Oral, Volume 5, Issue 1 (March 2025) – 7 articles

Restoring endodontically treated teeth has always been a challenge in dentistry. Dental posts are used when further retention is required for the final restoration, indicating that the tooth is already structurally compromised. Varying survival rates have been reported by previous studies, and there does not seem to be consensus on what factors are favorable regarding the survival of teeth treated with dental posts. Background/Objectives: This study investigated the survival of teeth treated with direct and indirect posts placed by dentists and dental students at an Australian university over a five-year period. Methods: This retrospective study included 684 direct and indirect posts placed from January 2018 to December 2022 at Griffith University dental clinic. The survival of the teeth treated with dental posts was assessed using Kaplan–Meier analysis. The potential effect of patient, tooth and operator factors was assessed using Cox regression analysis. Results: The posts had a five-year survival rate of 94% and survival time of 46.16 months. No statistically significant difference in survival was noted between the different groups in this study. Conclusions: Teeth treated with dental posts have been shown to have good short-term survival; however, long-term survival could not be commented on. Within the limitations of this study, survival was not associated with the location of the tooth, type of tooth, operator expertise, post material, cement, restoration or opposing dentition. Full article

Background/Objectives: Low-grade myofibroblastic sarcoma is a rare malignant myofibroblastic tumor, first described by Gabbiani et al. in 1971. It predominantly affects adult males and is uncommon in children. The tumor can occur anywhere in the body, with a preference for the limbs and head and neck regions, including the oral cavity. Methods: A case report of a 22-year-old male patient with no systemic conditions who presented with a painless, red, firm swelling between teeth 34 and 35 was examined. Panoramic radiography was unremarkable. The lesion measured 19 × 8 mm. Histological analysis revealed a spindle cell proliferation with atypia. Immunohistochemical staining was positive for SMA and showed a low Ki-67 proliferative index, while negative for Desmin, CD34, and beta-catenin. The final diagnosis was low-grade myofibroblastic sarcoma. Results: After surgical excision, the lesion recurred within one month. The patient was referred to the Portuguese Institute of Oncology for further treatment. Conclusions: Low-grade myofibroblastic sarcoma is a rare tumor with a tendency for local recurrence and metastasis. Accurate diagnosis, which includes histological examination and immunohistochemistry, is essential to differentiate it from other benign and malignant lesions. This case highlights the importance of an incisional biopsy to confirm diagnosis prior to surgical excision, thereby reducing the risk of relapse and enabling appropriate treatment planning. Full article

Objective: This mixed methods study explores gender differences in, and reasons for, toothbrushing and flossing among Mexican-origin adults. Methods: Interviews and surveys about oral hygiene behaviors were collected from 72 adults (ages 21–40) living on the California–Mexico border. Interviews were audio-recorded, transcribed in their original language (English/Spanish), then coded. Survey responses were linked to coded transcripts in Dedoose. Qualitative reports were thematically analyzed for each behavior, stratified into four groups by gender and whether or not participants met American Dental Association (ADA) weekly guidelines (brushing ≥ 14/week; flossing ≥ 7/week). Self-reported weekly frequencies of brushing and flossing were collected continuously, and then dichotomized as meeting guidelines or not. Kruskal–Wallis and chi-square tests assessed differences in hygiene behavior frequency by gender. Negative binomial and logistic regressions were performed, accounting for socio-demographic characteristics. Results: Overall, 76% and 40% of adults met ADA guidelines for brushing and flossing, respectively. There were no differences in meeting ADA guidelines by gender. When brushing was examined continuously, women brushed 1.24 (1.05–1.47; p = 0.0099) times the rate of weekly brushing than men in the full model; flossing frequency differences were not found. Men and women, whether ADA guidelines were met or not, identified similar brushing and flossing facilitators (health concerns, aesthetics), and barriers (lack of time, not being home). Some women (mothers) were motivated to brush to be role models for their children. Self-efficacy, or confidence in ability to brush or floss, was described differently by adults who met ADA guidelines (high self-efficacy) compared to the adults not meeting guidelines (low self-efficacy). Conclusions: Integrating quantitative and qualitative data obtained from Mexican-origin adults identified few differences in both oral hygiene behaviors and the factors that influence their enactment. Full article

Background/Objectives: Graphene and its derivatives have garnered attention for their unique properties that could enhance dental biomaterials. Understanding their interactions with biological systems is crucial for optimizing their application in dentistry. This study aimed to comprehensively evaluate the biocompatibility, molecular interactions, and toxicity profiles of graphene and its derivatives for potential dental applications using in silico approaches. Methods: The study employed molecular-docking simulations, 100 ns molecular dynamics (MD) simulations, pharmacophore modeling, and in silico toxicity assessments. Key bone-related proteins and receptors were selected to assess the potential of graphene-based materials in dental restorative and regenerative therapies. Results: Molecular-docking simulations revealed strong interactions of Graphene Quantum Dots (GQDs) and sulfur-doped graphene with critical bone-related receptors, suggesting their potential for reinforcing dentin and promoting bone regeneration. MD simulations demonstrated stable complex formations, with occasional fluctuations indicating areas for material optimization. In silico toxicity assessments indicated favorable profiles for high-purity graphene and selected doped graphenes (nitrogen-, fluorine-, and sulfur-doped), while graphene oxide (GO) exhibited concerning toxicity levels, highlighting the importance of mitigating strategies. Conclusions: Graphene and its derivatives exhibit promising biocompatibility and molecular interaction profiles relevant to dental applications. Challenges such as GO’s toxicity and occasional instability in simulations suggest the need for further research into surface modifications and material refinement. These findings pave the way for advancing graphene-based dental materials toward clinical implementation, potentially revolutionizing dental prosthetics and treatments. Full article

Purpose: The purpose of this study was to compare multiple deep learning models for estimating age and sex using dental panoramic radiographs and identify the most successful deep learning models for the specified tasks. Methods: The dataset of 437 panoramic radiographs was divided into training, validation, and testing sets. Random oversampling was used to balance the class distributions in the training data and address the class imbalance in sex and age. The models studied were neural network models (CNN, VGG16, VGG19, ResNet50, ResNet101, ResNet152, MobileNet, DenseNet121, DenseNet169) and vision–language models (Vision Transformer and Moondream2). Binary classification models were built for sex classification, while regression models were developed for age estimations. Sex classification was evaluated using precision, recall, F1 score, accuracy, area under the curve (AUC), and a confusion matrix. For age regression, performance was evaluated using mean squared error (MSE), mean absolute error (MAE), root mean squared error (RMSE), R², and mean absolute percentage error (MAPE). Results: In sex classification, neural networks achieved accuracies of 85% and an AUC of 0.85, while Moondream2 had much lower accuracy (49%) and AUC (0.48). DenseNet169 performed better than other models for age regression, with an R² of 0.57 and an MAE of 7.07. Among sex classes, the CNN model achieved the highest precision, recall, and F1 score for both males and females. Vision Transformers that specialised in identifying objects from images demonstrated weaker performance in dental panoramic radiographs, with an inference time of 4.5 s per image. Conclusions: The CNN and DenseNet169 were the most effective models for classifying sex and age regression, performing better than other models for estimating age and sex from dental panoramic radiographs. Full article

Artificial intelligence (AI), particularly through machine learning (ML) and deep learning (DL) techniques such as convolutional neural networks (CNNs) and natural language processing (NLP), has shown remarkable promise in image analysis and clinical documentation in oral pathology. In order to explore the transformative potential of artificial intelligence (AI) in oral pathology, this review highlights key studies demonstrating current AI’s improvement in oral pathology, such as detecting oral diseases accurately and streamlining diagnostic processes. However, several limitations, such as data quality, generalizability, legal and ethical considerations, financial constraints, and the need for paradigm shifts in practice, are critically examined. Addressing these challenges through collaborative efforts, robust validation, and strategic integration can pave the way for AI to revolutionize oral pathology, ultimately improving patient outcomes and advancing the field. Full article

Objective: Malocclusion affects oral health and quality of life, emphasizing the critical need to assess the knowledge and practices of healthcare providers in the prevention and treatment of malocclusion. The aim of this cross-sectional study was to investigate the knowledge and practice of Croatian pediatricians and family physicians regarding malocclusion, its causes and its impact on children’s health. Methods: An online self-structured questionnaire with 34 closed-ended questions was distributed to pediatricians and general practitioners throughout Croatia. The questionnaire addressed demographic data, knowledge of the causes of malocclusion, impact on children’s health and referral practices. Data were summarized in descriptive statistics, and a generalized linear model (GLM) examined the relationships between knowledge, referral practices and sociodemographic factors (p < 0.05). Results: Of 446 participants, including 364 general practitioners and 82 pediatricians (77.8% women), the mean knowledge score was 12.77 ± 3.41 out of 18, with 54.9% scoring at or above the median (Md = 13.00). Pediatricians had a higher mean score (13.77 ± 1.19) than family physicians (12.54 ± 3.60, p = 0.042). A higher level of knowledge was found among physicians working in community health centers (p ≤ 0.001) and among those recommending orthodontic examinations (p = 0.042). Over 90% of pediatricians and family physicians recognized hereditary factors, pacifier use, thumb and finger sucking, bottle feeding, trauma and accidents as causes of malocclusion. In addition, over 80% of respondents reported informing parents about harmful habits that can lead to misaligned teeth, with 100% of pediatricians giving such advice. Conclusions: Pediatricians have better knowledge about malocclusion compared to family physicians, and physicians in community health centers have the highest level of knowledge. It is recommended to improve the training of general practitioners and to promote early orthodontic examinations to improve preventive care. Full article