Search Results (108)

This study evaluated the biomechanically optimal insertion angle for miniscrew-assisted anterior intrusion by analyzing stress in the periodontal ligament (PDL) and alveolar bone. A three-dimensional finite element model from cone-beam computed tomography (CBCT) data, comprising maxillary bone, anterior dentition, and a bonded orthodontic appliance, and segmented 0.019 × 0.025-inch stainless-steel archwire were used. Titanium miniscrews (1.4 × 6 mm) were placed at 5 mm from the alveolar crest between the lateral incisor and canine. Four insertion angulations relative to the occlusal plane (30°, 60°, 90°, and 120°) were simulated under a 90 g intrusive force. Results demonstrated that while all configurations achieved intrusion with minor labial tipping and maintained miniscrew stability, stress localization was highly angle-dependent: the 90° insertion generated the highest central incisor PDL tensile stress and maximum cortical bone Von Mises stress; the 120° insertion yielded peak canine PDL Von Mises stress and maximum root displacement; and the 60° insertion localized peak stresses within the cancellous bone and the bone–implant interface. Miniscrews remained stable in all scenarios. While all tested miniscrew angulations provided stable anchorage for upper anterior teeth intrusion, the selection of insertion angle critically influenced stress patterns within the supporting tissues. Full article

Background: Autogenous tooth-derived grafts have been proposed as an alternative to xenografts for alveolar ridge preservation, offering biological similarity to bone and potentially more favorable remodeling. This study compared the healing outcomes of a collagenated xenograft, and a tooth-derived graft prepared with an automated processing device. Methods: Six Beagle dogs underwent bilateral extraction of the third and fourth mandibular premolars. Each animal contributed two sockets grafted with root-derived particulate prepared using an automated device for tooth cleaning, grinding, and demineralization, and two sockets grafted with a collagenated xenograft, all covered by a collagen membrane. After 3 months, histological sections were analyzed to assess crestal dimensions and the relative proportions of mature (lamellar) and immature bone (woven/parallel fibered), residual graft material, and soft tissues. Results: Lingual crest height did not differ between groups, whereas the buccal crest was slightly higher at xenograft sites compared with the tooth-graft sites. The tooth-graft group exhibited significantly fewer residual particles (0.5 ± 1.1%) and a higher proportion of total bone (65.6 ± 9.1%) compared with the xenograft group, which showed 19.7 ± 16.0% graft remnants (p = 0.032). Corticalization at the socket entrance was observed predominantly in the tooth-graft sites. No inflammatory infiltrates were detected in the examined section. Conclusions: Tooth-derived grafts promoted an almost complete replacement by vital bone with minimal residual material, whereas xenografts provided slightly better buccal contour preservation but resulted in regenerated tissues containing persistent graft particles. The biological differences observed may have implications for subsequent implant placement. Full article

Periodontitis is a chronic inflammatory condition characterized by dysregulated immune responses that promote alveolar bone destruction. Targeting inflammatory signaling pathways has therefore become an important area of investigation. This study investigated the anti-inflammatory and bone-protective effects of Magnolia kobus DC. extract (MKE) in a ligature-induced periodontitis rat model. Rats were assigned to five groups (n = 5 per group): non-ligature control, ligature control, doxycycline (20 mg/kg), MKE 100 mg/kg, and MKE 400 mg/kg, and treated orally for eight weeks. Periodontal damage and alveolar bone loss were assessed by micro-computed tomography (micro-CT), gingival index, and tooth mobility. Micro-CT analysis demonstrated a dose-dependent reduction in alveolar bone loss, as evidenced by a significant decrease in the cementoenamel junction–alveolar bone crest (CEJ–ABC) distance and reduced furcation involvement in MKE-treated groups compared with the ligature control group, while tooth mobility scores were significantly improved. Serum levels of receptor activator of nuclear factor kappa-B ligand, interleukin-1β, tumor necrosis factor-α, and cyclooxygenase-2 were significantly decreased, while nuclear factor kappa-B signaling was suppressed in gingival tissue. The extract also significantly reduced matrix metalloproteinases 3, 8, 9, and 13, and increased collagen type I and II expression. In summary, MKE exerted anti-inflammatory and bone-protective properties, effectively reducing alveolar bone loss and maintaining periodontal structure. These findings support MKE’s potential application as a natural anti-inflammatory and bone-protective agent and as a functional food ingredient for periodontitis prevention and treatment, meriting further clinical evaluation. Full article

Introduction: The split crest (SC) is a technique for horizontal ridge augmentation that enables simultaneous implant placement. While the use of bone grafts within the osteotomy gap is well-documented, the efficacy of dentin as a graft material in SC procedures has not been thoroughly evaluated. Objective: This study aimed to assess whether the addition of bone graft or dentin to the osteotomy gap during the SC procedure improves bone width, density, and implant stability compared to SC without grafting. Materials and Methods: A partially randomized prospective study was conducted on 24 implants divided into three groups: SC only, SC and bone graft, and SC and dentin graft. Clinical and radiographic evaluations, including CBCT-based bone measurements and implant stability (ISQ) values, were performed preoperatively, immediately postoperatively, and three months after surgery. All patients were followed for one year. Results: Significant increases in bone width were recorded in all groups, with gains exceeding 2 mm in the SC and SC and bone graft groups. The SC and dentin group showed the least bone gain and the greatest horizontal bone resorption (p < 0.05). Conclusions: While bone grafting may offer modest advantages in bone preservation, the use of dentin grafting may not demonstrate significant benefits. Full article

Background: Periodontitis is a common inflammatory disease characterized by progressive loss of alveolar bone. Cone-beam computed tomography (CBCT) can visualize 3D periodontal bone defects, but its interpretation is time-consuming and examiner-dependent. Deep learning may support standardized CBCT assessment if performance and biological relevance are adequately characterized. Methods: We used the publicly available MMDental dataset (403 CBCT volumes from 403 patients) to train a 3D ResNet-18 classifier for binary discrimination between periodontitis and healthy status based on volumetric CBCT scans. Volumes were split by subject into training (n = 282), validation (n = 60), and test (n = 61) sets. Model performance was evaluated using area under the receiver operating characteristic curve (AUROC), area under the precision–recall curve (AUPRC), and calibration metrics with 95% bootstrap confidence intervals. Grad-CAM saliency maps were used to visualize the anatomical regions driving predictions. To explore phenotype-level biological concordance, we analyzed an independent gingival transcriptomic cohort (GSE10334, n ≈ 220 arrays after quality control) and an independent oral microbiome cohort based on 16S rRNA amplicon sequencing, using unsupervised clustering, differential expression/abundance testing, and pathway-level summaries. Results: On the held-out CBCT test set, the model achieved an AUROC of 0.729 (95% CI: 0.599–0.850) and an AUPRC of 0.551 (95% CI: 0.404–0.727). At a high-sensitivity operating point (sensitivity 0.95), specificity was 0.48, yielding an overall accuracy of 0.62. Grad-CAM maps consistently highlighted the alveolar crest and furcation regions in periodontitis cases, in line with expected patterns of bone loss. In the transcriptomic cohort, inferred periodontitis samples showed up-regulation of inflammatory and osteoclast-differentiation pathways and down-regulation of extracellular-matrix and mitochondrial programs. In the microbiome cohort, disease-associated samples displayed a dysbiotic shift with enrichment of classic periodontal pathogens and depletion of health-associated commensals. These omics patterns are consistent with an inflammatory–osteolytic phenotype that conceptually aligns with the CBCT-defined disease class. Conclusions: This study presents a proof-of-concept 3D deep learning model for CBCT-based periodontal disease classification that achieves moderate discriminative performance and anatomically plausible saliency patterns. Independent transcriptomic and microbiome analyses support phenotype-level biological concordance with the imaging-defined disease class, but do not constitute subject-level multimodal validation. Given the modest specificity, single-center imaging source, and inferred labels in the omics cohorts, our findings should be interpreted as exploratory and hypothesis-generating. Larger, multi-center CBCT datasets and prospectively collected paired imaging–omics cohorts are needed before clinical implementation can be considered. Full article

Background/Objectives: Sinus elevation in the posterior maxilla carries a risk of hemorrhage due to injury of the posterior superior alveolar artery (PSAA). Accurate preoperative identification of the PSAA using cone-beam computed tomography (CBCT) can enhance surgical safety. This retrospective study evaluated the prevalence, location, diameter, and visibility of the PSAA in a Saudi population. Methods: A total of 117 CBCT scans (234 sinuses) obtained between 2022 and 2024 were analyzed. The PSAA’s visibility, diameter, and distances from the alveolar crest, sinus floor, medial wall, and sinus septa were measured. Associations with age, sex, smoking status, and the presence of sinus septa were statistically assessed. Results: The PSAA was identified in 98.3% of sinuses. Intraosseous and submucosal locations predominated in premolar and molar regions, respectively. Class A arteries (≤1 mm) were most frequent. Significant differences were found between premolar and molar regions in arterial location and distances from the alveolar crest and sinus walls (p < 0.001). Older individuals exhibited medial displacement of the artery in the molar region, and smokers showed significantly smaller diameters (p < 0.05). Sinus septa were associated with increased PSAA distances from the sinus floor and medial wall. Conclusions: The PSAA demonstrates high detectability and marked variability in position and caliber within this Saudi cohort. Recognition of these anatomical variations is essential for reducing complications during sinus-augmentation procedures. Full article

Background/Objectives: This study aimed to investigate the relationships between facial morphology and alveolar crest cortical bone thickness and to determine the computed tomography (CT) values using multidetector CT (MDCT). Methods: A total of 39 subjects were categorized into three groups based on the Frankfort mandibular plane angle: low angle, average angle, and high angle. The thickness of the alveolar crest cortical bone and CT values between the canines and first premolars and between the second premolars and first molars in the maxilla and mandible were measured and analyzed from pre-treatment MDCT images. The Kruskal–Wallis and Dunn–Bonferroni tests were applied to investigate the relationships between facial types and alveolar crest cortical bone thickness, and to determine the CT values. Results: Significant differences in cortical bone thickness between the mandibular premolar and first molar were observed when comparing the high-angle group with the low-angle group (p = 0.001) and the average-angle group with the low-angle group (p = 0.022). Conclusions: These findings indicate that examining facial type may reveal differences in anchor loss in the mandibular molar region, which could prove useful in formulating treatment plans. Full article

Implant treatment in the aesthetic regions of the jaw often requires hard and soft tissue augmentation to ensure optimal prosthetic outcomes. Radiological evaluation with cone-beam computed tomography (CBCT) and visual inspection of intraoral photographs are effective for assessing hard tissues but are limited in evaluating soft tissues. This study aimed to objectively evaluate volumetric and dimensional changes of the alveolar ridge, including both hard and soft tissues, following simultaneous horizontal bone augmentation and implant placement using intraoral digital scanning. Intraoral digital scans were obtained at baseline (T0) and at 2 (T1), 6 (T2), and 12 weeks (T3) post-surgery. Scans were superimposed using dedicated imaging software to measure volumetric and cross-sectional changes. Volumetric gain was significant at T1 but decreased significantly from T1 to T2 (p = 0.0006) and from T1 to T3 (p = 0.0002). Cross-sectional analysis showed significant increases in ridge width at T1 at all measured levels, accompanied by a significant vertical decrease at the alveolar crest from T1 to T2 (p = 0.0056) and T3 (p = 0.0106).These findings indicate that horizontal augmentation provides initial volumetric gain but is followed by substantial reduction at the crest, suggesting that rigid fixation may enhance stability; however, controlled clinical trials are required. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Evaluating the implant site immediately after implant removal is crucial for assessing its condition and ensuring morphological stability. Immediate reconstruction at the time of implant removal has been proposed as a strategy to preserve alveolar ridge width. This study aims to evaluate whether immediate alveolar bone reconstruction at the time of implant removal provides comparable or superior dimensional stability of the alveolar ridge compared to staged reconstruction approaches. The null hypothesis of this study is that there is no significant difference in alveolar bone dimensions between immediate and staged reconstructions following implant removal. This retrospective study included seven participants, consisting of six males and one female. The participants were categorized into three groups based on the treatment approach following implant removal. In Group 1, no bone grafting was performed after implant removal. In Group 2, bone grafting was conducted following implant removal, with an adequate healing period before implant placement. In Group 3, bone grafting was performed simultaneously with implant removal. Cone-beam computed tomography (CBCT) imaging was conducted before implant removal (T0), after implant removal or bone grafting (T1), and after implant placement (T2). All removed implants were successfully replaced with new ones, regardless of bone grafting. In terms of alveolar ridge width at 1 mm below the crest, Group 1 exhibited the greatest reduction (ΔT1 − T0 = −5.1 ± 3.7 mm), while Group 2 showed a mild increase (+1.1 ± 2.6 mm), and Group 3 had a moderate decrease (−1.3 ± 1.0 mm). This suggests that delayed bone grafting can better preserve or enhance bone volume during healing. A reduction in buccal ridge height between T1 and T0 (ΔT1 − T0) was observed, particularly in Group 1. In contrast, an increase in buccal ridge height was most pronounced in Group 2. Although immediate reconstruction (Group 3) did not result in statistically significant gains, it achieved successful implant placement without complications and reduced the total treatment duration, which might be beneficial from a clinical efficiency and patient satisfaction standpoint. Therefore, staged bone grafting (Group 2) appears to offer greater dimensional stability, particularly in maintaining ridge height, whereas immediate reconstruction (Group 3) remains a clinically viable alternative for stable healing in select cases, especially when shorter treatment timelines are prioritized. Full article

Background/Objectives: During alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g., intraoral bone, xenografts) are being tested. The aim of this study was to compare the efficacy of using an autologous tooth-derived graft material and iliac crest cancellous bone in the reconstruction of the alveolar cleft in patients with a unilateral cleft lip and palate. Methods: A total of 21 patients with a unilateral cleft lip and palate, who underwent alveolar bone grafting between 2020 and 2023 were included in the study. In 11 cases, the donor site was the iliac crest; in the rest of the cases, deciduous teeth were harvested, processed, and used as an autologous particulate graft material for alveolar reconstruction. The mean follow-up time was 30.0 months, CBCT scans were taken, and the results were compared based on the ranking system published by Stasiak et al. Results: The Wilcoxon signed-rank test showed that the amount of bone on the cleft side was significantly less than that on the contralateral non-cleft side (ATB: p = 0.002, iliac crest: p = 0.005). The Mann–Whitney U test showed that there were no significant differences in bone quantity on the cleft side between the two groups (U = 47.5, p = 0.617). Conclusions: The use of ATB might be a feasible alternative to autologous bone during alveolar cleft reconstruction. This type of graft shows long-term stability, which is comparable to the bone harvested from the iliac crest. Full article

Background: Periodontitis is a chronic inflammatory disease influenced by host aging, yet the specific effects of aging on disease susceptibility remain unclear. Objective: This study aimed to evaluate whether aging increases susceptibility to Porphyromonas gingivalis (P. gingivalis)-induced periodontitis in a murine model. We formulated the null hypothesis that age does not affect susceptibility to periodontal bone loss. Methods: Young (8 weeks) and aged (78 weeks) male C57BL/6 mice were randomly assigned into four groups: young control, young infected, old control, and old infected (n = 8 per group, except for old control, where n = 7). Experimental periodontitis was induced by oral application of P. gingivalis suspended in 5% carboxymethylcellulose (CMC), administered every other day, for a total of three applications. Alveolar bone loss was assessed 39 days after the last inoculation using histomorphometric measurement of buccal distance from the cemento-enamel junction to the alveolar bone crest (CEJ–ABC distance) and micro-computed tomography (μCT) at mesial and distal interdental sites. Bonferroni’s correction was applied to the Mann–Whitney U Test to determine statistical significance. A p-value of less than 0.05 was considered statistically significant. Results: Morphometric analysis showed significantly greater buccal bone loss in infected mice versus controls in both age groups (young: 0.193 mm vs. 0.100 mm, p < 0.01; old: 0.262 mm vs. 0.181 mm, p < 0.01). μCT analysis revealed that interdental bone loss was significant only in aged infected mice (mesial: 0.155 mm vs. 0.120 mm, p < 0.05; distal: 0.185 mm vs. 0.100 mm, p < 0.01), and not significant in young infected mice. Conclusions: Aging significantly exacerbates P. gingivalis-induced alveolar bone loss, particularly in interdental regions. These results allowed us to reject the null hypothesis. This study validates a clinically relevant murine model for analyzing age-related periodontitis and provides a foundation for investigating underlying molecular mechanisms and potential therapeutic interventions. Full article

Background: Stereolithography is a rapid prototyping and 3D printing technique that creates solid three-dimensional models. An accurate and functional 3D model using stereolithography is invaluable in scientific research, particularly in studies involving edentulous patients. Additive manufacture and CAD systems help achieve accurate measurements and procedures and be easily replicated by lowering human error mistakes. The main objective of this study was to develop an in vitro simulation model with a reduced alveolar ridge with the same characteristics as mandibular edentulous patients using stereolithography. Methods: A mandibular model with a resorbed mandibular crest was scanned, and the STL model was aligned to the XYZ reference system. A reduction in the alveolar ridge corresponding to the mandibular mucosa of an edentulous patient was achieved. A negative model also derived from the original model was made to ensure the space for oral simulation material. A dimensional stability test was performed to validate the model. Results: The maximal mean displacement of the model was 0.015 mm, and the minimal mean displacement was 0.004 mm. The oral mucosa had a displacement of approximately 1.6 mm. Conclusions: An in vitro 3D simulation model of a complete edentulous patient mucosa was achieved. Full article

Odontogenesis, the development of teeth, is a complex, multistage process that unfolds from early embryogenesis through tooth eruption and maturation. It serves as a classical model of organogenesis due to the intricate reciprocal interactions between cranial neural crest-derived mesenchyme and oral epithelium. This narrative review synthesizes current scientific knowledge on human tooth development, tracing the journey from the embryological origins in the first branchial arch to the formation of a fully functional tooth and its supporting structures. Key morphogenetic stages—bud, cap, bell, apposition, and root formation—are described in detail, highlighting the cellular events and histological features characterizing each stage. We discuss the molecular and cellular regulatory networks that orchestrate odontogenesis, including the conserved signaling pathways (Wnt, BMP, FGF, SHH, EDA) and transcription factors (e.g., PAX9, MSX1/2, PITX2) that drive tissue patterning and cell differentiation. The coordinated development of supporting periodontal tissues (cementum, periodontal ligament, alveolar bone, gingiva) is also examined as an integral part of tooth organogenesis. Finally, developmental anomalies (such as variations in tooth number, size, and form) and the fate of residual embryonic epithelial cells are reviewed to underscore the clinical significance of developmental processes. Understanding the normal course of odontogenesis provides crucial insight into congenital dental disorders and lays a foundation for advances in regenerative dental medicine. Full article

Objective: This ex vivo study aimed to evaluate the influence of different acquisition protocols, combining voxel size and field of view (FOV), across four cone-beam computed tomography (CBCT) systems, on the accuracy of alveolar bone level measurements for periodontal assessment. Materials and Methods: A dry human mandible was used, with standardized radiopaque markers placed on the cementoenamel junction (CEJ) of the buccal–mesial and buccal–distal aspects of teeth 34 and 43. CBCT scans were performed using four systems—Veraview^® X800, OP300 Pro^®, I-CAT Next Generation^®, and Orthophos XG^®—applying various combinations of field of view (FOV) and voxel resolution available in each device. Reference measurements were obtained in situ using a digital caliper. CBCT images were exported in DICOM format and analyzed with OnDemand3D software (version 4.6) to obtain paracoronal sections. Linear measurements from the CEJ to the alveolar crest were recorded in triplicate and compared to the gold standard using ANOVA and the Dunnett test (α = 0.05). Results: Protocols with smaller voxel sizes and limited FOVs generally yielded measurements closer to the gold standard. However, some larger-FOV protocols with intermediate voxel sizes also achieved comparable accuracy. Among the systems, the I-CAT showed lower agreement within in situ measurements, while others demonstrated reliable performance depending on the acquisition parameters. Conclusions: The findings suggest that CBCT protocols with smaller voxel sizes and reduced FOVs can enhance measurement accuracy in periodontal bone assessments. Nevertheless, intermediate protocols may offer a balance between diagnostic quality and radiation exposure, aligning with the ALADA principle. This study reinforces the need for standardized acquisition parameters tailored to periodontal imaging. Full article