This study aimed to compare the linear and angular Arnett cephalometric measurements obtained from WebCeph Premium™ with those from manual cephalometric analysis and to assess the reliability of the automated measurements. Thirty-two pre-treatment lateral cephalograms of patients were randomly selected. Images were calibrated, 29 landmarks were manually traced, and 40 parameters were recorded by two orthodontists (6 angular, 34 linear). WebCeph Premium™ (version 2.0.0, AssembleCircle Corp., Gyeonggi-do, Republic of Korea) automatically identified landmarks and performed Arnett's cephalometric analysis. After 15 days, orthodontists reassessed the radiographs. Reliability and repeatability were evaluated using the intraclass correlation coefficient (ICC), which exceeded 0.95, indicating excellent agreement. Normality was assessed using the Shapiro-Wilk test, and group comparisons were performed with paired t-tests. For Researcher 1, initial ICC values ranged from 0.003 to 0.984 and final values from 0.617 to 0.996. For Researcher 2, initial ICC values ranged from 0.022 to 0.999 and final values from 0.601 to 0.999. Inter-observer ICC values ranged from 0.03 to 0.984, with most measurements showing high agreement. Manual tracing and WebCeph Premium™ showed high agreement, with ICC values ranging 0.913 and 0.995. WebCeph Premium™ demonstrates high concordance with manual Arnett analyses; however, further refinement of certain parameters is necessary to enhance AI precision. The utilization of WebCeph Premium™ within clinical settings has the capacity to enhance the efficiency of cephalometric analysis for orthognathic cases by minimizing manual workload and inter-examiner variability. This can result in more consistent and efficient treatment planning.

To evaluate the efficacy of a new orthodontic primer (Ambar APS Ortho; FGM Dental Products, Joinville, SC, Brazil) on shear bond strength (SBS) and degree conversion (DC) of metallic brackets bonding. 240 sound maxillary premolars were randomized into 24 experimental groups based on: (1) Orthodontic primer (Ambar APS Ortho, Orthoprimer and Transbond XT); (2) Light-curing time (3-seconds and 10-seconds); (3) Light-curing unit (Valo Cordless and Quazar); and (4) Storage condition (immediate time [IT] and after thermocycling [TC]). After each storage time, specimens were subjected to SBS testing at a crosshead speed of 1 mm/min until failure, and values were recorded in MPa. For DC (%) analysis, adhesive discs were prepared and evaluated using micro-Raman spectroscopy at IT only. SBS and DC data were analyzed using four and four-way ANOVA, respectively and Tukey's post hoc test (α = 0.05). Ambar APS Ortho showed significantly higher SBS values across both light-curing units compared to all other groups (p = 0.0001). For DC, Orthoprimer showed the lowest values, while Ambar APS Ortho achieved the highest. Across all primers, a 10s light-curing exposure resulted in significantly higher DC values compared to 3s (p < 0.0001). Ambar APS Ortho exhibited superior performance in both SBS and DC, for both 3s and 10s light-curing times as well as IT or AT, supporting its reliability for bonding metallic orthodontic brackets.

The aim of this study was to compare the effectiveness of two antimicrobial photodynamic therapy (aPDT) protocols using different methylene blue formulations in the treatment of initial pericoronitis. The research question was whether the new methylene blue formulation provides superior clinical outcomes compared to the conventional formulation. This randomized, controlled, double-blind clinical trial involved 34 healthy young patients with pericoronitis. The following groups were established: G1 (positive control, n = 17), irrigation with saline solution and aPDT with conventional methylene blue (0.005%, laser λ = 660nm, 9J per point, 318J/cm²); and G2 (experimental, n = 17), using the same therapy but with a patented new formulation of methylene blue. Pain assessed using the Visual Analog Scale (VAS) was defined as the primary outcome. Secondary outcomes include mouth opening, edema, and quality of life (OHIP-14). Microbiological and immunological analyses were performed to complement clinical outcomes. All outcomes were assessed at baseline and on the fourth day after aPDT. Both groups showed statistically significant improvement in pain (G1: p = 0.022; G2: p = 0.001) and mouth opening (G1: p < 0.001; G2: p = 0.002) after treatment. However, no statistically significant differences were observed between the groups in final pain and mouth-opening outcomes (p = 0.845 and p = 0.318, respectively). Within the limitations of this study, both aPDT protocols were associated with improvements in clinical outcomes. No between-group differences were observed in clinical outcomes; differences were limited to microbiological and immunological parameters, with no clinical superiority of the new formulation. Both methylene blue formulations may be used as adjunctive treatment options for the management of initial pericoronitis. However, no additional clinical benefit was observed with the new formulation, and these findings do not support a change in current clinical practice.

The present study evaluated clinically and radiographically the effectiveness of Regenerative endodontic procedures (REPs) using platelet-rich fibrin (PRF) versus induced bleeding (IB) in treating mature necrotic teeth. Fifty patients with necrotic mature teeth with periapical lesions were randomly divided into two groups, Group 1, IB (n = 25), and Group 2, PRF (n = 25). Treated teeth were assessed clinically and radiographically at 6 and 12 months. Survival rate, success rate, and clinical outcome measures were analyzed. Survival rate was 98% at the 12-month follow-up period, with no significant difference between the groups (P=0.166). A statistically significant increase in periradicular healing was found in both groups at 6 and 12 months, compared to that at baseline (P< 0.001). A significant difference was found in final treatment success between the two groups (p = 0.0219). The IB group achieved a 100% success rate (23/23), while the PRF group showed a 75% success rate (18/24). The overall success rate was 85.4%. All teeth treated with either IB or PRF survived throughout the follow-up period. The preliminary results of this study showed comparable clinical outcomes between the two treatment modalities, although teeth treated with IB showed higher overall success rate than those treated with PRF this should be interpreted within the framework of early phase clinical evidence as the study was not adequately powered to confirm superiority. REPs may represent a viable treatment option for mature necrotic teeth, offering a biologically based approach that aims to restore tissue function. Longer follow-up as planned in the second phase of this study, will allow for a more definitive comparison between IB and PRF approaches.

This study aimed to evaluate the clinical outcomes of gingival recession Type 1 (RT1) treatment using a coronally advanced flap (CAF) alone and in combination with L-PRF at 6 months. A total of 70 RT1 from 19 patients were included. Participants were randomly assigned to the test group (TG, CAF + L-PRF, n = 42) and the control group (CG) (CAF alone, n = 28). Clinical parameters were assessed at baseline and at 6 months: the primary outcomes were percentage of root coverage (%RC) and complete root coverage (CRC); and the secondary outcomes included mean root coverage (MRC), changes in gingival thickness (GT) and volumetric tissue gain, recession area reduction, analgesic consumption, healing quality (the Inflammatory Proliferative Remodeling [IPR] score), and patient-reported outcome measures (PROMs). Statistical analyses were performed to determine differences between groups; a random-intercept mixed-effects model was used for all site-level outcomes. At six months, %RC was 89.30% ± 20.33% (TG) and 81.60% ± 27.93% (CG) (p > 0.05). For the TG and CG, respectively, %CRC was 73.81% and 57.14%; the mean GT gain was 0.16 ± 0.10mm and 0.11 ± 0.10mm (p = 0.08); the mean volume gain was 1.13 ± 1.25 mm3 and 0.86 ± 0.84 mm3 (p = 0.32); the mean number of pills taken was 1.67 ± 0.98 and 2.25 ± 1.02 (p = 0.04); the esthetic satisfaction was 95% ± 5% and 90% ± 7% (p = 0.31); willingness to undergo the procedure again: 93% ± 4% and 88% ± 6% (p = 0.22); sensitivity reduction: 85% ± 6% and 80% ± 8% (p = 0.19). There was no statistically significant difference in healing quality and PROMs. Both CAF alone and CAF combined with L-PRF yielded comparable clinical and volumetric outcomes in RT1 treatments. No statistically significant advantages were observed with the adjunctive use of L-PRF. Because CAF alone achieves high predictability for RT1 defects, the routine adjunctive use of L-PRF provides limited additional clinical benefits.

To evaluate the efficacy of artificial intelligence (AI)-driven three-dimensional (3D) anatomical models as an adjunct to cone-beam computed tomography (CBCT) for root canal assessment regarding diagnostic accuracy, observer confidence, and time efficiency among undergraduate and postgraduate students. In this observational diagnostic study, 26 observers (13 undergraduates and 13 postgraduates) evaluated 22 tooth roots with complex anatomy from nine CBCT scans under two conditions: CBCT alone and CBCT supplemented with AI-generated 3D anatomical models. Observers assessed the number of roots, root canals, and apical foramina, while confidence (5-point Likert scale) and assessment time were recorded. Each observer performed 132 assessments, totaling 3,432 evaluations. A reference standard was established by consensus between two specialists. A significance level was set at 5% (α = 0.05) for all statistical analyses. Augmenting CBCT with AI-generated 3D models significantly improved diagnostic accuracy for all parameters (p < 0.001). Root detection accuracy reached 100% in both groups. Root canal detection increased from 83% to 94% among undergraduates and from 88% to 99% among postgraduates, while apical foramina detection increased to 99% in both groups. Observer confidence significantly increased (p < 0.001), reaching a median score of 5 (IQR: 5-5). Workflow efficiency also improved (p < 0.001), with median assessment time decreasing from 102s to 39s for undergraduates and from 97s to 24s for postgraduates. AI-driven 3D anatomical models used with CBCT enhance diagnostic accuracy, observer confidence, and evaluation efficiency in endodontic assessment. However, multi-centre studies with larger, more diverse samples, particularly including cases with pronounced artefacts, would further support generalisability. AI-generated 3D anatomical models derived from CBCT scans may serve as a valuable adjunct for the interpretation of complex root canal anatomy, improving diagnostic accuracy, increasing observer confidence, and reducing assessment time. These findings support their potential role not only in clinical decision-making but also as an effective educational tool for training dental students and clinicians.

Hydraulic calcium silicate-based sealers (CSBSs) are increasingly used in endodontics, but evidence on their long-term clinical effectiveness remains limited. This retrospective study evaluated the 5-year outcomes of primary root canal treatments and retreatments performed with a CSBS in teeth with symptomatic apical periodontitis. The sample consisted of 637 teeth with symptomatic apical periodontitis treated by a single experienced operator using a premixed CSBS (CeraSeal; Meta Biomed Co., Cheongju, South Korea) with the cold hydraulic condensation technique (CHC). Data were retrospectively collected from clinical charts and radiographic archives. Preoperative variables included sex, systemic health, tooth type, arch location, lesion size, pulpal diagnosis, sinus tract, and preoperative small perforation. Intraoperative factors comprised intracanal medication, apical diameter, obturation length, and sealer extrusion. Postoperative information included the type of coronal restoration. Follow-up evaluations were based on available radiographs and clinical notes at 1, 2, 3, 4, and 5 years. Outcomes were classified according to strict criteria (absence of symptoms and complete radiographic resolution) and loose criteria (absence of symptoms with complete or partial healing). Prognostic factors were investigated using bivariate associations and multivariate logistic regression models. Strict success rates increased progressively (80.2% at 1 year, 85.7% at 2 years, 86.8% at 3 years, 88.2% at 4 years, and 87.67% at 5 years). Loose success remained consistently high (99.2% at 1 year; 90.7% at 4 years, and 87.67% at 5 years). Higher baseline periapical index (PAI) scores significantly reduced odds of strict success at 2, 3, 4 years. Other factors, including age, sex, tooth type, treatment type, extrusion, and restoration, were not significant. CSBSs demonstrated favorable long-term outcomes. Preoperative lesion severity was the main prognostic factor, while demographic and procedural variables showed limited influence on long-term success. This study supports the long-term clinical reliability of CSBSs used with CHC in teeth with apical periodontitis. Preoperative lesion severity remains the primary prognostic factor influencing periapical healing over time.

The aim of this randomized clinical trial was to evaluate the 18-month clinical performance of alkasite and glass-hybrid restorations compared with resin composite in Class II restorations. A total of 50 patients requiring at least three Class II restorations in premolar and molar teeth were recruited. Each patient received three restorations, which were randomly assigned to one of the following materials: an alkasite (Cention N, Ivoclar Vivadent), a glass-hybrid (Equia Forte HT, GC Corp.), or a resin composite (Gradia Direct Posterior, GC Corp.). Alkasite and glass-hybrid served as test groups while resin composite served as the control group. During the 18-month follow-up, restorations were scored at baseline, 6, 12, and 18 months using the FDI criteria. Data were analyzed using the Chi-square and Cochran's Q tests (α = 0.05). No significant differences were detected among the groups for esthetic, functional, or biological criteria over 18 months (p > 0.05). Regarding esthetic properties, the control group showed 100% success for all esthetic criteria at all recall visits, while the alkasite group maintained a 96% success rate at all time points, and glass-hybrid showed 98% success at 6 and 12 months and 92% at 18 months. Minor score-2 changes in color match and gloss were detected in the glass-hybrid and alkasite groups but were not significant (p > 0.05). For functional and biological outcomes, all groups achieved 100% success rates for all evaluated parameters. Alkasite and glass-hybrid groups exhibited clinical performance comparable to resin composite over the 18-month follow-up in Class II cavities. All materials demonstrated excellent functional and biological stability while achieving clinically acceptable aesthetic results.

Plasma inflammatory biomarkers linked to cardiovascular risk have been associated with asymptomatic apical periodontitis. However, it remains unclear whether endodontic treatment can reverse these alterations. This review evaluated the effect of endodontic treatment on inflammatory markers in individuals with asymptomatic apical periodontitis. A comprehensive search was conducted in PubMed/Medline, Embase, Web of Science, Scopus, VHL, gray literature, and reference lists between October and November 2022, with an update in September 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence using the GRADE approach. Random-effects meta-analysis estimated pooled mean differences (MD) and 95% confidence intervals (95%CI) for serum inflammatory markers concentrations between treated individuals and controls (α = 5%). The search identified 6,295 records; sixteen studies were assessed and eight included in the quantitative synthesis. All studies showed moderate risk of bias, and evidence certainty was very low. Meta-analysis suggested possible reductions in C-reactive protein (CRP) [MD = 0.76 (95% CI: - 0.15, 1.67)] , interleukin-6 (IL-6) [MD = 0.81 (95% CI:-0.27, 1.90)], and tumor necrosis factor-alpha (TNF-α) [MD = 1.04 (95% CI:-0.38, 2.46)] after endodontic treatment, with levels similar to control groups. Evidence, although limited, suggests endodontic treatment may lower serum CRP, IL-6, and TNF-α levels in asymptomatic apical periodontitis patients. Endodontic treatment of asymptomatic apical periodontitis may help reduce systemic inflammatory biomarkers associated with cardiovascular risk, reinforcing its potential role beyond local infection control.