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Comparison of the accuracy/precision among guided (static), manual, and dynamic navigation in dental implant surgery: a systematic review and meta-analysis
No full textObjective: To assess whether dynamic navigation (dCAIS) has greater accuracy/precision and less discrepancy in parallelism compared to guided (static, sCAIS) and free-hand (FH) surgery in Implantology. Materials and methods: A search was conducted across six databases using specific key terms. Randomized controlled trials (RCTs), retrospective or prospective clinical studies published within the last 10 years (2014–2024) were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. A meta-analysis using a random-effects model was employed. The heterogeneity analysis was conducted using Cochran’s Q-test and Higgins’ I2 statistic. Results: Thirteen articles were included. A total of 554 patients and 687 implants were enrolled, with 215 using the FH system, 195 using sCAIS, and 277 using dCAIS. The meta-analysis compared the following: (1) dCAIS vs. sCAIS; (2) dCAIS vs. FH; (3) sCAIS vs. FH. The first group had a mean difference of -0.08 mm, with a substantial heterogeneity (I² = 52%) and no statistically significant difference (p = 0.08); the second presented a mean difference of -0.48 mm, high heterogeneity (I²=89%), and a statistically significant better accuracy for dCAIS than FH (p \u3c 0.01); the last comparison found a mean difference of -0.62 mm, with a considerable heterogeneity (I²=84%), and sCAIS showing statistically significantly better accuracy than the FH approach (p \u3c 0.01). Conclusions: Using CAIS (dCAIS or sCAIS) substantially improved accuracy compared to the FH approach, with no statistically significant difference between dCAIS and sCAIS. Clinical relevance: The findings support the use of CAIS for improved implant accuracy and precision compared to FH techniques
Comparison of Dentoalveolar Changes with Miniscrew-Assisted Versus Conventional Rapid Palatal Expansion in Growing Patients: A Systematic Review and Meta-Analysis
No full textBackground: This meta-analysis aimed to evaluate the dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) compared with conventional rapid palatal expansion (CRPE) in growing patients (≤16 years). Methods: A systematic and comprehensive literature search was carried out independently by two reviewers using both MeSH terms and free-text keywords across PubMed, the Cochrane Library, and Embase, with studies published through February 2025 included. The risk of bias was assessed using the Cochrane ROB 2.0 tool. The GRADE system was employed to determine evidence quality. Results: Of the 462 initially screened articles, 6 met the inclusion criteria and were selected for quantitative synthesis. Most studies had a low risk of bias with some concerns in reporting. The pooled standardized mean difference (SMD) for tooth inclination changes in CRPE compared with MARPE was 0.98 (95% confidence interval (CI), 0.54 to 1.42; p \u3c 0.01). The test for overall effect was significant (p \u3c 0.01), but no significant differences were found between the subgroups. The pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.69 (95% CI, 0.37 to 1.00; p \u3c 0.01). The test for overall effect was significant (p \u3c 0.01), and there were substantial differences between the subgroups. The supporting evidence ranged in certainty from moderate to low. Conclusions: MARPE was more effective than CRPE in minimizing the buccal tipping and buccal bone loss of the maxillary first premolars and first molars. However, to further confirm these outcomes and guide evidence-based clinical practice, well-designed randomized controlled trials with long-term follow-up are necessary
Tooth Movement Patterns Based on Traction Methods for Mandibular Canine Retraction Using Skeletal Anchorage: A Finite Element Analysis
No full textObjective: This study compared the tooth movement patterns of a power arm and a lever jig during mandibular canine retraction into a premolar extraction space using skeletal anchorage. Methods: A finite element model was developed based on anatomical structures. A mini-implant was placed between the mandibular second premolar and first molar, and canine retraction was simulated using a power arm and a lever jig. The lever jig’s vertical arm lengths were 6 mm, 8 mm, and 10 mm, corresponding to force application distances of 4.5 mm, 6.4 mm, and 8.2 mm from the archwire, matching the power arm. Finite element analysis was performed using linear mechanical properties and an explicit method. Results: With the power arm, increasing vertical length led to greater extrusion, while the posterior force remained unchanged. The lever jig also showed increased extrusion with length but to a lesser extent. Posterior force increased proportionally with the lever jig length. Initial displacement analysis showed greater extrusion and distal tipping with the power arm, while the lever jig suppressed extrusion and facilitated controlled tipping. Stress analysis revealed a more uniform periodontal ligament stress distribution with the lever jig. Conclusion: The lever jig minimizes extrusion and enhances force concentration posteriorly, promoting efficient distal movement
Integrating Median Nerve Sonography and Clinical Wrist Examinations for Dental Practitioners at Risk for Carpal Tunnel Syndrome
No full textObjective: The goal of this study was to conduct a multimodal wrist examination among dental practitioners. The purposes were twofold: (1) to describe bilateral wrist function and sonographic measures, including exploratory intraneural blood flow measures, and (2) to identify if otherwise healthy dental practitioners present with early signs and symptoms of carpal tunnel syndrome (CTS). Materials and Methods: This exploratory cross-sectional study examined both wrists of dental practitioners without CTS. Measurements included symptoms, grip strength, wrist motion, median nerve cross-sectional area (CSA, cm2), anterior-to-posterior distance (mm), intraneural peak systolic velocity (PSV, cm/sec) and power Doppler intensity quantification (PDI-Q) ratio. Results: A cohort of 23 dental practitioners were examined (age: 50.4 ± 10.9 years). Dominant wrists exhibited stronger grip (p \u3c .001, Cohen d = 0.79), more flexion (p = .014, Cohen d = 0.56), and less extension (p = .01, Cohen d = −0.59). Intraneural blood flow was detected in all dominant (100%, n = 23/23) and 91% of nondominant (n = 21/23) wrists. There were no side-to-side differences in median nerve CSA (p = .625–.88), anterior-to-posterior distance (p = .39), PSV (p = .24) or PDI-Q ratio (p = .61). Conclusion: This exploratory study of healthy dental practitioners may suggest early signs and symptoms of CTS, such as decreased grip strength, enlarged median nerve, and ischemic changes in intraneural blood flow, which warrants further study. Routine examination may lead to early detection of changes and risk reduction for injury
Orofacial Cleft and Poor Birth Health Outcomes: A Populational Cross-Sectional Study
No full textObjective This study aimed to examine whether newborns with orofacial clefts are at increased prevalence of poor birth health outcomes. Study Design This is a population-based cross-sectional study, conducted with information from 25,879,282 live births registered in the U.S. Vital Statistics Natality Birth Data from 2017 to 2023. The prevalence ratios and logistic regression models between orofacial cleft status (all, isolated, or nonisolated) and each child\u27s birth health variables (delivery method, maternal morbidity, 5-minute Apgar score, gestational age, birth weight, abnormal conditions, infant breastfed at discharge) were calculated, assuming a p ≤ 0.05 as statistically significant. Results The prevalence ratios showed that newborns with orofacial clefts were more susceptible to being born by cesarean section (prevalence ratio [PR] = 1.18, p = 0.000, 95% confidence interval [CI] = 1.16-1.21), having lower birth weight (PR = 2.18, p = 0.000, 95% CI = 2.11-2.25), lower Apgar 5 score (PR = 4.08, p = 0.000, 95% CI = 4.08-4.50), prematurity (PR = 1.55, p = 0.000, 95% CI = 1.50-1.60), experiencing more abnormal conditions at birth (PR = 3.72, p = 0.000, 95% CI = 3.64-3.80), and having more difficulty to be breastfed (PR = 2.16, p = 0.000, 95% CI = 2.11-2.22) than newborns without clefts. These ratios were even higher among those with nonisolated orofacial clefts. Associations were statistic significant even after adjustments. Conclusion This study provides evidence that newborns with orofacial clefts are at increased prevalence of poor birth health outcomes. Key Points Orofacial clefts are associated to higher prevalence of birth outcomes. Newborns with orofacial clefts were more susceptible to have low birth weight. Newborns with orofacial clefts were more susceptible to preterm birth
Tumour-Associated Macrophages in Oral Squamous Cell Carcinoma
No full textObjective: Tumour-associated macrophages (TAMs) are crucial in the progression and treatment response of oral squamous cell carcinoma (OSCC). TAMs infiltrate OSCC, adopting an M2-like phenotype that promotes tumour growth, metastasis and immune suppression. The current narrative review explored the roles of TAMs in OSCC, focusing on their impact on the tumour microenvironment, invasion, metastasis, angiogenesis, immunosuppression and potential therapeutic targeting. Methods: A comprehensive analysis of the current literature on TAMs in OSCC was conducted. Specifically, we evaluated the biological functions of TAMs, their interactions within the tumour microenvironment, and their influence on disease progression and treatment outcomes. Results: TAMs contribute to OSCC progression by secreting cytokines, such as IL-10 and TGF-β, that inhibit effector immune cells. They facilitate angiogenesis, extracellular matrix remodelling and the epithelial–mesenchymal transition, which are essential for tumour invasion and metastasis. TAMs support cancer stem cells and recruit regulatory T cells and myeloid-derived suppressor cells, enhancing resistance to therapies. Their presence correlates with advanced OSCC stages, lymph node metastasis and poor prognosis. Conclusion: TAMs regulate OSCC progression and therapy resistance. Reprogramming them to an M1-like phenotype or depleting them enhances treatments. Understanding TAM–OSCC interactions is crucial for developing interventions against their tumour-promoting functions and restoring anti-tumour immunity
The role of sucrose incorporated into milk on biofilm formation, pH change, and enamel demineralization
No full textBackgroud: While breastfeeding is endorsed for the overall health of infants and reduces the hazard of developing various illnesses, spontaneous breastfeeding should be considered a contributing element in the growth of early childhood caries (ECC). This investigation evaluated the effects of sucrose combined with milk on biofilm formation, pH change, and enamel demineralization. Methods: Biofilm formation and pH change of in vitro medium with human milk (HM), bovine milk (BM), and infant formula (IF) were measured with/without the presence of 10% sucrose and/or Streptococcus mutans (S. mutans). Enamel areas were made on extracted permanent molars and incubated using milk specimens. Demineralization of enamel and progression of caries were evaluated histologically after two weeks. Results: HM had less biofilm formation than BM and IF. However, adding 10% sucrose and S. mutans augmented biofilm formation in all three milk types. Sweetened HM exhibited the most significant change in pH and the most severe progression of carious lesions into the enamel. Enamel lesion depths were increased and pH was more acidic under a high load of sucrose and S. mutans. Conclusions: In conclusion, HM is recommended for health and reducing the threat of disease, but spontaneous breastfeeding after introducing additional nutritional carbohydrates is a risk factor for EEC
Cosmic Radiation Exposure: A Review of Recent Research on the Incidence and Prevention of Cancer in Aircrews
No full textAbstract
The author provides a literature review examining the clinical risks of cosmic radiation exposure and incidence of cancer in aircrews including pilots, flight attendants, and flight engineers or navigators. The review focuses on ionizing radiation exposure in aircrews as an occupational working group. The author will discuss the types of cancer associated with cosmic ionizing radiation exposure and the prevalence of certain cancer types noted in this population. Monitoring of ionizing radiation of aircrews in the United States is not required in 2024, which makes assessing exposure a challenge. The author also discusses associated risk factors and prevention strategies in aircrews. United States aircrews are an occupational group with known elevated exposure to ionizing radiation from natural cosmic sources, which has been linked to health risks, particularly for cancer. This occupational group is not monitored in 2024 and would benefit from occupational exams for medical surveillance and hazard awareness
Investigating trends in orthopedic surgery match for osteopathic and allopathic graduates post-single accreditation transition
No full textRevisiting and rethinking on staging (severity and complexity) periodontitis from the new classification system: A critical review with suggestions for adjustments and a proposal of a new flowchart
No full textThis critical review revisited the new classification system for periodontitis, specifically for staging, suggesting modifications and introducing a new flowchart for a better clinical evaluation. It evaluated articles published between 2018 and 2024 in the English language, which had an educational motivation focused on staging periodontitis. The PubMed/MEDLINE, Web of Science and Embase databases were used to retrieve the articles. The focus questions involved the analysis of all parameters for staging periodontitis. A total of 836 articles were initially found, of which 388 duplicates were excluded, 448 were evaluated by title and abstract, 26 articles were followed for full-text reading, and 6 articles were finally included in this critical review (k = 0.98). All articles included detailed parameters and steps referring to diagnosing periodontitis. Therefore, it was possible to observe instability and ‘gray zones’ in the staging step, which was due to the lack of priority and an organized order sequence. This review suggests the severity parameters cannot be overcome by the complexity parameters, following a cumulative sequence: clinical attachment loss (CAL) (1st); radiographic bone loss (RBL) (2nd); tooth loss due to periodontitis (TLP) (3rd); and then the complexity parameters. An exception must be permitted only for the complexity factors between Stages III and IV that can change the initial Stage (III or IV) obtained through the severity analysis, but only between the 2 stages. Moreover, for patients without tooth loss or with TLP ≤ 4 (without the need for complex rehabilitation), and presenting any type of drifting or flaring or a secondary traumatic occlusion, there is no justification for moving the diagnosis from Stage III to Stage IV