Search Results (149)

This study aimed to investigate the effect of enamel matrix derivatives (EMD) on the early healing biomarkers’ expression following flapless treatment. Thirty-eight patients with residual deep intrabony defects after steps 1 and 2 of periodontal therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Periodontal parameters were recorded at baseline and 6 months after treatment. Gingival crevicular fluid (GCF) was collected at baseline and 2 weeks after treatment to quantify the levels of biomarkers related to epithelial healing (epidermal growth factor, EGF), connective tissue healing (matrix metalloproteinase-8 [MMP-8], fibroblast growth factor [FGF], transforming growth factor-β [TGF-β]), and bone formation (osteoprotegerin [OPG]). The test group showed a significant reduction in MMP-8 levels (p = 0.039), along with significant increases in EGF (p < 0.01), FGF (p < 0.01), and OPG (p < 0.01). The control group demonstrated a significant decrease in MMP-8 (p = 0.010). No significant changes in TGF-β levels were observed in either group. At 6 months, the test group exhibited significantly greater reductions in probing pocket depth and clinical attachment level compared to the control group. This study is the first to characterize the biochemical changes following flapless treatment with EMD. These preliminary findings suggest that EMD may enhance early wound healing by modulating the expression of key regenerative biomarkers. Full article

Molar-incisor hypomineralization (MIH) is a developmental enamel defect that poses significant challenges to achieving long-term restorative success. The aim of this bibliometric review is to map the research landscape on treatment strategies for teeth affected by MIH and to provide insights that will guide future research and clinical practice. A comprehensive search of the Web of Science (WoS) and PubMed/MEDLINE databases was conducted for studies on MIH treatment published between 2014 and 2024, using defined keywords related to MIH treatment. Eligible studies were analyzed using VOSviewer, Bibliometrix R-tool, and Carrot2 software to assess publication trends, authorship, citations, and thematic focus. The comprehensive database search of the databases retrieved 933 studies, of which 230 met the inclusion criteria. A notable increase in publications was observed from 2018 to 2022, accompanied by a substantial rise in citations from 2019 onwards. Most of the research is concentrated in pediatric dentistry journals. Key topics include “children”, “resin infiltration”, “resin composite”, and “management/performance”, with an increasing emphasis on innovative and conservative approaches. Although international collaboration remains limited, Brazil (18.7%), Germany (15.5%), and England/Italy (7.7%) lead in research output. This highlights the need for international collaboration and the development of standardized, effective treatment protocols. Full article

Background: Treatment of gingival recessions starts from an accurate diagnosis considering both periodontal tissue status and adjacent exposed dental tissues. Based on current scientific evidence and the authors’ clinical experience, a decisional scheme has been proposed for the management of gingival recession defects, with or without non-carious cervical lesions, taking into account gingival thickness and interproximal attachment levels. To illustrate its practical application, a series of representative clinical cases is presented, documenting the rationale and outcomes of the therapeutic decisions. Methods: According to the 2017 World Workshop Classification of Periodontal and Peri-Implant Diseases and Conditions, the gingival recession defect classifications have been used to build up a decision-making therapeutic process. Combined periodontal and restorative treatments in presence or absence of dental lesions have been performed. Results: In case of an identifiable cemento-enamel junction (CEJ) with or without non-carious cervical lesions (class A+ and class A−, respectively) and absence of interproximal attachment loss (RT1), flap approaches alone or in combination with connective tissue graft (CTG) were suggested. In case of an unidentifiable CEJ without cervical lesion (class B−), flap approaches alone were proposed in presence of adequate residual keratinized tissue (KT) and absence of interproximal attachment loss (RT1); if KT is extremely reduced, flap approaches + CTG may be performed. If the unidentifiable CEJ is associated with cervical lesions involving both root and crown surfaces (class B+), the combined restorative–periodontal treatment results as the most indicated approach. The adjunctive use of CTG should be also considered in presence of interproximal attachment loss (RT2 and RT3) and reduced gingival thickness (<1 mm). Conclusions: The proposed decisional scheme could be useful to address the clinicians during the decision-making process in the treatment of gingival recessions. Full article

Objectives: Comparison of clinical, radiological, and microbiological outcomes following periodontal regeneration procedures with or without local antibiotic therapy. Methods: Forty patients, each presenting with a single vertical defect, were randomly assigned to either the test (SRP+ANB+MIST/M-MIST) or the control group (SRP+MIST/M-MIST). The periodontal regenerative procedures were carried out according to the general minimally invasive surgical technique principles, and the vertical bone defect was filled with an enamel matrix derivative (EMD—Emdogain^®). Periodontal condition assessments were performed two weeks before the procedure, on the day of the surgical procedure, and at follow-up visit after 6 months. Radiographs were taken two weeks before, and 6 months after the surgery. To determine the microbiological profile of the surgical sites, subgingival plaque samples were collected for PCR analysis. Results: In both groups, a statistically significant pocket depth (PD) reduction and clinical attachment level (CAL) gain were observed over the 6-month follow-up period. The difference between the groups for PD and CAL parameters at 6 months was not statistically significant. Both groups showed a statistically significant reduction in the radiological depth and width of intrabony defects. Microbiological analysis revealed a statistically significant difference between the groups two weeks after subgingival antibiotic application for Fusobacterium nucleatum, Tannerella forsythia, and Prevotella intermedia. Conclusions: Periodontal tissue regeneration procedures according to minimally invasive principles (MIST/M-MIST) with the use of EMD lead to improvements in clinical and radiological parameters. Local antibiotic application results in a reduction in bacterial counts in short-term observations. Its use prior to regeneration procedures does not lead to additional improvements in clinical and radiological parameters. Full article

Molar incisor hypomineralization (MIH) is characterized by systemic hypomineralization affecting one to four first permanent molars (FPMs), often accompanied by lesions in incisors and potentially involving other primary or permanent teeth. MIH poses clinical challenges, including hypersensitivity, susceptibility to pulp involvement, and aesthetic concerns. Optical Coherence Tomography (OCT), an advanced, non-invasive imaging modality, has gained interest as a potential diagnostic tool in dentistry. This exploratory observational case-control study aims to compare the structural characteristics of MIH-affected and healthy teeth using in vivo OCT, focusing on identifying qualitative imaging patterns associated with enamel hypomineralization. This study included 50 mild MIH-affected permanent teeth from pediatric patients and 50 healthy permanent teeth as controls. Representative OCT scans were acquired, analyzed, and compared for both groups. In OCT imaging, healthy enamel and dentin appeared as two distinct superimposed layers defined by the dentin-enamel junction. Conversely, MIH-affected teeth exhibited characteristic subsurface hyper-reflective zones, indicative of hypomineralized enamel, with deeper hypo-reflective shadowing. This first in vivo study applying OCT to MIH-affected teeth demonstrates its potential as a non-invasive technique for the real-time assessment of enamel structural anomalies, supporting its future role in monitoring remineralization therapies and improving early detection strategies in pediatric dental care. Full article

The evolutionarily conserved Notch signalling pathway regulates the fate, proliferation and differentiation of cells in most developing organs, thus affecting their morphogenesis and function. Here, we investigated the role of the Notch2 receptor in the generation and function of epithelial cells of the continuously erupting rodent incisors. We used transgenic Notch1-Cre^ERT2/+;Rosa26^mT/mG and Notch2-Cre^ERT2/+;Rosa26^mT/mG mice to compare the contribution of Notch1- and Notch2-expressing cells and their progeny in the generation of the different epithelial cell populations. Furthermore, we examined if the dental epithelium organisation and enamel structure are affected in early postnatal incisors of Keratin14^Cre/+;Notch2^fl/fl mice using immunofluorescent staining, gene expression analysis, microcomputed tomography and scanning electron microscopy. Our results showed that Notch2 deletion resulted in smaller incisors with disorganised dental epithelium and defective enamel. Delayed eruption was correlated with alterations in the proliferative and differentiation status of epithelial stem cells in the cervical loop area of the incisors. Similar results were obtained with in vitro studies, where inhibition of the Notch signalling by the CB103 blocker recapitulated the in vivo phenotype. In conclusion, this study demonstrates for the first time the importance of Notch2 in epithelial cell fate acquisition, dental epithelium organisation and enamel structure in rodent incisors. Full article

This systematic review aimed to evaluate the effectiveness of teriparatide (TP) in guided bone regeneration (GBR). An electronic search without language or date restrictions was performed in PubMed, Web of Science, Scopus, Scielo, and gray literature for articles published until June 2025. Inclusion criteria considered studies evaluating the effect of TP on bone regeneration, analyzed using SYRCLE’s Risk of Bias tool. Twenty-four preclinical studies were included, covering diverse craniofacial models (mandibular, calvarial, extraction sockets, sinus augmentation, distraction osteogenesis, segmental defects) and employing systemic or local TP administration. Teriparatide consistently enhanced osteogenesis, graft integration, angiogenesis, and mineralization, with potentiated effects when combined with various biomaterials, including polyethylene glycol (PEG), hydroxyapatite/tricalcium phosphate (HA/TCP), biphasic calcium phosphate (BCP), octacalcium phosphate collagen (OCP/Col), enamel matrix derivatives (EMDs), autografts, allografts, xenografts (Bio-Oss), strontium ranelate, and bioactive glass. Critically, most studies presented a moderate-to-high risk of bias, with insufficient randomization, allocation concealment, and blinding, which limited the internal validity of the findings. TP shows promising osteoanabolic potential in guided bone regeneration, enhancing bone formation, angiogenesis, and scaffold integration across preclinical models. Nonetheless, its translation to clinical practice requires well-designed human randomized controlled trials to define optimal dosing strategies, long-term safety, and its role in oral and craniomaxillofacial surgical applications. Full article

Background/Objectives: Amelogenesis imperfecta (AI) represents a heterogeneous group of inherited disorders affecting the quality and quantity of dental enamel, making clinical diagnosis challenging. This study aimed to identify genetic variants in Slovenian patients with non-syndromic AI and to evaluate enamel morphology using radiographic parameters. Methods: Whole exome sequencing (WES) was performed on 24 AI patients and their families. Panoramic radiographs (OPTs) were analyzed using Fiji ImageJ to assess crown dimensions, enamel angle (EA), dentine angle (DA), and enamel–dentine mineralization ratio (EDMR) in lower second molar buds, compared to matched controls (n = 24). Two observers independently assessed measurements, and non-parametric tests compared EA, DA, and EDMR in patients with and without disease-causing variants (DCVs). Statistical models, including bootstrap-validated random forest and logistic regression, assessed variable influences. Results: DCVs were identified in ENAM (40% of families), AMELX (15%), and MMP20 (10%), including four novel variants. AI patients showed significant enamel deviations with high reproducibility, particularly in hypomineralized and hypoplastic regions. DA and EDMR showed significant correlations with DCVs (p < 0.01). A bootstrap-validated random forest model yielded a 90% (84.0–98.0%) AUC-estimated predictive power. Conclusions: These findings highlight a novel and reproducible radiographic approach for detecting developmental enamel defects in AI and support its diagnostic potential. Full article

The junctional epithelium, which lines the inner gingival surface, seals the gingival sulcus to block the infiltration of food debris and pathogens. The junctional epithelium is derived from the reduced enamel epithelium, consisting of late developmental stage ameloblasts and accessory cells. No prior studies have investigated whether defective ameloblast differentiation or enamel matrix formation affects junctional epithelium anatomy or function. Here, we examined the junctional epithelium in mice exhibiting amelogenesis imperfecta due to loss-of-function mutations in the major enamel matrix protein amelogenin (Amelx^−/−) or the critical enamel matrix protease KLK4 (Klk4^−/−). Histological analyses demonstrated altered morphology and cell layer thickness of the junctional epithelium in Amelx^−/− and Klk4^−/− mice as compared to wt. Immunohistochemistry revealed reduced ODAM, laminin 5, and integrin α6, all of which are critical for the adhesion of the junctional epithelium to the enamel in Amelx^−/− and Klk4^−/− mice. Furthermore, we observed altered cell–cell adhesion and increased permeability of Dextran-GFP through the mutants’ junctional epithelium, indicating defective barrier function. Reduced β-catenin and Ki67 at the base of the junctional epithelium in mutants suggest impaired mitotic activity and reduced capacity to replenish continuously desquamated epithelium. These findings highlight the essential role of normal amelogenesis in maintaining junctional epithelium homeostasis. Full article

Background\Objectives: Chronic kidney disease (CKD) is defined as a clinical syndrome secondary to a permanent change in kidney function or structure, making it irreversible. Most patients at the onset of the disease are asymptomatic or present nonspecific symptoms, including signs and symptoms at the oral level. These manifestations, such as hyposalivation, increased calculus index, enamel defects, or changes in saliva composition, contribute to the diagnosis of this pathology and can also significantly affect the patient’s quality of life. The aim is to systematically assess the presence and relevance of oral manifestations in patients with CKD, and to identify correlations between these symptoms and clinical parameters such as glomerular filtration rate or concomitant conditions of the patient. Materials and Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was carried out in the PubMed, Scopus, Scielo, and The Cochrane Library databases on 7 April 2025, using terms related to “chronic kidney disease” and “oral manifestations”. Inclusion criteria referred to observational studies published in the last ten years that reported oral symptoms in patients with CKD. The quality of cohort and case-control studies was assessed using the Newcastle–Ottawa Scale (NOS), while for cross-sectional studies, the Joanna Briggs Institute (JBI) critical appraisal checklist was used. Results: A total of 27 studies met the inclusion criteria, primarily cross-sectional in design. The most frequently reported oral manifestations included hyposalivation, increased calculus and plaque indices, enamel defects, periodontal disease, and oral candidiasis. Significant associations were identified between the duration of dialysis and severity of periodontal disease, as well as between CKD stage and taste dysfunction. Findings varied by age group and CKD stage, with children showing distinct salivary profiles and adults presenting more pronounced periodontal and mucosal conditions. Conclusions: This review highlights a clear relationship between CKD and various oral health disturbances, although more studies are needed to better understand oral–systemic interactions in CKD. What is necessary is the establishment of multidisciplinary care approaches. Full article

Background: Early childhood dental decay remains a pervasive chronic condition, and environmental toxicants—particularly lead—may exacerbate its development. This systematic review was designed to synthesize evidence on how lead exposure correlates with both the occurrence of carious lesions and aesthetic alterations in children’s primary teeth. Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science through April 2025, selecting observational investigations that assessed the link between lead levels and primary-tooth decay in pediatric cohorts. Thirteen eligible studies, encompassing 44,846 participants aged 2–19 years, were included for qualitative synthesis. Aesthetics were screened using author-defined enamel-defect or discoloration endpoints; however, only three studies reported compatible metrics, precluding quantitative pooling. Heterogeneity in exposure matrices likewise ruled out meta-analysis. Results: Most studies reported a statistically significant association between higher lead burden and greater prevalence or severity of caries in primary teeth. Blood lead concentrations across studies ranged from means of 1.53 μg/dL to geometric means of 7.2 μg/dL. Notably, elevated lead was linked to increased decayed, missing, or filled surfaces—with an adjusted risk ratio of 1.14 (95% CI: 1.02–1.27) at levels below 5 μg/dL—and adjusted mean ratios of up to 2.14 for decayed or filled teeth when blood lead reached 5–10 μg/dL. Conclusions: Current evidence suggests that children’s exposure to lead may heighten the risk of caries and detract from the aesthetic quality of primary teeth. However, variability in study design, lead quantification methods, and confounder adjustment limit the consistency of findings. Mitigating lead exposure in early life could represent a valuable preventive strategy against dental decay in susceptible pediatric populations. Full article

Background: Traumatic injuries to the alveolar process and primary teeth in early childhood can have long-term consequences on the development of permanent dentition and eruption pathways. Objective: This case report aims to illustrate the impact of early orofacial trauma on the eruption and development of permanent maxillary incisors and to emphasize the importance of timely interdisciplinary management. Case Presentation: An 8-year-old female patient presented to a pediatric dentistry clinic with delayed eruption of the maxillary anterior permanent teeth. In contrast, her monozygotic twin sister exhibited complete eruption of all permanent anterior teeth, raising parental concern regarding a possible pathological delay. Her medical history revealed orofacial trauma at the age of two, resulting in an alveolar process fracture, avulsion of the primary maxillary left central incisor (tooth 61), and luxation of the primary maxillary right central incisor (tooth 51). A clinical examination demonstrated sufficient arch space without signs of eruption and enamel defects on tooth 52. Radiographic evaluations, including panoramic imaging and cone beam computed tomography (CBCT), confirmed the presence of impacted permanent teeth with structural anomalies suggestive of trauma-related developmental disturbances. Results: The patient underwent a multidisciplinary treatment over a three-year period involving pediatric dentistry, oral surgery, and orthodontics. Management included surgical exposure of the impacted teeth followed by orthodontic traction to guide the eruption and treatment of enamel hypoplasia. Conclusions: This case highlights the long-term consequences of early traumatic dental injuries on permanent dentition development. It underscores the necessity of early diagnosis and a coordinated interdisciplinary approach to optimize outcomes and enhance the long-term oral health and quality of life of affected individuals. Full article

C-terminal-binding proteins (CtBPs) dimerize and function predominantly as transcriptional corepressors by recruiting various chromatin-modifying factors to promoter-bound repressors. Hypotonia, ataxia, developmental delay, and tooth enamel defects syndrome (HADDTS) is a recently discovered neurodevelopmental disorder resulting from a heterozygous missense mutation in CTBP1. It is often associated with the early onset of profound cerebellar atrophy in patients. Allen Institute’s Allen Brain Cell (ABC) atlas of human brain data was used to localize CTBP1 expression in the brain to elucidate the etiology of HADDTS. Based on the ABC atlas, CTBP1 is highly expressed in the upper rhombic lip supercluster, which gives rise to cerebellar cells and provides insights into the cerebellar pathophysiology observed in HADDTS patients. Full article

Background/Objectives: This systematic review aims to investigate the potential association between vitamin D levels and the occurrence of developmental enamel defects (DDE) in children, including conditions like molar–incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPMs). DDEs, which occur during tooth development, can result in significant aesthetic and functional issues, and their exact etiology remains unclear, with both genetic and environmental factors contributing. Among environmental factors, vitamin D deficiency has been proposed as a possible risk factor, given its role in enamel mineralization. Methods: A thorough literature search was conducted in PubMed, Scopus, and Embase. The search strategy included terms such as “vitamin D”, “vitamin D deficiency”, “developmental defects of enamel”, “enamel hypoplasia”, “molar-incisor hypomineralization”, and “hypomineralized second primary molars”. Studies were included if they were original human observational research (cohort, case–control, or cross-sectional) conducted in children under 18 years of age or involving maternal–child cohorts. Ten studies were included in the analysis, with a total of 15,891 participants. The primary data extracted from the selected studies included the following: study design, participants’ age, sample size, vitamin D status in relation to developmental defects of enamel, and statistical significance Results: The findings were mixed, with only a few studies suggesting a significant association between low vitamin D levels and the presence of DDEs. Specifically, one study found a link between insufficient maternal vitamin D levels during pregnancy and an increased number of teeth affected by MIH in children. However, the majority of the studies did not report a significant association. Conclusions: This review concludes that while there is some evidence to suggest a possible relationship between vitamin D and DDEs, more research is needed to confirm these findings and better understand the underlying mechanisms. Full article

Background: This study aimed to assess the effectiveness of a modified entire papilla preservation technique (MEPPT) for treating isolated intrabony defects in patients with stage III periodontitis. Material and Methods: Fifteen patients with 15 interdental intrabony defects were treated with a MEPPT using enamel matrix derivative and allogenic bone. Their probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), keratinized tissue width (KTW), defect depth (DD), full-mouth plaque score (FMPS), full mouth bleeding score (FMBS), radiographic images (radiographic angles, BF and LDF) and intrasurgical parameters were assessed at baseline and 3 years postsurgery. Standardized measurements were taken to evaluate the defect characteristics and treatment outcomes. Results: At 3 years, significant improvements from baseline were maintained. Probing pocket depth (PPD) decreased from 7.03 ± 1.61 mm to 3.33 ± 0.89 mm (p < 0.0001), clinical attachment level (CAL) improved to 3.08 ± 1.16 mm (p < 0.001) and defect depth (DD) decreased from 4.59 ± 1.24 mm to 0.38 ± 0.31 mm (p < 0.001). The changes in gingival recession and keratinized tissue were not statistically significant. The results demonstrate sustained clinical stability over a 3-year period. Conclusions: Within the limitations of this study, the findings suggest that the modified entire papilla preservation technique (MEPPT) in conjunction with enamel matrix proteins and allogenic bone grafting is an effective approach for the treatment of intrabony defects, leading to statistically significant and sustained clinical improvements over a 3-year period. The study protocol was registered in ClinicalTrials.gov ID NCT05029089. Full article