Deep overbite correction with clear aligners faces challenges including decreased anterior intrusion efficiency and spontaneous molar intrusion. Bite planes are often incorporated to address these issues, but their effects remain debated. This study aimed to investigate the impact of bite planes on anterior intrusion efficiency and posterior displacement during a specific deep overbite correction phase using clear aligners. This retrospective study included 36 adult patients with deep overbite who were treated with the clear aligner (Smartee® system) divided into a bite plane group (n = 15) and a control group (n = 21). Pre- (T1) and post-intrusion (T2) digital models were superimposed to measure tooth displacement and subsequently calculate intrusion accuracy of anterior teeth. Comparisons of tooth displacement and intrusion accuracy between the two groups were performed using an independent t-test or a Mann-Whitney U test, intragroup vertical changes of posterior teeth were analyzed by one-way analysis of variance, and Pearson correlation was used to assess the relationship between molar intrusion and treatment duration. No significant difference was found in anterior intrusion accuracy between the bite plane group (18.8% ± 24.7%) and the control group (18.4% ± 21.6%). The bucco-lingual movement of teeth where bite planes were designed was not significantly affected. Premolars in both groups exhibited extrusion ranging from 0.0 to 0.5mm, with no significant intergroup difference. Molars in the control group exhibited 0.1-0.2mm of spontaneous intrusion (P<0.01), which showed a positive correlation with treatment duration. The maxillary molar intrusion correlated moderately with the number of aligners (r = 0.49, P<0.0001), while the correlation was weaker in the mandible (r = 0.33, P = 0.0031). In contrast, the bite plane group showed no spontaneous molar intrusion but rather slight extrusion of 0.1-0.2mm, with no correlation with treatment duration. Bite planes in clear aligners do not enhance anterior intrusion efficiency or affect labiolingual movement but effectively prevent spontaneous molar intrusion caused by the "posterior bite-block effect," thereby helping maintain vertical molar position during deep overbite correction. The bite planes in clear aligners are less effective in inducing posterior teeth extrusion and the associated increase in vertical facial height compared to those in fixed appliances. However, they do not affect the intrusion and labiolingual movement of anterior teeth, and prevent spontaneous intrusion of molars, making them a recommended design for deepbite correction in both normodivergent and hypodivergent patients.

This study evaluated whether spectrophotometric CIELAB color measurements can support machine-learning (ML) classification of occlusal caries severity based on ICDAS categories. Three hundred extracted human teeth were visually classified using ICDAS (0-4) and served as labels for supervised learning. Five occlusal sites per tooth were measured using a spectrophotometer under standardized conditions. Site-level CIELAB values were transformed into engineered color features and aggregated at the tooth level. Teeth were categorised as sound (ICDAS 0), initial carious lesions (1-2), and moderate carious lesions (3-4). Five ML models: Random Forest (RF), XGBoost, CatBoost, Multilayer Perceptron (MLP), and a Deep Sets architecture were trained. Performance was evaluated using accuracy, balanced accuracy (BA), and macro-F1, with additional binary analyses for early (ICDAS 1-4 vs. 0) and operative lesion detection (ICDAS 3-4 vs. 0-2), based on the included ICDAS range. Learning curve analysis was performed to evaluate the effect of training data size on model performance. Deep Sets achieved the highest multiclass performance (BA = 0.89) followed by the MLP (BA = 0.72). Tree-based models demonstrated lower performance overall. For early lesion detection, all models showed high sensitivity (SE) but reduced specificity (SP). At the operative level, the MLP achieved 100% SE and moderate SP. Learning-curve analysis showed that neural models benefited most from increased training data, whereas tree-based models showed limited improvement. Under controlled in-vitro conditions, spectrophotometric CIELAB measurements enabled machine-learning classification of occlusal caries severity. Deep sets achieved the highest overall performance, supporting the potential of color-based approaches as adjunctive tools for caries assessment. Spectrophotometric tooth color measurements may support machine learning classification of occlusal caries severity under controlled conditions, using an image-independent approach. Such color-based methods may complement visual assessment by providing a more standardized and reproducible evaluation of enamel changes following further validation.

The aim of this in vitro study was to evaluate the cytotoxicity of two direct-printed photopolymers, LuxCreo and Nylon, intended for orthodontic applications. LuxCreo (LuxCreo Inc., Chicago, IL) and Nylon (EOS, Munich, Germany) direct-printed materials were compared to conventionally used orthodontic materials including polyethylene terephthalate glycol (PETG) and polymethyl methacrylate (PMMA). Human gingival fibroblasts (hGFB) were cultured in 12-well plates on sterilized material discs for 24-h, 72-h or 7-day intervals (n = 3). Following co-incubation of hGFB with the materials, an MTT assay was conducted to evaluate cell viability, an LDH assay was used to evaluate cell death, and ELISA was used to measure IL-6, IL-8, and IL-1β production. Nylon significantly reduced cell metabolic activity at 24h, 72h, and 7days, while LuxCreo showed a reduction only at 72h and 7days, compared to conventional materials. None of the materials induced a significant increase in cell death in hGFB. Elevated levels of IL-6 and IL-8 were observed only in the Nylon group. IL-1β levels were not significantly different between groups. Direct-printed materials reduced cell viability. While none of the materials induced cell death, Nylon did increase the pro-inflammatory cytokine response. Future studies should investigate the underlying mechanisms of cytotoxicity and pro-inflammatory responses to improve the safety and biocompatibility of orthodontic materials. The elevated pro-inflammatory cytokine response observed with direct-printed photopolymers highlight the need for clinical studies to investigate the mechanisms underlying cytotoxic and inflammatory responses. Future research should also evaluate the effects of long-term intraoral exposure and monitor relevant biomarkers during orthodontic treatment to better assess the safety and biocompatibility of these materials.

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.

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.

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.

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.

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.