Search

Background: Phosphorous necrosis of the jaw (PNJ) exhibits similar clinical and pathological features as medical-related osteonecrosis of the jaw (MRONJ). This study aims at comparing the similarities and differences between PNJ and MRONJ regarding pathological features and to provide a theoretical basis for the clinical diagnosis and management of PNJ., Material and Methods: A retrospective analysis was conducted to assess clinical differences among 38 PNJ patients and 31 MRONJ patients, who were diagnosed and treated between January 2009 and October 2022. Pathological alterations in bone tissue were evaluated using EDS, H&E, Masson, and TRAP staining on five specimens from both MRONJ and PNJ cases; furthermore, immunohistochemistry was used to determine the expression levels of OPG, RANKL, and Runx2. The mandibular coronoid process was removed from individuals with temporomandibular joint ankylosis to serve as a control., Results: CBCT imaging demonstrated necrotic bone formation in block, strip, or plaque shapes. EDS analysis showed that the calcium/phosphorus ratio in the bone tissue of PNJ and MRONJ was significantly lower than that of the control group (P < 0.05). Additionally, staining indicated reduced osteoblast counts, disrupted bone trabecular structure, and decreased collagen fiber content in the bone tissues of PNJ and MRONJ. Immunohistochemistry demonstrated that RANKL expression was significantly lower in MRONJ compared to PNJ and control groups (P < 0.05). Conversely, Runx2 expression was significantly higher in PNJ than in MRONJ and control groups (P < 0.05), and there was no significant difference in OPG expression., Conclusion: PNJ and MRONJ demonstrate comparable clinical manifestations and pathological traits, although disparities may exist in their underlying exhibit comparable clinical manifestations, pathological traits, and molecular mechanisms., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aimed to identify the levels of halitosis in patients with Medication-related osteonecrosis of the jaw (MRONJ) and osteoporosis and to suggest a new MRONJ screening method using halitosis measurement., Materials and Methods: From October 2019 to April 2023, participants aged 19 years or older without periodontal disease were selected. Seventy-five participants, 25 in each group, were divided into an MRONJ group, an osteoporosis group without MRONJ, and a control group without osteoporosis and not taking osteoporosis drugs or antibiotics. Each participant underwent halitosis assessment twice using an exhaled breath analyzer to measure halitosis twice by blowing a straw for 1 min. Measured concentrations of hydrogen, hydrogen sulfide, and methyl mercaptan were compared between groups., Results: Data from 22 patients in the MRONJ group, 25 in the osteoporosis group, and 25 in the control group were analyzed. The concentrations of hydrogen sulfide and methyl mercaptan were significantly higher in the MRONJ group than in the other groups, but the concentrations of hydrogen did not differ between the groups. When comparing the concentrations of hydrogen sulfide and methyl mercaptan in osteoporosis patients and solid cancer patients in the MRONJ group, there was a significant difference in hydrogen sulfide concentration, but there was no significant difference in methyl mercaptan., Conclusions: Quantifying the level of halitosis can be used to screen for MRONJ in patients taking bisphosphonates, such as patients with osteoporosis, prostate cancer, and breast cancer., Clinical Relevance: MRONJ is accompanied by bad breath, and the concentrations of hydrogen sulfide and methyl mercaptan are associated with MRONJ., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The occurrence of implant-associated osteonecrosis of the jaw (ONJ) has been reported in osteoporotic patients, particularly in association with bisphosphonate therapy. This study aimed to investigate the risk of implant surgery and implant presence for ONJ occurrence in osteoporotic patients longitudinally., Methods: Based on Korean National Health Information Database, subjects over the age of 65 who were diagnosed with osteoporosis between July 2014 and December 2016 were included. The implant group included subjects who had undergone dental implant surgery between January 2017 and December 2017, while the control group included those who had no history of dental implants. The primary outcome was the occurrence of ONJ, and the date of final follow-up was December 2020., Results: A total of 332,728 subjects with osteoporosis were included in the analysis: 83,182 in the implant group and 249,546 in the control group. The risk of ONJ among those who had undergone implant surgery (risk of implant surgery-associated ONJ) was not higher than that among those without implant surgery. The risk of ONJ among those with implants (risk of implant presence-associated ONJ) was lower than that among those without implants. Even in subjects with a history of bisphosphonates, steroids, periodontitis, or tooth extraction, those who had undergone implant surgery or had implants did not have a higher ONJ risk than those who had not undergone surgery or did not have implants; rather, they showed a lower risk., Conclusions: The results may suggest that dental implants are not associated with an increased risk of ONJ. A further study on whether dental implants are associated with lower ONJ risk is needed., Clinical Relevance: Dental implants did not increase the risk of ONJ development in osteoporotic patients, even with a history of bisphosphonates. This may suggest that the risk profiles for ONJ occurrence between selective insertion of dental implants and other dentoalveolar surgery associated with infectious conditions are different., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The need for prevention and management of medication-related osteonecrosis of the jaw (MRONJ) has increased with the growing number of patients using antiresorptive agents. The scope of this systematic review (SR) was to determine whether the withdrawal of antiresorptive agents is necessary for tooth extractions in patients receiving each of the antiresorptive medications., Materials and Methods: The searches were performed using the MEDLINE databases. We selected SRs, randomized controlled trials (RCTs), prospective and retrospective non-randomized clinical (observational) studies, and case reports/case series in this order of preference., Results: We included one SR, one RCT, five observational studies, and three case reports. Meta-analyses were not conducted because the RCT had an extremely small sample size and the observational studies had different definitions of intervention and comparison that could not be integrated across studies. In this SR, no studies showed a benefit (i.e., a reduction in the incidence of osteonecrosis of the jaw) of short-term withdrawal of antiresorptive agents for tooth extraction. Additionally, no studies examined the harm (i.e., an increase in femoral and vertebral fractures and skeletal-related events during bone metastasis) of withdrawal for tooth extraction., Conclusions: We were unable to determine whether withdrawal before and after tooth extraction is necessary with a high certainty of evidence. Future systematic reviews including RCTs with larger samples are expected to provide such evidence., Clinical Relevance: This systematic review provides evidence-based information for multidisciplinary collaborations related to patients receiving antiresorptive agents., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Patients with hematological malignancies have dynamic changes in oral microbial communities before and after treatment. This narrative review describes the changes in oral microbial composition and diversity, and discusses an oral microbe-oriented strategy for oral disease management., Materials and Methods: A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1980 and 2022. Any articles on the changes in oral microbial communities in patients with hematological malignancies and their effects on disease progression and prognosis were included., Results: Oral sample detection and oral microbial sequencing analysis of patients with hematological malignancies showed a correlation between changes in oral microbial composition and diversity and disease progression and prognosis. The possible pathogenic mechanism of oral microbial disorders is the impairment of mucosal barrier function and microbial translocation. Probiotic strategies, antibiotic strategies, and professional oral care strategies targeting the oral microbiota can effectively reduce the risk of oral complications and the grade of severity in patients with hematological malignancies., Clinical Relevance: This review provides dentists and hematologists with a comprehensive understanding of the host-microbe associated with hematologic malignancies and oral disease management advice., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of the present cross-sectional study was to compare the interocclusal contact records obtained by three different digital methods (intra- and extraoral digital scanners and T-Scan III system) with the conventional method (articulating paper)., Materials and Methods: Twenty-five healthy volunteers were selected. As a control group, maximum intercuspation occlusal contacts were registered and photographed from the patients with an 8 µm articulating paper. Then, intraoral conventional elastomer impressions were taken and after obtaining the corresponding plaster models of every patient they were scanned with an extraoral scanner (Zfx Evolution, Zimmer Biomet Dental) (group 1). Moreover, digital impressions were made with an intraoral scanner (Trios Color POD, Phibo, 3Shape) and contacts were also registered (group 2). Finally, T-Scan III records were made and stored for further analysis (group 3). Two previously calibrated examiners independently evaluated the interocclusal contacts from every group. Data was analyzed by using Kappa index test and Pearson's chi-square test. Diagnostic tests and ROC curve were also performed., Results: Kappa interoperator index was 70.6% (better agreement). In Kappa intraoperator index, the best value was obtained in the intraoral scanner group (moderate agreement) and the worst with T-Scan III group (low agreement). ROC curve showed highest values in the intraoral scanner group (0.817) and lowest values in the T-Scan III group (0.613)., Conclusion: Results suggest greater reliability to record occlusal contacts with the intraoral scanner., Clinical Relevance: Intraoral scanners seem to be reliable in registering intermaxillary occlusal contacts when compared with the current gold standard., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study investigated the surface characteristics of denture base resin coatings prepared using a novel silica-based film containing hinokitiol and assessed the effect of this coating on Candida albicans adhesion and growth., Methods: Silica-based coating solutions (control solution; CS) and CS containing hinokitiol (CS-H) were prepared. C. albicans biofilm formed on denture base specimens coated with each solution and these uncoated specimens (control) were analyzed using colony-forming unit (CFU) assay, fluorescence microscopy, and scanning electron microscopy (SEM). Specimen surfaces were analyzed by measuring the surface roughness and wettability and with Fourier-transform infrared (FT-IR) and proton nuclear magnetic resonance ( 1 H NMR). Stability of coated specimens was assessed via immersion in water for 1 week for each group (control-1w, CS-1w, and CS-H-1w) followed by CFU assay, measurement of surface roughness and wettability, and FT-IR., Results: CS-H and CS-H-1w contained significantly lower CFUs than those present in the control and control-1w, which was also confirmed via SEM. Fluorescence microscopy from the CS-H group identified several dead cells. The values of surface roughness from coating groups were significantly less than those from the control and control-1w. The surface wettability from all coating groups exhibited high hydrophobicity. FT-IR analyses demonstrated that specimens were successfully coated, and 1 H NMR analyses showed that hinokitiol was incorporated inside CS-H., Conclusions: A silica-based denture coating that incorporates hinokitiol inhibits C. albicans growth on denture., Clinical Relevance: We provide a novel antifungal denture coating which can be helpful for the treatment of denture stomatitis., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this study is to compare the sensitivity of T-Scan digital occlusal analysis system and the occlusal analysis mode of the CEREC Omnicam system, which is mainly used for design/production, using the data recorded at the maximum intercuspal position., Materials and Methods: Occlusal recordings were obtained from healthy 20 females and 20 males aged 18-25 at the maximum intercuspal position. Records were saved as.jpeg format and transferred to Adobe Photoshop CS6 program. Blue, green, and red colors (shown by the same color codes in both systems) representing light, intense, and tight contacts, respectively, were evaluated in terms of the pixel counts. For statistical comparison, the differences between the systems independent sample T test and, between the genders, one sample T test were used (α = 0.05)., Results: The total numbers of pixels of all colors which are evaluated with T-Scan and CEREC Omnicam in females were 31,296.6 and 15,745, respectively, and in males 39,812.3 and 17,462, respectively. In both systems, the blue contact area is the most seen. For all colors tested, T-Scan recorded more contact than those of CEREC Omnicam in both genders and statistically significant difference was found between two systems for all colors. In both systems, recorded contacts are significantly higher in men than in women. Compared with women, 27% more contact area was recorded in men with T-Scan and 11% more with CEREC Omnicam was obtained., Conclusions: While T-Scan was found sensitive even in the diagnosis of light contacts, the CEREC Omnicam was found sensitive only in the diagnosis of tight contacts., Clinical Relevance: Although both T-Scan and CEREC Omnicam are effective in occlusal analysis, T-Scan's sensitivity was found to be higher., Trial Registration: ClinicalTrials.gov identifier: NCT04798729., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this study was to evaluate the preventive effect of ozonated oil on the development of MRONJ-like lesions at tooth extraction sites in rats submitted to zoledronic acid treatment., Materials and Methods: Twelve rats were divided into two groups. Each rat received an injection of zoledronic acid solution once a week for 5 weeks before having its upper first molar extracted. In group 1, the clotted socket was maintained, while in the group 2, the socket was treated with ozonated oil for 10 min/day during 3 days. After euthanasia, block resection was performed for histological analysis. Necrotic bone was defined as the area of the bone with empty osteocyte lacunae and vital bone as the area with osteocyte-occupied lacunae., Results: There was no statistically significant difference between the groups in the average area of vital bone (p = 0.2248) and the average area of necrotic bone (p = 0.1208). However, the average area of vital bone in group 1 was smaller (24.1 ± 2.9 cells/cm 2 ) than in group 2 (26.8 ± 4.2 cells/cm 2 ), and the average area of necrotic bone in group 1 was higher (7.0 ± 2.5 cells/cm 2 ) than in group 2 (4.0 ± 1.1 cells/cm 2 ), indicating that ozonated oil may reduce the development of osteonecrosis., Conclusions: Our findings suggest that ozonated oil might prevent MRONJ-like lesions at tooth extraction sites in rats submitted to a disease induction protocol. Further research should be conducted to confirm this hypothesis., Clinical Relevance: MRONJ has been reported as a complication of surgical dental procedures, and there are currently no predictable preventive therapies., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation., Materials and Methods: Thirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups., Results: There were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05)., Conclusion: Taste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions., Clinical Relevance: Maxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly., The Trial Registration Number (trn): NCT06103422/Date of registration: 10.17.2023 (retrospectively registered)., (© 2024. The Author(s).)

Objective: Craniofacial and oral manifestations of Osteogenesis Imperfecta (OI) can affect the functioning of the stomatognathic system and impact the patient's quality of life. The objective of the study was to evaluate the relationship between craniofacial and oral manifestations and the Oral Health-related Quality of Life (OHRQoL) of OI children and adolescents., Material and Methods: A total of 30 OI patients aged eight to fourteen years old followed up at the Oral Care Center for Inherited Diseases were enrolled in the research. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ) for eight to ten-year-olds (CPQ 8-10 ) and 11 to 14-year-olds (CPQ 11-14 ). The relationship between the OHRQoL index and its assessment domains, OI types, and the presence of dentinogenesis imperfecta (DI), class III malocclusion, and dental agenesis were evaluated., Results: The median CPQ score of patients was 5, and there was no significant difference in OHRQoL between children and adolescents, nor associated with the disease severity or the presence of DI. The oral manifestations evaluated did not directly impact the patients' OHRQoL., Conclusions: The study demonstrated that the perception of OHRQoL is similar for both adolescents and children. The oral symptom was the most relevant domain for the index among patients aged eight to fourteen years while the emotional well-being was the most impacted., Clinical Relevance: this study makes contributions by indicating that addressing dental care for children and adolescents with OI is important in clinical management and better OHRQoL for this population., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aimed to investigate changes in salivary flow rates, buffering capacity, and salivary chromogranin A (CHGA) levels in adults undergoing bariatric surgery (BS) compared with a non-obese control group., Materials and Methods: Salivary analyses were performed on 62 participants aged over 50 years, stratified into two groups matched for age and gender-individuals who had undergone bariatric surgery (BS) (n = 31) and a corresponding healthy control group (n = 31). Before saliva collection, participants completed a comprehensive 11-point visual numerical rating scale (NRS 0-10) xerostomia questionnaire, assessing subjective perceptions of two key aspects: dryness of the oral mucosa and resultant impact on oral functional ability. Three distinct saliva measurements were obtained: unstimulated whole saliva (UWS), stimulated whole saliva (SWS), and unstimulated upper labial saliva (ULS). The buffering capacity of unstimulated saliva was assessed using pH indicator strips, and concentrations of salivary Chromogranin A (CHGA) were quantified in stimulated saliva via enzyme-linked immunosorbent assay (ELISA)., Results: After BS, more than 40% of BS group patients reported xerostomia, with 16.1% experiencing only mild symptoms without significant functional impact (p = 0.009). The prevalence of xerostomia and tongue dryness was higher in the BS group compared to the control group (p = 0.028 and p = 0.025, respectively). The comparative analysis unveiled no statistically significant differences in flow rates of unstimulated upper labial saliva (ULS), unstimulated whole saliva (UWS), and stimulated whole saliva (SWS) between the control group and patients who underwent bariatric surgery. However, in patients undergone BS with xerostomia, both ULS and UWS flow rates were significantly lower than in controls with xerostomia (p = 0.014 and p = 0.007, respectively). The buffering capacity was significantly lower in patients undergone BS than in controls (p = 0.009). No differences were found between groups regarding CHGA concentration and output values, nevertheless, higher values of CHGA concentrations were significantly correlated to lower flow rates., Conclusion: According to the results, this study suggests that individuals undergoing BS may exhibit altered salivary buffering capacity and reduced unstimulated salivary flows in the presence of xerostomia. Additionally, the findings suggest that elevated concentration of salivary CHGA might be associated, in part, with salivary gland hypofunction., Clinical Relevance: The clinical significance of this study lies in highlighting the changes in salivary functions after BS. The identified salivary alterations might be attributed to adverse effects of BS such as vomiting, gastroesophageal reflux, and dehydration. Understanding these changes is crucial for healthcare professionals involved in the care of post-BS patients, as it sheds light on potential oral health challenges that may arise as a consequence of the surgical intervention. Monitoring and managing these salivary alterations can contribute to comprehensive patient care and enhance the overall postoperative experience for individuals undergoing BS., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this systematic review was to assess the efficacy and safety of topical non-steroidal immunomodulators (TNSIs) for oral lichen planus (OLP) treatment., Materials and Methods: A search strategy designed for this purpose retrieved 1156 references. After analysis of titles and abstracts, 75 studies were selected for full-text analysis. Only randomized controlled clinical trials were selected, resulting in 28 studies included for qualitative and quantitative analysis., Results: The meta-analysis showed similar benefits in clinical response and symptom resolution between tacrolimus 0.1% and pimecrolimus 1% in comparison to topical steroids (TS). Pimecrolimus showed superior efficacy of clinical response but not for symptom resolution compared to placebo. Tacrolimus and pimecrolimus showed better performance preventing symptom relapse, while pimecrolimus also prevented clinical relapse better than TS. Cyclosporine was superior to placebo; however, TS showed better efficacy of clinical response. Thalidomide and retinoid were assessed in only one trial each, and both showed similar efficacy to TS. Rapamycin also presented similar clinical response to TS; however, the later showed greater reduction of symptoms. Mycophenolate mofetil 2% mucoadhesive was no better than placebo. No serious adverse effects have been reported. Cyclosporine showed a higher frequency and variety of adverse effects., Conclusions: Topical tacrolimus and pimecrolimus are safe and effective alternatives for OLP treatment., Clinical Relevance: TS are usually the first choice for OLP treatment. Because some oral lesions may have a low response to treatment with TS, more topical therapeutic options, such as TNSIs, should be considered before systemic steroids are used., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of our study was to describe microbial flora associated with MRONJ and characterize the susceptibility of pathogens to help guide an effective empiric antibiotic treatment in these patients., Materials and Methods: A retrospective, single-center analysis was performed, using 116 bone samples from 98 patients. The bone samples were homogenized and subjected to routine culture methods. Growing bacteria were differentiated to the species level using whole-cell mass spectrometry and subjected to susceptibility testing., Results: A highly diverse microbial flora was detected in necrotic bone, with a simultaneous presence of two or more bacterial species in 79% of all patients. In at least 65% of samples, gram-negative isolates were detected. Therefore, bacterial species resistant against β-lactamase inhibitors were present in at least 70% of all patients., Conclusions: The empiric choice of antibiotics in MRONJ patients should consider the high rate of gram-negative bacteria and resistance against β-lactam antibiotics., Clinical Relevance: According to recent guidelines and recommendations, systemic antibiotic treatment is a key component in the treatment of all stage 2 and 3 MRONJ patients. We recommend using fluoroquinolones for empiric treatment and emphasize the use of bacterial cultivation and susceptibility testing to enable an effective antibiotic treatment.

Objectives: High-dose bone-modifying agents (BMAs), such as bisphosphonates and denosumab, are essential for the treatment of cancer patients with bone metastases. The incidence of medication-related osteonecrosis of the jaw (MRONJ) is increasing. Inflammatory dental diseases could lead to MRONJ, and hence, they should be managed appropriately. Tooth extractions are commonly advised to prevent dental inflammation; however, the accurate indications for tooth extractions before starting BMA therapy have not been established. Hence, we assessed teeth with inflammatory dental diseases to identify indicators for prophylactic extraction before starting BMA therapy., Materials and Methods: We included 745 teeth with inflammatory dental diseases of 212 cancer patients on high-dose BMA therapy. We assessed the relationship between inflammatory dental disease and risk of MRONJ development. Multivariate Cox regression analysis was used for statistical analysis. The cumulative occurrence rate of MRONJ was calculated using the Kaplan-Meier method., Results: MRONJ occurred in 43 of 745 teeth. Teeth characteristics significantly correlated with MRONJ occurrence were mandible (p = 0.009), molar region (p = 0.005), radiopaque changes in bone surrounding the root on orthopantograms obtained at patients' first visits (p < 0.001), and tooth extractions after starting BMA therapy (p < 0.001)., Conclusions: Radiopaque changes in bone surrounding the root are an important radiographic finding that indicates the need for prophylactic tooth extractions before starting BMA therapy., Clinical Relevance: Our results suggest that the prophylactic extraction of teeth with radiopaque changes in bone surrounding the root before starting BMA therapy could prevent the onset of MRONJ.

Objective: To investigate the association of the severity of temporomandibular disorders (TMD) pain and dysfunction with the frequency of self-reported awake bruxism (AB), sleep bruxism (SB), and stress in an adult TMD-patient population., Materials and Methods: This cross-sectional study included 237 TMD patients based on the Diagnostic Criteria for TMD. Age, sex, frequency of self-reported AB and SB, and stress were included as independent variables. TMD pain and TMD dysfunction were included as dependent variables in regression analyses. Univariate and multivariable linear regression analyses were used to predict TMD pain and TMD dysfunction in two separate models. Finally, network analysis was performed to investigate the associations between all variables., Results: In the univariate analyses, TMD pain was significantly associated with self-reported AB-frequent (unstandardized coefficient (B) = 3.196, 95%CI 1.198-5.195, p = 0.002). TMD dysfunction was significantly associated with AB-frequent (B = 2.208, 95%CI 0.177-4.238, p = 0.033) and SB-sometimes (B = 1.698, 95%CI 0.001-3.394, p = 0.050). In the multivariable analyses, TMD pain was significantly associated with TMD dysfunction (B = 0.370, p < 0.001), stress (B=0.102, p < 0.001). TMD dysfunction was significantly associated with TMD pain (B = 0.410, p < 0.001) only. Network analysis showed that TMD pain is a bridge factor between AB, stress, and TMD dysfunction., Conclusions: TMD pain is directly associated with AB, stress, and TMD dysfunction, while TMD dysfunction is only associated with TMD pain., Clinical Relevance: Reducing pain may improve pain-related dysfunction, and the management of AB and stress may improve TMD pain and dysfunction, and vice versa., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this study was to investigate the effect of maternal's depression trajectory in the first 1000 days of the child's life on the prevalence of early childhood dental caries (ECC), in a birth cohort., Materials and Methods: All infants born in Pelotas in 2015 were identified, and the mothers were invited to participate in the cohort. A total of 3645 children were included in the study. The outcome was ECC at 48 months of age assessed according to ICDAS. Maternal depression was collected using Edinburgh Postnatal Depression Scale (EPDS) antenatally, at 3, 12, and 24 months of age. Maternal depressive symptom trajectory variables were created using group-based trajectory models and adopting two cutoff points. Poisson regression model with robust variance was used to identify the total effect of maternal depressive symptom trajectories on ECC, adjusting by confounders., Results: A total of 29.2% of the mothers presented a high trajectory for screening of depression, and 18.8% presented a high trajectory of depression diagnosis. The prevalence of ECC was 26.7%. After adjusted analysis, maternal depression trajectories (screening and diagnosis) from pregnancy to 24 months increased the risk for ECC at 48 months of age (RR = 1.14; 95% CI 1.02-1.28 and RR = 1.19; 95% CI 1.05-1.35)., Conclusions: Children from mothers with high depression trajectory had higher risk of having dental caries at 48 months compared to children from mothers with low depression trajectory., Clinical Relevance: Strategies of early detection and treatment of maternal mental disorders during the Golden Period should be considered of high priority in health services since it could impact positively in children's life., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The objective of this study was to investigate the influence of various antiresorptive and antiangiogenic medications on morphological changes in periodontal and oral tissue structures., Materials and Methods: Fifty-five Wistar rats randomly received dual application (i.e., at baseline and after 12-weeks) one of the following medications: (1) amino-bisphosphonate [zoledronate (Zo)], (2) RANKL inhibitor [denosumab (De)], (3) antiangiogenic [bevacizumab (Be)], (4) Zo + Be, (5) De + Be or (6) no medication [Control (Co)]. Periodontal and oral tissue biopsies were obtained at 17 (n = 21 animals, Phase 1, (De = 3, De + Be = 3, Zo = 5, Be = 3, Zo + Be = 2, Co = 5) and 29 (n = 34 animals, (De = 8, De + Be = 6, Zo = 2, Be = 7, Zo + Be = 4, Co = 7, Phase 2) weeks after the second drug application. The following outcomes were histomorphometrically assessed: periodontal space width in the coronal (PLS-C, mm) and apical sections (PLS- A), number of empty alveolar bone lacunae in the coronal, apical sections and at the apex at respective tooth sites (EL - C, EL- A, EL- Ap), mucosal thickness at edentulous alveolar ridge areas (MT, mm), and, when present, associated areas of inflammatory cell infiltrates (ICI, mm 2 )., Results: Comparable mean PLS-C, PLS-A, ET-A, ET-C, ET-Ap, and MT values were observed in all experimental groups after Phases 1 and 2. The presence of ICI was identified in 3 animals in the Co group (Phase 1: 1, Phase 2: 2), and 17 animals in the test groups (Phase 1: 4; Phase 2: 14). The estimated ICI surface area was significantly higher in the Zo + Be group, followed by the Zo and Be groups compared to that measured in the Co group. The time (i.e., Phases 1 and 2) was not found to be a predictor for the extent of the ICI area. In all groups, the EL-C, EL-A, and EL-Ap values were significantly higher after Phase 2 compared to those assessed after Phase 1. The MT values were significantly reduced in all groups after Phase 2 compared to those measured after Phase 1., Conclusions: The present evaluation was not able to find any morphological effects of different antiresorptive and antiangiogenic medications on periodontal and oral tissue structures. The presence of inflammatory cell infiltrates was more frequently observed in the animals administered with antiresorptive and antiangiogenic medications as well as combinations thereof., Clinical Relevance: Administration of antiresorptive and antiangiogenic medications may be capable of inducing inflammatory reactions in periodontal tissues., (© 2023. The Author(s).)

Objectives: The aim of this in vitro study was to evaluate the effect of a 3D-printed drill sleeve (DS) on the precision and duration of coronectomy sections., Materials and Methods: Thirty-six trainees and oral surgeons performed 72 coronectomy cuts in a 3D-printed, entirely symmetric mandible model. Coronectomy was performed freehand (FH) on one side and with a DS on the other side. The occurrence of "too superficial" (≥ 4 mm unprepared lingual tooth tissue) and "too deep" (drilling ≥ 1 mm deeper as tooth contour) cuts and sectioning times were registered., Results: In 7 cases, the sections were "too deep" with FH, while none with DS (OR: 18.56; 95%CI: 1.02-338.5; p = 0.048). The deviation between virtually planned and real cut depths was significantly greater in the FH group (1.91 ± 1.62 mm) than in DS group (1.21 ± 0.72 mm) (p < 0.001). A total of 18 "too superficial" buccolingual sections occurred with FH, while 8 cases with DS (OR: 3.50; 95%CI: 1.26-9.72; p = 0.016). Suboptimal sections did not correlate with experience (p = 0.983; p = 0.697). Shortest, suboptimal drillings were most frequently seen distolingually (OR: 6.76; 95% CI: 1.57-29.07; p = 0.01). In the inexperienced group, sectioning time was significantly longer with FH (158.95 ± 125.61 s vs. 106.92 ± 100.79 s; p = 0.038)., Conclusions: The DS effectively reduced tooth sectioning times by less experienced colleagues. Independently from the level of experience, the use of DS obviated the need for any preparation outside the lingual tooth contour and significantly decreased the occurrence of "too superficial" cuts, leaving thinner unprepared residual tooth tissue lingually., Clinical Relevance: Coronectomy sections may result in lingual hard and soft tissue injury with the possibility of damaging the lingual nerve. The precision of the buccolingual depth-control can be improved, while surgical time can be reduced when applying a drilling sleeve., (© 2023. The Author(s).)

Objectives: To compare the multilayer panoramic radiography (MPAN) and conventional panoramic radiography (CPAN) in the evaluation of mandibular third molars using cone-beam computed tomography (CBCT) as a reference., Methods: CPAN, MPAN, and CBCT scans from 33 dry human mandibles were acquired using the OP300 Maxio unit, totalizing 56 mandibular third molars to be evaluated. Three examiners evaluated each third molar according to their position, depth of impaction in the mandibular ramus, proximity between the dental root apexes and the mandibular canal, and the presence of radiographic signs of proximity to the mandibular canal. In addition, when there was a distance between the root apexes and the mandibular canal, it was measured. As a reference, these same parameters were assessed in the CBCT scans by a fourth examiner. For the statistical analysis, the weighted Kappa, Bland Altman, and Wilcoxon tests were performed (α = 0.05)., Results: The agreement between the assessments performed in the panoramic modalities with the CBCT ranged from 66.1% to 100.0% for the categorical variables. Overall, the agreement values of CPAN and MPAN with CBCT were similar. The distances between the dental root apex and the mandibular canal for both CPAN and MPAN were significantly underestimated compared to CBCT (p < 0.05). The intra- and interexaminer agreements of the examiners ranged from poor to almost perfect; in general, the agreements were higher in the evaluation performed in the MPAN than in the CPAN., Conclusions: The MPAN performs similarly to CPAN for evaluating mandibular third molars and their proximity relationship to the mandibular canal., Clinical Relevance: Preoperative evaluation of lower mandibular third molars is usually performed using CPAN. Recently, a new tool, MPAN, was developed, which has not yet been tested for the evaluation of mandibular third molars and showed similar performance to CPAN in the present study. Future studies using MPAN are encouraged to evaluate other diagnostic tasks., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate the influence of various antiresorptive and antiangiogenic medications on the resolution of experimentally induced peri-implantitis lesions after different surgical treatment approaches., Materials and Methods: Forty-eight albino rats randomly received a dual application of the following medications: (1) amino-bisphosphonate (zoledronate (Zo)) (n = 8), (2) RANKL inhibitor (denosumab (De)) (n = 8), (3) antiangiogenic (bevacizumab (Be)) (n = 8), (4) Zo + Be (n = 8), (5) De + Be (n = 8), or (6) no medication (control (Co)) (n = 8). Ligature-induced peri-implantitis lesions were established at 2 maxillary implants over 16 weeks. Afterward, animals were randomly treated either with open flap debridement (OFD) or reconstructive therapy (RT). Treatment procedures were followed by a 12-week healing period. The histological outcomes included residual defect length (DL); defect width (DW) at the bone crest (BC-DW); 25%, 50%, and 75% of the DL; and areas of inflammatory cell infiltrate (ICT). When present, areas of bone sequester (BS) were assessed considering the animal as a statistical unit., Results: A total of 21 animals were analyzed (Zo: RT = 3, OFD = 1; De: RT = 3, OFD = 2; Be: OFD = 1; Zo + Be: RT = 2, OFD = 2; Co: RT = 3, OFD = 2). Implant loss rates were comparable among the experimental groups. Except for the 25% and 75% DW values that were significantly higher in the Zo + Be group compared to the Co group (p = 0.04 and p = 0.03, respectively), no significant differences were found among the experimental groups for the DL (lowest-Be: 0.56 mm; highest-Co: 1.05 mm), BC-DW (lowest-De: 0.86 mm, highest-Co: 1.07 mm), 50% DW (lowest-De: 0.86 mm; highest-Be + Zo: 1.29 mm), and ICT (lowest-Be: 0.56 mm 2 ; highest-Be + Zo: 1.65 mm 2 ). All groups, except for the Zo and Be following RT, showed presence of BS., Conclusions: The present findings did not reveal a marked effect of various antiresorptive/antiangiogenic medications on the resolution of experimentally induced peri-implantitis lesions, regardless of the surgical approach employed (OFD and RT)., Clinical Relevance: Resolution of peri-implantitis lesions may not be affected by the investigated antiresorptive/antiangiogenic medications., (© 2023. The Author(s).)

Objectives: To investigate oral health and oral health-related quality of life (OHRQoL) of patients under antiresorptive therapy (ART) during supportive periodontal care (SPC) considering history of medication-related osteonecrosis of the jaw (MRONJ)., Materials and Methods: In this cross-sectional study, 100 patients (50 receiving ART (exposed) and 50 without ART (unexposed)) in regular SPC were enrolled for a clinical oral examination and the evaluation of OHRQoL using the OHIP-G14-questionnaire. History of MRONJ was assessed by anamnesis and reviewing patient records., Results: There were no statistically significant group differences in age (exposed: 70.00 ± 9.07 versus unexposed: 71.02 ± 8.22 years), sex, distribution of systemic diseases and duration of SPC (on average 8.61 ± 5.73 years). Number of teeth (21.02 ± 5.84 versus 21.40 ± 5.42), DMFT (18.38 ± 3.85 versus 17.96 ± 4.08), probing pocket depth (2.31 ± 0.20 versus 2.38 ± 0.26), clinical attachment level (3.25 ± 0.76 versus 3.46 ± 0.58) and bleeding on probing (15.07 ± 11.53 versus 15.77 ± 13.08) were also not significantly different. The OHIP-G14 sum-score was significantly higher in exposed participants (6.10 ± 6.76 versus 3.62 ± 5.22, p = 0.043). History of MRONJ was prevalent in 8% of patients under ART. Periodontal/peri-implant-related MRONJ were reported in three participants with cancer (n = 1 before and n = 2 after active periodontal therapy). History of MRONJ due to endodontic/restorative reasons was reported in one patient with osteoporosis., Conclusions: Patients under ART in SPC demonstrated similar clinical periodontal and dental status but lower OHRQoL compared to unexposed (not statistically significant). Patient awareness of the MRONJ-risk and appropriate preventive measures should be ensured., Clinical Relevance: SPC in osteoporotic patients under ART appeared safe regarding MRONJ, but further investigations on the MRONJ-risk in patients with different risk-profiles are necessary., Study Registration: clinicaltrials.gov (#NCT04192188)., (© 2023. The Author(s).)

Introduction: The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE)., Methods: This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05)., Results: The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity., Conclusions: Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla., Clinical Relevance: EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The purposes of this retrospective study were to investigate the prevalence of various periodontal chief complaints (pCCs) of patients, diagnosed with periodontitis, as well as to identify the association between pCCs and periodontal parameters or periodontitis staging according to AAP/EFP 2017 classification., Materials and Methods: Five hundred eighty-nine patients, applied to the clinic with pCCs, were screened. The demographic characteristics, smoking status, brushing behaviors, history of periodontal therapy, medical data, and periodontal parameters were obtained. A multinomial logistic regression analysis was performed to determine the most common pCCs and co-variables among the indicators of Stage III and IV periodontitis., Results: In Stage IV periodontitis, patients with pCC of mobility were observed the most (26.8%), and pCC of halitosis were the least (7.3%). Among all pCCs of patients, those with the pCC of gingival enlargement and tooth mobility had the highest percentage of sites with PPD ≥ 4 mm and CAL ≥ 5 mm, respectively (p < .001). According to regression analysis, those with pCC of gingival bleeding, recession and mobility were more likely to be in Stage IV than those in Stage I/II., Conclusion: Among pCCs, only patients with pCCs of mobility, gingival recession and bleeding are related to periodontitis staging. Moreover, the extent of periodontal pockets in patients with pCC of gingival enlargement, and the extent of attachment loss in patients with pCC of mobility are greater than other patients., Clinical Relevance: New machine-learning technology models can be developed with the aim of classifying the patients based on their chief complaints, to support diagnosing the severity of periodontal diseases., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To characterize the soft-tissue wall of remaining periodontal pockets for wound healing-related parameters versus healthy gingival crevices in the same individuals., Materials and Methods: Gingival tissues collected from the diseased interface of pockets (GT biopsies) and from healthy gingival crevices (G biopsies) were subjected to RT 2 -profiler PCR Array for wound healing-related markers and network analysis of differentially expressed genes. Lymphangiogenesis-related gene expression was determined by qRT-PCR. The migration potential of mesenchymal stem cells isolated from GT biopsies (GT-MSCs) and G biopsies (G-MSCs) was evaluated by the scratch- and the transwell migration assays. The total collagen protein content was determined in GT-MSCs and G-MSCs homogenates., Results: Gene-ontology analysis on significantly upregulated genes expressed in GT biopsies revealed enrichment of several genes involved in processes related to matrix remodeling, collagen deposition, and integrin signaling. No significantly expressed genes were seen in G biopsies. Regarding lymphangiogenesis-related genes, GT biopsies demonstrated greater expression for PROX1 than G biopsies (p = 0.05). Lower migration potential (p < 0.001), yet greater production of collagen protein (p = 0.05), was found for GT-MSCs over G-MSCs., Conclusion: Differential expression patterns of various molecular pathways in biopsies and cell cultures of diseased versus healthy gingival tissues indicate a potential of the former for tissue remodeling and repair., Clinical Relevance: In the course of periodontitis, granulation tissue is formed within a periodontal defect in an attempt to reconstruct the site. Following treatment procedures periodontal granulation tissue remains inflamed but appears to retain healing potential., (© 2023. The Author(s).)

Objectives: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in intensive care units (ICUs), and the use of mouthwash is the most widely used method to prevent its incidence. The aim of this study was to investigate effect of clove mouthwash on the incidence of VAP in the ICU., Materials and Methods: This comparative, randomized, triple-blind, clinical trial was conducted on 168 eligible ICU patients at Kosar Hospital in Semnan, Iran, during 2021-2022, who were divided into intervention and control groups using random blocks. The intervention group received clove extract mouthwash at 6.66% concentration, and the control group received chlorhexidine 0.2% twice a day for 5 days (routine care). Data were collected using a demographic questionnaire, and disease severity was measured based on the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, oral health status was examined using the Beck Oral Assessment Scale (BOAS), and VAP diagnosis was made based on the Modified Clinical Pulmonary Infection Score (MCPIS)., Results: Before the intervention, there was no significant difference in disease severity (p = 0.412) and oral health status (p = 0.239) between the patients in the two groups. After the intervention, 20.2% of the patients in the intervention group and 41.7% of those in the control group acquired VAP. The risk of VAP was 2.06 times higher in the control group than in the intervention group (p = 0.005, 95% CI: 1.26-3.37, RR = 2.06), but the severity of VAP did not differ significantly between the patients in the two groups (p = 0.557)., Conclusion: The findings showed that clove mouthwash reduces the incidence of VAP significantly., Clinical Relevance: Clove mouthwash can be used as a simple and low-cost method to prevent VAP in ICU patients., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this clinical observational study was to assess the efficacy of L-PRF as a hemostatic agent in patients under treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs)., Materials and Methods: Patients under oral anticoagulant therapy (VKA or DOACs) who needed a single simple tooth extraction were enrolled. L-PRF plug was positioned inside the alveolus and secured with non-absorbable sutures. Surgical time, pain-VAS, paracetamol intake, intra-operative, post-operative biological complications, and bleeding events have been registered., Results: A total of 112 patients (59 patients for DOAC and 53 for VKA group) were enrolled. Post-operative bleeding was recorded in nine patients (17%) for VKA group and nine patients (15.3%) for DOACs group. None of the patients needed a medical support for managing of bleeding. Seven days after surgery, no cases of post-extractive complications occurred., Conclusions: The use of L-PRF resulted in limited mild late post-operative bleedings without the need of medical intervention., Clinical Relevance: The use of L-PRF can be adopted for an uneventful post-operative curse in anticoagulated patients without chasing their therapy for single tooth extraction., (© 2023. The Author(s).)

Objective: Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time., Material and Methods: This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time., Results: About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90)., Conclusion: There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups., Clinical Relevance: The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To investigate the effect of layer height of FFF-printed models on aligner force transmission to a second maxillary premolar during buccal torquing, distalization, extrusion, and rotation using differing foil thicknesses., Materials and Methods: Utilizing OnyxCeph 3 ™ Lab (Image Instruments GmbH, Chemnitz, Germany, Release Version 3.2.185), the following movements were programmed for the second premolar: buccal torque (0.1-0.5 mm), distalization (0.1-0.4 mm), extrusion (0.1-0.4 mm), rotation (0.1-0.5 mm), and staging 0.1 mm. Via FFF, 91 maxillary models were printed for each staging at different layer heights (100 µm, 150 µm, 200 µm, 250 µm, 300 µm). Hence, 182 aligners, made of polyethylene terephthalate glycol (PET-G) with two thicknesses (0.5 mm and 0.75 mm), were prepared. The test setup comprised an acrylic maxillary model with the second premolar separated and mounted on a sensor, measuring initial forces and moments exerted by the aligners. A generalized linear model for the gamma distribution was applied, evaluating the significance of the factors layer height, type of movement, aligner thickness, and staging on aligner force transmission., Results: Foil thickness and staging were found to have a significant influence on forces delivered by aligners, whereas no significance was determined for layer height and type of movement. Nevertheless, at a layer height of 150 µm, the most appropriate force transmission was observed., Conclusions: Printing aligner models at particularly low layer heights leads to uneconomically high print time without perceptible better force delivery properties, whereas higher layer heights provoke higher unpredictability of forces due to scattering. A z-resolution of 150 µm appears ideal for in-office aligner production combining advantages of economic print time and optimal force transmission., (© 2023. The Author(s).)

Objectives: Similar to other dental specialties, there are many clinical procedures in restorative dentistry that may or may not be supported by good evidence. Thus, the effectiveness of these procedures is uncertain. The aim of this paper is to reduce this knowledge gap by critically inspecting selective procedures in restorative dentistry and exploring if these well-established or widely advocated treatment modalities are necessary for improving treatment outcomes based on the best available evidence., Materials and Methods: A MEDLINE search was conducted to identify research on selective procedures while focusing on clinical trials and systematic reviews. Due to their practical relevance in the decision-making process, cost-effectiveness analyses were also included., Results: Mixed results were identified regarding the included interventions. Some procedures had adequate evidence supporting them while others were mostly based on beliefs., Conclusions: A critical review of the available literature indicates that some common restorative procedures lack adequate support from high-quality research evidence., Clinical Relevance: This paper attempts to highlight the need to critically examine the scientific validity of traditional knowledge and techniques through the context of current research evidence. This will not only help generate consensus between educators, clinicians, and researchers regarding restorative procedures but will also lead to improved patient care and outcomes., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate the factors directly and indirectly associated with a cariogenic diet among southern Brazilian adolescents., Materials and Methods: This cross-sectional study included 15-19-year-old students attending high schools in Santa Maria, southern Brazil. The participants completed a questionnaire on sociodemographic and behavioral variables. The Oral Health Impact Profile-14 was applied to collect data on oral health-related quality of life (OHRQoL). Clinical examination was used to assess the dental caries status (decayed, missing, and filled teeth index). A cariogenic diet was considered a latent variable measured by the self-perception of a healthy diet and the frequency of consumption of sugary foods and drinks. Structural equation modeling was used to analyze the direct and indirect pathways to a cariogenic diet., Results: A total of 1197 adolescents were included. Low toothbrushing frequency (standardized coefficient (SC), 0.10; p < 0.05), cigarette smoking (SC, 0.15; p < 0.01), and alcoholic beverages (SC, 0.14; p < 0.01) were directly linked to a cariogenic diet, which, in turn, was directly linked to untreated dental caries (SC, 0.18; p < 0.01) and poor OHRQoL (SC, 0.16; p < 0.01). In addition, household income (via toothbrushing frequency) and age (via alcoholic beverages) were indirectly linked to a cariogenic diet., Conclusion: A cariogenic diet was consistently associated with a range of unhealthy behaviors during adolescence as well as poor household income., Clinical Relevance: Health promotion strategies to restrict sugar consumption and encourage healthier lifestyles should be aware of the synergism observed among unhealthy behaviors during adolescence., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aimed to determine the possible relationship between periodontal disease and ankylosing spondylitis (AS) by evaluating clinical periodontal measurements and gingival crevicular fluid (GCF) levels of sclerostin, interleukin-1β (IL-1ß), and matrix metalloproteinase-8 (MMP-8) levels., Materials and Methods: Twenty-eight patients with AS (AS group) and 28 systemically healthy controls (C group) were enrolled in this study. Full-mouth periodontal measurements: plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were obtained from all patients. AS-related parameters were included in the data analyses. An enzyme-linked immunosorbent assay determined GCF IL-1β, MMP-8, and sclerostin levels., Results: There were no significant differences in the clinical periodontal measurements between the two groups (p > 0.05). Interestingly, patients with AS had significantly lower GCF sclerostin levels than the C group (p < 0.05). But there were no statistical differences in the GCF levels of IL-1ß and MMP-8 between the two groups (p > 0.05). Serum C-reactive protein (CRP) levels strongly correlated with both BOP (r = 0.497, p < 0.05) and PPD (r = 0.570, p < 0.05) in the AS group. Bath AS Metrology Index (BASMI) also positively correlated with both BOP (r = 0.530, p < 0.05) and CAL (r = 0.568, p < 0.05). Similarly, Maastrıcht Ankylosing Spondylitis Enthesis Score (MASES) strongly correlated with both BOP (r = 0.487, p < 0.05) and CAL (r = 0.522, p < 0.05)., Conclusion: These results suggest that the patient's systemic condition may influence local sclerostin levels in GCF, and the strong correlations between periodontal measurements and AS-related parameters may indicate an interrelationship between inflammatory periodontal disease and AS., Clinical Relevance: The present study provides important information concerning the relationship between periodontal disease and ankylosing spondylitis., Trial Registration: Thai Clinical Trials.gov (TCTR20200908001) (08. September 2020)., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To investigate the effects of antiresorptive treatment on the survival of plateau-root form dental implants., Materials and Methods: Patients undergoing antiresorptive therapy via oral or intravenous administration as well as patients not undergoing antiresorptive therapy and healthy control patients were included in this retrospective cohort study. In total, 1472 implants placed in 631 postmenopausal patients (M: 66.42 ± 9.10 years old), who were followed for a period of up to 20 years (8.78 ± 5.68 years). Kaplan-Meier survival analysis was performed, and univariate and multivariate Cox regression, clustered by each patient, was used to evaluate and study factors affecting the survival of their implants., Results: Implants placed in patients undergoing oral antiresorptive treatment presented significantly higher survival rates, than implants placed in the osteoporosis/osteopenia control cohort (p value < 0.001), and similar survival rates, when compared to healthy controls (p value = 0.03). Additionally, clustered univariate and multivariate Cox regression analysis also revealed higher implant survival when oral antiresorptive drugs (p value = 0.01 and 0.007, respectively) were used, and lower implant survival in the presence of untreated osteoporosis/osteopenia (p value = 0.002 and 0.005, respectively). Overall, the 20-year implant survival in osteoporotic patients undergoing antiresorptive therapy was 94%. For the failed implants, newly replaced implants in patients under antiresorptive treatment presented a 10-year survival of 89%., Conclusions: Long-term plateau-root form implant survival in osteoporotic patients taking oral antiresorptives was similar to a healthy population and significantly higher than the untreated controls., Clinical Relevance: These results suggest that plateau-root form implants provide a robust solution for treating tooth loss in patients, who are undergoing antiresorptive therapy., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To perform a bibliometric analysis on silicate-based biomaterials in endodontics; to elucidate the evolution and distribution of scientific production regarding research on these biomaterials, the authors and institutions involved, and the most used descriptors/keywords in this field., Materials and Methods: A general advanced broad search was performed in Web of Science Core Collection, using the terms "Silicate" and "Endod*." By means of the "Analyze Results" and "Citation Analysis" tools from Web of Science, bibliometric data were extracted. Bibliometric networks on co-authorship and keyword co-occurrence were illustrated using VOSviewer software tool., Results: Research in the field of silicate-based endodontic materials in endodontics has followed an exponential crescent tendency over the period between 1995 and 2020. Two major co-authorship networks lead the research production in the field, headed by Gandolfi MG and Prati C, and Rodríguez-Lozano FJ and Forner L; respectively. "Mineral trioxide aggregate," "MTA", "Biocompatibility," "Biodentine," and "In vitro" were the terms with the highest occurrence. The modal study type in this research area are laboratory studies, representing 77.7% of the total number of records. The relationship between keywords illustrates the recent tendency to assess biological properties of MTA and Biodentine, which could be extrapolated to other silicate-based materials., Conclusions: The results from the present study highlight the exponential increase and distribution of scientific production on silicate-based materials in endodontics, along with the modal keywords used as descriptors and the major authorship networks involved. The predominance of laboratory studies in this research field reinforces the need for clinical studies, to extrapolate the reported performance and characteristics of silicate-based materials into the clinical setting., Clinical Relevance: The present study may aid the clinician's continuing education and evidence-based practice by providing knowledge and facilitating the literature search on the field of silicate-based biomaterials in endodontics., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This retrospective study aimed to comprehensively delineate the epidemiological and 3-dimensional radiographic characteristics of non-third molar (non-M3) impacted teeth in a Chinese dental population., Material and Methods: Patients with impacted teeth except for the third molar (ITEM3) were retrospectively screened via cone-beam CT images from 75,021 patients treated at our institution from June 2012 to December 2018. Demographic and clinical data of patients with ITEM3 were retrieved from medical records. CBCT coupled with 3-dimensional reconstruction was employed to characterize the radiographic features of ITEM3. Associations between these epidemiological, clinical, and radiographic features were further statistically analyzed., Results: Among 1975 eligible patients, 2467 ITEM3s were identified with a prevalence of 2.63% (1975/75,021). Females slightly outnumbered males with a ratio of 1.12:1. The majority of ITEM3 was single (1577, 79.85%) in the maxilla. The maxillary canine teeth were the most frequently impacted (52.45%), followed by maxillary incisors. The mesioangular position was the most common orientation (43.8%), followed by vertical and buccal-lingual orientations. The most frequently associated lesion was external root resorption of the adjacent tooth, which was significantly correlated with the morphology and position of the impacted tooth., Conclusion: Most ITEM3 was single, mesioangular, found at maxillary canines, sometimes associated with diverse complications. Our data advance the current understanding of ITEM3 and offer insights into the management of this dental abnormality., Clinical Relevance: These findings are useful for clinicians to comprehensively understand the prevalence, radiographic features, and complications of non-M3 impacted teeth., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Fractal analysis is a mathematical method used for the calculation of bone trabeculation and lacunarity. This study aims to evaluate the relationship between resonance frequency analysis (RFA) and fractal dimension (FD) of peri-implant bone to determine the preload stability of implants., Materials and Methods: In this study, the results of the fractal analysis calculated from the resonance frequency analysis results taken in the 3rd month of the patients who underwent 2-stage implant by the same doctor and the radiographs taken in the same session were evaluated. A hundred implants in 20 patients were applied in this study. The implant stability quotient (ISQ) values of the implants and fractal dimension values of the peri-implant bone were calculated., Results: The findings showed that the ISQ1 (p = 0.008), ISQ2 (p = 0.038), ROI2 (p = 0.013), and ROI3 (p < 0.001) values were statistically significantly higher in men than women. The ISQ1 (p = 0.003), ISQ2 (p = 0.013), ROI1 (p = 0.011), and ROI3 (p < 0.001) of the mandible were statistically higher than the maxilla. The fractal dimension cut-off value to assess prosthetic loading was found 1.198., Conclusion: Fractal analysis is a non-invasive method that can be used in conjunction with clinical examination in the prosthetic loading decision of implants. It is a valuable parameter that can be used without the need for an extra device when it is necessary to reduce the clinical study time., Clinical Relevance: Calculating the fractal dimension of the peri-implant bone is a practical, economical, and applicable method for clinicians. FD calculated from panoramic radiographs used for diagnosis in routine treatments in clinics where access to the necessary devices for ISQ measurement is not available will contribute to clinical practice., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aimed to evaluate a digital multi-piece zirconia post-crown to restore a mandibular second molar with extensive coronal loss and limited restoration space, and to compare the stress distribution between endocrowns made of zirconia or alloy and CAD/CAM multi-piece zirconia post-crowns., Material and Methods: Four three-dimensional finite element analysis models of a mandibular second molar with extensive coronal loss and limited restoration space were created as follows: (A) intact molar; (B) zirconia endocrown restored molar; (C) multi-piece post-crown restored-molar with tapered nail; (D) multi-piece post-crown restored molar with T-shaped nail. Models C and D were divided into two subgroups according to the material type: C1/D1, zirconia; C2/D2, NiCr alloy. The maximum modified von Mises failure criterion (mvM) stresses were calculated, and the stress distribution was recorded to analyze the effects of the restoration and material types on the biomechanical properties of dentin and prosthesis., Results: The maximum mvM stress of dentin in model B (33.80 MPa) was lower compared with models C (C1, 37.81 MPa; C2, 36.36 MPa) and D (D1, 36.34 MPa; D2, 34.97 MPa) under vertical load, but the opposite was observed under oblique load. The highest mvM stress was concentrated in the nail region located in the root canal, and the T-shaped nail values were greater than the tapered nail, whereas model D with T-shaped nail showed a lower mvM stress level in dentin compared with Model C with tapered nail., Conclusions: The digital multi-piece zirconia post-crown is a potential approach to restore mandibular second molars with extensive coronal loss and limited restoration space., Clinical Relevance: The digital multi-piece zirconia post-crown has potential to restore mandibular second molars with extensive coronal loss and limited restoration space using an innovative approach., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Dental treatments are inherently associated with the appearance of potentially infective aerosols, blood and saliva splashes. The aim of the present study was to investigate the quantitative contamination of protective eyewear during different dental treatments and the efficacy of the subsequent disinfection., Materials and Methods: Fifty-three standardized protective eyewear shields worn by students, dentists and dental assistants during different aerosol-producing dental treatment modalities (supragingival cleaning, subgingival periodontal instrumentation, trepanation and root canal treatment and carious cavity preparation; within all treatments, dental evacuation systems were used) were analysed, using common forensic techniques. For detection of blood contamination, luminol solution was applied onto the surface of safety shields. A special forensic test paper was used to visualize saliva contamination. Further analysis was conducted after standardized disinfection using the same techniques. Statistical analysis was performed using SPSS., Results: Macroscopically detectable contamination was found on 60.4% of protective eyewear surfaces. A contamination with blood (median 330 pixels, equivalent to 0.3% of the total surface) was detected on all shields after dental treatment. Between various dental treatments, the contamination with blood tend to be statistically significant (p = 0.054). Highest amount of blood was observed after professional tooth cleaning (median 1,087 pixels). Significant differences of saliva contamination were detected between the different measurements (p < 0.001) with contamination only after dental treatment. Due to the low variance and right-skewed distribution for saliva contamination, no statistical analysis between different treatments could be performed. After disinfection, 0.02% blood contamination and no saliva contamination were detected., Conclusions: Disinfection is effective against blood and saliva contamination. Macroscopically, clean protective eyewear contains up to 12% surface contamination with blood. Based on the results, it may be concluded that protective eyewear is essential for each dental practitioner., Clinical Relevance: As standard for infection prevention in the dental practice, disinfection of protective eyewear after each patient is necessary., (© 2022. The Author(s).)

Objectives: Screw-retained restoration of implants is advantageous for biological and esthetic reasons. Due to buccal concavities, however, this preferred type of restoration can only be used in about half of the anterior indications. Based on case series, an optimized method for the treatment of such indications is to be described; the clinical reliability is to be ascertained by means of measurements (before and after augmentation) and assigned to the current literature., Material and Methods: A case series of seven cases with buccal concavities of the anterior alveolar ridge were treated with optimized method, which is presented step-by-step until the prosthetic restoration. The depths of the bone concavities were measured and related to the bone gain after augmentation procedure respectively after implantation., Results: Linear measurements of the buccal concavities showed an average undercut of 4 mm [SD ± 1.13]. After healing period of six months, the buccal concavities could be compensated bony to such an extent that implants could be inserted in correct position and angulation. On average, there was a horizontal bone gain of 3.7 mm [SD ± 0.59]. Even after implantation and another six months of healing, stable bone dimensions could be assumed with an average of 4.3 [SD ± 0.83] mm of bone gain compared to baseline. In six of the seven cases, the favorite screw-retained, one-piece full-ceramic restoration could be fixed on the implants. Due to the implant axis, one case had to be treated with a cemented two-part full-ceramic system., Conclusions: With the described optimized method the most favorable screw-retained restoration can also be used in situations with unfavorable concavities of buccal bone. Especially for this indication, a special form of the horizontal deficit, the customized bone regeneration with titanium meshes is highly reliable in terms of healing and extent of augmentation. However, long-term results and a study/control group are required to evaluate the effectiveness of the presented protocol., Clinical Relevance: Since these situations require an augmentation that is up to 5 mm thick and a procedure that is as minimally invasive as possible appears to be necessary in the visible area, an optimized method is described in this publication., (© 2022. The Author(s).)

Objectives: The aim of this prospective, randomized, double-blind, controlled clinical study was to evaluate the analgesic effect of ibuprofen versus diclofenac plus orphenadrine on postoperative pain in orthognathic surgery., Material and Methods: Patients who underwent orthognathic surgery were randomized into two groups to receive intravenously either 600 mg of ibuprofen (I-group) or 75 mg diclofenac plus 30 mg orphenadrine (D-group), both of which were given twice daily. Additionally, both groups were given metamizole 500 mg. Rescue pain medication consisted of acetaminophen 1000 mg and piritramide 7.5 mg as needed. To assess the pain intensity, the primary end point was the numeric rating scale (NRS) recorded over the course of the hospital stay three times daily for 3 days., Results: One hundred nine patients were enrolled (age range, 18 to 61 years) between May 2019 and November 2020. Forty-eight bilateral sagittal split osteotomies (BSSO) and 51 bimaxillary osteotomies (BIMAX) were performed. Surgical subgroup analysis found a significant higher mean NRS (2.73 vs.1.23) in the BIMAX D-group vs. I-group (p = 0.015) on the third postoperative day. Additionally, as the patient's body mass index (BMI) increased, the mean NRS (r = 0.517, p = 0.001) also increased. No differences were found between age, gender, length of hospital stay, weight, operating times, number of patients with complete pain relief, acetaminophen or piritramide intake, and NRS values. No adverse events were observed., Conclusion: The results of this study demonstrate that ibuprofen administration and lower BMI were associated with less pain for patients who underwent bimaxillary osteotomy on the third postoperative day. Therefore, surgeons may prefer ibuprofen for more effective pain relief after orthognathic surgery., Clinical Relevance: Ibuprofen differs from diclofenac plus orphenadrine in class and is a powerful analgetic after orthognathic surgery., (© 2022. The Author(s).)

Objectives: To estimate the economic costs of oral lichen planus (OLP) through a multicenter university hospital-based outpatient study conducted in Italy and Finland., Materials and Methods: A multicenter retrospective study was conducted on patients affected by OLP to evaluate the economic cost of managing the disease. Direct costs concerning diagnostic procedures, therapeutic management, and follow-up visits were obtained from clinical records. Statistics was performed with IBM SPSS Statistics., Results: One hundred and eight patients with a confirmed diagnosis of OLP (81 women and 27 men), 58 Italians and 50 Finnish, were enrolled in this study. The mean annual cost was 1087.2 euros per patient. The mean annual cost was higher in Finnish than in Italian cohort (1558.7 euros vs. 680.7 euros-p < 0.05). Within the Italian cohort, the local immunosuppressive therapy group and atrophic and erosive OLP type had a higher cost (p < 0.05). Within the Finnish cohort, the local immunosuppressive therapy group had a higher cost (p < 0.05)., Conclusions: OLP-related costs are very similar to other chronic oral disorders (i.e., periodontitis) with differences between investigated countries. Moreover, patients with more severe clinical features, who need immunosuppressive therapy, are facing more expensive costs., Clinical Relevance: In this multicenter cost of illness study, we estimated the direct health care costs of OLP and we found that patients with more severe clinical features, who therefore need symptomatic therapy, are facing more expensive costs., (© 2022. The Author(s).)

Background: The objective of this systematic review and meta-analysis (SRM) was to assess the evidence between the association of oral lichen planus and periodontal disease, evaluating the periodontal clinical parameters and biomarkers levels., Methods: This systematic review and meta-analysis followed PRISMA and was registered in PROSPERO (CRD42020181513). Searches were accomplished in databases for articles published until June 2021. The meta-analysis was performed with the variables: plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). The mean difference was applied with a 95% confidence interval., Results: Six articles were included. Qualitative analysis showed the levels of biomarkers (matrix metalloproteinases, interleukins, and periodontal microbiological profile) are increased in subjects with periodontal disease and oral lichen planus. In the meta-analysis, these subjects also presented increases in all periodontal clinical parameters evaluated: GI-gingivitis 0.22 [0.14, 0.31] p < 0.0001 and periodontitis 0.12 [0.06, 0.19] p = 0.0003; PI-gingivitis 0.22 [0.12, 0.31] p < 0.0001 and periodontitis 0.15 [0.08, 0.23] p < 0.0001; PD-gingivitis 0.27 [0.06; 0.48] p = 0.0107 and periodontitis 0.11 [0.01; 0.21] p = 0.0299; and CA-periodontitis 0.06 [0.01, 0.12] p = 0.0176., Conclusions: Evidence suggests a significant relationship between the severity of periodontal disease and the presence of oral lichen planus. Although the association is biologically plausible, further studies are needed using populations and well-defined biochemical and clinical outcomes with consideration of potential confounding factors., Clinical Relevance: This SRM provides information on the interaction between OLP and periodontal disease and guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Dentistry is stuck between the one-size-fits-all approach towards diagnostics and therapy employed for a century and the era of stratified medicine. The present review presents the concept of precision dentistry, i.e., the next step beyond stratification into risk groups, and lays out where we stand, but also what challenges we have ahead for precision dentistry to come true., Material and Methods: Narrative literature review., Results: Current approaches for enabling more precise diagnostics and therapies focus on stratification of individuals using clinical or social risk factors or indicators. Most research in dentistry does not focus on predictions - the key for precision dentistry - but on associations. We critically discuss why both approaches (focus on a limited number of risk factors or indicators and on associations) are insufficient and elaborate on what we think may allow to overcome the status quo., Conclusions: Leveraging more diverse and broad data stemming from routine or unusual sources via advanced data analytics and testing the resulting prediction models rigorously may allow further steps towards more precise oral and dental care., Clinical Significance: Precision dentistry refers to tailoring diagnostics and therapy to an individual; it builds on modelling, prediction making and rigorous testing. Most studies in the dental domain focus on showing associations, and do not attempt to make any predictions. Moreover, the datasets used are narrow and usually collected purposively following a clinical reasoning. Opening routine data silos and involving uncommon data sources to harvest broad data and leverage them using advanced analytics could facilitate precision dentistry., (© 2022. The Author(s).)

Objectives: While risk factors of bisphosphonate (BP) associated osteonecrosis of the jaw have been properly analyzed, studies focusing on risk factors associated with denosumab (DNO) are sparse. The purpose of this study was to identify risk factors influencing the onset of medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive treatment (ART) with DNO by comparing patients suffering from MRONJ and patients without MRONJ. Multiple variables were evaluated including the impact of a previous BP intake., Materials and Methods: A retrospective single-center cohort study with patients receiving DNO was conducted. One-hundred twenty-eight patients were included and divided into three groups: I (control, n = 40) receiving DNO with absence of MRONJ; group II (Test 1, n = 46), receiving DNO with presence of MRONJ; and group III (Test 2, n = 42) sequentially receiving BP and DNO with presence of MRONJ. Patients' medical history, focusing on the identification of MRONJ risk factors, was collected and evaluated. Parameters were sex, age, smoking habit, alcohol consumption, underlying disease (cancer type, osteoporosis), internal diseases, additional chemo/hormonal therapy, oral inflammation, and trauma., Results: The following risk factors were identified to increase MRONJ onset significantly in patients treated with DNO: chemo/hormonal therapy (p = 0.02), DNO dosage (p < 0.01), breast cancer (p = 0.03), intake of corticosteroids (p = 0.04), hypertension (p = 0.02), diabetes mellitus (p = 0.04), periodontal disease (p = 0.03), apical ostitis (p = 0.02), and denture use (p = 0.02). A medication switch did not affect MRONJ development (p = 0.86)., Conclusions: Malignant diseases, additional chemotherapy, DNO dosage, and oral inflammations as well as diabetes mellitus and hypertension influence MRONJ onset in patients treated with DNO significantly., Clinical Relevance: Patients receiving ART with DNO featuring aforementioned risk factors have a higher risk of MRONJ onset. These patients need a sound and regular prophylaxis in order to prevent the onset of MRONJ under DNO treatment., (© 2021. The Author(s).)

Objective: To determine the usefulness of Serum C-terminal telopeptide cross-link of type 1 collagen (sCTX) as a preoperative marker for predicting the risk of developing medication-related osteonecrosis of the jaws (MRONJ) after invasive oral surgery in patients on antiresorptive medication., Materials and Methods: Two authors independently searched four electronic databases up to March 25, 2021, for case-control studies and prospective and retrospective cohort studies that assessed preoperative sCTX levels in patients taking antiresorptive medication who underwent oral surgery procedures. The main outcome was the number of MRONJ cases in patients with an sCTX value lower and higher than 150 pg/mL. Qualitative and quantitative data was extracted in tables and the risk of bias was assessed using the QUADAS-2 tool. Estimates of diagnostic accuracy were expressed as sensitivity, specificity, negative and positive likelihood ratio (LR - and LR +), and diagnostic odds ratio (DOR), with a 95% confidence interval (95%CI). The data were combined using random-effects models based on the inverse variance method., Results: Seven studies were included in the meta-analysis. The results were as follows: sensitivity 57% (95%CI: 41-71%), specificity 72% (95%CI: 64-79%), LR + 2 (95%CI: 1.3-3.1), LR - 0.6 (95%CI: 0.4-0.9), and DOR 3.4 (95%CI: 1.5-7.7)., Conclusions: The low overall performance of sCTX indicates that this parameter is not suitable for predicting MRONJ risk in patients on antiresorptive medication who need an oral surgery procedure., Clinical Relevance: sCTX should not be considered a reliable preoperative marker to predict MRONJ development., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of this systematic review was to provide evidence related to the association between non-antiresorptive medications and MRONJ., Materials and Methods: The following three electronic databases were screened: PubMed, EMBASE, and Web of Science from December 2020 until April 2021. Two reviewers independently performed the study selection, data extraction, and quality assessment of the included studies. The Newcastle-Ottawa Scale (NOS) was used for assessing the risk of bias. A meta-analysis was performed for assessing the relationship between MRONJ and non-antiresorptive medications., Results: The search strategy retrieved 996 articles. Following removal of duplicates, title, and abstract screening and full-text reading, 58 publications were eligible to be included in the review. A total of 867 cases of MRONJ were included (33% female, 55% male, 12% no gender reported). The mean age of the patients when MRONJ was diagnosed was 61 years (range 19-100 years) and the average time of diagnosis was 10 months following non-antiresorptive drug therapy. Patients with a history of corticosteroids (0.61, 95% CI 0.39, 0.82, p =  < 0.001) and chemotherapy (0.59, 95% CI 0.51, 0.67, p =  < 0.001) showed the highest significant effect size (ED) compared to the control group for MRONJ occurrence., Conclusion: A significant association existed between MRONJ and non-antiresorptive drugs. However, considering limited evidence, findings should be interpreted with caution., Clinical Relevance: The non-antiresorptive drugs might allow the dentist to apply the principle of "drug holiday" following concurrence from the drug prescribing clinician., Prospero Registration Number: CRD42020173891., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)