Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 8 appraisals
Journal of dental research
AI in Oral Health Surveillance: Critical Review
Artificial intelligence (AI) holds transformative potential for advancing oral health surveillance by streamlining data collection, integration, and dissemination. This review critically synthesizes AI applications in oral health surveillance, highlighting its roles in 1) mapping population-level trends and oral health inequities using machine learning on epidemiological data; 2) enabling remote screening of oral diseases/conditions, including caries, oral hygiene, gingivitis, oral cancer, and malocclusion from intraoral images via computer vision models; and 3) integrating multimodal data through emerging large language models (LLMs) to enhance precision public health. We clarify the comparative strengths of distinct AI modeling for processing the primary data types in surveillance: structured clinical records, unstructured images, and integrated multimodal data. Traditional machine learning methods have been effectively applied to map population-level oral health disparities and identify risk factors but are constrained to structured data. Computer vision methods excel in individual-level diagnostics using intraoral photographs. To translate such capability into scalable surveillance, it is recommended to establish standardized imaging protocols for nonclinical settings, develop scalable models for fine-grained feature extraction, and implement reliable evaluation. These steps are essential to address pervasive challenges, including inconsistent image quality, domain shift, prevalence imbalance, and cost-effectiveness constraints. The future of AI-driven oral health surveillance lies in developing dental-adapted multimodal LLMs (MLLMs). Such MLLMs are uniquely capable of synthesizing disparate data streams, from structured clinical data to heterogeneous imaging modalities (e.g., intraoral photographs and radiographs), or even biomolecular data. This integration capacity facilitates a paradigm shift, moving current applications in dental consultation and clinical decision support toward a novel, tiered system for population-level monitoring. Such a system would provide actionable insights for public health policymaking via spatiotemporal analysis and causal inference. Next-generation AI-driven oral health surveillance systems can only succeed when built on a strong foundation of rigorous ethical principles and safeguards.
2 July 2026
Read appraisal →Clinical oral investigations
Temporal dynamics of human biomarkers of orthodontically-induced root resorption: A systematic review
OBJECTIVE: To summarize time-related biomarker changes in orthodontically-induced root resorption (OIRR), classify biomarkers by function, and examine trajectories across OIRR stages. MATERIALS AND METHODS: PubMed/MEDLINE, Embase, Scopus, Web of Science, CENTRAL, CINAHL and grey literature, were searched from inception to October 1, 2025. Reference lists were manually searched. The risk of bias was assessed using the Cochrane RoB 2 for RCTs and ROBINS-I for non-RCTs. The certainty of evidence was evaluated via GRADE. Because of heterogeneity, findings were synthesized narratively. RESULTS: From 11,434 records, 14 studies (225 participants) were included. Gingival crevicular fluid, saliva and serum were analyzed, mainly using enzyme-linked immunosorbent assay. RoB was 'moderate'- 'serious' (non-RCTs) or 'some concerns' (RCTs). Studies reported a rise of pro-inflammatory cytokines right after force application. Subsequent force application phases showed signals of osteoclastic activity and regulation, followed by detection of root hard tissue degradation products that correlated with OIRR volume. Higher baseline salivary secretory IgA and anti-dentin humoral responses and lower baseline mineralized-tissue regulators were associated with greater OIRR severity. CONCLUSION: Evidence suggests time-related changes involving early inflammatory activation and later matrix degradation, which may be shaped by interaction between orthodontic force and patients' biological responses. Standardized multicenter prospective cohorts are needed for validation. CLINICAL RELEVANCE: Early cytokines changes and later signals of osteoclast regulation and root hard tissue degradation may help define candidate monitoring method for OIRR during treatment. Baseline immune profiles could inform future risk stratification, while bone turnover biomarkers may reflect tooth movement rather than resorption.
26 June 2026
Read appraisal →Clinical oral investigations
Changes in the sagittal pharyngeal airway dimension following levelling and alignment in class II division 2 patients: a prospective clinical trial
OBJECTIVES: This study aimed to evaluate changes in the sagittal pharyngeal airway dimensions (SPAD) and the related mandibular position following maxillary levelling and alignment in late adolescent Class II division 2 (Class II/2) patients. MATERIALS AND METHODS: Thirty Class II/2 patients (mean age 14.07 ± 1.21 years) were included. Pre-treatment orthodontic records were acquired, including panoramic and lateral cephalometric x-rays (T0), photographs, and study models, followed by the onset of levelling and alignment in the upper arch. Lateral cephalometric x-rays and photographs were repeated six months later at the termination of this stage (T1), and measurements were performed in comparison to T0. SPAD was assessed at the nasopharyngeal, oropharyngeal, and laryngopharyngeal levels. Mandibular position was evaluated using the Ba-Ar distance, while sagittal and vertical skeletal relationships were assessed using SNA°, SNB°, ANB°, and FMA°. Upper incisor inclination was accounted for using the U1-FH° measurement. RESULTS: Alignment of the maxillary arch in Class II/2 patients elicited a significant SPAD increase at the nasopharyngeal and the oropharyngeal levels (p < 0.001), with a non-significant change evoked at the laryngopharyngeal level (p = 0.42). Antero-posteriorly, a significant increase in the SNAº, SNBº, together with a significant decrease in the ANBº angle have been documented at T1. A significant increase in the Ba-Ar has been noted at T1 in contrast to T0, in addition to a significant reduction in the vertical dimension (FMAº). Dentally, a significant increase in the U1-FHº has been documented following the implemented treatment stage (p < 0.001). CONCLUSIONS: Results of this study may suggest that maxillary levelling and alignment in Class II/2 patients during the decelerating growth phase is associated with augmentation of the nasopharyngeal and oropharyngeal airways. These changes coincide with the significant labial tipping of the maxillary incisors and subsequent functional mandibular advancement, which collectively improve the intermaxillary relationship and reduce the vertical skeletal dimension. While natural growth cannot be entirely excluded, the rapid change suggests that these improvements are closely linked to the functional mandibular response. CLINICAL RELEVANCE: Maxillary alignment in Class II division 2 cases may enhance upper airway patency by triggering a forward functional mandibular response, highlighting a potential link between orthodontic correction and upper airway patency. Name of the Registry: ClinicalTrials.gov Trial Registration Number: NCT06602518 Date of Registration: 19/09/2024 "Retrospectively registered". URL: https://clinicaltrials.gov/study/NCT06602518?cond=nct06602518&rank=1.
7 June 2026
Read appraisal →Clinical oral investigations
Effectiveness of BRIX3000 for chemo-mechanical caries removal: a systematic review and meta-analysis of time and pain outcomes
AIMS: This systematic review was conducted to critically assess and statistically synthesise data from all available clinical studies on this topic. This study focused on the efficacy and safety of this agent (BRIX3000), the time required for caries removal, and the pain experienced by patients during the procedure, to provide clinicians and researchers with clear evidence on whether BRIX3000 is genuinely effective. MATERIALS AND METHODS: Electronic literature searches were performed using PubMed, Scopus, and Web of Science to collect eligible randomised clinical trials that had evidence regarding the efficacy of BRIX3000 for chemo-mechanical caries removal in comparison with the conventional rotary instruments and other atraumatic restorative treatment (ART) methods. The selected studies included children and adults of both sexes, with no age or gender preference, who had dentinal carious lesions in primary or permanent teeth without pulpal involvement. RESULTS: Nine randomised trials (eight in paediatric and one in adult populations) were included. Pooled analyses indicated that BRIX3000 was associated with a longer mean caries removal time than control techniques (MD 4.58 min, 95% CI 2.45 to 6.70; p < 0.0001; I² = 96%) and with lower pain scores on the Wong-Baker FACES scale among paediatric patients (MD - 2.50, 95% CI - 4.37 to - 0.62; p = 0.009; I² = 92%). Complete caries removal did not differ significantly between groups in either the paediatric (OR 0.45, 95% CI 0.02 to 8.34; p = 0.59) or adult (OR 0.73, 95% CI 0.15 to 3.49; p = 0.69) subgroup. All pooled estimates exhibited substantial heterogeneity, and the adult evidence comprised only two trials. Most included studies were judged to be at low overall risk of bias on the RoB 2 tool. CONCLUSION: Within the limits of substantial heterogeneity, short follow-up, and a small adult evidence base, BRIX3000 may represent a useful chemo-mechanical alternative - particularly in paediatric and anxiety-prone patients - at the cost of a modest increase in procedural time. Adequately powered trials with longer follow-up are required to confirm these preliminary findings. CLINICAL RELEVANCE: Our results indicate that BRIX3000 can be a viable option for patients with extensive fear of conventional methods, as well as for the paediatric population.
7 June 2026
Read appraisal →Clinical oral investigations
Exploring orofacial myofunctional therapy and its core components in mixed-dentition anterior open bite: the ombit study
OBJECTIVES: To explore the therapeutic effects of OMT in children with AOB in the mixed dentition phase, including a reduced form of OMT (focusing exclusively on breathing pattern and resting postures; OMTBPO) and traditional OMT (also including strength training and correction of swallowing; OMTBPSS). MATERIALS AND METHODS: In this double-baseline, longitudinal study, eight children with AOB (mean age 8.1 years old) were randomly allocated to the OMTBPO (n = 4) or OMTBPSS group (n = 4). Each participant received 7.5 h of OMT across 10 sessions. Outcomes included occlusal parameters, Photographic Open bite Severity Index (POSI) and Peer Assessment Rating (PAR) using 3D intraoral scans, orofacial function based on clinical and standardized assessment (Orofacial Myofunctional Evaluation with Scores; OMES), strength and endurance measurements, and oral health-related quality of life (child oral health impact profile - ortho; COHIP-ortho). RESULTS: Immediately post-therapy, anterior tongue strength had significantly increased in the full sample. At three-month follow-up, palatal volume, lateral lip endurance, and OMES function and deglutition scores had significantly increased, and vertical overbite had decreased. The PAR index showed a significant proportional reduction of 35% from baseline to the last follow-up moment (on average 6 months after therapy). The OMTBPO group showed significantly lower rates of atypical tongue posture and interdental articulation at six-month follow-up. CONCLUSION AND CLINICAL RELEVANCE: This study took a first step in exploring the effectiveness of OMT components in mixed-dentition AOB. Measurable short- to mid-term functional and occlusal improvements were found, and comparable outcomes between protocols suggest that posture-focused OMT may be an efficient interceptive approach. Further research including randomized controlled trials with larger sample sizes is required to provide evidence on efficacy and long-term stability.
1 June 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 →American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics
Prediction of skeletal maturity using machine learning based on multiple biological indicators
INTRODUCTION: Accurate assessment of skeletal maturity is essential for orthodontic treatment planning and growth modulation. This study aimed to develop a comprehensive machine learning (ML) model to predict skeletal maturation stages using cervical vertebral morphology, dental maturation stage (DMS), gender, and age. METHODS: A total of 860 patients with lateral cephalograms, panoramic, and hand-wrist radiographs were included. A baseline model using 6 cervical morphologic parameters was compared with enhanced models incorporating DMS, gender, and age. Six ML algorithms were evaluated, with CatBoost showing the highest performance. Feature importance was analyzed using 2 methods, and the final model was assessed using a confusion matrix, receiver operating characteristic curves, and calibration curves. RESULTS: Incorporating DMS, gender, and age significantly improved predictive performance. The CatBoost model achieved an area under the receiver operating characteristic curve of 0.924, an area under the precision-recall curve of 0.806, and an F1-score of 0.752. Feature importance analysis confirmed the strong predictive contribution of DMS, especially the mandibular second molar. The final model demonstrated high accuracy, strong discrimination, and good calibration across all skeletal maturity stages. CONCLUSIONS: This study presents a novel and clinically practical ML model for skeletal maturity prediction, integrating routinely acquired orthodontic records. The results demonstrate that combining DMS with cervical morphology, age, and gender enhances prediction accuracy, offering a reliable alternative to traditional hand-wrist assessments.
5 May 2026
Read appraisal →Infection and immunity
Maternal influences on oral microbiome development and implications for early childhood health: a systematic review
A deeper understanding of how maternal-infant interactions shape the establishment and diversification of the oral microbiome could have significant clinical applications; however, relatively few studies emphasize early maternal-infant microbial connections. This systematic review provides a longitudinal analysis of oral microbiome development from birth to five years, focusing on the relationship between maternal and infant microbiomes. We conducted a systematic search (June 2025) using keywords "mother," "children," "oral microbiome," and "longitudinal" across PubMed, Cochrane Library, and Embase. Twelve studies fulfilled the inclusion criteria: longitudinal design, healthy mother-child dyads, saliva sample collection, and relevant age range. We excluded review articles, non-English publications, and studies with overlapping data. Results were synthesized by developmental stage and topic. Overall, current literature agrees that the mother is an important source of exposure for initial colonization of the newborn's oral microbiome. Several studies indicated that the oral microbiome at birth is diverse and unspecialized, composed mostly of maternally derived strains. Rapid selection occurs over the first few weeks, as the relative abundances of typical oral bacterial species increase. Throughout the first year, increases in diversity strengthen the resemblance between infant and maternal microbiomes. The microbiome appears to stabilize around 3-5 years. In conclusion, maternal-infant connections play a significant role in influencing oral microbiome development during the first 5 years of life. This review highlights the need for future studies to incorporate larger, longitudinal designs with metadata and advanced tools to clarify the roles of delivery mode, tooth eruption, and parental lifestyle habits in shaping early oral microbiome development.
17 Apr 2026
Read appraisal →