Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
Dento maxillo facial radiology
JADE: jawbone lesion diagnosis and decision supporting system
OBJECTIVES: To develop and evaluate JADE, a proof-of-concept retrieval-augmented generation (RAG) diagnostic assistive system, designed to enhance large language model (LLM) reasoning for jawbone lesion assessment. This study examined whether RAG improves diagnostic accuracy and stability compared with standalone LLMs and ORAD, a supervised learning-based system. METHODS: JADE was developed as a cloud-based RAG system integrating an expert-curated oral radiology database embedded using text-embedding-3-large and indexed in Qdrant Cloud. Structured clinical inputs were encoded as prioritized vector queries. Hybrid semantic and keyword-based retrieval appended relevant evidence to prompts for differential diagnosis generation across LLM backbones. Performance was evaluated in 25 validation cases and compared with GPT-5, Claude Sonnet 4.5, DeepSeek-R1, Gemini 2.5 Flash, their RAG configurations, and ORAD. Diagnostic accuracy was analyzed using Cochran's Q test, with post-hoc McNemar's tests and Bonferroni correction. Intra-model stability and response time were assessed. RESULTS: RAG-GPT-5 achieved the highest diagnostic accuracy (20/25), followed by RAG-Claude Sonnet 4.5 (18/25), RAG-DeepSeek R1 (17/25), and RAG-Gemini 2.5 Flash (15/25). Standalone models achieved 9-13/25 correct diagnoses, ORAD achieved 17/25. No significant differences were observed among standalone models or RAG-based models and ORAD. A significant improvement was observed for GPT-5 when integrated with RAG (P = .002). RAG configurations showed higher intra-model stability, with RAG-GPT-5 achieving mean stability of 0.90 ± 0.11. Mean response times ranged from 3 to 10 s. CONCLUSIONS: JADE improved diagnostic accuracy and stability compared with standalone LLMs, underscoring value of RAG reasoning in jawbone lesion assessment and marking the first RAG application in dentomaxillofacial radiology.
3 July 2026
Read appraisal →BMC oral health
Can poor nutrition and diet influence temporomandibular disorder? A systematic review.
BACKGROUND: The relationship between diet, nutrition, and painful temporomandibular disorders (TMD) is not well established, despite increasing interest in lifestyle factors in chronic pain. This systematic review aimed to synthesize available evidence on how dietary patterns and nutritional status may be associated with painful TMD. METHODS: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to November 2025. Risk of bias was performed using the Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (NHLBI). RESULTS: Out of 7,760 records and after the risk of bias assessment, only seven studies judged as having a low risk of bias were included. Overall, the included studies indicate that the association between dietary factors and TMD remains unclear. Prospective cohort studies did not demonstrate that prenatal or adolescent diet quality independently predicted TMD. Cross-sectional studies suggested that specific dietary patterns may be related to TMD-related symptoms. Women with myogenous TMD showed lower intake of several nutrients compared with controls. Experimental evidence indicated that monosodium glutamate ingestion increased pain intensity in myofascial TMD, while the only randomized trial found no significant pain differences between vitamin D supplementation and diclofenac. CONCLUSIONS: Current evidence suggests that some dietary components and nutritional factors may be associated with TMD-related symptoms or pain responses; however, the findings are limited, heterogeneous, and insufficient to support firm causal or therapeutic conclusions.
25 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Photobiomodulation for oral mucositis in cancer care: prevention, clinical management, and evidence from randomized controlled trials.
PURPOSE: This systematic review aimed to evaluate the efficacy of photobiomodulation (PBM) for the prevention and clinical management of oral mucositis (OM) in adult cancer patients, with particular emphasis on protocol characteristics potentially associated with favorable clinical outcomes. METHODS: A systematic search of PubMed, Web of Science, and Scopus was conducted up to March 31, 2026, in accordance with PRISMA guidelines. Randomized controlled trials in adult cancer patients comparing PBM with sham interventions were included. Outcomes of interest included OM incidence, severity, pain, and related clinical outcomes. The review protocol was prospectively registered in PROSPERO. RESULTS: Fifteen randomized controlled trials involving 868 adult patients were included. Most studies reported favorable effects of PBM, including reductions in severe OM incidence, pain intensity, analgesic requirements, and nutritional support needs compared with controls. Preventive intraoral PBM protocols were generally associated with more favorable outcomes, although variability in treatment parameters, delivery methods, and outcome reporting limited comparability. Most included studies demonstrated acceptable methodological quality. CONCLUSIONS: PBM appears to be a promising supportive care intervention for reducing the burden of OM in adult cancer patients, particularly in preventive settings. However, variability across protocols precludes definitive conclusions regarding optimal treatment parameters. Further high-quality randomized trials with standardized reporting are needed to refine protocol recommendations and expand evidence in therapeutic settings.
20 June 2026
Read appraisal →Lasers in medical science
Comparative clinical effects of extraoral photobiomodulation using laser and LED on pain, swelling, and quality of life following impacted mandibular third molar surgery: a randomized split-mouth trial
This study aimed to compare the clinical effectiveness of extraoral photobiomodulation using laser and light-emitting diode (LED) in reducing postoperative pain, swelling, and improving oral health-related quality of life following impacted mandibular third molar surgery. This randomized, split-mouth clinical trial included 72 patients with bilaterally symmetrical impacted mandibular third molars. Participants were allocated into three groups: low-level laser therapy (LLLT), LED, and LLLT-LED. Each patient received PBM treatment on one side and served as their own control. LLLT (810 nm GaAlAs diode laser) and LED (618 nm OsseoPulse) were applied extraorally on postoperative days 0, 2, and 7. Pain was assessed using a visual analog scale (VAS) at 4h and daily up to day 7. Swelling was measured via standardized facial distances at baseline, day 2, and day 7. Quality of life was evaluated using the OHIP-14 questionnaire preoperatively and on day 7. LED therapy significantly reduced pain at the 4th hour and on postoperative days 3 to 6 (p < 0.05). Regarding postoperative swelling, a significant difference was observed only in the LLLT-LED group, where the LED-treated side showed greater overall swelling reduction from preoperative to postoperative day 7 (p < 0.05). Quality-of-life scores improved in both groups, with more domains showing significant change in the LLLT group (10 vs. 7). LED was more effective for early postoperative pain control and showed greater late-phase swelling reduction in the side-to-side comparison. Quality-of-life scores improved in both groups, with a larger number of significantly improved domains in the LLLT group.
21 May 2026
Read appraisal →Oral and maxillofacial surgery
Does adjunctive low-level laser therapy provide additional benefit following temporomandibular joint arthrocentesis with hyaluronic acid? A randomized clinical trial.
PURPOSE: This study aimed to evaluate whether adjunctive low-level laser therapy (LLLT) provides additional clinical benefit over an optimized arthrocentesis protocol with hyaluronic acid in patients with ADDwoR. MATERIALS AND METHODS: From December 2022 to December 2023, a single-blinded prospective randomized clinical trial was conducted at The British University in Egypt's Department of Oral and Maxillofacial Surgery. The study involved 40 female participants diagnosed with Anterior Disc Displacement without Reduction (ADDwoR). Following TMJ arthrocentesis, subjects were assigned to one of two parallel cohorts: Group A received ten subsequent sessions of low-level laser therapy (LLLT), while Group B served as the control, receiving arthrocentesis alone. Treatment efficacy was evaluated based on pain intensity measured via a Visual Analogue Scale (VAS) and maximum mouth opening (MMO). Clinical assessments were performed at 2-week intervals over a 12-week follow-up period. RESULTS: No significant age-related differences were detected when comparing the intervention group to the control group (p = 0.087). No significant intergroup differences were observed in maximum mouth opening (MMO) or pain scores (VAS) at any follow-up time point (p > 0.05). Over the 12-week period, both study arms demonstrated significant clinical enhancement in terms of MMO and pain intensity (p < 0.001). Improvements in MMO were large in both groups, with postoperative values significantly higher than preoperative measurements. Pain scores decreased markedly following treatment, with preoperative scores significantly higher than all postoperative values. Overall, both interventions resulted in significant functional improvement and pain reduction, with no added benefit of the intervention over the control. CONCLUSION: While both TMJ arthrocentesis alone and arthrocentesis supplemented with LLLT significantly improved maximum mouth opening and reduced pain, LLLT did not provide a significant incremental benefit over arthrocentesis with hyaluronic acid. These findings suggest that clinical improvements are primarily driven by the main intervention and may reflect a possible therapeutic ceiling effect, beyond which adjunctive LLLT does not confer measurable short-term benefit. CLINICAL TRIAL NUMBER: Not applicable.
18 May 2026
Read appraisal →Clinical oral investigations
Classification of occlusal caries severity using spectrophotometric CIELAB measurements and machine learning algorithms
OBJECTIVES: This study evaluated whether spectrophotometric CIELAB color measurements can support machine-learning (ML) classification of occlusal caries severity based on ICDAS categories. METHODS: Three hundred extracted human teeth were visually classified using ICDAS (0-4) and served as labels for supervised learning. Five occlusal sites per tooth were measured using a spectrophotometer under standardized conditions. Site-level CIELAB values were transformed into engineered color features and aggregated at the tooth level. Teeth were categorised as sound (ICDAS 0), initial carious lesions (1-2), and moderate carious lesions (3-4). Five ML models: Random Forest (RF), XGBoost, CatBoost, Multilayer Perceptron (MLP), and a Deep Sets architecture were trained. Performance was evaluated using accuracy, balanced accuracy (BA), and macro-F1, with additional binary analyses for early (ICDAS 1-4 vs. 0) and operative lesion detection (ICDAS 3-4 vs. 0-2), based on the included ICDAS range. Learning curve analysis was performed to evaluate the effect of training data size on model performance. RESULTS: Deep Sets achieved the highest multiclass performance (BA = 0.89) followed by the MLP (BA = 0.72). Tree-based models demonstrated lower performance overall. For early lesion detection, all models showed high sensitivity (SE) but reduced specificity (SP). At the operative level, the MLP achieved 100% SE and moderate SP. Learning-curve analysis showed that neural models benefited most from increased training data, whereas tree-based models showed limited improvement. CONCLUSION: Under controlled in-vitro conditions, spectrophotometric CIELAB measurements enabled machine-learning classification of occlusal caries severity. Deep sets achieved the highest overall performance, supporting the potential of color-based approaches as adjunctive tools for caries assessment. CLINICAL RELEVANCE: Spectrophotometric tooth color measurements may support machine learning classification of occlusal caries severity under controlled conditions, using an image-independent approach. Such color-based methods may complement visual assessment by providing a more standardized and reproducible evaluation of enamel changes following further validation.
16 May 2026
Read appraisal →Oral health & preventive dentistry
Prevalence and Risk of Dental Erosion Linked to Carbonated Drinks in Adolescents: A Systematic Review and Meta-Analysis
PURPOSE: To determine the prevalence of dental erosion due to carbonated beverage consumption among adolescents and the association between both variables through a systematic review and meta-analysis. METHODS AND MATERIALS: This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for systematic reviews. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, LILACS, and SciELO. Observational studies were included, and the PEO framework was used to identify dental erosion and non-erosion (outcome) and intake of carbonated beverages (exposure) in adolescents (population). The prevalence of dental erosion and odds ratio (OR) with 95% confidence interval (95%CI) to determine the risk of carbonated beverages were estimated with MedCalc V.23.0.2 and Review Manager (RevMan V.5.4.1) software, respectively. A P value 0.05 was considered to indicate statistical significance. RESULTS: A total of 24 studies met the eligibility criteria. The pooled sample included 21,541 adolescents, and the overall erosion prevalence was 37.6% (95%CI 26.3, 49.7%). The meta-analysis revealed a significant association between carbonated beverage consumption and dental erosion (OR = 1.98, 95%CI: 1.42-2.77; 7785 participants; I2 = 80%; P 0.0001). CONCLUSION: Dental erosion is a prevalent condition among adolescents, with a pooled prevalence of 37.6%. Carbonated beverage consumption among adolescents is associated with a 98% increased risk of dental erosion.
13 May 2026
Read appraisal →PloS one
The impact of physical adjunctive interventions on outcomes of clear aligner treatment: A systematic review of randomized controlled trials
INTRODUCTION: Physical adjunctive interventions (PAIs), including vibration devices and low-level laser therapy, are promoted to accelerate tooth movement, improve aligner tracking, and reduce discomfort in clear aligner treatment (CAT), but randomized evidence remains inconsistent. This systematic review aimed to assess whether PAIs improve CAT outcomes in terms of objective tooth-movement metrics, aligner tracking, overall treatment efficiency, and patient-centered outcomes, and to appraise the risk of bias and the certainty of the evidence at the outcome level. METHODS: Comprehensive electronic searches of PubMed, Embase, Scopus, Web of Science, and CENTRAL were conducted from database inception (earliest available indexing date in each database) to 30 June 2025 (coverage cut-off). Grey literature searching and hand-searching were also performed, with no restrictions on language or publication status. Eligible studies were human randomized controlled trials (RCTs) comparing CAT combined with PAIs versus CAT alone or sham interventions. Two independent reviewers performed study selection and data extraction, with risk of bias assessed using the Cochrane RoB 2 tool and certainty of evidence appraised with GRADE. Random-effects meta-analyses were conducted when feasible; otherwise, results were narratively summarized. The protocol was prospectively registered (PROSPERO CRD420251132229). RESULTS: Seven RCTs involving 266 participants were included. No significant improvement in Little's Irregularity Index (maxilla MD = 0.08, p = 0.869; mandible MD = 0.44, p = 0.487). Vibration improved aligner tracking under a 7-day change schedule (p = 0.003) but not case completion (p = 0.999). Overall compliance was approximately 77%, and no between-group difference was observed (p = 0.390). Pain was slightly lower on days 1-3 only (p < 0.05); no quality-of-life benefits were observed; periodontal indices remained unchanged; biomarkers showed inconsistent results. The certainty of evidence was low to very low, suggesting that further well-designed RCTs are likely to change the effect estimates and may alter the conclusions. CONCLUSIONS: Across objective tooth-movement metrics, aligner tracking, treatment efficiency, and patient-centered outcomes, current randomized evidence does not demonstrate a consistent benefit of physical adjunctive interventions in clear aligner treatment. Interpretation is limited by outcome-level risk of bias concerns and low to very low certainty of evidence.
9 Apr 2026
Read appraisal →Quintessence international (Berlin, Germany : 1985)
Intentional partial odontectomy and effect on inferior alveolar nerve injuries: a systematic review
OBJECTIVES: To synthesize current evidence comparing coronectomy (intentional partial odontectomy) and complete extraction of mandibular third molars in close radiographic proximity to the inferior alveolar nerve, focusing on neurosensory complications and other clinically relevant postoperative outcomes. DATA SOURCES: PubMed, Scopus, and Google Scholar databases were manually searched using strings combining terms such as 'coronectomy,' 'partial odontectomy,' 'root retention,' 'mandibular third molar,' 'extraction,' and 'inferior alveolar nerve injury.' Searches were conducted in accordance with PRISMA 2020 guidelines. CONCLUSION: Coronectomy significantly reduces the risk of inferior alveolar nerve injury in mandibular third molar surgery compared to extraction in cases with inferior alveolar nerve proximity. The main drawback to this technique is subsequent root migration, which is common but rarely clinically problematic. Careful patient selection and follow-up are essential in selecting this procedure.
4 Apr 2026
Read appraisal →Quintessence international (Berlin, Germany : 1985)
The association between concurrent oral cancer and periodontal disease: a systematic review and meta-analysis
OBJECTIVE: Since emerging studies have reported a positive association on oral cancer and periodontal disease, the present study aimed to evaluate the odds ratio of having concurrent oral cancer in patients with periodontal disease. METHOD AND MATERIALS: A systematic review following the PRISMA guidelines was conducted with three electronic databases. The inclusion criteria were structured according to the PECOS framework: (P) Human subjects aged over 18; (E) Patients with periodontal disease; (C) Individuals without periodontal disease; (O) The odds of patients developing oral and/or head and neck cancers; (S) Case-control studies. After screening, 18 clinical studies from 13 different regions, comprising a total of 31,504 participants, were included. RESULTS: A meta-analysis was performed and revealed that the odds ratio for developing oral cancer in patients with periodontal disease, compared to those without, was 3.35 (95% CI 2.63-4.26; P .001). After adjusting for potential confounding factors, the adjusted odds ratio was found to be 2.32 (95% CI 1.71-3.15; P .001). Case definition also has an impact, with odds ratio of 2.02 if using missing teeth compared to odds ratio of 2.68 by using American Academy of Periodontology clinical periodontal parameters. CONCLUSION: Clinical considerations for this specific group of patients should draw new attention for a strategic interdisciplinary care.
4 Apr 2026
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