Journal of Applied Oral Science
type: channel
description: Focus and Scope JAOS’s mission is to disseminate scientific and technological advances made by the dental and speech and hearing communities, respecting quality indicators in order to ensure their acceptability to researchers in the field. Its main objective is to publish the results of original research in the field of oral sciences, with an emphasis on dentistry, speech therapy and related areas. Submissions of case reports (including case series and clinical protocols) and short communications are not accepted by JAOS and review manuscripts (including systematic reviews) can only be sent at the invitation of the editor.
publisher: Universidade de São Paulo. Faculdade de Odontologia de Bauru
language: en
publication name: Journal of Applied Oral Science
issn: 1678-7757
copyright: Todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons do tipo atribuição CC-BY.
items: FOXO3a promotes odontoblast differentiation in human dental pulp cells in coordination with RUNX2
items: Comparison of the effects of two different wound dressing materials on wound healing in mucosal defects created in diabetic and healthy rats
items: Association of periodontitis stages with glycemic control in adults with and without type 2 diabetes mellitus: a cross-sectional study
items: Prevalence and factors associated with pulp stones: a systematic review with meta-analysis and meta-regression
items: Physicomechanical properties of PMMA denture base resins reinforced with nanofibers: a systematic review and meta-analysis
items: Curcumin-loaded chitosan thermosensitive hydrogel with sustained release for periodontal applications: an in vitro evaluation
items: Association between serum vitamin D3 levels and gingival crevicular fluid osteocalcin and N-terminal telopeptide levels in periodontal health and disease
items: Impact of local hyaluronic acid on early gingival wound healing and heat shock protein 47
items: Self-adhesive flowable resin composite for occluso-proximal restorations in primary teeth: restorative time and fracture resistance analysis
items: Implant placement accuracy using computer-guided surgical templates supported by bone and mucosa: an in vitro study
items: Synergistic growth, metabolic products, and matrix quantification in dual-species biofilms of oral pathogens
items: Lactobacillus sp. attenuates oral and hepatic alterations and decreases caspase-8 expression in ligature-induced periodontitis
items: The effect of physical activity on growth factor concentrations in platelet-rich fibrin: a cross-sectional study
items: Evaluation of the early effects of peptide-containing agents in sensitivity treatment regarding their structural, morphological, and elemental changes in dentin tissue and their penetration efficacy
items: Dynamics of oropharyngeal structures during respiration with the volume-altered tongue base of minipigs
items: Hormone therapy and psychosocial factors in menopausal women with painful TMD: a pilot cross-sectional study
items: Molecular alterations in MAPK/ERK, β-Catenin/Wnt, and PI3K/mTOR pathways in adenomatoid odontogenic tumor
items: Time-series trends and regional disparities in complete denture production in Brazil (2000–2023)
items: Expression of p53, Ki-67, sox-2, oct-4, and NANOG in the tongue and trachea of Swiss mice exposed to narghile smoke
items: Modulation of TLR4, hBD-2, and hBD-3 expression and hepatic tissue response by systemic probiotics in experimental apical periodontitis in rats
items: Systemic toxicity assessment of tissue conditioners modified with nystatin and chlorhexidine in a rat model of denture stomatitis
items: Salivary cotinine and S100A8/A9 levels in children exposed to environmental tobacco smoke
items: Polyphenol-functionalized silver nanoparticles promote differential remineralization and reinforcement of demineralized dentin
items: Statin-loaded carbonated hydroxyapatite nanoemulsion controls matrix metalloproteinase-1 activity to enhance post-orthodontic stability in rats
items: Comparison of root coverage by injectable-platelet rich fibrin in thick and thin phenotypes
items: Influence of impacted mandibular third molars on pathological changes on themselves and adjacent tissues across different age groups
items: Expression of caspase-8 in non-alcoholic fatty liver disease related to ligature-induced periodontitis in rats
items: Can angiotensin II affect the inflammatory response of human dental pulp cells in vitro?
items: Clinical and aesthetic outcomes of enamel matrix derivative and subepithelial connective tissue graft using the modified coronally advanced tunnel technique

FOXO3a promotes odontoblast differentiation in human dental pulp cells in coordination with RUNX2
type: item
description: Introduction Forkhead box O3a (FOXO3a) is a stress-responsive transcription factor involved in cellular differentiation across multiple tissues. However, its role in odontoblast differentiation and dentin matrix formation remains poorly defined. Objective This study investigated the functional involvement of FOXO3a in odontoblast differentiation and its association with key odontogenic regulators. Methodology Human dental pulp cells (HDPCs) were induced to undergo odontoblast differentiation in vitro. FOXO3a gene and protein expression patterns were examined during differentiation and in postnatal Sprague Dawley rat molars. Gain- and loss-of-function approaches assessed the role of FOXO3a in odontogenic differentiation. Odontoblast marker expression, alkaline phosphatase activity, and mineralized matrix formation were evaluated. RUNX2 transcriptional activity was analyzed using promoter reporter assays, and the interactions between FOXO3a and AKT signaling were examined through pharmacological modulation. Results FOXO3a expression increased during early odontoblast differentiation. FOXO3a silencing reduced odontogenic marker expression, including DSPP, DMP1, and RUNX2, and significantly attenuated mineralization, whereas FOXO3a overexpression enhanced these effects. FOXO3a increased RUNX2 transcriptional activity and cooperated with RUNX2 to regulate DSPP promoter activity. AKT activation partially rescued odontogenic marker expression in FOXO3a-silenced cells, supporting functional interplay between these pathways. Conclusions FOXO3a contributes to odontoblast differentiation by coordinating with RUNX2-associated transcriptional activity and interacting dynamically with AKT signaling. FOXO3a may represent a regulatory component of dentin matrix gene expression, relevant to regenerative endodontic applications.
subject: Original Articles
  topic: section
subject: FOXO3a
  topic: keywords
subject: Odontoblast differentiation
  topic: keywords
subject: RUNX2
  topic: keywords
subject: DSPP
  topic: keywords
subject: AKT signaling
  topic: keywords
subject: Human dental pulp cells
  topic: keywords
creator: Su-Kyung Son
creator: Jung-Sun Moon
creator: Na-Ri Jung
creator: Jee-Hae Kang
creator: Bin-Na Lee
creator: Min-Seok Kim
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-14
publication date: 2026-08-14
starting page: e20260114
ending page: e20260114
doi: 10.1590/1678-7765-2026-0114

Comparison of the effects of two different wound dressing materials on wound healing in mucosal defects created in diabetic and healthy rats
type: item
description: Introduction Diabetes mellitus impairs oral mucosal wound healing by prolonging inflammation and disrupting angiogenesis and growth factor regulation. Aim To evaluate the effects of Ora-Aid (TBM Corporation, Gwangju, Republic of Korea) and cyanoacrylate (GluStitch, City of Industry, CA, USA) on palatal wound healing in diabetic and healthy rats. Methodology A total of 146 male Wistar albino rats were used: 144 were divided into six groups: control (C), cyanoacrylate (CY), Ora-Aid (OA), diabetes (D), diabetes+cyanoacrylate (DCY), and diabetes+Ora-Aid (DOA) (n=24 each; 8 per time point), and 2 served as baseline controls. Diabetes was induced by intraperitoneal streptozotocin (STZ; Santa Cruz Biotechnology, Texas, USA) at 60 mg/kg. A 4-mm palatal excisional wound was created. Wound area was measured from photographs using ImageJ v1.54g (Wayne Rasband, National Institutes of Health, USA). Immunohistochemical analyses assessed vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), interleukin-10, and tumor necrosis factor-alpha. Data were analyzed using the Kruskal-Wallis test and Bonferroni-adjusted Mann-Whitney U tests. Statistical significance was evaluated based on adjusted p-values, with p<0.05 considered significant. Results In healthy rats, wound areas after cyanoacrylate and Ora-Aid were similar to controls. In diabetic rats, both wound dressings reduced wound area, particularly on day 14 [median (IQR): D, 0.33 (0.82); DCY, 0.27 (0.71); DOA, 0.09 (0.09); D vs DCY, p=0.037; D vs DOA, p=0.002]. Immunohistochemical analyses showed that Ora-Aid more pronouncedly affected VEGF expression in healthy groups and FGF expression in diabetic groups, whereas cyanoacrylate showed time-dependent effects on growth factors and inflammatory markers. Conclusion Ora-Aid and cyanoacrylate positively influenced oral mucosal wound healing under diabetic conditions. Ora-Aid more prominently supported the VEGF-related angiogenic response under healthy conditions and…
subject: Original Articles
  topic: section
subject: Wound healing
  topic: keywords
subject: Wound dressing
  topic: keywords
subject: Diabetes mellitus
  topic: keywords
subject: Rats
  topic: keywords
creator: Merve Yalçın
creator: Vildan Bostancı
creator: Özhan Karataş
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-14
publication date: 2026-08-14
starting page: e20260096
ending page: e20260096
doi: 10.1590/1678-7765-2026-0096

Association of periodontitis stages with glycemic control in adults with and without type 2 diabetes mellitus: a cross-sectional study
type: item
description: Objective: To investigate associations among periodontal parameters, glycated hemoglobin (HbA1c), and metabolic parameters in adults with and without type 2 diabetes mellitus (T2D). Methodology: A cross-sectional study included 74 adults diagnosed with periodontitis according to the current periodontal classification of 2018. Participants underwent a full-mouth periodontal examination, laboratory assessment, and Body Mass Index (BMI). Periodontitis was categorized into Stages I/II and Stages III/IV. HbA1c, lipid profile, high-sensitivity C-reactive protein (CRP), and insulin resistance (HOMA-IR) were assessed. Periodontal inflammatory burden was quantified using the Periodontal Inflamed Surface Area (PISA). Non-parametric tests and Spearman correlation analyses were performed, stratified by diabetes status (α=5%). Results: Individuals with advanced periodontitis (Stages III/IV) had significantly higher HbA1c levels (6.8% vs. 5.8%; p=0.007), higher triglyceride concentrations (142.0 vs. 100.5 mg/dL; p=0.016), and lower HDL-cholesterol levels (46.0 vs. 52.0 mg/dL; p=0.012) than those in Stages I/II. Poor glycemic control (HbA1c >8.5%) and T2D duration ≥10 years were significantly associated with advanced stages (p<0.05). No significant differences were observed for BMI, LDL, total cholesterol (TC), CRP, or HOMA-IR between groups. In adults with T2D, PISA correlated positively with TC and LDL-cholesterol, whereas in non-diabetic individuals, PISA was associated primarily with triglycerides. Conclusions: Advanced periodontitis was associated with poorer glycemic control and a more atherogenic lipid profile, particularly characterized by elevated triglycerides and reduced HDL-cholesterol. The findings support periodontitis as a potential marker of systemic metabolic dysregulation and reinforce the importance of integrating periodontal care into cardiometabolic risk management strategies.
subject: Original Articles
  topic: section
subject: Periodontitis
  topic: keywords
subject: Diabetes mellitus
  topic: keywords
subject: Glycated hemoglobin
  topic: keywords
subject: Dyslipidemia
  topic: keywords
creator: Maria Eduarda Oliveira Rodrigues
creator: Josy Lorena Peres da Silva Vilarinho
creator: João Gabriel Jucá Chermont
creator: Cristine Miron Stefani
creator: Valéria Martins de Araújo Carneiro
creator: Maria do Carmo Machado Guimarães
creator: Bruna Frizon Greggianin
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-07
publication date: 2026-08-07
starting page: e20260178
ending page: e20260178
doi: 10.1590/1678-7765-2026-0178

Prevalence and factors associated with pulp stones: a systematic review with meta-analysis and meta-regression
type: item
description: Introduction Pulp stones are radiopaque calcified masses located within the coronal or radicular pulp tissue. They are typically asymptomatic and detected incidentally on radiographic examination. Global prevalence estimates vary widely, and methodological inconsistencies across studies hinder a comprehensive understanding of their epidemiology. Therefore, this systematic review aimed to answer the following question: “What is the global prevalence of pulp stones, and what factors are associated with their occurrence?” Aim: To systematically review and synthesize the evidence on the global prevalence of pulp stones and to identify factors associated with their occurrence. Methodology Six electronic databases were searched up to March 2024. Data extraction included participant demographics, diagnostic methods, tooth type, and the presence of systemic diseases. Risk of bias was assessed using the JBI checklist, and prevalence was pooled using random-effects meta-analyses at individual and tooth levels. Meta-regression was performed to explore potential sources of heterogeneity, and the certainty of evidence was assessed using GRADE. Results Twenty-four studies comprising 10,738 individuals and 94,416 teeth met the inclusion criteria. Pulp stones were present in 46% of individuals and 20% of teeth, with substantial heterogeneity across studies. Meta-regression identified systemic conditions and tooth type as significant contributors to prevalence variability. Individuals with both cardiovascular and renal diseases exhibited a higher prevalence (β=0.31, p=0.04), whereas those with cardiovascular diseases alone showed a lower prevalence (β=-0.33, p=0.04) than healthy participants (R2= 26.0). Risk of bias was moderate in most studies, and the overall certainty of evidence was very low. Conclusion Pulp stones are highly prevalent, and their occurrence may be influenced by systemic conditions and tooth-related factors. However, these findings are based on very-low-certainty…
subject: Systematic Review
  topic: section
subject: Dental pulp calcification
  topic: keywords
subject: Meta-analysis
  topic: keywords
subject: Prevalence
  topic: keywords
subject: Pulp stones
  topic: keywords
subject: Systematic review
  topic: keywords
creator: Yasmin Alves Sanches
creator: Theodoro Weissheimer
creator: Alex Nogueira Haas
creator: Ricardo Abreu da Rosa
creator: Gabriel Barcelos Só
creator: Marcus Vinicius Reis Só
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: e20260252
ending page: e20260252
doi: 10.1590/1678-7765-2026-0252

Physicomechanical properties of PMMA denture base resins reinforced with nanofibers: a systematic review and meta-analysis
type: item
description: Despite the potential of nanofibers to reinforce poly(methyl methacrylate) (PMMA) denture base resins, no consensus exists regarding their effects on material properties. This systematic review and meta-analysis aimed to evaluate whether the incorporation of nanofibers into PMMA denture base resins improves flexural strength and other physicomechanical properties when compared with unmodified PMMA. Methodology: This study followed PRISMA guidelines and was registered on the Open Science Framework (<osf.io/3g9pn>). Searches were conducted on Medline/PubMed, Scopus, Cochrane Library, Web of Science, EMBASE, Lilacs, and SciELO. Eligibility criteria included in vitro or in vivo studies comparing nanofiber-reinforced PMMA to conventional PMMA. The meta-analysis was conducted for flexural strength (the only property assessed in all studies). A subgroup meta-analysis was performed to explore heterogeneity between studies. Results: From the 1,893 initially screened articles, six were included. The investigated nanofibers included carbon, acrylonitrile-butadiene-styrene, polyamide-6, polystyrene, cellulose, PMMA–cerium, and polyvinyl alcohol at concentrations from 0.1 to 23%. The evaluated properties included impact strength, flexural strength, fracture resistance, hardness, elasticity, toughness, surface roughness, contact angle, and spectrophotometric color analysis. While the qualitative analysis showed divergent findings regarding property improvement, the quantitative analysis revealed no significant differences in flexural strength between nanofiber-reinforced PMMA and conventional PMMA at the evaluated concentrations: PMMA vs. 0.5% PMMA (p=0.554), PMMA vs. 1% PMMA (p=0.847), PMMA vs. 3% PMMA (p=0.9825), and PMMA vs. 5% PMMA (p=0.222). However, subgroup analysis indicated higher flexural strength for the conventional PMMA when compared with nanofiber-reinforced PMMA, particularly at higher nanofiber concentrations (p<0.0001). Conclusion: Incorporating nanofibers into P…
subject: Original Articles
  topic: section
subject: Dentures
  topic: keywords
subject: Polymethyl methacrylate
  topic: keywords
subject: Acrylic resins
  topic: keywords
subject: Nanofibers
  topic: keywords
subject: Flexural strength
  topic: keywords
creator: Bianca Tavares Rangel
creator: Amanda Aparecida Maia Neves Garcia
creator: Carolina Yoshi Campos Sugio
creator: Vanessa Migliorini Urban
creator: Simone Soares
creator: Joel Ferreira Santiago Júnior
creator: André Ulisses Dantas Batista
creator: Karin Hermana Neppelenbroek
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: e20260076
ending page: e20260076
doi: 10.1590/1678-7765-2026-0076

Curcumin-loaded chitosan thermosensitive hydrogel with sustained release for periodontal applications: an in vitro evaluation
type: item
description: Objective: Thermosensitive hydrogels have emerged as promising localized drug delivery systems for periodontal therapy. Curcumin possesses anti-inflammatory and antimicrobial properties but is limited by its poor solubility and bioavailability. This study aimed to develop and evaluate a curcumin-loaded chitosan thermosensitive hydrogel for periodontal application. Methodology: This in vitro experimental study included five groups as positive controls, negative control, blank chitosan hydrogel, free curcumin, curcumin-loaded hydrogel, and chlorhexidine (0.12%). The hydrogel was formulated using chitosan and β-glycerophosphate and was characterized for thermosensitive gelation and injectability. Drug release was assessed using dialysis. Cytocompatibility was evaluated in human gingival fibroblasts (HGF-1) using the MTT assay at 24, 48, and 72 h. The anti-inflammatory activity was assessed by measuring the levels of TNF-α and IL-1β in LPS-stimulated cells. Antibacterial activity (MIC/MBC) and antibiofilm efficacy were tested against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Data were analyzed using ANOVA with the appropriate post-hoc tests (p<0.05). Results: The curcumin-loaded hydrogel showed high cell viability (>90%) and significantly reduced TNF-α and IL-1β levels when compared with free curcumin. It demonstrated improved antibiofilm activity (∼74–79%) and lower MIC values than free curcumin, although slightly less effective than chlorhexidine. A sustained drug release profile (∼81.6% at 14 days) following Korsmeyer–Peppas kinetics was observed. Conclusion: The curcumin-loaded chitosan thermosensitive hydrogel showed improved biological performance and sustained release when compared with free curcumin, suggesting its potential as a localized periodontal drug delivery system. Further in vivo studies are required to validate these findings.
subject: Original Articles
  topic: section
subject: Thermosensitive hydrogel
  topic: keywords
subject: Localized periodontal drug delivery
  topic: keywords
subject: Sustained-release biomaterials
  topic: keywords
subject: Antibiofilm activity
  topic: keywords
subject: Periodontitis
  topic: keywords
creator: Reema M Rao
creator: Monali Nikalje
creator: Shiprita Kumari
creator: Rahul Tiwari
creator: Kailash Chandra Dash
creator: Saurabh Shekhar
creator: Manish Sharma
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: e20260308
ending page: e20260308
doi: 10.1590/

Association between serum vitamin D3 levels and gingival crevicular fluid osteocalcin and N-terminal telopeptide levels in periodontal health and disease
type: item
description: Objectives: This study aimed to investigate the association between serum vitamin D3 levels and gingival crevicular fluid (GCF) osteocalcin and N-terminal telopeptide (NTx) levels in periodontally healthy patients and those living with periodontitis. Methodology: This study included 120 non-smoking males aged from 25 to 40 years (60 healthy patients and 60 with periodontitis). Each group was further subdivided into three subgroups according to serum 25-hydroxyvitamin D3 (25[OH]D3) levels: 0–10, 11–20, and 21–30 ng/mL. GCF samples were collected from the buccal sites of maxillary premolar or molar teeth. GCF osteocalcin and NTx levels were measured using enzyme-linked immunosorbent assay and statistically analyzed. Results: Total osteocalcin levels were significantly higher in healthy individuals than in those with periodontitis (p<0.001). The lowest osteocalcin levels were found in patients with periodontitis with 0–10 ng/mL vitamin D3 (p=0.001). Total NTx levels showed no significant differences between groups (p=0.148), but among healthy individuals, NTx decreased with increasing vitamin D3 (p=0.049). Conclusion: Patients with periodontitis and severe vitamin D3 deficiency showed the lowest GCF osteocalcin levels, suggesting that vitamin D3 deficiency may be associated with further alterations in local bone turnover activity in periodontal disease. Further studies are needed to explain these relationships. ClinicalTrials.gov (Trial ID: NCT06871631)
subject: Original Articles
  topic: section
subject: Vitamin D3
  topic: keywords
subject: Gingival crevicular fluid
  topic: keywords
subject: Osteocalcin
  topic: keywords
subject: N-terminal telopeptide
  topic: keywords
creator: Burcin Cevik
creator: Atanur Sarioglu
creator: Tugrul Kirtiloglu
creator: Bahattin Avci
creator: Leman Tomak
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: e20260009
ending page: e20260009
doi: 10.1590/

Impact of local hyaluronic acid on early gingival wound healing and heat shock protein 47
type: item
description: Hyaluronic acid (HA) is important for tissue repair, especially in oral soft tissue healing. Objective: This study aimed to evaluate the effect of HA on gingival healing and its relationship with heat shock protein 47 (HSP 47), which binds to procollagen. Methodology: 40 female Wistar albino rats were divided into two groups: a control (Group C) and an HA-treated group (Group H), each split into four subgroups for different time points (t1, t3, t7, t14 days). Excisional wounds were made in the palates of all rats. Group H received topical HA gel, whereas Group C received no treatment. HSP 47 levels were measured using enzyme-linked immunosorbent assay, and wound areas were analyzed with ImageJ. Results: No significant difference in HSP 47 levels was observed between groups (p>0.05). However, wound areas in Group C were significantly larger than in Group H on day 3 (p=0.009). HSP 47 levels increased in both groups, with higher values on day 1 (p=0.043). Wound areas decreased over time in both groups, with significant reduction in Group H from days 1 to 3 (p=0.043). Conclusion: Topical HA gel may accelerate early periodontal wound healing but failed to significantly affect HSP 47 levels.
subject: Original Articles
  topic: section
subject: Hyaluronic acid
  topic: keywords
subject: Heat shock protein 47
  topic: keywords
subject: Wound healing
  topic: keywords
subject: Gingiva
  topic: keywords
creator: Gizem Ceren Yiğit
creator: Feyza Otan Özden
creator: Özgür Korhan Tunçel
creator: Eser Çakmak
creator: Fikret Yilmaz
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-27
publication date: 2026-07-27
starting page: e20260091
ending page: e20260091
doi: 10.1590/1678-7765-2026-0091

Self-adhesive flowable resin composite for occluso-proximal restorations in primary teeth: restorative time and fracture resistance analysis
type: item
description: Restoring occluso-proximal cavities in primary molars is clinically challenging due to their anatomical characteristics and the difficulty of matrix adaptation. Although resin composites are widely used, their technique sensitivity has led to simpler alternatives, such as self-adhesive flowable composites, whose performance in primary teeth remains unclear. Objective: This in vitro study evaluated the restorative time and fracture resistance of occluso-proximal restorations in primary molars using a self-adhesive flowable resin composite, a flowable resin composite, and a conventional resin composite. Methodology: Thirty primary molars received two standardized occluso-proximal cavities and were randomly assigned to three groups (n=10): (1) self-adhesive flowable resin composite (Yflow SA), with the entire cavity restored; (2) universal adhesive (Scotchbond Universal) in self-etch mode + flowable resin composite (Filtek Z350 XT Flow), with the entire cavity restored; and (3) universal adhesive in self-etch mode + conventional resin composite (Filtek Z350 XT), inserted incrementally. Restoration time was measured using a digital chronometer, and all teeth underwent 14 days of pH cycling before the fracture resistance test. Mean fracture resistance values were analyzed using one-way ANOVA and Tukey's test. The Kruskal–Wallis and Dwass–Steel–Critchlow–Fligner tests were used to compare the restoration time among groups. Failure modes were analyzed descriptively. Results: The self-adhesive flowable resin composite required the shortest restoration time, followed by the flowable resin composite and the conventional resin composite (p<0.001). Fracture resistance was significantly lower in the self-adhesive flowable resin composite group compared to the flowable and conventional resin composite groups (p<0.01). Adhesive failures predominated in the self-adhesive flowable resin composite group (45%), while mixed failures were more frequent in the other restorative approache…
subject: Original Articles
  topic: section
creator: Tyler Zanella Brustolin
creator: Cleber Paradzinski Cavalheiro
creator: Duvan Cala Castillo
creator: Gabriel Kalil Rocha Pereira
creator: Tathiane Larissa Lenzi
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-27
publication date: 2026-07-27
starting page: e20260045
ending page: e20260045
doi: 10.1590/1678-7765-2026-0045

Implant placement accuracy using computer-guided surgical templates supported by bone and mucosa: an in vitro study
type: item
description: Computer-guided surgery, which combines tomographic data and digital models, has been widely used in implant dentistry to improve implant placement accuracy. Objective: This in vitro study evaluated the accuracy of virtual planning for single implant placement in the regions of teeth 33 and 43, comparing bone-supported and mucosa-supported guides. A secondary analysis assessed differences related to insertion method, since implant placement in the 43 region used a manual ratchet and in the 33 region used a motorized handpiece. Methodology: In total, 32 implants were placed in 16 edentulous artificial mandibles (8 using bone-supported guides and 8 using mucosa-supported guides), with two implants per mandible. Implant positions were assessed using computed tomography and compared with the virtual plan using ImageJ (2.16.0/1.54p) and OneViewerApp (version 1.18.0.0, 2023). Statistical analysis was performed on Jamovi (p<0.05). Linear deviations between the planned and actual implant placement were compared using t-test or the Mann-Whitney U test, depending on data distribution. Results: Results indicated greater deviations for mucosa-supported guides, especially in the buccolingual direction, whereas bone-supported guides exhibited greater accuracy. Conclusion: Within the limitations of this in vitro study, the type of guide support may influence implant placement accuracy and should be carefully considered, particularly in procedures requiring high precision. Further studies are needed to confirm these findings in clinical settings.
subject: Original Articles
  topic: section
subject: Dental Implants
  topic: keywords
subject: Surgery
  topic: keywords
subject: Computer-Assisted
  topic: keywords
subject: In vitro techniques
  topic: keywords
creator: Ana Maria Alves Ribeiro
creator: Déborah Rocha Seixas
creator: Eduardo Sanches Gonçalves
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: e20250926
ending page: e20250926
doi: 10.1590/1678-7765-2025-0926

Synergistic growth, metabolic products, and matrix quantification in dual-species biofilms of oral pathogens
type: item
description: Biofilms exhibit virulence traits that promote microbial protection, such as an extracellular matrix composed of exopolysaccharides (EPS), and contribute to host tissue damage via acid production. Objective This study evaluated bacterial viability, biovolume, matrix (β-polysaccharides), and EPS (α-polysaccharides) formation in monospecies and mixed biofilms of Streptococcus mutans and Enterococcus faecalis, as well as pH and lactic acid production. Methodology Biofilms were grown on dentin blocks for 7 days, and aliquots were collected for colony-forming unit (CFU/mL) counts. Subsequently, biofilms were stained with LIVE/DEAD®, Calcofluor White®, and Alexa Fluor 647–dextran conjugate® to assess bacterial viability, matrix formation, and EPS formation, respectively, using confocal laser scanning microscopy (CLSM). Lactic acid production was determined by enzymatic spectrophotometry, and the pH of the culture medium was measured using a pH meter. Kruskal–Wallis and Dunn’s tests were used for pH, viability, biovolume, matrix, and EPS analyses, while one-way ANOVA followed by Tukey’s test was applied for CFU/mL counts and lactic acid production (α = 0.05). Results Dual-species biofilms showed higher viability and biovolume than S. mutans monospecies biofilms (p < 0.05), whereas the other parameters did not differ among groups (p > 0.05). Conclusion Dual-species biofilms of S. mutans and E. faecalis may represent a suitable model for investigating antimicrobial strategies, as their association increased viability and biovolume, which are relevant features in cariology and endodontics.
subject: Original Articles
  topic: section
subject: Biofilms
  topic: keywords
subject: Dental caries
  topic: keywords
subject: Endodontics
  topic: keywords
subject: Enterococcus faecalis
  topic: keywords
subject: Extracellular polysaccharides
  topic: keywords
subject: Matrix
  topic: keywords
subject: Streptococcus mutans
  topic: keywords
creator: Evelyn Giuliana Velásquez-Espedilla
creator: Victor Feliz Pedrinha
creator: Maricel Rosario Cardenas Cuellar
creator: Pedro Luis Busto Rosim
creator: Daniela Alejandra Cusicanqui Méndez
creator: Thiago Cruvinel
creator: Flaviana Bombarda de Andrade
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-20
publication date: 2026-07-20
starting page: e2025
ending page: 0887
doi: 10.1590/1678-7765-2025-0887

Lactobacillus sp. attenuates oral and hepatic alterations and decreases caspase-8 expression in ligature-induced periodontitis
type: item
description: Background Periodontitis affects millions of people and is characterized by the accumulation of bacteria in the gingival sulcus with an immune-inflammatory response of the body causing effects. There is a notable relation between periodontitis and steatosis, in which caspase-8 may be a relevant player in the pathophysiology of these conditions. This study is the first to investigate the effect of treatment based on Lactobacillus sp. on steatosis and caspase-8 expression in a ligature-induced periodontitis model. This study aims to investigate whether treatment with Lactobacillus sp. reduces oral and hepatic changes caused by ligature-induced periodontitis. Methodology Twenty-four Wistar rats were separated into groups: control, periodontitis, and periodontitis plus Lactobacillus sp. Administration of 1 mL of fermented milk containing 108 CFU/mL of Lactobacillus sp. by gavage was performed daily for 20 days of ligature-induced periodontitis. After the treatment, we evaluated the gingival bleeding index (GBI), tooth mobility, probing pocket depth (PPD), alveolar bone loss, histomorphometry, and histopathological aspects of liver, as well as the levels of glutathione (GSH), malondialdehyde (MDA) and myeloperoxidase (MPO). We also evaluated caspase-8-positive cells and blood biomarkers. Results Lactobacillus sp. reduced inflammatory clinical parameters, including GBI, PPD, and tooth mobility, as well as neutrophil infiltration in gingival tissue. Morphometric analysis showed significantly less alveolar bone loss. Analysis of hepatic tissue showed reduced neutrophilic infiltration and improved antioxidant activity. Treatment also decreased caspase-8 expression. Conclusions Lactobacillus sp. significantly reduced the clinical parameters of periodontal lesion and steatosis score, improved hepatic oxidative status, and decreased caspase-8 expression in the liver tissue.
subject: Original Articles
  topic: section
subject: Anti-Inflammatory agents
  topic: keywords
subject: Antioxidants
  topic: keywords
subject: Fatty Liver
  topic: keywords
subject: Periodontal diseases
  topic: keywords
creator: Victor Lucas Ribeiro Lopes
creator: Even Herlany Pereira Alves
creator: Alan Leandro Farias de Carvalho
creator: Vinícius da Silva Caetano
creator: Hélio Mateus Silva Nascimento
creator: Maria Vitoria Pereira de Sousa
creator: Paulo Roberto Carneiro Gomes
creator: Any Carolina Cardoso Guimarães Vasconcelos
creator: André Luiz dos Reis Barbosa
creator: Daniel Fernando Pereira Vasconcelos
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-17
publication date: 2026-07-17
starting page: e2026
ending page: 0143
doi: 10.1590/1678-7765-2026-0143

The effect of physical activity on growth factor concentrations in platelet-rich fibrin: a cross-sectional study
type: item
description: Objective This study investigated the impact of physical activity levels on growth factor concentrations within leukocyte- and platelet-rich fibrin (L-PRF). Methodology In total, 120 participants were categorized into sedentary (n=60) and physically active (n=60) groups via the International Physical Activity Questionnaire. Venous blood was collected to analyze platelet count, mean platelet volume, white blood cell count, red blood cell count, plateletcrit, platelet distribution width, and platelet-large cell ratio, and to prepare the L-PRF. Concentrations of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), and platelet-derived growth factor (PDGF) were determined using ELISA. Results Metabolic equivalent of task (MET) values were significantly higher in the active group (p<0.001). Conversely, VEGF, TGF-β, and PDGF levels were significantly higher in the sedentary group (p<0.001). Hemoglobin and hematocrit values were also significantly higher in active individuals (p=0.025 and p=0.040, respectively). A significant moderate negative correlation was found between MET values and concentrations of VEGF, TGF-β, and PDGF (r=−0.33, r=−0.33, and r=−0.31, respectively; p<0.01). Multivariable linear regression analyses, adjusted for sex, periodontal parameters, and hematological variables, confirmed that Total MET constituted an independent negative predictor of all growth factors (all p<0.001), whereas periodontal indices showed no significant independent associations. Sex-stratified analyses and interaction models showed that the association between physical activity and growth factor levels was significantly sex dependent (MET × sex interaction: all p<0.05), with stronger effects in women. Conclusions Physical activity seems to be associated with variations in growth factor levels in L-PRF, suggesting that individual physiological status may influence the biological composition of autologous platelet concentrates.
subject: Original Articles
  topic: section
subject: International physical activity questionnaire
  topic: keywords
subject: Growth factors
  topic: keywords
subject: Physical activity
  topic: keywords
subject: PRF
  topic: keywords
subject: Platelets
  topic: keywords
creator: Elif Yucel
creator: Meltem Karsiyaka Hendek
creator: Hakan Yapici
creator: Mehmet Gulu
creator: Osman Caglayan
creator: Ebru Olgun
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-17
publication date: 2026-07-17
starting page: e20260128
ending page: e20260128
doi: 10.1590/

Evaluation of the early effects of peptide-containing agents in sensitivity treatment regarding their structural, morphological, and elemental changes in dentin tissue and their penetration efficacy
type: item
description: Purpose This study aimed to evaluate the effects of various therapeutic agents on dentin tissue in the management of dentin hypersensitivity. Methodology Overall, 30 caries-free human third molars were sectioned into dentin specimens (n=120) and randomly assigned to control or treatment groups (Curodont™ D’Senz, PRG Barrier Coat, and Curodont™ Repair). After 24 h of artificial saliva storage, dentin microhardness, surface morphology, open dentin tubule count, elemental composition, and penetration depth were evaluated using Vickers microhardness testing, SEM/EDS, and CLSM. Statistical analyses were conducted with a 0.05 significance level. Results The microhardness measurements showed a statistically significant increase in all groups in comparison with the control group (p<0.05), with no significant differences between the treated groups (p>0.05). EDS analysis showed statistically significant differences between the groups, with the highest calcium and phosphorus levels observed in the PRG Barrier Coat group (p<0.05). SEM analysis showed that the PRG Barrier Coat treatment resulted in the most extensive tubule occlusion and the smallest open tubule diameters (p<0.05). Curodont™ D'Senz and PRG Barrier Coat showed the most significant tubule penetration depths and the highest laser fluorescence values, as per CLSM analyses (p<0.001). Conclusion The findings suggested that the tested materials may occlude dentinal tubules and penetrate dentin to varying extents, with PRG Barrier Coat showing the most pronounced effect. Self-assembling peptide-based agents show limited short-term efficacy but offer potential for biomimetic remineralization.
subject: Original Articles
  topic: section
subject: Dentin hypersensitivity
  topic: keywords
subject: Biofunctional materials
  topic: keywords
subject: Self-assembling peptides
  topic: keywords
subject: SPRG
  topic: keywords
creator: Tugba Ozdemir
creator: Selcuk Savas
creator: Ebru Kucukyilmaz Izgi
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-17
publication date: 2026-07-17
starting page: e20260127
ending page: e20260127
doi: 10.1590/1678-7765-2026-0127

Dynamics of oropharyngeal structures during respiration with the volume-altered tongue base of minipigs
type: item
description: Objective This study aimed to analyze the functional adaptations of tongue base volumetric enlargement and reduction on the kinematics of oropharyngeal structures during respiration in a minipig model. Methodology Six same-sex sibling pairs of 8-to-9-month-old Yucatan minipigs were studied. Of each pair, one was diet-induced obese with a BMI>50 (obesity-associated volume enlargement) while the other was normal-weight and underwent partial ablation of the tongue base volume (volume-reduction). Real-time X-ray video fluoroscopic images (30 frames/s) were recorded under sedation, at baseline (before surgery) and 5 weeks postoperatively. Selected landmarks of the soft palate, epiglottis, tongue base, and pharyngeal wall were digitized frame by frame for 25–30 respiratory cycles. Directional movements and distance changes of these oropharyngeal structures were analyzed within the defined coordinate system using video-analysis software. Correlations between areas of airway spaces during respiration and biometric measurements of the dissected tongue at week 5 were included. Results During respiratory phases, movement distances of the soft palate and the pharyngeal wall were significantly larger in the volume-reduced group than in the volume-enlarged group at baseline (p<0.05). These moving distances were also larger compared to those of the volume-enlarged group at both time points. Similarly, distance changes during inspiration between structures (soft palate-pharyngeal wall, soft palate-tongue base, and epiglottis-pharyngeal wall) were significantly larger at week 5 than at baseline (p<0.05) in both groups. Positive correlations during respiratory phases were detected between tongue volume and velopharyngeal width in the volume-reduced group (r=0.86, p<0.05). Negative correlations occurred between retromolar space area and tongue thickness in the volume-enlarged group (r=−0.9, p<0.05). Conclusions These results suggest that oropharyngeal spatial dynamics are enhanced in …
subject: Original Articles
  topic: section
subject: Oropharynx
  topic: keywords
subject: Tongue Base
  topic: keywords
subject: Videofluoroscopy
  topic: keywords
subject: Respiration
  topic: keywords
subject: Minipig
  topic: keywords
creator: Nino Geradze
creator: Doris Haydee Rosero Salazar
creator: Phuc Hoang Nguyen
creator: Zi-Jun Liu
rights: Copyright (c) 2026 Nino Geradze, Doris Haydee Rosero Salazar, Phuc Hoang Nguyen, Zi-Jun Liu https://creativecommons.org/licenses/by/4.0
date: 2026-07-17
publication date: 2026-07-17
starting page: e2025
ending page: 0722
doi: 10.1590/1678-7765-2025-0722

Hormone therapy and psychosocial factors in menopausal women with painful TMD: a pilot cross-sectional study
type: item
description: Introduction: Temporomandibular Disorder (TMD) is a musculoskeletal condition prevalent in women, especially during menopause. This phase of life is marked by decreased estrogen levels, which can exacerbate pain and psychosocial symptoms. Objective: This study aimed to evaluate the association between menopause with and without hormone replacement therapy, grade of chronic pain, jaw functional limitations, and symptoms of anxiety and depression in women with painful TMD. Methodology: This exploratory cross-sectional study was conducted with 45 women diagnosed with painful TMD, divided into three groups: women with regular menstrual cycles (RMC, n=15), women in menopause without hormone replacement therapy (M, n=14), and women in menopause with hormone replacement therapy (MWH, n=16). The evaluation was conducted using the following instruments: the Graded Chronic Pain Scale (GCPS-2), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Jaw Functional Limitation Scale (JFLS-8), and the Pain Catastrophizing Scale (B-PCS). The data were analyzed descriptively using Jamovi software (version 2.3.21). Analysis of variance (ANOVA) was performed, followed by multivariate analysis of covariance (MANOVA). Tukey's post-hoc test was used to identify differences between groups. The significance level adopted for all analyses was 5%. Results: The mean age of participants was 50.0 years (±13.7). The overlap between muscle and joint disorders was most prevalent among the groups. The interference score was significantly lower in the MWH group (p=0.003), as was also the case with depressive symptoms (p<0.001) and anxious symptoms (p=0.012). Conclusion: The findings highlight the association between menopause, especially with hormone replacement therapy, and emotional and psychosocial aspects related to pain, with lower scores for interference with daily activities, depression, anxiety, and fewer catastrophic thoughts about pain.
subject: Original Articles
  topic: section
subject: Menopause.
  topic: keywords
subject: Temporomandibular joint dysfunction syndrome
  topic: keywords
subject: Psychosocial effects of the disease
  topic: keywords
creator: Lays Nóbrega Gomes Farias
creator: Raimundo Euzébio da Costa Neto
creator: Mayara Abreu Pinheiro
creator: Yuri Wanderley Cavalcanti
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-03
publication date: 2026-07-03
starting page: e20250586
ending page: e20250586
doi: 10.1590/1678-7765-2025-0586

Molecular alterations in MAPK/ERK, β-Catenin/Wnt, and PI3K/mTOR pathways in adenomatoid odontogenic tumor
type: item
description: Background Previous studies have suggested that tumorigenesis of adenomatoid odontogenic tumor (AOT) may involve the activation of the mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathway. However, research on other oncogenic signaling pathways in AOT remains limited. Objective This study aimed to investigate gene mutations (Kirsten rat sarcoma viral oncogene homolog (KRAS), catenin beta 1 (CTNNB1), and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)) and their associated protein expressions (phosphorylated extracellular signal-regulated kinase 1 and 2 (p-ERK1/2), β-catenin, and phosphorylated mechanistic target of rapamycin (p-mTOR)) in AOT cases. The association between gene mutations and protein expression was also examined. Methodology In total, eight formalin-fixed, paraffin-embedded AOT tissue samples were manually micro-dissected for DNA extraction. Polymerase chain reaction was performed. Positive samples underwent DNA sequencing. Mutations were analyzed in KRAS exon 2 (codons 12 and 13), CTNNB1 exon 3 (codons 32-45), and PIK3CA exon 9 (codons 542-549). Protein expression was assessed using immunohistochemistry. Results KRAS mutations (specifically G12R and G12V) were detected in three of the eight cases (37.5%). CTNNB1 mutation (T42I) was identified in one of six cases (16.7%), whereas no PIK3CA mutation was observed. Moreover, moderate expression of p-ERK1/2 and p-mTOR were found in tumor cells of AOT. β-catenin accumulation was detected in seven cases (87.5%), predominantly showing membranous and cytoplasmic localization with no nuclear β-catenin expression. Statistical analysis indicated no association between gene mutations and protein expression. Conclusions KRAS mutations and p-ERK1/2 expression support a potential role of MAPK/ERK signaling in AOT pathogenesis. The absence of PIK3CA mutations despite p-mTOR expression may in part suggest mutation-independent activation of the PI3K/m…
subject: Original Articles
  topic: section
subject: Adenomatoid odontogenic tumor
  topic: keywords
subject: KRAS
  topic: keywords
subject: CTNNB1
  topic: keywords
subject: PIK3CA
  topic: keywords
subject: β-catenin
  topic: keywords
subject: p-mTOR
  topic: keywords
subject: p-ERK1/2
  topic: keywords
creator: Jintana Pankam
creator: Puangwan Lapthanasupkul
creator: Nakarin Kitkumthorn
creator: Siribang-on Piboonniyom Khovidhunkit
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-06-19
publication date: 2026-06-19
starting page: e20260073
ending page: e20260073
doi: 10.1590/1678-7765-2026-0073

Time-series trends and regional disparities in complete denture production in Brazil (2000–2023)
type: item
description: Introduction Tooth loss remains a public health problem in Brazil, reflecting social inequality, population aging, and limited access to oral rehabilitation. For many individuals, complete dentures (CD) are the only option available free of charge through the Brazilian Unified Health System (Sistema Único de Saúde, SUS). However, nationwide assessments of service delivery and regional equity in prosthetic rehabilitation are limited. Objective To quantify national trends and regional disparities in CD production within the SUS and examine how prosthetic output relates to demographic, socioeconomic, and infrastructure indicators using the most recent data available. Methodology This ecological-analytical time-series study used open data from the SUS Outpatient Information System (SIA/SUS). The analysis included maxillary and mandibular CD procedures recorded between 2000 and 2022, representing the most recent consolidated period for temporal modeling, and a state-level snapshot for 2023 to describe the latest correlational scenario. Production rates were standardized per 100,000 inhabitants. Temporal trends were analyzed using segmented linear regression to estimate the average annual percent change (AAPC), which summarizes overall long-term changes in complete denture production, and to identify inflection points. Correlations between CD production and demographic or socioeconomic indicators were tested using Spearman’s rho (α = 0.05). Results Between 2000 and 2022, a total of 5,239,089 complete dentures were delivered through the Brazilian Unified Health System. CD production increased significantly nationwide from 2000 to 2022 (AAPC = 9.7%; 95% CI: 4.8–14.9), a relatively high annual growth rate for public health service expansion, with the steepest rise between 2006 and 2014 (AAPC = 29.2%; 95% CI: 18.6–40.7). Regional trends varied across the country, with the highest growth observed in the Northeast (AAPC = 16.4%; 95% CI: 11.7–21.3), followed by the North (AAPC =…
subject: Original Articles
  topic: section
subject: Complete denture
  topic: keywords
subject: Interrupted time series analysis
  topic: keywords
subject: Public health dentistry
  topic: keywords
subject: Health services accessibility
  topic: keywords
subject: Epidemiology
  topic: keywords
creator: Maria Eduarda Broering da Silva
creator: Henrique Souza dos Santos
creator: Juliana Silva Ribeiro de Andrade
creator: Paulo Roberto Barbato
creator: Maurício Malheiros Badaró
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-06-22
publication date: 2026-06-22
starting page: e20250779
ending page: e20250779
doi: 10.1590/10.1590/1678-7765-2025-0779

Expression of p53, Ki-67, sox-2, oct-4, and NANOG in the tongue and trachea of Swiss mice exposed to narghile smoke
type: item
description: Introduction: Narghile (waterpipe) tobacco use has increased worldwide, partly due to limited awareness of its harmful effects. Despite the widespread misconception that the water filters toxic substances, the chemical composition of narghile smoke is comparable to that of cigarette smoke. However, its effects on airway tissues remain poorly understood. Objective: This study aimed to evaluate the histological and immunohistochemical profiles of the tongue and trachea in Swiss mice exposed to narghile smoke. Methodology: Sixty animals were divided into six groups: a control group (0 days) and experimental groups exposed daily to narghile smoke for seven, 15, 30, 60, and 90 days. After euthanasia, tongue and tracheal tissues were collected for histological (hematoxylin and eosin staining) and immunohistochemical analyses of NANOG, OCT-4, SOX-2 (neoplastic stem cell markers), Ki-67, and p53 in epithelial cells. Results: Histological evaluation revealed cytological and architectural alterations in the tongue, suggestive of early dysplastic changes. In the trachea, early metaplastic modifications were observed, including cilia loss, epithelial hyperplasia, and mild keratinization. These changes increased with longer exposure duration. Immunohistochemical analysis showed greater expression of NANOG, OCT-4, SOX-2, and p53, peaking at 30 days, whereas Ki-67 expression peaked at 90 days. Elevated p53 levels suggest alterations in cell cycle regulation and apoptosis. Conclusion: Narghile smoke induced histological and molecular changes in the tongue and tracheal epithelium of mice, indicating a potential carcinogenic effect. Further in vitro, in vivo, and clinical investigations are warranted to validate these biomarkers and better elucidate the biological effects of narghile smoke exposure.
subject: Original Articles
  topic: section
subject: Narghile
  topic: keywords
subject: Carcinogenesis
  topic: keywords
subject: Tongue
  topic: keywords
subject: Trachea
  topic: keywords
creator: Sarah Freygang Mendes Pilati
creator: Filipe Ivan Daniel
creator: Paulo Vinicius Fontanella Pilati
creator: Mariana Hornung Marins
creator: Aline Cristina Batista Rodrigues
creator: Filipe Modolo
rights: Copyright (c) 2026 Sarah Freygang Mendes Pilati, Filipe Ivan Daniel, Paulo Vinicius Fontanella Pilati, Mariana Hornung Marins, Aline Cristina Batista Rodrigues, Filipe Modolo https://creativecommons.org/licenses/by/4.0
date: 2026-05-25
publication date: 2026-05-25
starting page: e2025
ending page: 0839
doi: 10.1590/1678-7765-2025-0839

Modulation of TLR4, hBD-2, and hBD-3 expression and hepatic tissue response by systemic probiotics in experimental apical periodontitis in rats
type: item
description: Apical periodontitis is characterized by a robust inflammatory response and activation of innate immunity. Probiotics have been proposed as modulators of this response, but their local and systemic effects remain unclear. Objective To evaluate whether systemic supplementation with L. rhamnosus LR-04 and L. acidophilus LA-14 modulates the expression of TLR4, hBD-2, and hBD-3 in a rat model of experimental apical periodontitis (AP), and to assess potential histopathological alterations in the liver. Methodology Twenty-four male Wistar rats were randomly allocated into three groups (n=8): control (AP + water), AP + L. rhamnosus LR-04, and AP + L. acidophilus LA-14. AP was induced by exposing the pulp chambers of the first mandibular molars for 30 days. From the day of induction, probiotics (109 CFU/day via oral gavage) or water (control) were administered daily. After 30 days, the rats were euthanized. Mandibles were processed for immunohistochemical analysis of hBD-2, hBD-3, and TLR4 expression, which was assessed semi-quantitatively. Liver samples were collected, fixed, and stained with hematoxylin-eosin for histopathological evaluation of lobular inflammation, necrosis, portal inflammation, and fibrosis. Data were analyzed using the nonparametric Kruskal–Wallis test at a 5% significance level. Results No hepatic histopathological alterations were observed in any group. Probiotic supplementation resulted in significantly greater hBD-2 immunoreactivity in periapical tissues compared to the control group (P<0.05). hBD-3 expression was significantly higher in the L. acidophilus LA-14 group than in both the control and L. rhamnosus LR-04 groups (P<0.05). TLR4 expression in periapical lesions was increased in both probiotic groups relative to control (P<0.05). Conclusion Systemic supplementation with L. rhamnosus LR-04 and L. acidophilus LA-14 enhanced the local immune response in apical periodontitis, as evidenced by upregulation of TLR4, hBD-2, and hBD-3, without induci…
subject: Original Articles
  topic: section
subject: Apical periodontitis
  topic: keywords
subject: Probiotics
  topic: keywords
subject: Toll-like receptor
  topic: keywords
subject: Beta-defensins
  topic: keywords
subject: Liver
  topic: keywords
creator: Leopoldo Cosme-Silva
creator: Renan Dal-Fabro
creator: Gabrielle Cabral Melville de Souza Tenório
creator: José Alex da Silva
creator: Edilson Ervolino
creator: Letícia Cabrera Copalbo
creator: João Eduardo Gomes Filho
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: e20250859
ending page: e20250859
doi: 10.1590/

Systemic toxicity assessment of tissue conditioners modified with nystatin and chlorhexidine in a rat model of denture stomatitis
type: item
description: Denture stomatitis is a condition that commonly affects the palatal mucosa of denture wearers. Recently, several treatments have shown promising results, including the addition of antimicrobial drugs to tissue conditioners. However, before initiating clinical trials, the safety profile of this modified material must be assessed. Objective This study investigated the potential systemic toxicity of a tissue conditioner modified with antifungals in a rat model of denture stomatitis. Methodology Male Wistar rats (N=59) were randomly assigned to the following groups: NC (negative control), SD (sterile device), DS (denture stomatitis), Soft (Softone), Nys (nystatin), Nys:βCD (nystatin:β-cyclodextrin), Chx (chlorhexidine), and Chx:βCD (chlorhexidine:β-cyclodextrin). Animals of all groups, except for NC and SD, wore a palatal device contaminated with Candida albicans for the induction of denture stomatitis. Rats from the Soft group had their devices relined with a tissue conditioner (Softone) with no drugs added, while devices from groups Nys, Nys:βCD, Chx, and Chx:βCD were relined with antifungals at their minimum inhibitory concentrations against C. albicans SC5314 (32 mg, 36 mg, 64 mg, and 46 mg for each gram of tissue conditioner, respectively). Four days after treatment, the animals had their blood collected for biochemical analyses and had their livers, lungs, stomachs, and kidneys removed for histopathological and enzymatic analyses. Results No significant renal, gastric, or pulmonary changes were detected. Some rats from groups Nys, Nys:βCD, Chx, and Chx:βCD presented vacuolation of hepatocytes, although this is not necessarily a sign of hepatic damage. However, the livers of the Chx group presented higher myeloperoxidase activity when compared to the NC, SD, and DS groups. Conclusion These findings suggest that incorporating Nys, Nys:βCD, and Chx:βCD into this tissue conditioner may represent a safe option for denture stomatitis treatment.
subject: Original Articles
  topic: section
subject: Denture stomatitis
  topic: keywords
subject: Dental tissue conditioning
  topic: keywords
subject: Chlorhexidine
  topic: keywords
subject: Nystatin
  topic: keywords
subject: beta-Cyclodextrins
  topic: keywords
creator: Gustavo Simão Moraes
creator: Thaís Albach
creator: Carolina Yoshi Campos Sugio
creator: Victoria Schlumberger Cachoeira
creator: Falyne Kiratcz
creator: Eduardo Bauml Campagnoli
creator: Fabio André Dos Santos
creator: Karin Hermana Neppelenbroek
creator: Vanessa Migliorini Urban
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: e20250811
ending page: e20250811
doi: 10.1590/

Salivary cotinine and S100A8/A9 levels in children exposed to environmental tobacco smoke
type: item
description: Exposure to environmental tobacco smoke (ETS) poses significant risks to children’s oral health by inducing oxidative stress and triggering inflammatory responses. Even in the absence of clinically evident oral inflammation, early biological changes can be detected in children exposed to ETS. Objectives This study aimed to evaluate salivary cotinine and S100A8/A9 levels in children exposed to ETS and to examine the relationship between exposure intensity and inflammatory biomarker expression. Methodology This observational case-control study included 150 systemically healthy children aged 6–12 years. ETS exposure was determined using parent-reported questionnaires. Clinical parameters, including plaque index, gingival index, and probing pocket depth, were recorded. Unstimulated saliva samples were analyzed for cotinine, S100A8, and S100A9 using ELISA kits. Group comparisons were conducted using the Mann–Whitney U test, and correlations were assessed using Spearman’s rank correlation coefficient. Statistical significance was set at p<0.05. Results ETS-exposed and non-exposed groups did not differ significantly in age, sex, socioeconomic status, oral hygiene habits, or clinical periodontal parameters (p>0.05). However, salivary cotinine, S100A8, and S100A9 levels were significantly higher in ETS-exposed children (p<0.05). Cotinine demonstrated a moderate positive correlation with S100A8, while its correlation with S100A9 was weak and non-significant. Exposure intensity was positively associated with cotinine and S100A8 levels, but not with S100A9. Conclusion ETS exposure in children is associated with early biochemical signs of inflammation, even in the absence of clinically detectable periodontal changes. Elevated salivary cotinine and S100A8 levels highlight the potential utility of salivary biomarkers for identifying subclinical effects of passive smoking. These findings underscore the importance of interventions aimed at reducing children’s exposure to ETS to prot…
subject: Original Articles
  topic: section
subject: Biomarkers
  topic: keywords
subject: Children
  topic: keywords
subject: Cotinine
  topic: keywords
subject: Inflammation
  topic: keywords
subject: Smoking
  topic: keywords
creator: Arzu Kockanat
creator: Sukran Acipinar
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-05-15
publication date: 2026-05-15
starting page: e20250840
ending page: e20250840
doi: 10.1590/1678-7765-2025-0840

Polyphenol-functionalized silver nanoparticles promote differential remineralization and reinforcement of demineralized dentin
type: item
description: Silver nanoparticles (AgNPs) have gained relevance in restorative dentistry due to their antimicrobial and remineralizing properties. However, the role of AgNPs functionalized with different polyphenols in dentin remineralization remains insufficiently understood. Objectives This study aimed to synthesize and characterize AgNPs functionalized with crosslinking polyphenols extracted from grape seed extract (GSE) and green tea leaves (GT), and to evaluate their biocompatibility and their effects on the mechanical and physicochemical properties of demineralized dentin. Methodology AgNPs were characterized by TEM, XRD, TGA, and zeta potential analysis to determine particle morphology, crystalline structure, chemical composition, and surface charge. Biocompatibility was assessed using fibroblast cytotoxicity assays. In total, 40 human mid-coronal dentin specimens were randomly assigned to four groups (n=10): Control- (sound dentin), Control+ (pH-cycled dentin without treatment), AgGSE (pH-cycled + AgGSE, 1 min), and AgGT (pH-cycled + AgGT, 1 min). Treated dentin was analyzed by ATR-FTIR, XRD, TGA, and three-point bending tests. Results Both AgNPs were successfully synthesized and exhibited high biocompatibility. AgGSE demonstrated greater dentin matrix interaction, resulting in significantly higher flexural strength (p≤0.001). In contrast, AgGT induced pronounced remineralization with increased PO4/Amide I ratio (p=0.003) and CO3/PO4 ratios (p=0.007 by TGA; p=0.03 by ATR-FTIR), consistent with carbonated apatite deposition. Conclusions Green-synthesized AgNPs functionalized with GT or GSE promoted reinforcement and remineralization of demineralized dentin through distinct mechanisms of action. These findings highlight their potential as biocompatible agents for dental therapies.
subject: Original Articles
  topic: section
subject: Dental caries
  topic: keywords
subject: Metal nanoparticles
  topic: keywords
subject: Tooth remineralization
  topic: keywords
subject: Crosslinking reagents
  topic: keywords
subject: Flexural strength
  topic: keywords
creator: Tattiana Enrich
creator: Santiago González-López
creator: Alejandro B. Rodríguez-Navarro
creator: María V. Bolaños-Carmona
creator: Carolina Cifuentes-Jiménez
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-05-01
publication date: 2026-05-01
starting page: e20250848
ending page: e20250848
doi: 10.1590/1678-7765-2025-0848

Statin-loaded carbonated hydroxyapatite nanoemulsion controls matrix metalloproteinase-1 activity to enhance post-orthodontic stability in rats
type: item
description: Background The persistence of periodontal ligament (PDL) and alveolar bone remodeling following appliance removal is a key factor in orthodontic relapse, which is a significant barrier to treatment stability. In this study, a statin-loaded carbonated hydroxyapatite (CHA) nanoemulsion was evaluated as a local therapy to control relapse rate by modulating matrix metalloproteinase-1 (MMP-1) in rats. Methodology A total of 48 rats (n=48) were allocated to control, simvastatin, CHA hydrogel, or CHA–simvastatin nanoemulsion groups. Treatments were delivered intrasulcularly during stabilization, and relapse was measured at days zero, one, seven, and 14 post-debonding. MMP-1 expression in the PDL was assessed using immunofluorescence at the same time points. Collected data were evaluated using analysis of variance. Results Relapse occurred in all groups, with the highest relapse rate during early observation. At day one, the relapse rate was significantly reduced in treatment groups compared with the control, and the CHA–simvastatin group showed the lowest relapse rate (control 1048±20.20 vs. CHA–simvastatin 549.33±27.22 μmd−1; p=0.001). MMP-1 expression peaked at day one and was significantly lower in all treatment groups than control, with the greatest suppression in the CHA–simvastatin group (16.33±2.08 vs. 7.33±0.57 positive cells/field; p=0.001). By day 14, relapse rates and MMP-1 expression decreased across groups, with persisting advantages for the combined treatment. Conclusion Local CHA-simvastatin nanoemulsion decreased early relapse and downregulated MMP-1 expression in rats, suggesting a promising adjunctive strategy to enhance post-orthodontic stability.
subject: Original Articles
  topic: section
subject: Carbonated hydroxyapatite
  topic: keywords
subject: Matrix metalloproteinase
  topic: keywords
subject: Nanoemulsion
  topic: keywords
subject: Relapse
  topic: keywords
subject: Simvastatin
  topic: keywords
creator: Ananto Ali Alhasyimi
creator: Niswati Fathmah Rosyida
creator: Pinandi Sri Pudyani
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-04-17
publication date: 2026-04-17
starting page: e20260023
ending page: e20260023
doi: 10.1590/1678-7765-2026-0023

Comparison of root coverage by injectable-platelet rich fibrin in thick and thin phenotypes
type: item
description: Objective This study aimed to compare the effectiveness of injectable platelet-rich fibrin (I-PRF) using a submucosal injection technique for creeping attachment in thin and thick phenotypes with gingival recession. Methodology The study was designed as a prospective clinical trial. Participants were divided into two groups based on gingival thickness (GT): thin phenotype group (≤1.0 mm) and thick phenotype group (>1.0 mm). I-PRF was applied once a month to each gingival site using the submucosal injection technique, for a total of three applications. Periodontal parameters were measured at baseline (T0), nine months after treatment (T1), and 12–48 months after treatment (T2). Root coverage percentage (RC%) was calculated. Results Twelve systemically healthy, non-smoking patients (seven males and five females; mean age: 36.5±9.4), comprising 66 teeth, were analyzed. The primary outcome, RC%, demonstrated a statistically significant intergroup difference at T1 (p=0.032); however, this difference was not statistically significant at T2. In the thick phenotype group, RC% was 20.91±30.80% in T1 and increased to 31.40±30.92% in T2 (p=0.040). Conversely, the thin phenotype group showed higher RC% values at T1 (35.04±29.76%), which were not sustained at T2 (30.70±28.46%; p=0.355). Recession depth decreased in both groups at all time points, but this difference was not statistically significant. Keratinized tissue width showed a significant increase in both groups, from 2.34±1.08 and 2.73±0.95 at T0, respectively, to 2.89±1.17 and 3.28±1.12 at T1 (p<0.05). In the intergroup comparison, GT values were significantly higher in the thick phenotype group than in the thin phenotype group at T0 and T2, while no significant difference was observed at T1. Conclusion I-PRF application was shown to enhance RC% in both phenotypes. A significant increase in GT was observed in the thin phenotype; however, these increases in GT and RC% were not fully sustained during long-term follow-up i…
subject: Original Articles
  topic: section
subject: Injectable platelet-rich fibrin
  topic: keywords
subject: Gingival thickness
  topic: keywords
subject: Gingival phenotype
  topic: keywords
subject: Gingival recession
  topic: keywords
subject: Root coverage
  topic: keywords
creator: Berceste Guler Ayyildiz
creator: Busra Terzioglu
creator: Seyma Eken
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-04-17
publication date: 2026-04-17
starting page: e20250702
ending page: e20250702
doi: 10.1590/1678-7765-2025-0702

Comparison of root coverage by injectable-platelet rich fibrin in thick and thin phenotypes
type: item
description: Objective This study aimed to compare the effectiveness of injectable platelet-rich fibrin (I-PRF) using a submucosal injection technique for creeping attachment in thin and thick phenotypes with gingival recession. Methodology The study was designed as a prospective clinical trial. Participants were divided into two groups based on gingival thickness (GT): thin phenotype group (≤1.0 mm) and thick phenotype group (>1.0 mm). I-PRF was applied once a month to each gingival site using the submucosal injection technique, for a total of three applications. Periodontal parameters were measured at baseline (T0), nine months after treatment (T1), and 12–48 months after treatment (T2). Root coverage percentage (RC%) was calculated. Results Twelve systemically healthy, non-smoking patients (seven males and five females; mean age: 36.5±9.4), comprising 66 teeth, were analyzed. The primary outcome, RC%, demonstrated a statistically significant intergroup difference at T1 (p=0.032); however, this difference was not statistically significant at T2. In the thick phenotype group, RC% was 20.91±30.80% in T1 and increased to 31.40±30.92% in T2 (p=0.040). Conversely, the thin phenotype group showed higher RC% values at T1 (35.04±29.76%), which were not sustained at T2 (30.70±28.46%; p=0.355). Recession depth decreased in both groups at all time points, but this difference was not statistically significant. Keratinized tissue width showed a significant increase in both groups, from 2.34±1.08 and 2.73±0.95 at T0, respectively, to 2.89±1.17 and 3.28±1.12 at T1 (p<0.05). In the intergroup comparison, GT values were significantly higher in the thick phenotype group than in the thin phenotype group at T0 and T2, while no significant difference was observed at T1. Conclusion I-PRF application was shown to enhance RC% in both phenotypes. A significant increase in GT was observed in the thin phenotype; however, these increases in GT and RC% were not fully sustained during long-term follow-up i…
subject: Original Articles
  topic: section
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-07-20
publication date: 2026-07-20
doi: 10.1590/

Influence of impacted mandibular third molars on pathological changes on themselves and adjacent tissues across different age groups
type: item
description: Objective To investigate the effects of different types of impacted mandibular third molar (IMTM) on lesions in situ and on adjacent tissues at different ages. Methodology Cone Beam Computed Tomography (CBCT) images of 1007 IMTM cases were retrospectively analyzed. Associations between age, gender, impaction type, distal alveolar bone condition of mandibular second molar (MSM), IMTM-MSM contact status and occurrence of lesions on IMTM and its adjacent tissues were evaluated using Pearson’s chi-squared test and Fisher’s exact test. Results MSM distal alveolar bone defects showed the highest incidence among all IMTM-related lesions (79.2%), followed by MSM distal external root resorption (ERR) (25.5%) and MSM distal caries (10.4%). Mesioangular (96.2%, p<0.001) and horizontal (95.9%, p<0.001) IMTM were associated with more severe bone defects and the incidence increased with age. IMTM-MSM surface-to-surface contact was significantly associated with MSM distal caries severity (12.5%, p<0.001) and distal ERR (29.5%, p<0.001). Inflammatory resorption of MSM distal alveolar bone was significantly correlated with MSM distal caries (47.1%, p<0.001), ERR (36.5%, p<0.05), distal alveolar bone defects (100%, p<0.001), and IMTM caries (14.1%, p<0.05). Study design followed the STROBE guidelines. Conclusion Mesioangular impaction, horizontal impaction, MSM-IMTM surface-to-surface contact, and MSM distal alveolar bone in a state of inflammatory resorption greatly affect lesions on IMTM and its surrounding tissues. These findings suggest the prophylactic extraction in young adults (18–25 years) with high-risk impactions, while recommending observation or cautious management for asymptomatic older patients without signs of inflammatory bone resorption.
subject: Original Articles
  topic: section
subject: Third molar
  topic: keywords
subject: Alveolar bone loss
  topic: keywords
subject: Cone-beam computed tomography
  topic: keywords
creator: Xiaoyue Ge
creator: Yixiao Cui
creator: Ning Li
creator: Tianyang Lv
creator: Yuntong Liang
creator: Haochen Wu
creator: Yuxuan Gu
creator: Meiting Li
creator: Changkui Liu
creator: Yayuan Guo
creator: Kaijin Hu
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-30
publication date: 2026-03-30
starting page: e20250677
ending page: e20250677
doi: 10.1590/1678-7765-2025-0677

Expression of caspase-8 in non-alcoholic fatty liver disease related to ligature-induced periodontitis in rats
type: item
description: Aim This study aimed to evaluate the oral and hepatic changes, as well as the expression of caspase-8 in liver tissue damage, both associated with ligature-induced periodontitis in rats. Methodology A total of 16 female Wistar rats were divided into two groups (n=8): one received ligature around the first lower molar to promote periodontitis, and the other was the control group with no ligature. After the period of induction of the disease the animals were evaluated by clinical measures for periodontitis, euthanized, and the samples of gingival tissue, hepatic tissue, and serum were collected to the measurement of biomarkers for inflammation (myeloperoxidase), oxidative stress (glutathione, malonaldehyde, and nitrate [NO3]), liver damage and histopathological evaluation with immunohistochemistry for caspase-8. The data were expressed as mean and standard deviation for data with normal distribution or median and interquartile range for data with non-normal distribution. We used ANOVA followed by the Student-Newman-Keuls test for multiple comparisons of normally distributed data, and the Kruskal-Wallis test followed by Dunn's test for non-normally distributed data. The statistical tests were performed with GraphPad Prism Software (version 5.0), in which a p-value <0.05 was considered significant. Results Our study demonstrates that the group with ligature-induced periodontitis showed increased measurement of periodontal destruction, local and systemic biomarkers of inflammation as well as liver damage which we observed several hepatocytes with loss of conformation and steatosis in the periodontitis group. The histopathological evaluation evidenced the periodontitis-related steatosis and higher expression of Caspase-8 in comparison with the control group (p<0.0006). Conclusion Our study demonstrates the high expression of Caspase-8 in liver damage related to ligature-induced periodontitis in rats.
subject: Original Articles
  topic: section
subject: Apoptosis
  topic: keywords
subject: Periodontal Disease
  topic: keywords
subject: Liver dysfunction
  topic: keywords
subject: Oxidative stress
  topic: keywords
creator: Felipe Rodolfo Pereira da Silva
creator: Victor Brito Dantas Martins
creator: Hélio Mateus Silva Nascimento
creator: Paulo Roberto Carneiro Gomes
creator: Nikaely Brandão Barbosa
creator: Vinícius da Silva Caetano
creator: Ivana Márcia Alves Diniz
creator: Karine Duarte da Silva
creator: Any Carolina Cardoso Guimarães Vasconcelos
creator: Daniel Fernando Pereira Vasconcelos
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-04-06
publication date: 2026-04-06
starting page: e20250717
ending page: e20250717
doi: 10.1590/1678-7765-2025-0717

Can angiotensin II affect the inflammatory response of human dental pulp cells in vitro?
type: item
description: Dental pulp fibroblasts respond to various stimuli, including microbial agents, endodontic materials, restorative procedures, pulp protection treatments, and inflammatory molecules. Its inflammatory response to injury involves a complex set of mechanisms that have been increasingly studied for their roles in this intricate biological process. Among these mechanisms is angiotensin II (ANG-II), the involvement of which in inflammation has been shown in several pathological conditions via its local generation and action. Objective This study aimed to evaluate the capacity of fibroblasts from permanent and deciduous dental pulp to express inflammatory mediators when exposed to bacterial and inflammatory antigens. It also sought to assess the presence of components of the renin-angiotensin system (RAS) and the potential modulatory role of ANG-II in this response. Methodology Fibroblasts were cultured from the pulp of permanent and deciduous teeth obtained from three adult and four pediatric donors with informed consent. Cells were stimulated with Porphyromonas gingivalis and Escherichia coli lipopolysaccharides (LPS) either alone or in combination with ANG-II and, in some cases, with IL-1β. Gene expression of RAS components and various inflammatory mediators was analyzed by qRT-PCR. ANG-II receptor expression was quantified by flow cytometry. Results The results showed that both bacterial antigens and IL-1β significantly upregulated the expression of genes encoding key inflammatory mediators. However, ANG-II, either alone or in combination with other antigens, failed to alter the expression levels of these mediators. Conclusion These findings clearly show that ANG-II has no influence on the expression of inflammatory mediators by human dental pulp fibroblasts under the tested conditions.
subject: Original Articles
  topic: section
subject: Pulp fibroblasts
  topic: keywords
subject: Angiotensin II
  topic: keywords
subject: Inflammatory mediators
  topic: keywords
creator: Bella Luna Colombini-Ishikiriama
creator: Thiago José Dionisio
creator: Thais Francini Garbieri
creator: Rafaela Alves da Silva
creator: Sandra Helena Penha Oliveira
creator: Vanessa Soares Lara
creator: Andrew Seth Greene
creator: Carlos Ferreira dos Santos
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-04-06
publication date: 2026-04-06
starting page: e2025
ending page: 0822
doi: 10.1590/1678-7765-2025-0822

Clinical and aesthetic outcomes of enamel matrix derivative and subepithelial connective tissue graft using the modified coronally advanced tunnel technique
type: item
description: Objectives This randomized controlled clinical trial evaluated the short-term clinical outcomes of the modified coronally advanced tunnel technique combined with three different regenerative approaches—subepithelial connective tissue graft (as the gold standard), enamel matrix derivative (as a donor-site-sparing alternative), and their combination (to explore potential synergistic effects)—in treating recession type 1 gingival defects. Methodology A total of 52 systemically healthy patients (aged 18–60) with 90 recession type 1 gingival defects were enrolled and randomly assigned to one of the three treatment groups: Group 1 (n=18; subepithelial connective tissue graft), Group 2 (n=19; enamel matrix derivative), and Group 3 (n=15; both materials). Primary outcome consisted of the percentage of root coverage at 6 months. Secondary outcomes included plaque index, gingival index, gingival recession depth, gingival recession width, clinical attachment level, keratinized tissue width, gingival thickness, wound healing index, probing depth, and root coverage aesthetic score. Clinical parameters were measured at baseline, 3, and 6 months, and aesthetic outcomes were assessed at 6 months. Results All groups showed significant improvements in clinical parameters. Mean root coverage was 80.4% for Group 1, 76.2% for Group 2, and 73.6% for Group 3, with no significant differences among them. Keratinized tissue width significantly increased in Group 1 and Group 3, but not in Group 2. Mean root coverage aesthetic score values were 7.74 ± 2.35, 7.54 ± 2.39, and 7.62 ± 1.97, respectively (p > 0.05). Conclusion Within the limitations of this study, including its short-term follow-up period and baseline differences in recession width, all three groups exhibited comparable clinical and aesthetic outcomes at 6 months. Clinical Trial Registration Number: NCT06504329
subject: Original Articles
  topic: section
subject: Gingival recession
  topic: keywords
subject: Graft
  topic: keywords
subject: Enamel matrix proteins
  topic: keywords
subject: Minimally invasive surgical procedures
  topic: keywords
subject: Subepithelial connective tissue
  topic: keywords
creator: Fatma Altiparmak
creator: Fatma Ucan Yarkac
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-23
publication date: 2026-03-23
starting page: e2025
ending page: 0775
doi: 10.1590/1678-7765-2025-0775