Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 11 appraisals
The Journal of prosthetic dentistry
Deep learning-based object detection of dental implant systems in panoramic and periapical radiographs
STATEMENT OF PROBLEM: The manual identification of dental implant systems on radiographs is time-consuming, operator-dependent, and prone to diagnostic inaccuracies, particularly for patients where clinical documentation is lacking. The increasing variety of implant designs further complicates identification in prosthetic and surgical practice. PURPOSE: The purpose of this study was to develop and evaluate a deep learning-based model for the automated identification of 7 implant systems (Adin, Dentium, Dionavi, Make It Simple (MIS), Nobel, Noris, and Osstem) using panoramic radiographs and periapical radiographs in an effort to enhance diagnostic efficiency and support clinical decision-making in prosthodontic care. MATERIAL AND METHODS: A total of 4677 anonymized radiographic images with 8189 implants were curated and annotated using Roboflow with bounding boxes outlining fixture components. The preprocessing involved normalization, resizing to 640×640 pixels, and geometric augmentation (rotation, cropping, and blurring) to handle class imbalances. You Only Look Once (YOLO) v10 architecture, implemented with PyTorch, using CSPDarknet and PANet for multiscale feature fusion, was used to optimize real-time detection. Transfer learning used pretrained weights, with training for over 500 epochs (batch size: 32) on NVIDIA T4 GPUs. Data partitioning involved an 80:10:10 ratio (training: validation: testing), with performance evaluated using precision, recall, F1-score, and mean average precision (mAP). RESULTS: The model achieved a mAP of 98.3%, with mean precision, recall, and F1-score values of 93%, 86%, and 89%, respectively. Osstem implants demonstrated maximum discriminability (99% precision, 95% recall). In contrast, Nobel implants exhibited low recall (72.7%), attributed to the sparsity of the dataset (564 samples for Nobel compared with 2320 for Osstem) and similar radiopacity patterns. CONCLUSIONS: The YOLOv10 model demonstrated good performance in identifying dental implants, showing clinical promise for minimizing prosthetic mismatches. Subject to ethics and regulatory approvals, additional improvements involving 3-dimensional imaging and heterogeneous datasets may add precision and validate artificial intelligence as an evidence-based advance in implant dentistry.
2 July 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 →Clinical oral investigations
Partially demineralized allogeneic cancellous bone plug versus deproteinized bovine bone mineral for guided bone regeneration: a pilot randomized controlled clinical trial
OBJECTIVES: To compare a partially demineralized allogeneic cancellous bone plug (ACBP) with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR), focusing on CBCT-based dimensional outcomes and histomorphometric tissue composition at implant placement. MATERIALS AND METHODS: In this prospective randomized controlled clinical trial, 25 adults requiring GBR for two common indications-posterior maxillary sinus floor elevation or mandibular posterior extraction socket preservation-were randomized to ACBP (n = 12) or DBBM (n = 13), with collagen membrane coverage in both groups. Radiographic endpoints were indication-specific and were reported separately for sinus and socket sites. CBCT was obtained at baseline and 6 months to assess augmented height (sinus sites) and ridge dimensions at standardized levels (socket sites). At 6 months (implant placement), a 3-mm trephine core was harvested for H&E staining and histomorphometric quantification of vital bone (VB, %) and residual graft material (RG, %). Between-group comparisons used independent-samples t tests (two-sided P < 0.05). RESULTS: All participants completed the 6-month follow-up. VB did not differ significantly between ACBP and DBBM (38.84 ± 8.37% vs. 32.18 ± 11.04%, P = 0.105), whereas RG was significantly lower with ACBP (11.18 ± 5.48% vs. 19.80 ± 8.23%, P = 0.006). CBCT outcomes were comparable between groups, with no significant differences in sinus height gain (7.82 ± 1.52 mm vs. 8.21 ± 4.30 mm, P = 0.852) or socket-related ridge dimensional changes (all P > 0.05). CONCLUSION: Within a 6-month healing interval, ACBP showed CBCT-based dimensional outcomes comparable to DBBM and a lower residual graft fraction with a similar vital bone fraction at implant placement, suggesting that the observed difference was more related to graft turnover than to greater bone formation. CLINICAL RELEVANCE: At routine implant timing (~ 6 months), use of ACBP was associated with a lower residual graft fraction at re-entry while maintaining short-term CBCT-based dimensional stability.
15 May 2026
Read appraisal →Clinical oral investigations
Treatment of gingival recession type 1 using coronally advanced flap with leucocytes-platelet rich fibrin: a randomized controlled trial
OBJECTIVE: This study aimed to evaluate the clinical outcomes of gingival recession Type 1 (RT1) treatment using a coronally advanced flap (CAF) alone and in combination with L-PRF at 6 months. MATERIALS AND METHODS: A total of 70 RT1 from 19 patients were included. Participants were randomly assigned to the test group (TG, CAF + L-PRF, n = 42) and the control group (CG) (CAF alone, n = 28). Clinical parameters were assessed at baseline and at 6 months: the primary outcomes were percentage of root coverage (%RC) and complete root coverage (CRC); and the secondary outcomes included mean root coverage (MRC), changes in gingival thickness (GT) and volumetric tissue gain, recession area reduction, analgesic consumption, healing quality (the Inflammatory Proliferative Remodeling [IPR] score), and patient-reported outcome measures (PROMs). Statistical analyses were performed to determine differences between groups; a random-intercept mixed-effects model was used for all site-level outcomes. RESULTS: At six months, %RC was 89.30% ± 20.33% (TG) and 81.60% ± 27.93% (CG) (p > 0.05). For the TG and CG, respectively, %CRC was 73.81% and 57.14%; the mean GT gain was 0.16 ± 0.10 mm and 0.11 ± 0.10 mm (p = 0.08); the mean volume gain was 1.13 ± 1.25 mm3 and 0.86 ± 0.84 mm3 (p = 0.32); the mean number of pills taken was 1.67 ± 0.98 and 2.25 ± 1.02 (p = 0.04); the esthetic satisfaction was 95% ± 5% and 90% ± 7% (p = 0.31); willingness to undergo the procedure again: 93% ± 4% and 88% ± 6% (p = 0.22); sensitivity reduction: 85% ± 6% and 80% ± 8% (p = 0.19). There was no statistically significant difference in healing quality and PROMs. CONCLUSION: Both CAF alone and CAF combined with L-PRF yielded comparable clinical and volumetric outcomes in RT1 treatments. No statistically significant advantages were observed with the adjunctive use of L-PRF. CLINICAL RELEVANCE: Because CAF alone achieves high predictability for RT1 defects, the routine adjunctive use of L-PRF provides limited additional clinical benefits.
11 May 2026
Read appraisal →Medical image analysis
MICCAI STS 2024 challenge: Semi-supervised instance-level tooth segmentation in panoramic X-ray and CBCT images
Orthopantomogram (OPGs) and Cone-Beam Computed Tomography (CBCT) are vital for dentistry, but creating large datasets for automated tooth segmentation is hindered by the labor-intensive process of manual instance-level annotation. This research aimed to benchmark and advance semi-supervised learning (SSL) as a solution for this data scarcity problem. We organized the 2nd Semi-supervised Teeth Segmentation (STS 2024) Challenge at MICCAI 2024. We provided a large-scale dataset comprising over 90,000 2D images and 3D axial slices, which includes 2380 OPG images and 330 CBCT scans, all featuring detailed instance-level FDI annotations on part of the data. The challenge attracted 114 (OPG) and 106 (CBCT) registered teams. To ensure algorithmic excellence and full transparency, we rigorously evaluated the valid, open-source submissions from the top 10 (OPG) and top 5 (CBCT) teams, respectively. All successful submissions were deep learning-based SSL methods. The winning semi-supervised models demonstrated impressive performance gains over a fully-supervised nnU-Net baseline trained only on the labeled data. For the 2D OPG track, the top method improved the Instance Affinity (IA) score by over 44 percentage points. For the 3D CBCT track, the winning approach boosted the Instance Dice score by 61 percentage points. This challenge demonstrates the potential benefit benefit of SSL for complex, instance-level medical image segmentation tasks where labeled data is scarce. The most effective approaches consistently leveraged hybrid semi-supervised frameworks that combined knowledge from foundational models like SAM with multi-stage, coarse-to-fine refinement pipelines. Both the challenge dataset and the participants' submitted code have been made publicly available on GitHub (https://github.com/ricoleehduu/STS-Challenge-2024), ensuring transparency and reproducibility.
9 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Systematic Review of Case Reports and Case Series Published Between 2015 and 2025 on the Use of Biomaterials for Closure of Oroantral Fistula
Oroantral fistulas (OAFs) challenge the clinical decision-making of oral surgeons, requiring selection of an effective biomaterial for successful closure. This systematic review aims to evaluate recent biomaterials and techniques for closing oroantral fistulas, as reported in case reports and series. The goal of this review was to assess how different biomaterials affect the clinical closure of OAFs and oroantral communication. This systematic review followed PRISMA guidelines. Multiple scientific databases (Scopus, Web of Science, Cochrane Library) were comprehensively searched using relevant MeSH terms and Boolean operators. Inclusion criteria were case series, reports, and presentations using biomaterials for OAF closure published between 2015 and 2025, with visibly defined outcomes. Reviews, animal studies, and case series and reports without biomaterial use were excluded. Two independent reviewers performed title/abstract and full-text screening. Data extraction included patient demographics, OAF characteristics, biomaterials used, and outcomes. Narrative synthesis was performed after assessing quality using the Joanna Briggs Institute tool. The final assessment of 189 records yielded 18 eligible studies, having patients (age range 20-77 years) with varied etiologies, such as infections and extraction, OAF dimensions, and follow-up periods (9 days to 13 months). Commonly used biomaterials included platelet-rich fibrin (PRF), advanced PRF, collagen membranes, and other grafts. Patient outcomes showed consistent OAF closure, symptom relief, and uneventful healing. Studies represented 12 countries. Variability in reporting OAF characteristics was noted. Diverse biomaterials are effective for OAF closure, with frequent use of PRF and advanced PRF. Consistent reporting of OAF characteristics is essential for future research and improved comparability.
17 Apr 2026
Read appraisal →The Journal of oral implantology
Particulate Bone Grafts vs Split Bone Cortical Plates: Resorbable and Nonresorbable Membranes in Vertical Augmentation
This study aimed to evaluate vertical bone gain in the anterior edentulous mandible using the split cortical bone plate technique with 2 different graft and membrane combinations: autogenous particulate grafts with titanium-reinforced polytetrafluoroethylene membrane (T1) and a mixture of autogenous and xenograft particulate grafts with a collagen membrane (Bio-Gide) (T2). Twenty-two patients presenting with severe vertical alveolar ridge atrophy were randomly allocated into 2 equal groups with 11 participants in each group. Cone beam computerized tomography was used to assess vertical bone gain and crestal bone loss at 6 months, 1 year, and 5 years postgrafting. Keratinized tissue width and peri-implant probing depth were also measured at the same intervals to evaluate long-term soft tissue stability and peri-implant health. Whereas both groups demonstrated comparable vertical bone gain, the T1 group exhibited better maintenance of keratinized gingiva. It reduced crestal bone loss over time, suggesting the clinical utility of nonresorbable membranes in enhancing soft and hard tissue outcomes in complex augmentation cases.
8 Apr 2026
Read appraisal →Quintessence international (Berlin, Germany : 1985)
Photobiomodulation-assisted surgical wound healing at palatal donor site area: a systematic review
OBJECTIVE: The aim was to critically analyze the effects of photobiomodulation on recovery of the donor area after free gingival graft (FGG) surgery. DATA SOURCES: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science with date of access up to 7 April 2025, structured according to the PICO strategy: patients ≥ 18 years undergoing removal of FGGs from the palatal region (P), intervention with photobiomodulation at the donor site (I), compared with natural healing (C), evaluating wound healing as the primary and pain as the secondary outcome (O). A total of 668 records were identified and 8 randomized clinical trials, in which 284 participants were included. In outcomes, clinical healing parameters and patient-reported pain were analyzed, in which the majority of studies demonstrated that photobiomodulation positively influenced epithelialization, reduction in wound area, and tissue color during the first two postoperative weeks. However, the effect on pain control was inconsistent among studies, with only two showing statistically significant reductions. The studies included demonstrated clinical and methodologic heterogeneity due to different laser parameters, and their designs made statistical pooling of data unfeasible for a meta-analysis. CONCLUSION: Photobiomodulation appears to be a promising adjunctive therapy to accelerate palatal wound healing after FGG, particularly in the early postoperative period. Nevertheless, the clinical benefit in pain management remains uncertain. Future well-designed studies with standardized protocols are needed to strengthen contemporary evidence. (Quintessence Int 2026;57:230-241; doi: 10.3290/j.qi.b6762754).
5 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Novel Double Expansion Technique (Khalifah's Technique) Versus Ridge Splitting in Immediate Implant Placement in Narrow Ridges: A Randomized Clinical Trial
PURPOSE: To present and compare the novel double expansion technique (DET) (Khalifah's technique) and the ridge splitting technique (RST) in cases of narrow ridges. MATERIALS AND METHODS: A total of 40 patients (57 dental implants [DIs]) with narrow ridges were randomly allocated to a control group, which employed the RST, and to a study group, which employed the DET. Secondary stability, marginal bone loss (MBL), keratinized mucosa width (KMW), Plaque Index (PI), bleeding index (BI), and probing depth (PD) were assessed at baseline (time of definitive abutment and temporary crown placement) and then at 3, 6, and 12 months. Pain and the number of analgesic tablets consumed were assessed daily during the first postoperative week. RESULTS: The study group had lower pain levels during the first 2 days postoperatively and presented with greater primary and secondary stability at baseline and at 3 months. Moreover, patients in that group had less MBL at all time points and greater KMW at 6 and 12 months postoperatively. Otherwise, both groups showed comparable results regarding PI, BI, and BD. CONCLUSIONS: The study group had superior performance, which may be attributed to the lower degree of trauma with the DET.
5 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 →Journal of dentistry
A deep learning method for diagnosis of oral potentially malignant disorders
OBJECTIVES: This study aimed to develop and validate a two-stage deep learning method for diagnosing oral potentially malignant disorders (OPMDs). We also compared its diagnostic performance with that of clinicians at different levels of seniority and evaluated its utility as a clinical decision support tool. METHODS: A two-stage deep learning method was developed. CLA OPMD-OOML was designed to differentiate OPMDs from other oral mucosal lesions (OOML), while CLA OPMDs was designed to classify specific OPMD subtypes. The method was trained on an internal dataset (ZJUSS, n = 3305), and its generalizability was evaluated on two external multicenter datasets (WCHS and CS-SJTU, n = 1756). In a blinded, two-step comparative study, nine clinicians (junior, intermediate, and senior groups) performed diagnoses independently and then with AI assistance. RESULTS: The method significantly outperformed all clinician groups, achieving higher F1 scores in both CLA OPMD-OOML (89.9 % vs. 78.4-82.6 % for clinicians) and CLA OPMDs (92.2 % vs. 77.7-80.0 % for clinicians). It showed robust generalizability on the two external datasets, with F1 scores of 87.3 % and 86.9 % for CLA OPMD-OOML and 75.9-83.0 % for CLA OPMDs. With AI assistance, the diagnostic precision of junior and intermediate clinicians increased by 10.8 % and 5.9 %, respectively, raising the junior group's performance to the level of senior clinicians. CONCLUSIONS: The developed two-stage deep learning method demonstrated diagnostic performance comparable to or exceeding that of experienced clinicians in classifying OPMDs from clinical images. It functions as a powerful assistive tool that substantially enhances the diagnostic capabilities of junior and intermediate clinicians. CLINICAL SIGNIFICANCE: This AI method has the potential to serve as a reliable tool for large-scale early screening of OPMDs, particularly in regions with limited access to specialist dental care. It can also serve as a valuable training and decision support system for junior clinicians, helping to standardize diagnostic accuracy and improve patient outcomes through timely and accurate detection. A supplemental appendix to this article is available online.
4 Apr 2026
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