentist binomial statistics and Bayesian Beta-Binomial models were applied to estimate the true complication rate. No cases of ankylosis or replacement resorption were detected (0/40). The Clopper-Pearson 95% CI yielded an upper bound of 9.5%. Bayesian analysis demonstrated substantially lower credible upper bounds: 5.5% (Jeffreys prior), 6.6% (conservative prior), and 6.3% (literature-informed prior). Subgroup analysis (< 15min vs. ≥ 15min extraoral time) revealed identical outcomes. IOT may significantly reduce the risk of ankylosis and replacement resorption by mitigating PDL hypoxia through staged reoxygenation. Bayesian modelling strongly suggests that the true complication rate lies in the low single digits, substantially below historical values for traditional IR.

This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.

Despite being widely used for treatment planning, the accuracy of Invisalign arch width tables has not been independently assessed. The objective of this study was to assess whether the predicted and observed arch width changes calculated from Invisalign tables are consistent with measurements obtained from STL models. Thirty-five adults treated with Invisalign aligners were retrospectively selected. Arch width at the maxillary and mandibular canines, premolars, and first molars was measured on digital models (pretreatment, prediction and first-refinement) using Geomagic Control X. Predicted and observed expansions (difference between predicted or post-treatment and pretreatment arch widths), and their discrepancy, were compared with the corresponding values calculated from the ClinCheck arch width tables. Three references were selected: (1) the projection of the long axis of the tooth on the occlusal surface, (2) the buccal/mesiobuccal cusps, and (3) the most lingual point of the gingival margin. Normality was assessed with the Shapiro-Wilk test. Agreement was evaluated using Bland-Altman analysis with mixed-effects models to account for clustering of repeated measurements. 840 arch widths were analyzed (35 patients, 4 tooth pairs, 2 jaws, and 3 time points). Non-normality of inter-method differences was observed in predicted expansion (gingival and occlusal references) and in discrepancy (cusp reference) (p < 0.05). Non-parametric Bland-Altman analysis showed high agreement between Geomagic and ClinCheck measurements for predicted expansion, observed expansion, and discrepancy, with bias values ranging from - 0.49 to 0.2mm. ClinCheck arch width tables showed strong agreement with independent metrological assessment, particularly with occlusal reference points [bias: 0.00mm; limits of agreement: -0.80 to 1.01mm]. ClinCheck arch width tables have been validated with an independent metrological assessment (Geomagic Control X). Predicted expansion, observed expansion, and discrepancy derived from arch width tables agreed with independent measurements using virtual casts.

Existing evidence on transfusion requirements in oral and maxillofacial surgery (OMFS) is limited to selected indications. This study aimed to provide an overview of transfusion rates across the full diagnostic spectrum and to identify factors influencing transfusion rates with relevance for patient blood management (PBM). All operated OMFS patients from a five-year period (n = 13,239) were retrospectively analyzed. Diagnosis-specific transfusion rates were determined, followed by a subgroup analysis of free flap surgeries. Logistic regressions identified factors influencing transfusion rates. ROC analysis in the free flap subgroup determined preoperative hemoglobin cut-off values for increased transfusion risk. Differences in treatment course associated with preoperative anemia were assessed. Overall transfusion rate was 5.1%. Microvascular free flap surgery was the primary driver of transfusion with a rate of 58.8%, independent of underlying pathologies. Non-oncologic indications requiring free flap reconstruction showed high transfusion rates similar to oncologic indications, whereas the same diagnoses without free flaps had rates < 5%. Free flap reconstruction (OR 5.21) and preoperative anemia (OR 6.25) were the strongest factors influencing transfusion rates. ROC analysis identified preoperative hemoglobin of 12.25g/dl as risk threshold for intraoperative transfusion. Preoperative anemia was associated with a less favorable course regarding intensive care unit treatment, in-hospital mortality and hospital length of stay. Transfusion rates in OMFS are generally low but increased in reconstructive free flap surgery. These findings offer an evidence base for targeted PBM strategies, including early identification and treatment of preoperative anemia, like intravenous iron therapy in free flap patients, and transfusion rate-adapted blood product preparation to improve perioperative management.

To compare a partially demineralized allogeneic cancellous bone plug (ACBP) with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR), focusing on CBCT-based dimensional outcomes and histomorphometric tissue composition at implant placement. In this prospective randomized controlled clinical trial, 25 adults requiring GBR for two common indications-posterior maxillary sinus floor elevation or mandibular posterior extraction socket preservation-were randomized to ACBP (n = 12) or DBBM (n = 13), with collagen membrane coverage in both groups. Radiographic endpoints were indication-specific and were reported separately for sinus and socket sites. CBCT was obtained at baseline and 6 months to assess augmented height (sinus sites) and ridge dimensions at standardized levels (socket sites). At 6 months (implant placement), a 3-mm trephine core was harvested for H&E staining and histomorphometric quantification of vital bone (VB, %) and residual graft material (RG, %). Between-group comparisons used independent-samples t tests (two-sided P < 0.05). All participants completed the 6-month follow-up. VB did not differ significantly between ACBP and DBBM (38.84 ± 8.37% vs. 32.18 ± 11.04%, P = 0.105), whereas RG was significantly lower with ACBP (11.18 ± 5.48% vs. 19.80 ± 8.23%, P = 0.006). CBCT outcomes were comparable between groups, with no significant differences in sinus height gain (7.82 ± 1.52mm vs. 8.21 ± 4.30mm, P = 0.852) or socket-related ridge dimensional changes (all P > 0.05). Within a 6-month healing interval, ACBP showed CBCT-based dimensional outcomes comparable to DBBM and a lower residual graft fraction with a similar vital bone fraction at implant placement, suggesting that the observed difference was more related to graft turnover than to greater bone formation. At routine implant timing (~ 6 months), use of ACBP was associated with a lower residual graft fraction at re-entry while maintaining short-term CBCT-based dimensional stability.

The relationship between orthodontic treatment and upper airway morphology is increasingly recognized. Artificial intelligence (AI) now supports airway analysis, but traditional 3D U-Net models show limited accuracy, particularly in the laryngopharynx. This study proposes a deep learning model to accurately and efficiently extract 3D upper airway structures from CBCT scans, facilitating improved orthodontic monitoring. The 3D UX-Net was employed for airway segmentation. Biased pharyngeal interface information from the network output enabled precise localization of boundary landmarks on the midsagittal plane, enhancing interface delineation. On internal 5-fold cross-validation, 3D UX-Net achieved a mean Dice similarity coefficient (DSC) of 0.953 ± 0.007 for total airway segmentation, outperforming existing methods. External validation across three geographic datasets confirmed strong generalization. After refining the pharyngeal interface via midsagittal landmarks, mean DSC improved to 0.963 ± 0.006. The proposed model enables high-precision upper airway segmentation, supporting more efficient and comprehensive clinical image analysis. This study addresses the insufficient segmentation accuracy of prior 3D U-Net models, especially in the laryngeal region, offering enhanced reliability for orthodontic airway assessment.

Edentulism and sarcopenia are two prevalent ageing-related conditions, yet longitudinal evidence clarifying their bidirectional relationship remains limited. We investigated the reciprocal associations between edentulism and sarcopenia among Chinese middle-aged and older adults, and further examined potential age-dependent effects. We used data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS). Two longitudinal analytic cohorts were constructed: Cohort 1 included participants without sarcopenia at baseline (2011; n = 6,746) to evaluate whether edentulism predicts incident sarcopenia by 2015; Cohort 2 included participants without edentulism at baseline (2011; n = 7,193) to evaluate whether sarcopenia predicts incident edentulism by 2018. Sarcopenia status was classified using the 2019 Asian Working Group for Sarcopenia (AWGS) criteria based on handgrip strength, estimated appendicular skeletal muscle mass, and the five-times chair-stand test; severity was categorized as possible, confirmed, and severe. Edentulism was self-reported ("Have you lost all of your teeth?"). Multivariable logistic regression and ordinal logistic regression were applied with hierarchical adjustment for sociodemographic, health, and lifestyle covariates. Age × exposure interaction was tested, and the Johnson-Neyman technique was used to identify regions of significance. In Cohort 1, 390 participants (5.8%) developed sarcopenia during follow-up; cumulative incidence was higher among edentulous than non-edentulous participants (7.5% vs. 3.8%). In fully adjusted models, edentulism was associated with higher odds of incident sarcopenia (OR 2.13, 95% CI 1.35-3.37) and greater sarcopenia severity (ordinal OR 2.07, 95% CI 1.30-3.28). A significant age interaction was observed: the edentulism-sarcopenia association was statistically significant only below 64.05 years. In Cohort 2, 453 participants (6.3%) developed edentulism; incidence increased with baseline sarcopenia severity (5.2% in no sarcopenia to 14.8% in severe sarcopenia). After full adjustment, confirmed sarcopenia (OR 1.69, 95% CI 1.24-2.30) and severe sarcopenia (OR 1.85, 95% CI 1.22-2.82) predicted incident edentulism, whereas possible sarcopenia did not. This nationally representative study identified a robust bidirectional relationship between edentulism and sarcopenia in middle-aged and older Chinese adults. Edentulism was associated with an increased risk of developing sarcopenia, while confirmed and severe sarcopenia were predictive of incident edentulism. Age played a critical role in the edentulism-sarcopenia relationship, with a key threshold at 64.05 years, suggesting an earlier window for risk identification and prevention and supporting integrated "oral-muscle" screening strategies in primary care and community settings.

Pulpectomy is the standard treatment for irreversibly inflamed or infected primary molars. It depends on effective root canal cleaning and shaping. Traditional manual preparation and irrigation techniques face challenges when dealing with complex root canal systems in primary teeth. This study aims to retrospectively evaluate the clinical and radiographic outcomes of two rotary nickel-titanium file systems with distinct tapers (M3 and S3) combined with ultrasonic irrigation, compared to conventional manual K-files and syringe irrigation,inpulpectomy for primary molars. A retrospective cohort study included patients aged 4- to 9-year who underwent RCT for mandibular primary molars at the Pediatric Dentistry Clinic of the Third Hospital of Hebei Medical University. Participants were categorized into three groups based on the instrumentation and irrigation protocol used: M3 rotary files with ultrasonic irrigation (n=98), S3 rotary files with ultrasonic irrigation (n=84), and manual K-files with syringe irrigation (n=78). Instrumentation time was measured using a digital stopwatch. Obturation quality was radiographically classified as optimal, underfilled, or overfilled. Postoperative pain was assessed at 24-, 48-, and 72 h using the Wong-Baker FACES scale. Clinical and radiographic outcomes at the 12-month follow-up were categorized as success, uncertain, or failure. The M3 rotary group showed the shortest instrumentation time (210.45 ± 6.85 s) and the highest rate of optimal obturation (87.1%), significantly outperforming the S3 and manual file groups (P<0.05). Both rotary systems led to significantly lower pain scores at 24 and 48 hours compared to manual instrumentation (P<0.01). No significant differences were observed in pain at 72 hours or in 12-month therapeutic success rates among the groups (P>0.05). This study demonstrates that combining modern NiTi rotary instrumentation (specifically the 0.04 tapered M3 system) with ultrasonic irrigation significantly outperforms conventional manual techniques in operative efficiency, obturation quality, and postoperative pain control. The integration of NiTi and ultrasound translates into a clinically superior, patient-beneficial protocol for primary teeth pulp therapy, optimizing procedural experience without compromising therapeutic success.