Do authors of systematic reviews of epidemiological observational studies assess the methodologies of the included primary studies? An empirical examination of methodological tool use in the literature.

BACKGROUND: The procedures used to assess the methodological quality and risk of bias (RoB) of systematic reviews of observational dental studies have not been investigated. The purpose of this research was to examine the way that authors of systematic reviews of epidemiological observational studies published in dentistry conducted the methodological assessment of those primary studies. In the present article, we aimed to assess the characteristics and the level of reporting of tools used to assess the methodologies of these reviews. METHODS: We searched Scopus and the Web of Science from their inceptions to June 2023 for systematic reviews with meta-analyses of observational studies published in dentistry. Document selection and data extraction were performed in duplicate and independently by two authors. In a random sample of 10% of the systematic reviews, there was an agreement of more than 80% between the reviewers; data selection and extraction were conducted in the remaining 90% of the sample by one author. Data on the article and systematic review characteristics were extracted and recorded for descriptive reporting. RESULTS: The search in the two databases resulted in the inclusion of 3,214 potential documents. After the elimination of duplicates and the application of the eligibility criteria, a total of 399 systematic reviews were identified and included. A total of 368 systematic reviews reported a methodological tool, of which 102 used the Newcastle-Ottawa scale. Additionally, 76 systematic reviews stated the use of a modified methodological tool. Information about the approach of assessing the methodological quality or RoB of primary studies but reporting no tool or tool name occurred in 25 reviews. CONCLUSIONS: The majority of authors of systematic reviews of epidemiological observational studies published in dentistry reported the tools used to assess the methodological quality or RoB of the included primary studies. Modifying existing tools to meet the individual characteristics of various studies should be considered.

Extracellular vesicles as therapeutic tools in regenerative dentistry.

Dental and maxillofacial diseases are always accompanied by complicated hard and soft tissue defects, involving bone, teeth, blood vessels and nerves, which are difficult to repair and severely affect the life quality of patients. Recently, extracellular vesicles (EVs) secreted by all types of cells and extracted from body fluids have gained more attention as potential solutions for tissue regeneration due to their special physiological characteristics and intrinsic signaling molecules. Compared to stem cells, EVs present lower immunogenicity and tumorigenicity, cause fewer ethical problems, and have higher stability. Thus, EV therapy may have a broad clinical application in regenerative dentistry. Herein, we reviewed the currently available literature regarding the functional roles of EVs in oral and maxillofacial tissue regeneration, including in maxilla and mandible bone, periodontal tissues, temporomandibular joint cartilage, dental hard tissues, peripheral nerves and soft tissues. We also summarized the underlying mechanisms of actions of EVs and their delivery strategies for dental tissue regeneration. This review would provide helpful guidelines and valuable insights into the emerging potential of EVs in future research and clinical applications in regenerative dentistry.

Assessing transparency practices in dental randomized controlled trials.

BACKGROUND: To evaluate transparency practices in randomized controlled trials (RCTs) in dentistry. METHODS: This meta-research study included RCTs in dentistry regardless of topic, methods, or level of detail reported. Only studies in English were considered. We searched PubMed for RCTs in dentistry published in English from December 31, 2016, to December 31, 2021. The screening was performed in duplicate, and data extracted included journal and author details, dental specialty, protocol registration, data and code sharing, conflict of interest declaration, and funding information. A descriptive analysis of the data was performed. We generated maps illustrating the reporting of transparency items by country of the corresponding author and a heat table reflecting reporting levels by dental specialty. RESULTS: A total of 844 RCTs were included. Only 12.86% of studies reported any information about data and code sharing. Protocol registration was reported for 50.36% of RCTs. Conflict of interest (83.41%) and funding (71.68%) declarations were present in most studies. Conflicts of interest and funding were consistently reported regardless of country or specialty, while data and code sharing had a low level of reporting across specialties, as well as low dissemination across the world. Protocol registration exhibited considerable variability. CONCLUSIONS: Considering the importance of RCTs for evidence-based dentistry, it is crucial that everyone who participates in the scientific production and dissemination process actively and consistently promotes adherence to transparent scientific standards, particularly registration of protocols, and sharing of data and code.

Recent Advances in Whiskers: Properties and Clinical Applications in Dentistry.

Whiskers are nanoscale, high-strength fibrous crystals with a wide range of potential applications in dentistry owing to their unique mechanical, thermal, electrical, and biological properties. They possess high strength, a high modulus of elasticity and good biocompatibility. Hence, adding these crystals to dental composites as reinforcement can considerably improve the mechanical properties and durability of restorations. Additionally, whiskers are involved in inducing the value-added differentiation of osteoblasts, odontogenic osteocytes, and pulp stem cells, and promoting the regeneration of alveolar bone, periodontal tissue, and pulp tissue. They can also enhance the mucosal barrier function, inhibit the proliferation of tumor cells, control inflammation, and aid in cancer prevention. This review comprehensively summarizes the classification, properties, growth mechanisms and preparation methods of whiskers and focuses on their application in dentistry. Due to their unique physicochemical properties, excellent biological properties, and nanoscale characteristics, whiskers show great potential for application in bone, periodontal, and pulp tissue regeneration. Additionally, they can be used to prevent and treat oral cancer and improve medical devices, thus making them a promising new material in dentistry.

Assessment of Digital Dentistry Knowledge and Practices Among Dental Students at King Faisal University, Saudi Arabia.

BACKGROUND Digital dental (DD) technologies need to be developed for dental use because of the prominent position that these technologies have recently acquired. This 21-item online questionnaire-based study aimed to assess the understanding of DD methods in 120 undergraduate dental students at King Faisal University, Saudi Arabia (SA). MATERIAL AND METHODS Electronic surveys were sent to 123 dental students at different study phases (basic, preclinical, and clinical). Dental students were requested to answer the questionnaires in accordance with their knowledge, observations, particular experiences, and DD practice. Data were analyzed using descriptive statistics, which involved numerical values and ratios. Then, the associations among study level, knowledge, practice, and study phases were analyzed using chi-square and Fisher's exact tests. RESULTS Completed questionnaires were returned by 120 students. The chi-square test showed significant differences in relation to questions "Do you have any previous knowledge of DD?", "The field that uses DD the most is…", "Does DD provide more precise results than conventional dentistry?", and "Do you know about CAD/CAM?", with P values of 0.006, 0.000, 0.018, and 0.002, respectively. Students at clinical phase exhibited significantly higher levels of knowledge than those at the preclinical phase (P<0.01). With regard to DD practice, 73.3% of students expressed a negative viewpoint, 82.5% stated that DD is essential for the future, and half said that practicing DD will result in improvements in patient satisfaction, time consumed, and level of predictability. CONCLUSIONS Students at basic, preclinical, and clinical phases had good knowledge on DD and were motivated to practice it in future in their workplaces.

State-of-art technologies, challenges, and emerging trends of computer vision in dental images.

Computer vision falls under the broad umbrella of artificial intelligence that mimics human vision and plays a vital role in dental imaging. Dental practitioners visualize and interpret teeth, and the structure surrounding the teeth and detect abnormalities by manually examining various dental imaging modalities. Due to the complexity and cognitive difficulty of comprehending medical data, human error makes correct diagnosis difficult. Automated diagnosis may be able to help alleviate delays, hasten practitioners' interpretation of positive cases, and lighten their workload. Several medical imaging modalities like X-rays, CT scans, color images, etc. that are employed in dentistry are briefly described in this survey. Dentists employ dental imaging as a diagnostic tool in several specialties, including orthodontics, endodontics, periodontics, etc. In the discipline of dentistry, computer vision has progressed from classic image processing to machine learning with mathematical approaches and robust deep learning techniques. Here conventional image processing techniques solely as well as in conjunction with intelligent machine learning algorithms, and sophisticated architectures of dental radiograph analysis employ deep learning techniques. This study provides a detailed summary of several tasks, including anatomical segmentation, identification, and categorization of different dental anomalies with their shortfalls as well as future perspectives in this field.

Scaffold Application for Bone Regeneration with Stem Cells in Dentistry: Literature Review.

Bone tissue injuries within oral and dental contexts often present considerable challenges because traditional treatments may not be able to fully restore lost or damaged bone tissue. Novel approaches involving stem cells and targeted 3D scaffolds have been investigated in the search for workable solutions. The use of scaffolds in stem cell-assisted bone regeneration is a crucial component of tissue engineering techniques designed to overcome the drawbacks of traditional bone grafts. This study provides a detailed review of scaffold applications for bone regeneration with stem cells in dentistry. This review focuses on scaffolds and stem cells while covering a broad range of studies explaining bone regeneration in dentistry through the presentation of studies conducted in this field. The role of different stem cells in regenerative medicine is covered in great detail in the reviewed literature. These studies have addressed a wide range of subjects, including the effects of platelet concentrates during dental surgery or specific combinations, such as human dental pulp stem cells with scaffolds for animal model bone regeneration, to promote bone regeneration in animal models. Noting developments, research works consider methods to improve vascularization and explore the use of 3D-printed scaffolds, secretome applications, mesenchymal stem cells, and biomaterials for oral bone tissue regeneration. This thorough assessment outlines possible developments within these crucial regenerative dentistry cycles and provides insights and suggestions for additional study. Furthermore, alternative creative methods for regenerating bone tissue include biophysical stimuli, mechanical stimulation, magnetic field therapy, laser therapy, nutritional supplements and diet, gene therapy, and biomimetic materials. These innovative approaches offer promising avenues for future research and development in the field of bone tissue regeneration in dentistry.

Fine structural human phantom in dentistry and instance tooth segmentation.

In this study, we present the development of a fine structural human phantom designed specifically for applications in dentistry. This research focused on assessing the viability of applying medical computer vision techniques to the task of segmenting individual teeth within a phantom. Using a virtual cone-beam computed tomography (CBCT) system, we generated over 170,000 training datasets. These datasets were produced by varying the elemental densities and tooth sizes within the human phantom, as well as varying the X-ray spectrum, noise intensity, and projection cutoff intensity in the virtual CBCT system. The deep-learning (DL) based tooth segmentation model was trained using the generated datasets. The results demonstrate an agreement with manual contouring when applied to clinical CBCT data. Specifically, the Dice similarity coefficient exceeded 0.87, indicating the robust performance of the developed segmentation model even when virtual imaging was used. The present results show the practical utility of virtual imaging techniques in dentistry and highlight the potential of medical computer vision for enhancing precision and efficiency in dental imaging processes.

Understanding patient safety in dentistry: evaluating the present and envisioning the future-a narrative review.

BACKGROUND: Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals. METHODS: The review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry. RESULTS: The review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety. CONCLUSION: Patient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.

The application of virtual reality and augmented reality in dentistry - a literature review.

In recent times, dentistry has seen significant technological advancements that have transformed various specialized areas within the field. Developed into applications for mobile devices, augmented reality (AR) seamlessly merges digital components with the physical world, enhancing both realms while maintaining their individual separateness. On the other hand, virtual reality (VR) relies on advanced, tailored software to visualize a digital 3D environment stimulating the operator's senses through computer generated sensations and feedback. The current advances use the application of VR, haptic simulators, the use of an AI algorithm and many more that provides new opportunities for smart learning and enhance the teaching environment. As this technology continues to evolve, it is poised to become even more remarkable, enabling specialists to potentially visualize both soft and hard tissues within the patient's body for effective treatment planning. This literature aims to present the newest advancements and ongoing development of AR and VR in dentistry and medicine. It highlights their diverse applications while identifying areas needing further research for effective integration into clinical practice.

Interplay between leadership and patient safety in dentistry: a dental hospital-based cross-sectional study.

OBJECTIVES: The study aimed to study the association of leadership practices and patient safety culture in a dental hospital. DESIGN: Hospital-based, cross-sectional study SETTING: Riphah Dental Hospital (RDH), Islamabad, Pakistan. PARTICIPANTS: All dentists working at RDH were invited to participate. MAIN OUTCOME MEASURES: A questionnaire comprised of the Transformational Leadership Scale (TLS) and the Dental adapted version of the Medical Office Survey of Patient Safety Culture (DMOSOPS) was distributed among the participants. The response rates for each dimension were calculated. The positive responses were added to calculate scores for each of the patient safety and leadership dimensions and the Total Leadership Score (TLS) and total patient safety score (TPSS). Correlational analysis is performed to assess any associations. RESULTS: A total of 104 dentists participated in the study. A high positive response was observed on three of the leadership dimensions: inspirational communication (85.25%), intellectual stimulation (86%), and supportive leadership (75.17%). A low positive response was found on the following items: 'acknowledges improvement in my quality of work' (19%) and 'has a clear sense of where he/she wants our unit to be in 5 years' (35.64%). The reported positive responses in the patient safety dimensions were high on three of the patient safety dimensions: organisational learning (78.41%), teamwork (82.91%), and patient care tracking/follow-up (77.05%); and low on work pressure and pace (32.02%). A moderately positive correlation was found between TLS and TPSS (r=0.455, p<0.001). CONCLUSIONS: Leadership was found to be associated with patient safety culture in a dental hospital. Leadership training programmes should be incorporated during dental training to prepare future leaders who can inspire a positive patient safety culture.

A Systematic Umbrella Review of the Effects of Teledentistry on Costs and Oral-Health Outcomes.

Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry's clinical- and cost-effectiveness.

Could Teledentistry Be a Solution in the Diagnosis of Oral Lesions?

In recent years, teledentistry has gained visibility, especially because of the COVID-19 pandemic. Concerning oral medicine, there is great expectation, particularly about its potential to promote early diagnosis of oral lesions. In southern Brazil, two initiatives have shown a positive influence on each other and have led to greater awareness of oral cancer and more access to qualified advice on diagnosing and managing oral lesions. Although the contributions of this approach are promising, there are barriers to be overcome.

Surveying the landscape of diagnostic imaging in dentistry's future: Four emerging technologies with promise.

BACKGROUND: Advances in digital radiography for both intraoral and panoramic imaging and cone-beam computed tomography have led the way to an increase in diagnostic capabilities for the dental care profession. In this article, the authors provide information on 4 emerging technologies with promise. TYPES OF STUDIES REVIEWED: The authors feature the following: artificial intelligence in the form of deep learning using convolutional neural networks, dental magnetic resonance imaging, stationary intraoral tomosynthesis, and second-generation cone-beam computed tomography sources based on carbon nanotube technology and multispectral imaging. The authors review and summarize articles featuring these technologies. RESULTS: The history and background of these emerging technologies are previewed along with their development and potential impact on the practice of dental diagnostic imaging. The authors conclude that these emerging technologies have the potential to have a substantial influence on the practice of dentistry as these systems mature. The degree of influence most likely will vary, with artificial intelligence being the most influential of the 4. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The readers are informed about these emerging technologies and the potential effects on their practice going forward, giving them information on which to base decisions on adopting 1 or more of these technologies. The 4 technologies reviewed in this article have the potential to improve imaging diagnostics in dentistry thereby leading to better patient care and heightened professional satisfaction.

Stem cells in regenerative dentistry: Current understanding and future directions.

BACKGROUND: Regenerative dentistry aims to enhance the structure and function of oral tissues and organs. Modern tissue engineering harnesses cell and gene-based therapies to advance traditional treatment approaches. Studies have demonstrated the potential of mesenchymal stem cells (MSCs) in regenerative dentistry, with some progressing to clinical trials. This review comprehensively examines animal studies that have utilized MSCs for various therapeutic applications. Additionally, it seeks to bridge the gap between related findings and the practical implementation of MSC therapies, offering insights into the challenges and translational aspects involved in transitioning from preclinical research to clinical applications. HIGHLIGHTS: To achieve this objective, we have focused on the protocols and achievements related to pulp-dentin, alveolar bone, and periodontal regeneration using dental-derived MSCs in both animal and clinical studies. Various types of MSCs, including dental-derived cells, bone-marrow stem cells, and umbilical cord stem cells, have been employed in root canals, periodontal defects, socket preservation, and sinus lift procedures. Results of such include significant hard tissue reconstruction, functional pulp regeneration, root elongation, periodontal ligament formation, and cementum deposition. However, cell-based treatments for tooth and periodontium regeneration are still in early stages. The increasing demand for stem cell therapies in personalized medicine underscores the need for scientists and responsible organizations to develop standardized treatment protocols that adhere to good manufacturing practices, ensuring high reproducibility, safety, and cost-efficiency. CONCLUSION: Cell therapy in regenerative dentistry represents a growing industry with substantial benefits and unique challenges as it strives to establish sustainable, long-term, and effective oral tissue regeneration solutions.

Exploring the potential of calcium-based biomaterials for bone regeneration in dentistry: a systematic review.

INTRODUCTION: Regenerative medicine emerged as a promising strategy for addressing bone defects, with several bone grafts currently being used, including autografts, allografts, xenografts and alloplasts. Calcium-based biomaterials (CaXs), a well-known class of synthetic materials, have demonstrated good biological properties and are being investigated for their potential to facilitate bone regeneration. This systematic review evaluates the current clinical applications of CaXs in dentistry for bone regeneration. EVIDENCE ACQUISITION: A comprehensive search was conducted to collect information about CaXs and their applications in the dental field over the last ten years. The search was limited to relevant articles published in peer-reviewed journals. EVIDENCE SYNTHESIS: A total of 72 articles were included in this scoping review, with eight studies related to periodontology, 63 in implantology and three in maxillofacial surgery respectively. The findings suggest that CaXs hold promise as an alternative intervention for minor bone regeneration in dentistry. CONCLUSIONS: Calcium-based biomaterials have shown potential as a viable option for bone regeneration in dentistry. Further research is warranted to fully understand their efficacy and safety in larger bone defects. CaXs represent an exciting avenue for researchers and clinicians to explore in their ongoing efforts to advance regenerative medicine.

The impact of digital healthcare and teledentistry on dentistry in the 21st Century: a survey of Hungarian dentists.

BACKGROUND: The era of digitalization has arrived in the field of dentistry. Teledentistry (TD), the use of digital solutions in dentistry, is already used in practice; however, only some possibilities are considered. During the COVID-19 pandemic, remote patient monitoring and patient communication had to be solved with TD, thus causing a rapid spread of new tools. In addition to digital workflows, patient communication, AI, and online forums are also available. METHODS: An online self-administered survey was developed for the study. The Hungarian Medical Chamber contacted potential respondents in a newsletter or e-mail. The Evasys survey system was used. The weighting procedure was executed for gender, age group, and type of settlement. A digital dental index variable was created and built with a linear regression model as a dependent variable. Explanatory variables are advantages, disadvantages, what would be necessary, experienced needs from the patients, and age. RESULTS: A total of 171 dentists completed the survey. The best-known digital technologies are online conferences (96.5%), E-prescriptions (94.6%), and digital impressions (86.0%). Unawareness is the highest in the field of artificial intelligence in dentistry (50.5%), store-forward solutions (43.5%), and real-time solutions (41.8%). The digital dental index is 14.24 (standard deviation (SD) = 5.5), with a high power of the model. CONCLUSION: Hungarian dentists need to be made aware of all the possibilities of TD. In addition to digital workflows, store-forward and real-time solutions can be beneficial to substitute face-to-face visits. TD can be used effectively to monitor oral cavity changes and develop dental confidence and proper oral care habits. Our survey suggests that it is necessary and inevitable to integrate TD into both graduate and postgraduate education, which may form the basis of primary health care in the next decade.

A phenomenological study on East and Southeast Asian dental educators: perceived importance, challenges, and strategies in teaching dental materials science.

BACKGROUND: Effective teaching of dental materials science is crucial for dental students to develop a comprehensive understanding of materials used in clinical practice. However, literature on educators' views on teaching this subject is still scarce. This qualitative study aimed to explore the lived experiences of dental educators in teaching dental materials science subjects, thereby addressing potential gaps and enhancing teaching practices. METHODS: Thirteen dental educators from East and Southeast Asian countries (Malaysia, China, Indonesia, Thailand, South Korea, and Japan) participated in the present study. The present study adopted a transcendental phenomenological approach. One-to-one semi-structured online interviews were conducted. Interviews were recorded and transcribed verbatim. Thematic analysis was employed to identify patterns in the educators' experiences. RESULTS: Three themes emerged from the present study. First, perceptions of the importance of dental materials science, highlighting its relevance in clinical practice, patient care, and lifelong learning. Second, the challenges faced in teaching dental materials science include limited instructional time, complex content, and insufficient resources. Third, specific strategies, such as applying interactive teaching methods, integrating clinical scenarios, and promoting critical thinking skills have been suggested to enhance teaching and learning. CONCLUSION: Understanding dental educators' experiences can improve dental materials science education, curriculum development, teaching methods, and faculty training programmes, ultimately enhancing the knowledge and skills of dental students in this field.

Ultrasound protocol in odontogenic infections: a new proposal.

BACKGROUND: Point-of-care-ultrasound can be applied to preview a difficult airway, detect the presence of fluid collection, and soft-tissue edema, and guide the drainage location, although is rarely used. The purpose of this study is to validate a protocol for the assessment of these clinical features on patients with severe odontogenic infections. MATERIAL AND METHODS: This was a single-group prospective cohort study (n=20) including patients with the diagnosis of deep-neck propagation of odontogenic infection. A transcervical linear high-frequency probe transducer (13-6 MHz) was used to scan the structures of the upper airway and the infectious collections. The drainage was guided by ultrasound and the patients were daily evaluated, according to the protocol. The data were extracted and the airway volume, midline deviation, and other important data such as length of hospital stay, dysphagia, voice alteration, raised floor of the mouth, dyspnea, and neck swelling were registered. RESULTS: The ultrasound examination was correlated with multiple clinical findings, such as dyslalia (p=0,069), dysphagia (p=0,028), dyspnea (p=0,001), among others. This protocol has an advantage as it can be used at bedside evaluation, allowing the assessment of severe and unstable patients, and predicting the increase of the hospitalization time (p=0,019). CONCLUSIONS: This protocol is reliable for the assessment of the upper airway, even in an emergency, predicting not only the severity of the clinical features but aids in the determination of the length of the hospitalization time.