Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 19 appraisals
International dental journal
Deep Learning Based on Swin-Transformer and 3D U-Net: Implant Three-Dimensional Position Planning
INTRODUCTION AND AIMS: This study aimed to devise a deep learning-based model for the automated identification of anatomical mandibular lingual concavities in the posterior mandible and the prediction of biologically guided three-dimensional implant positions. METHODS: Cone-beam computed tomography (CBCT) images with single-tooth posterior mandibular edentulism were included. A deep learning framework was constructed utilizing 3D U-Net and Swin-Transformer. This framework was designed to perform automated segmentation of teeth, mandible, and the mandibular nerve canal; to classify morphological types of lingual concavities; and to identify implant key points with coordinate prediction. Model performance was assessed via five-fold cross-validation. RESULTS: The proposed model achieved Dice similarity coefficients ranging from 0.87 to 0.91 for dental segmentation. In the classification of mandibular lingual concavities, an accuracy of 0.92 to 0.97 was attained. Regarding the prediction of three-dimensional implant positions, the automatically generated plans maintained a safety margin of 3.20 to 3.89 mm from the mandibular nerve canal. Furthermore, sufficient bone volume was preserved at both cervical and apical implant levels, with buccal/lingual cervical bone widths averaging 4.94 to 5.78 mm. CONCLUSION: The deep learning model in this experiment performed well across different views and learning tasks in a retrospective internal validation setting. Furthermore, it demonstrated the ability to accurately identify relevant anatomical structures, and the predicted three-dimensional implant positions showed clinically acceptable safety margins in the internal validation cohort. CLINICAL RELEVANCE: This model provides a preliminary AI-assisted framework for identifying critical mandibular anatomical structures and generating biologically guided preliminary implant position suggestions, thereby helping to mitigate intraoperative complications and reduce the risk of postoperative mechanical and biological complications in preclinical evaluation.
2 Aug 2026
Read appraisal →Acta odontologica Scandinavica
Predicting gingival embrasure risk after invisible orthodontics using multimodal data and machine learning
OBJECTIVE: To develop and validate a risk prediction model for gingival embrasures after clear aligner therapy using multimodal oral data. METHODS: A retrospective study of 340 patients (December 2022-June 2025) was randomly divided into training (n = 238) and validation (n = 102) sets (7:3). Univariate analysis, multivariate logistic regression, and least absolute shrinkage and selection operator regression were applied to identify independent risk factors. Three machine learning models - random forest (RF), logistic regression, and support vector machine - were constructed based on seven core variables. Model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis, and Shapley Additive Explanations (SHAP) values for interpretability. RESULTS: No significant baseline differences existed between sets (p > 0.05). Seven indicators were identified (p < 0.05). Multivariate analysis confirmed percentage of bleeding on probing-positive sites, interproximal alveolar bone height, and relative movement of adjacent teeth at target site as independent risk factors, while gingival thickness, proximal contact area, interdental papilla height, and buccal/lingual bone plate thickness were protective factors (p < 0.05). The RF model performed best: training AUC = 0.849 (95% CI: 0.786-0.912), validation AUC = 0.815 (95% CI: 0.720-0.910), with good calibration and net benefit. SHAP analysis highlighted gingival thickness and interproximal alveolar bone height as key predictors. CONCLUSION: A risk prediction model for post-clear aligner gingival embrasures was successfully developed and validated using multimodal oral data, with RF as the optimal algorithm. The model exhibits good discrimination, calibration, and clinical utility, which can be used as an objective auxiliary tool for individualized risk prediction following clear aligner therapy and supplement traditional clinical empirical judgment.
23 July 2026
Read appraisal →Clinical oral investigations
Deep learning-based automated assessment of alveolar bone loss in CBCT for periodontitis
OBJECTIVES: This study aimed to develop and validate a CBCT-based automated system for assessing radiographic alveolar bone loss (RBL) to improve the accuracy and efficiency of periodontitis diagnosis. METHODS: A total of 110 patients (2,796 teeth) with Stage I-IV periodontitis from four center were included. The nnU-Net framework was used to segment teeth, alveolar bone, and the cemento-enamel junction (CEJ). RBL was calculated automatically using an edge-constrained shortest path algorithm. The model was trained on data from Center A and externally validated with datasets from Centers B-D. Linear periodontal measurements from 11 CBCT scans were compared between manual and CAD-based segmentation. An independent validation set was used to assess automated staging accuracy and time efficiency. RESULTS: The CAD system achieved Dice similarity coefficients (DSC) of 95.85% for teeth, 95.75% for alveolar bone, and 86.18% for the CEJ. External validation showed alveolar bone and tooth DSC values both above 95% and CEJ DSC values above 77%. Linear measurements showed strong agreement with manual segmentation (Spearman's ρ = 0.9187; ICC = 0.9266). For staging, the CAD system reached an overall accuracy of 87.31%, with 97.01% for Stage Ⅰ, 88.06% for Stage Ⅱ and 89.55% for Stage Ⅲ/Ⅳ. The CAD system represented a 13.42-fold acceleration compared with the manual workflow. CONCLUSION: The CAD system enables accurate automated segmentation and RBL quantification on CBCT images, with robust multicenter performance and substantial gains in efficiency. CLINICAL SIGNIFICANCE: This system offers a fast and reliable method for RBL assessment, supporting consistent diagnosis and monitoring of periodontitis.
19 July 2026
Read appraisal →Acta odontologica Scandinavica
Obstructive sleep apnea and periodontitis: a systematic review with considerations on CPAP therapy
OBJECTIVE: To evaluate the association between obstructive sleep apnoea (OSA) and periodontitis and to assess the available evidence on the effects of continuous positive airway pressure (CPAP) therapy on periodontal status. MATERIALS AND METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Comprehensive literature searches were performed in Cochrane, PubMed, Scopus, and Web of Science. Study selection and data extraction were carried out independently by two reviewers. A total of 20 original studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: Fourteen of the 20 studies (70%) reported a significant association between OSA and periodontitis. However, only two studies fulfilled all methodological quality criteria, indicating an overall moderate to low quality of evidence. Data on the effects of CPAP therapy on periodontal outcomes were limited, and the available studies generally showed no significant impact. CONCLUSIONS: Current evidence supports an association between OSA and periodontitis, suggesting that OSA may contribute to periodontitis. Robust, well-designed studies with larger sample sizes and rigorous methodology are needed to clarify the nature of this relationship and to determine whether CPAP therapy influences periodontal health.
17 July 2026
Read appraisal →Journal of prosthodontic research
Peri-implant soft-tissue responses to tooth-colored abutment materials: A systematic review.
PURPOSE: This systematic review aimed to investigate and compare peri-implant soft-tissue responses to tooth-colored abutment materials frequently used in implant dentistry. STUDY SELECTION: A comprehensive electronic search was performed in three databases (MEDLINE via PubMed, Google Scholar, and Scopus) to identify relevant literature. The study-selection criteria included original research articles written in English that investigated the effects of various tooth-colored abutment materials on peri-implant soft-tissue responses. RESULTS: In total, 136 articles were included in this systematic review. Tooth-colored abutment materials, particularly zirconia and polyetheretherketone (PEEK), facilitated favorable soft-tissue adaptation, enhanced esthetics, and contributed to long-term implant success. Zirconia demonstrated excellent biocompatibility, enhanced cell viability and attachment, and lower inflammatory responses compared to titanium, suggesting improved soft-tissue integration and reduced biofilm-related risks. PEEK exhibited favorable mechanical properties and biocompatibility but limited cell attachment due to its hydrophobicity, indicating the need for surface modification. Titanium remains the clinical standard for integration but is associated with greater inflammation and biofilm formation than tooth-colored materials. CONCLUSIONS: This review highlights the effects of tooth-colored abutment materials on peri-implant soft-tissue responses and emphasizes the importance of selecting appropriate materials for successful dental implants. Zirconia represents a promising biological alternative to titanium, promoting a stable soft-tissue barrier that contributes to minimizing inflammation and maintaining long-term tissue health. Conversely, while PEEK offers strong mechanical properties, it faces challenges regarding cell proliferation and matrix production, limiting its optimal biological performance. Further research will provide deeper insights into the best options for enhancing patient and esthetic outcomes.
14 July 2026
Read appraisal →Science advances
A battery-free wireless intelligent aligner for spatially resolved, closed-loop theranostics of chronic oral diseases
Intelligent wearable theranostic systems are advancing personalized health care by enabling continuous monitoring and proactive therapy. However, managing chronic oral diseases such as caries and periodontitis is challenging due to the oral cavity's complex, spatially heterogeneous microenvironments and limited space for powered intraoral electronics. To address this, we developed a wireless, battery-free, and wearable intelligent therapeutic aligner (WiB-ITA) that integrates a butterfly-inspired dual-sided flexible integrated theranostic electrode array (iTEA) to simultaneously monitor compartment-matched pH and nitrite and electrochemically gate on-demand antimicrobial release. The system is powered and commanded via a relay-assisted near-field communication (NFC)-Bluetooth low energy (BLE) dual-hop link, enabling stable battery-free operation across tooth positions and full-arch usability. Validated from in vitro to preliminary human studies, WiB-ITA establishes a scalable, compartment-matched intraoral closed-loop theranostic framework. This integrated theranostic platform represents a breakthrough in personalized oral health care and provides a paradigm for managing other chronic conditions.
27 June 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 →Oral health & preventive dentistry
Natural Agents for the Improvement of Gingival Health: Systematic Review and Meta-Analysis of Randomized Clinical Trials
PURPOSE: This systematic review and meta-analysis evaluated the efficacy of natural ingredients used in toothpastes and gels in improving gingival health. MATERIALS AND METHODS: A comprehensive search strategy using different databases was conducted in accordance with PRISMA guidelines to identify randomized clinical trials (RCTs) on the use of natural ingredients for improving gingival health. Included studies focussed on outcomes measuring gingival health parameters, such as gingival index (GI), or bleeding on probing (BoP). Out of 249 identified studies, 10 RCTs met the inclusion criteria. Formulations included natural ingredients from plant extracts such as Aloe vera or Pudilan, and hydroxyapatite (as tooth-like calcium phosphate). RESULTS: The meta-analysis demonstrated a statistically significant improvement in gingival health when natural ingredients were used compared to control toothpastes and gels (p=0.0051). These findings suggest that natural ingredients may offer comparable or superior efficacy to conventional oral care products in terms of gingival health. Notably, Aloe vera and hydroxyapatite consistently demonstrated clinical benefits. CONCLUSIONS: Natural ingredients used in oral care products represent a promising strategy in gingivitis prevention and management. Their use in toothpastes and gels may therefore provide clinicians and patients with evidence-based, well-tolerated alternatives or adjuncts to conventional formulations for maintaining and improving gingival health.
20 June 2026
Read appraisal →Scientific reports
3D‑printed training model for periodontal splinting: a randomized preclinical study
Preclinical simulation is essential for students to practice before clinical treatment. A low-cost 3D-printed model was developed with repositionable mobile maxillary anterior teeth to train periodontal splinting and evaluate learner perception and repositioning accuracy. In a two-period randomized cross-over course 43 students in their fourth year completed two palatal slot splints from the right to the left maxillary canine (FDI 13-23) in randomized material order. They used a polyethylene ribbon and a pre-impregnated unidirectional glass-fibre bundle. Outcomes included an electronic questionnaire using an anchored 6‑point ordinal scale from 1 for "Excellent" to 6 for "Unsatisfactory" following the German school grading system and geometric deviation of each tooth to an ideal position. The course was rated overall as good (Md 2.0, IQR 1.0) and highly clinically relevant (Md 1.0, IQR 1.0). Self-reported preparedness for splinting improved from poor (Md 5.0, IQR 1.0) before the course to good (Md 2.0, IQR 1.0; p < 0.001) after the course. In this pilot study, no statistically detectable positional deviations between materials or between the first and second session in this cohort were observed. This inexpensive, reproducible 3D-printed model enables realistic periodontal splinting training under simulated mobility conditions and may support structured preparation for clinical teaching.
25 May 2026
Read appraisal →Quintessence international (Berlin, Germany : 1985)
Mapping sequential patterns of periodontal breakdown using longitudinal electronic health records data
OBJECTIVE: To identify probabilistic, sequential patterns of periodontal breakdown using sequential pattern mining (SPM) on a large longitudinal cohort. METHOD AND MATERIALS: Electronic health records from 19,428 patients with periodontitis (2011-2022) were analyzed. A custom SPM algorithm was developed to identify frequent temporal subsequences of tooth mobility and furcation involvement, enforcing strict temporal precedence. 'High-risk' states (eg, generalized clinical attachment loss [CAL] > 3.0 mm) were evaluated as precursors to localized failure. Association rules were ranked by confidence (conditional probability). RESULTS: The analysis revealed distinct biomechanical cascading patterns. In the mandibular anterior sextant, mobility in the central incisors was a strong probabilistic precursor to subsequent failure in the lateral incisors and canines (confidence 7.3%). A significant 'antagonistic cascade' was identified, where mandibular incisor mobility preceded maxillary incisor instability (confidence 8.1%). For molars, furcation involvement acted as a specific temporal sentinel for future mobility (confidence ~5% to 6%). Generalized high CAL was the strongest predictor of localized failure (confidence 18.9%), significantly outperforming active inflammation (bleeding on probing) as a driver of mechanical instability. CONCLUSION: Progressive biomechanical compromise (such as tooth mobility and advanced furcation involvement) follows predictable, probabilistic sequential patterns. The identification of specific 'sentinel events,' such as mandibular incisor mobility and molar furcation involvement, allows for a shift from reactive site-by-site management to predictive intervention. CLINICAL RELEVANCE: These findings underscore the critical role of generalized attachment loss in driving localized mechanical failure cascades.
22 May 2026
Read appraisal →Clinical oral investigations
Evaluation of a novel dual-headed toothbrush design for periodontal health: split-mouth randomized blind clinical trial
BACKGROUND: Optimal oral health largely depends on the successful removal of plaque through effective brushing, but success typically relies on user technique, time, and adherence. The aim was to compare the effectiveness of a newly introduced dual-headed toothbrush with a conventional single-headed toothbrush in control of plaque and gingival health using a split-mouth design. METHODS: In the study, 37 dental professionals used two types of toothbrushes: a dual-headed toothbrush on one side of the mouth (Test side) and a conventional single-headed toothbrush on the other side (Control side). The study compared plaque removal, gingival status, and brushing time, assessing clinical outcomes using plaque index (PI), gingival index (GI), and modified sulcus bleeding index (mSBI) at baseline, 2 weeks, and 4 weeks. At the end, participants completed a Likert scale questionnaire. RESULTS: Both types of toothbrushes were effective in enhancing oral hygiene over time; however, dual-headed toothbrush group showed significant short-term reductions in plaque accumulation, gingival inflammation, and bleeding, particularly at the 2-week interval. A significant majority of participants (89.2%) rated dual-headed brush as "very easy" to use. Using a dual-headed toothbrush significantly reduces the brushing time (0.54 ± 0.17 vs. 0.99 ± 0.05 min for a conventional single-headed toothbrush), suggesting enhanced time efficiency. CONCLUSION: A dual-headed toothbrush would be more effective, faster, and easier to use than a single-headed brush. It would be a convenient alternative, especially for individuals with time constraints.
21 May 2026
Read appraisal →Oral health & preventive dentistry
Screening for Periodontitis Using Blood Biomarkers and Demographic Data: A Machine Learning Study
PURPOSE: Periodontitis is a common chronic disease associated with systemic conditions such as diabetes and cardiovascular disease. Diagnosis typically relies on dental examinations and radiographs, which may be underutilised by individuals who avoid, delay, or lack dental care. This study evaluated the potential of routine blood biomarkers and demographic data for screening moderate-to-severe periodontitis. METHODS AND MATERIALS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 adults aged ≥ 30 years (N = 3,338). Periodontal status was classified using CDC/AAP definitions. An XGBoost classifier was trained on 77 features spanning demographics, complete blood count, glycemic and hemo-globin markers, heavy metals, and additional biochemical assays. Model performance was assessed with Accuracy, Precision, Recall, and F1 score. SHapley Additive exPlanations (SHAP) were used for interpretability. Subgroup analyses were conducted by age and gender. RESULTS: The model achieved 61.1% Accuracy, 57.4% Precision, 94.6% Recall, and an F1 score of 71.5%. Performance was higher in males (F1 = 78.2) than in females (F1 = 63.9%). SHAP identified age, gender, blood cadmium, blood lead, and glycohaemoglobin (HbA1c) as top predictors. CONCLUSION: Routine blood biomarkers and demographics can be leveraged for non-dental screening of periodontitis, offering a feasible preventive strategy in primary care. The model achieved high recall, minimising false negatives, and identified biologically plausible predictors. This approach may help flag at-risk individuals, particularly in underserved populations, and support integration of oral health into general medical care.
21 May 2026
Read appraisal →Brazilian oral research
Effect of strict oral hygiene on self-rated halitosis and quality of life in patients with periodontitis: a secondary randomized controlled trial analysis
This single-blind, randomized clinical trial evaluated the impact of a strict oral hygiene (OH) phase on self-reported halitosis and quality of life (QoL) in patients with periodontitis. This study reports a secondary analysis of a single-blind randomized controlled trial (parallel, 1:1), registered at RBR-5jmx32v. The study included 24 individuals diagnosed with periodontitis who were randomly assigned to the intervention group (IG; n = 12) and the no-intervention group (NIG; n = 12). After receiving personalized OH instructions, the IG participants followed a rigorous OH phase for 45 days, whereas the NIG participants received no guidance during this period. The halitosis-associated QoL test (HALT) was administered at baseline and after 45 days. Data were analyzed using t-tests, chi-square tests, and multilevel linear regression, with significance set at p < 0.05. The average age of the study participants was 47.2 years, with a balanced sex distribution and no differences in income or education. Self-reported halitosis decreased from 100% to 50% in the IG after 45 days, whereas it remained at 91.6% in the NIG (p = 0.034). The IG also showed a mean HALT score reduction of 11.9 points (-11.88; 95% CI: -19.40 to -4.36), with significant improvements in social impact and self-esteem (p < 0.05). Clinically, BOP (p < 0.001) and VPI (p = 0.03) improved significantly in the IG, with no significant changes in NIG. This exploratory trial demonstrates that implementing a strict OH phase in patients with periodontitis may help reduce self-reported halitosis, improve HALT scores, and improve clinical outcomes, supporting its role as an adjunctive strategy in periodontal care.
21 May 2026
Read appraisal →Clinical oral investigations
Efficacy of subgingival irrigation with chemical agents as adjuvants to non-surgical periodontal therapy: systematic review and meta-analysis
OBJECTIVE: This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. METHODS: Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). RESULTS: From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. CONCLUSION: Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CLINICAL RELEVANCE: CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.
14 May 2026
Read appraisal →International journal of oral science
Machine learning-driven discovery of therapeutic nucleoside hydrogels for periodontitis
Supramolecular hydrogels hold significant potential in drug delivery and tissue engineering, with standing out for their unique properties. Despite their promise, predicting nucleoside bioactivity remains challenging. This study aims to predict the biological activity of nucleosides to guide the rational synthesis of hydrogels. Specifically, nine predictive models and databases for various biological activities were built with feature-selected machine learning methods including decision trees, logistic regression, random forest, and extreme gradient boosting. Then, the Molecular Bioactivity Specificity Index (MBSI) was introduced to gauge the primary bioactivity of nucleoside derivatives, and the Composite Molecular Attribute Score (CMAS) was devised to measure the overall performance of nucleoside derivatives. Subsequently, screening strategies for bioactive nucleoside hydrogels were established, and two candidate hydrogels (GMP and dGMP) with high hydrogel-forming ability, biocompatibility, and antibacterial activity were identified. Finally, two hydrogels were validated for antibacterial treatment of periodontitis. This study highlights the feasibility of ML-based strategies and MBSI/CMAS in rationally designing bioactive nucleoside hydrogels for biomedical applications. The discovery of GMP and dGMP hydrogels and their successful validation in periodontitis models highlight the potential of this strategy for developing targeted therapies for oral diseases.
14 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 →JMIR formative research
Evaluation of GPT-5 in Periodontitis Staging and Grading: Retrospective Observational Study
BACKGROUND: Periodontitis is a chronic gum disease affecting approximately 42% of adults aged 30 years and older in the United States. Training dental students to accurately diagnose and manage periodontitis is a critical component of dental education and clinical care. Recent advances in large language models offer new opportunities to support both domains, yet their performance in periodontal diagnosis remains largely unexplored, particularly for newer models such as GPT-5. OBJECTIVE: This study conducted an exploratory evaluation of GPT-5's ability to stage and grade periodontitis. METHODS: A total of 25 publicly available clinical cases explicitly reporting periodontitis stage and grade were identified through Google and PubMed searches. Each case description was entered into GPT-5 using a zero-shot prompting approach to assess guideline-based reasoning without exemplar conditioning. The model's predictions were compared with the published reference diagnoses. Performance was measured using accuracy, 95% CI, unweighted Cohen κ, and weighted Cohen κ. RESULTS: Across these cases, GPT-5 showed marked class-dependent performance and a tendency to overestimate disease severity. Grading performance was notably imbalanced, with high recall for grade C but substantially lower discrimination for grade B. GPT-5 achieved a staging accuracy of 68% (95% CI 48.4%-82.8%) and a grading accuracy of 77.3% (95% CI 56.6%-89.9%), with corresponding Cohen κ values of 0.454 (95% CI 11.0%-75.6%) and 0.179 (95% CI -15.8% to 63.8%), respectively. While staging performance showed fair agreement beyond chance, the low κ for grading indicates poor agreement and limited reliability in distinguishing periodontal disease severity. CONCLUSIONS: These findings suggest that although GPT-5 demonstrates potential for guideline-based periodontitis staging and grading, its current diagnostic performance, particularly for periodontitis grading, limits its use in clinical assessment and educational training. Meaningful application in periodontal diagnosis and training will require substantial improvements in reliability and rigorous validation in larger, more diverse, and prospectively collected datasets.
7 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Dimensional Changes of the Alveolar Ridge After Tooth Extraction Using the Socket Shield Technique Without Immediate Implant Placement: A Randomized Controlled Study
PURPOSE: To compare radiographic dimensional changes in postextraction sites treated with spontaneous healing versus the modified socket shield technique (mSST) without immediate placement using CBCT scans. MATERIALS AND METHODS: This randomized clinical study included 80 patients with a single maxillary anterior tooth that was not restorable. Patients were divided into two equal groups: (1) the test group, which used the mSST, and (2) the control group, which used the atraumatic extraction technique with spontaneous healing. CBCT scans were performed at baseline (before or immediately after extraction) and 6 months postsurgery. Measurements included alveolar ridge width at 1-mm, 3-mm, and 5-mm levels and buccal and palatal bone plate heights. Following this, implants were placed, and their primary stability was assessed. The main intervention was the use of the mSST compared to the atraumatic tooth extraction technique. The primary outcome was the change in buccal bone plate height over a 6-month follow-up period. In addition, covariates included patient age and sex. Paired t tests and independent t tests were used to evaluate intra- and intergroup differences, respectively. Statistical significance was set at P < .05. RESULTS: In the test group, a significant reduction in palatal wall height was observed (P < .001), while no significant changes were noted in other parameters (P ≥ .05). In the control group, significant decreases were observed in buccal and palatal plate heights as well as ridge width (P < .05). When comparing the groups, the test group demonstrated significantly less buccal wall height and ridge width resorption than the control group (P < .05). However, no significant difference was observed in palatal plate height resorption between the two groups (P = .507). The test group exhibited significantly higher primary stability rates compared to the control group (P = .001). CONCLUSIONS: The mSST with delayed implant placement demonstrated superior maintenance of buccal bone plate height and ridge width, along with significantly greater primary implant stability, compared to spontaneously healed sockets. This approach is beneficial for maintaining ridge integrity when immediate implant placement is not planned.
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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