Clinical Oral Investigations

Gil, Javier; Sanz, Mariano

doi: 10.1007/s00784-025-06424-zpmid: 40560422

ObjectiveA new passivation method for titanium dental implants has been studied, where the nanotextured layer features spikes that provide a high bactericidal capacity without compromising the degree of osseointegration of the dental implants.Materials and methodsThis layer has been obtained through a sulfuric acid treatment with hydrogen peroxide. It has been characterized using electron microscopy, the roughness was determined by confocal microscopy and wettability and surface energy assessed through contact angle. The incorporation of hydrogen was assessed using a fusion spectrometer. Fatigue behavior was evaluated with a servo-hydraulic testing machine. The adhesion of human osteoblastic cells SaOs-2 at 3 and 7 days was measured, and the level of mineralization was analyzed by alkaline phosphatase levels. Bacterial colonization assays were conducted using four strains to assess their bactericidal capacity. Implants were inserted into rabbit tibiae. After 21 days, the animals were sacrificed, and bone index contact determined.ResultsA uniform surface created by nanospikes was obtained, exhibiting the same roughness as the control implant, no hydrogen was incorporated inside the titanium. The fatigue behavior showed no variation compared to the control. An increased wettability and higher surface energy compared to the control implant were noted. Enhanced osteoblastic adhesion was observed for the nanospikes surface in comparison with control at 3 days, with a significant level of alkaline phosphatase at 14 days, indicating a good degree of mineralization. The bactericidal capacity of nanospike surface is evidenced showing reductions ranging from 70 to 90%. In vivo tests demonstrate higher bone contact index values for dental implants with nanospikes (56%) compared to the control (41%).ConclusionsThe surface formed by nanospikes maintains the mechanical properties of the control and improves the wettability of the surface which improves the behavior of the osteoblasts generating a better osseointegration. At the same time, it has a high bactericidal capacity that prevents microbiological colonization.Clinical relevancePeri-implantitis has become one of the major problems for the success of implant dentistry and this new surface may be a solution for the prevention of the disease.

Rohr, Nadja; Rutscheidt, Mark; Meinen, John; Jäggi, Marco; Stawarczyk, Bogna

doi: 10.1007/s00784-025-06447-6pmid: 40593330

ObjectiveTo obtain the retention strength of translucent zirconia crowns on human tooth abutments and evaluate effects of specimen preparation, bonding protocol, and comparing aging in two different chewing simulators.Materials and methodsTranslucent zirconia crowns were bonded to prepared human teeth using two resin composite luting materials: Panavia V5 (PV5) and RelyX Universal (with primer [RUV] and without primer [RUO]). Specimens were fabricated at two sites (B and M) and the retention strength was determined before and after aging in two different chewing simulators (N = 216, n = 12) using 1.2 million cycles, 50 N, 1.5 Hz and 6000 thermal cycles. Data were analyzed with 3-way ANOVA and Bonferroni post-hoc test (α = 0.05).ResultsHigher retention strength values were observed for specimens produced at site M (7.1 ± 2.6 MPa) compared to B (5.5 ± 2.7 MPa). Overall, highest values were obtained with PV5 (7.0 ± 2.1 MPa) and RUV (7.0 ± 2.7 MPa), while retention strength with RUO was lower (4.9 ± 2.9 MPa). The highest values overall were determined before aging (8.1 ± 1.8 MPa), followed by aging in the industrially available simulator using weight-loading (6.1 ± 2.4 MPa) and the custom-built hydraulic simulator (4.8 ± 2.9 MPa) enhancing aging effects.ConclusionsThe specimen production affected retention strength values. Bonding protocols PV5 and RUV revealed similar results, while lower values were obtained using the self-adhesive approach RUO. Aging in the hydraulic simulator was more pronounced, despite identical settings.Clinical relevanceDifferences in retention strength may occur between operators, despite strict bonding protocol adherence. An adhesive bonding protocol using the respective primer is recommended over self-adhesive bonding of translucent zirconia crowns on human teeth.

de Oliveira Alves, Roberta; Garcia Orsi, Caroline; Alves Oliveira, Jovânia; de Rezende Barbosa, Gabriella Lopes; de Oliveira, Guilherme José Pimentel Lopes; Ferreira Soares, Priscilla Barbosa

doi: 10.1007/s00784-025-06423-0pmid: 40522340

ObjectiveTo assess the impact of injectable platelet-rich fibrin (i-PRF) as an adjunct to scaling and root planing (SRP) in patients with periodontitis.Materials and methodsTwenty-four patients, with two pairs of contralateral teeth (probing depth [PD] ≥ 5 mm), were enrolled. The tooth pairs were randomly assigned to either the control group (SRP, n = 149 sites) or the experimental group (SRP + i-PRF, n = 135 sites). The clinical parameters PD, gingival recession (GR), clinical attachment level (CAL), plaque index (PI), and full mouth bleeding on probing (fBOP) were evaluated at baseline and 45 and 90 days. Radiographic analysis measured the distance from the cementoenamel junction to the alveolar bone crest (CEJ-BC) at baseline and 90 days.ResultsBoth groups showed significant reductions in PD, CAL, fBOP, and PI from baseline to 45 days (p < 0.001), without significant differences between the groups (p > 0.05). The test group exhibited increased GR at 45 days (p < 0.05). CEJ-BC decreased in both groups at 90 days with no significant intergroup difference (p > 0.05). At 90 days, no significant intra- or intergroup differences were observed in any of the clinical parameters (p > 0.05).ConclusionSRP alone or combined with i-PRF resulted in comparable clinical and radiographic improvements in patients with periodontitis. Adjunctive i-PRF did not offer significant additional benefits.Clinical relevanceThis study shows SRP alone and SRP + i-PRF yield satisfactory periodontal outcomes. Moreover, this study introduces the injection of i-PRF around the periodontal pocket, which, to the best of our knowledge, has not been extensively explored in the existing literature.Trial registrationhttps://ensaiosclinicos.gov.br/: RBR-52h647m.

van Gennip, Lucky L.A.; Bulthuis, Marjolein S.; Thomas, Renske Z.; Bronkhorst, Ewald M.; Hannink, Gerjon; Laheij, Alexa M.G.A.; Raber-Durlacher, Judith E.; Rozema, Frederik R.; Brennan, Michael T.; von Bültzingslöwen, Inger; Blijlevens, Nicole M.A.; van Leeuwen, Stephanie J.M.; Huysmans, Marie-Charlotte D.N.J.M.

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Kadayıf, Asena; Taşçi, Özge Elif; Karaduman, Burcu

doi: 10.1007/s00784-025-06420-3pmid: 40542868

ObjectivesThis study investigated the gingival crevicular fluid (GCF) levels of complement-C1q tumor necrosis factor related protein-1 (CTRP-1), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) following non-surgical periodontal therapy (NSPT) in systemically healthy individuals with periodontal health (H), generalized gingivitis (G), and stage III grade B periodontitis (P). Moreover, this study aimed to investigate their diagnostic potential in distinguishing different periodontal diseases.Materials and methods73 systemically healthy non-smoking individuals were divided into H (n = 25), G (n = 23) and P (n = 25) groups. Clinical periodontal parameters were recorded, and GCF samples were collected at baseline in all groups, and 3rd month after NSPT in the G and P groups. GCF levels of CTRP-1, TNF-α, and IL-10 were analyzed using ELISA. The area under the curve (AUC) was assessed using the receiver operating characteristic curve analysis.ResultsCTRP-1 levels were significantly elevated in the G and P group compared to the H group (p < 0.001), while there was no significant difference between the G and P groups (p = 0.095). TNF-α and IL-10 levels were significantly higher in the P group compared to the other groups (p < 0.001). GCF CTRP-1 demonstrated an excellent diagnostic performance to discriminate periodontitis and gingivitis from periodontal health (AUC value of 0.998 and 0.974 with 100% and 91.3% sensitivity).ConclusionCTRP-1 could serve as a potential biomarker for periodontal diseases. CTRP-1 demonstrated excellent diagnostic performance in distinguishing stage III grade B periodontitis and gingivitis from periodontal health.Clinical relevanceGCF CTRP-1 levels may serve as a valuable marker for diagnosing periodontal diseases.

Wang, Xin; Tian, Xumeng; Zeng, Yiling; He, Hong; Yuan, Wenjun

doi: 10.1007/s00784-025-06455-6pmid: 40616672

ObjectivesThe study aims to compare methods for 3D volumetric assessment of unilateral alveolar clefts using CBCT, evaluating their accuracy and analysing clinical applicability, and to provide recommendations for improved precision in treatment planning and scientific research.Materials and methodsTwo methods were used to assess the volumes of 20 patients with unilateral alveolar clefts. One was based on anterior nasal spine (ANS) and greater palatine foramen (GPF); while the other was based on ANS and posterior nasal spine (PNS), regarding the palatal plane (PP) as the reference plane. Reliability for the different outcome variables was analyzed with intra-class correlation (ICC) and by calculating a paired Student’s t tests and Pearson’s correlation coefficient.ResultsThe mean volume measured by the ANS&PNS based method (957.70 ± 174.25 mm3) was higher than the one measured by the combined method based on ANS&GPF (786.74 ± 146.10 mm3) with statistically significant difference (P < 0.001). The Pearson correlation coefficient between the groups showed good stability in the differences (r = 0.957, P < 0.001).ConclusionsThe volumetric assessment of alveolar clefts varies with the reference plane used. The method based on palatal plane offers relatively easier identification of landmarks, closely reflecting actual alveolar bone volume.Clinical relevanceThe refined method for alveolar cleft assessment could improve treatment planning for orthodontics and alveolar bone grafting in patients with UCLP, while also supporting research on alveolar cleft morphology and its developmental mechanisms.

Polesso Patias, Matheus; Fernandes-e-Silva, Paula; Carreño, Neftali Lenin Villareal; Lund, Rafael Guerra; Piva, Evandro; da Silva, Adriana Fernandes; De Oliveira Da Rosa, Wellington Luiz

doi: 10.1007/s00784-025-06427-wpmid: 40560221

ObjectiveTo evaluate the clinical performance of universal adhesives (UA) in different modes in direct dental resin composite restorations compared to control self-etch and etch-and-rinse adhesives.Materials and methodsThe study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A literature search was performed in five databases (Pubmed, Web of Science, Embase, Scopus, and Cochrane) until August 2024. Only RCTs that compared retention, marginal staining, and postoperative sensitivity of different forms of application of UA with etch-and-rinse and self-etching adhesives were included. The meta-analysis was performed using the Revman software (Cochrane Collaboration, UK), and this review was preregistered with the PROSPERO (CRD42022314408).ResultsA total of 15 RCTs were included, with a follow-up varied from 6 months to 4 years. In the global analysis, considering three outcomes, UA were statistically similar to control adhesives (etch-and-rinse and self-etch) regardless of the mode of application (ER, SE or EE), with a risk difference of -0.01 (-0.04, 0.02; p = 0.43; I2 = 45%) for retention, -0.02 (-0.05, 0.01; p = 0.32; I2 = 27%) for marginal discoloration and 0.00 (-0.01, 0.01; p = 0.82; I2 = 0%) for postoperative sensitivity.ConclusionUniversal adhesives had similar clinical performance to conventional ER and SE adhesives.Clinical relevanceUniversal adhesives provide clinical performance comparable to conventional etch-and-rinse and self-etch adhesives, offering a simplified and effective option for adhesive procedures.

Akamp, Tobias; Pohl, Sandra; Scholz, Konstantin J.; Sigl, Philipp; Rosendahl, Andreas; Wölflick, Melanie; Pielnhofer, Florian; Buchalla, Wolfgang; Widbiller, Matthias

doi: 10.1007/s00784-025-06429-8pmid: 40593225

ObjectivesFluoride-based cariostatic agents are commonly used in dental products and are generally considered safe. However, ongoing discussions about potential adverse effects are driving research into alternative agents, such as lanthanide salts. This study aims to evaluate the cytotoxic effects of different cariostatic agents, including fluoride compounds (NaF, Na2PO3F, NH4F) and lanthanide salts (Ce(NO3)3, CeCl3, Sm(NO3)3, SmCl3).Materials and methodsMouse fibroblasts (L-929) were cultured in Eagle’s Minimum Essential Medium supplemented with 5% fetal bovine serum and 1% penicillin-streptomycin. Cell viability was assessed via MTT assay after 24 h of exposure to test compounds at concentrations of 0.0128, 0.064, 0.32, 1.6, 8, 40, 200 and 1000 mM, and lactate dehydrogenase (LDH) release was quantified to assess membrane integrity. The accumulation of reactive oxygen species (ROS) was determined after 24 h. Data were analyzed by non-parametric methods at a significance level of α = 0.05 (Mann-Whitney U and Kruskal-Wallis tests).ResultsCell viability decreased significantly for NaCl and NaNO3 at 200 mM, and for NaF, NH4F, Ce(NO3)3, CeCl3, Sm(NO3)3 and SmCl3 at 1.6 mM, falling below 70% of control (P ≤ 0.0178). Similarly, LDH assays indicated a significant incline in cytotoxicity at a concentration of 200 mM for NaCl, NaNO3 and Na2PO3F, and at 8 mM for NaF, NH4F and all lanthanide compounds (P ≤ 0.0016). ROS quantification showed that NaF, NH4F, CeCl3, Sm(NO3)3 and SmCl3 induced oxidative stress at 1.6 mM with statistical significance (P ≤ 0.0065).ConclusionsFluoride and lanthanide compounds exhibited similar in vitro biocompatibility, comparable to that of table salt.Clinical relevanceBoth fluoride- and lanthanide-based cariostatic agents appear to pose a low biological risk to surrounding oral tissues when used at appropriate doses in dental products.

Kaya Mumcu, Arzu; Tuzcu, Ecenur; Kurnaz, Safa; Kiraz, Gülsen

doi: 10.1007/s00784-025-06435-wpmid: 40560202

ObjectivesThis randomized controlled clinical trial aimed to evaluate the effect of intracanal cryotherapy using cold saline (2.5 °C) as a final irrigant on postoperative pain and analgesic consumption following single-visit nonsurgical endodontic retreatment of asymptomatic mandibular premolars.Materials and methodsSixty systemically healthy patients with asymptomatic apical periodontitis in previously treated single-rooted mandibular premolars were enrolled and randomly assigned to two groups (n = 30 each). Both groups underwent standardized retreatment protocols, with the cryotherapy group receiving final irrigation with cold saline (2.5 °C) and the control group with room-temperature saline, both for 5 min. Postoperative pain was assessed using a 10-point Visual Analog Scale (VAS) at 6, 12, 24, 48, 72, and 168 h. Analgesic intake was also recorded. Statistical analysis was performed using the Chi-Square and Mann-Whitney tests with a significance level set at 0.05.ResultsThe cryotherapy group exhibited significantly lower pain scores at 6 h (p = 0.014) and 12 h (p = 0.028) postoperatively compared to the control group. No significant differences were observed at 24, 48, 72, or 168 h. Although fewer patients in the cryotherapy group reported analgesic use, this difference was not statistically significant (p = 0.278). No adverse events were reported.ConclusionsIntracanal cryotherapy using cold saline effectively reduced short-term postoperative pain following endodontic retreatment but did not significantly influence long-term pain or analgesic intake.Clinical relevanceIntracanal cryotherapy offers a simple, low-cost adjunct that may effectively reduce early postoperative pain and improve patient comfort in single-visit retreatment.

Chayawatto, Suphachart; Kornsuthisopon, Chatvadee; Linsuwanont, Pairoj

doi: 10.1007/s00784-025-06380-8pmid: 40562895

ObjectivesTo compare the effect of fluocinolone acetonide (FA), mineral trioxide aggregate (MTA), and their combination on inflamed human dental pulp cells (HDPCs), focusing on cell viability, expression of inflammation and mineralisation-associated genes, and odontogenic differentiation.MethodsHDPCs were treated with 20 µg/mL lipopolysaccharide (LPS) alone or in combination with and 400 µM hydrogen peroxide (H2O2) for 6, 12, 24 and 48 h to induce inflammatory conditions. Normal and inflamed HDPCs were further treated with FA, MTA extraction medium, or a combination of MTA and FA. Cell viability was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The expression of inflammatory and mineralisation-associated genes was evaluated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Odontogenic differentiation was determined by alkaline phosphatase staining (ALP) and alizarin red S staining (ARS).ResultsHDPCs pretreated with LPS and H2O2 had reduced cell viability, increased expression of IL-1β and IL-6, decreased expression of ALP and DSPP, and reduced odontogenic differentiation. Treatment with FA alone or in combination with MTA improved these parameters, except for odontogenic differentiation, which was enhanced only in the FA-treated group.ConclusionFA exerted anti-inflammatory properties and promoted odontogenic differentiation under the inflammatory milieus of HDPCs in this in vitro study.Clinical relevanceUnder the simulated inflammatory condition of HDPCs, this in vitro study suggests the potential benefit of FA for anti-inflammatory and mineralisation enhancing properties.