Leveraging Large Language Models for Improved Patient Access and Self-Management: Assessor-Blinded Comparison Between Expert- and AI-Generated Content.

BACKGROUND: While large language models (LLMs) such as ChatGPT and Google Bard have shown significant promise in various fields, their broader impact on enhancing patient health care access and quality, particularly in specialized domains such as oral health, requires comprehensive evaluation. OBJECTIVE: This study aims to assess the effectiveness of Google Bard, ChatGPT-3.5, and ChatGPT-4 in offering recommendations for common oral health issues, benchmarked against responses from human dental experts. METHODS: This comparative analysis used 40 questions derived from patient surveys on prevalent oral diseases, which were executed in a simulated clinical environment. Responses, obtained from both human experts and LLMs, were subject to a blinded evaluation process by experienced dentists and lay users, focusing on readability, appropriateness, harmlessness, comprehensiveness, intent capture, and helpfulness. Additionally, the stability of artificial intelligence responses was also assessed by submitting each question 3 times under consistent conditions. RESULTS: Google Bard excelled in readability but lagged in appropriateness when compared to human experts (mean 8.51, SD 0.37 vs mean 9.60, SD 0.33; P=.03). ChatGPT-3.5 and ChatGPT-4, however, performed comparably with human experts in terms of appropriateness (mean 8.96, SD 0.35 and mean 9.34, SD 0.47, respectively), with ChatGPT-4 demonstrating the highest stability and reliability. Furthermore, all 3 LLMs received superior harmlessness scores comparable to human experts, with lay users finding minimal differences in helpfulness and intent capture between the artificial intelligence models and human responses. CONCLUSIONS: LLMs, particularly ChatGPT-4, show potential in oral health care, providing patient-centric information for enhancing patient education and clinical care. The observed performance variations underscore the need for ongoing refinement and ethical considerations in health care settings. Future research focuses on developing strategies for the safe integration of LLMs in health care settings.

Novel application of bergapten and quercetin with anti-bacterial, osteogenesis-potentiating, and anti-inflammation tri-effects.

The bacteria-mediated inflammatory conditions adversely affect the osseointegration process of endosseous implants, which can even lead to implant malfunction or failure. Local drug delivery has been designed to exert anti-inflammatory and antibacterial activities, but whether this strategy has an effect on the compromised osseointegration under inflammation has rarely been studied. The present study focused on the osteoinductive efficacy of two known phytoestrogens [bergapten (BP) and quercetin (QE)] on implant sites under multiple bacteria-infected conditions in situ. Furthermore, the gene expression profiles of rat bone mesenchymal stem cells (rBMSCs) treated with BP and QE in the presence of Porphyromonas gingivalis-derived lipopolysaccharide were identified. The results showed that both drugs, especially QE, had significant potentiating effects on promoting osteogenic differentiation of rBMSCs, resisting multiple pathogens, and reducing inflammatory activity. Meanwhile, RNA sequencing analysis highlighted the enriched gene ontology terms and the differentially expressed genes (Vps25, Il1r2, Csf3, Efemp1, and Ccl20) that might play essential roles in regulating the above tri-effects, which provided the basis for the drug delivery system to be used as a novel therapeutic strategy for integrating peri-implant health. Overall, our study confirmed that QE appeared to outperform BP in osteogenesis and bacterial killing but not in anti-inflammation. Moreover, both drugs possess favorable tri-effects and can serve as the pivotal agents for the drug delivery system to boost osseointegration at inflammatory implant sites.

Dioscin Alleviates Periodontitis by Inhibiting NLRP3 Inflammasome Activation via Regulation of K+ Homeostasis and Mitochondrial Function.

Gingival inflammation and alveolar bone loss are characteristic manifestations of periodontitis. Interleukin (IL)-1ß, the maturation of which is mainly regulated by NOD-like receptor protein (NLRP) 3 inflammasome, not only amplifies the inflammatory response but also triggers osteoclastogenesis, thereby accelerating the progression of periodontitis. Dioscin, a natural steroid saponin, has been shown to inhibit NLRP3 inflammasome. Nevertheless, research on the effectiveness of Dioscin for the management of periodontitis remains scarce. In this study, Dioscin was found to dramatically reduce the integral components of NLRP3 inflammasome, ultimately limiting IL-1ß secretion. Notably, the inhibitory impact of Dioscin on NLRP3 inflammasome might be exerted by curbing the generation of mitochondrial (mt) reactive oxygen species (ROS) and oxidized (ox) mtDNA, which were mediated by inhibition of K+ efflux. Furthermore, Dioscin effectively alleviated periodontitis in mice. Overall, the results established that Dioscin could alleviate periodontitis by inhibiting NLRP3 inflammasome via modulation of the K+ efflux-mtROS-ox-mtDNA pathway, holding the potential to treat periodontitis and other NLRP3-driven inflammatory diseases.

Fabrication and Characterization of Collagen/PVA Dual-Layer Membranes for Periodontal Bone Regeneration.

Guided tissue regeneration (GTR) is a promising treatment for periodontal tissue defects, which generally uses a membrane to build a mechanical barrier from the gingival epithelium and hold space for the periodontal regeneration especially the tooth-supporting bone. However, existing membranes possess insufficient mechanical properties and limited bioactivity for periodontal bone regenerate. Herein, fish collagen and polyvinyl alcohol (Col/PVA) dual-layer membrane were developed via a combined freezing/thawing and layer coating method. This dual-layer membrane had a clear but contact boundary line between collagen and PVA layers, which were both hydrophilic. The dual membrane had an elongation at break of 193 ± 27% and would undergo an in vitro degradation duration of more than 17 days. Further cell experiments showed that compared with the PVA layer, the collagen layer not only presented good cytocompatibility with rat bone marrow-derived mesenchymal stem cells (BMSCs), but also promoted the osteogenic genes (RUNX2, ALP, OCN, and COL1) and protein (ALP) expression of BMSCs. Hence, the currently developed dual-layer membranes could be used as a stable barrier with a stable degradation rate and selectively favor the bone tissue to repopulate the periodontal defect. The membranes could meet the challenges encountered by GTR for superior defect repair, demonstrating great potential in clinical applications.

Melatonin prevents peri­implantitis via suppression of TLR4/NF-κB.

Peri­implantitis, which is characterized by peri­implant mucositis and alveolar bone resorption, significantly shortens the service life of dental implants. Melatonin is well-known for its anti-inflammatory and osteoprotective activities. Nevertheless, the effects and mechanisms of melatonin to prevent peri­implantitis remain unknown. In this study, the lipopolysaccharide-induced peri­implantitis model was established after the titanium implants were osseointegrated, and the rats received daily administrations of melatonin. The gingival fibroblasts and osteoclasts/osteoblasts were also co-cultured to simulate the inflammatory environment in vitro. We found that prophylactic administration of melatonin decreased proinflammatory cytokine levels and osteoclast numbers, attenuated alveolar bone resorption, and reduced the incidence of peri­implantitis in vivo. Furthermore, melatonin suppressed osteoclastic formation and function in the inflammatory co-culture environment, while melatonin promoted osteoblastic differentiation and function in the in vitro model. Mechanistically, melatonin reduced TLR4 protein levels, and inhibited activation of NF-κB to downregulate the levels of TNF, IL-1ß, and IL-6. These data showed that melatonin was a potent agent to prevent peri­implantitis through inhibiting TLR4/NF-κB signaling. Our findings provide a novel strategy to prevent peri­implantitis, and expand the applications of melatonin. STATEMENT OF SIGNIFICANCE: Dental implants have become the first choice for restoring partial and full edentulism, but its service life is seriously affected by peri­implantitis. Exploration of novel and effective approaches to prevent peri­implantitis is an important and urgent need. In the present study, we have reported for the first time that prophylactic administration of melatonin delayed the occurrence and reduced the incidence of peri­implantitis by decreasing proinflammatory cytokine levels, inhibiting osteoclastogenesis, and promoting osteogenesis. The study is expected to have an important significance on the prevention of peri­implantitis.

The endoscopically assisted transcrestal sinus floor elevation with platelet-rich fibrin at an immediate implantation of periapical lesion site: A case report.

RATIONALE: The traditional maxillary sinus floor elevation has serious postoperative complications and long healing periods, for patients with insufficient residual bone height (RBH). The endoscopic technique improves the blind nature of the sinus floor elevation procedure. Platelet-rich fibrin (PRF) can promote tissue healing and prevent perforation. PATIENT CONCERN: A 25-year-old female with residual roots in the maxillary right second molar visited our hospital for dental implants. DIAGNOSE: CBCT results showed a low-density shadow at the root tip, and the height of the periapical distance from the maxillary sinus floor was less than 1 mm. INTERVENTION: Patient was immediately subjected to implant after root extraction. Two-step sinus floor elevation was performed under endoscopy. A 12 mm-long implant was installed. OUTCOMES: At 10 months after surgery, the hard and soft tissues were stable, and a full-ceramic crown was placed. LESSONS: Immediate implant and endoscope-guided sinus floor elevation through a transcrestal approach by using PRF as the only grafting material is viable in periapical infected sites with a RBH of less than 1 mm.

Novel ultrafine-grained ß-type Ti-28Nb-2Zr-8Sn alloy for biomedical applications.

Titanium alloys are widely accepted as orthopedic or dental implant materials in the medical field. It is important to evaluate the biocompatibility of an implant material prior to use. A new ß-type ultrafine-grained Ti-28Nb-2Zr-8Sn (TNZS) alloy with low Young's modulus of 31.6 GPa was fabricated. This study aims to evaluate the biocompatibility of TNZS alloy. In this study, we examined the microstructure, chemical composition and surface wettability of the TNZS alloy. The mouse embryonic osteoblast MC3T3-E1 cells and human umbilical vein endothelial cells (HUVECs) were cultured to study the cytocompatibility of TNZS alloy. Also, we evaluated the proinflammatory response of TNZS alloy in vitro and in vivo. The results show that the TNZS did not cause cytotoxicity, genotoxicity to MC3T3-E1 cells and HUVECs. Whereas, the TNZS alloy could significantly promote the cell proliferation, cell spreading and cell adhesion of MC3T3-E1 cells and HUVECs, as well as facilitate the osteogenic differentiation of MC3T3-E1 cells. Moreover, the TNZS alloy did not induce any remarkable proinflammatory response in vitro and in vivo. Thus, the novel TNZS alloy with an elasticity closer to that of human bone is biologically safe and could be a potential candidate for biomedical implant application. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1628-1639, 2019.

Chitosan/Dextran Hydrogel Constructs Containing Strontium-Doped Hydroxyapatite with Enhanced Osteogenic Potential in Rat Cranium.

It is an effective way in bone tissue engineering to promote the mechanical and osteogenic capability of hydrogels by encapsulating mineral particles into polymer matrix. In this work, we reported novel kinds of nanocomposite scaffolds based on hydroxypropyl chitosan/aldehyde dextran hydrogel (CDH) and strontium-nanohydroxyapatite (Sr-nHA) nanoparticles. The molar ratios of Sr/(Sr + Ca) at 0% (nHA), 50% (Sr50nHA), and 100% (Sr100nHA) were fabricated and subsequently incorporated into CDH. The characterization of Sr-nHA/CDH constructs and CDH alone was studied by Fourier transform infrared analysis, X-ray powder diffraction detection, and scanning electron microscopy. The physical properties of hydrogels were further detected by swelling studies, degradation behavior, rheological measurements, mechanical testing, and ion-release behavior. Cell biocompatibility on the scaffolds was determined in vitro, and bone formation in vivo was examined by a rat calvarium defect model. The results showed that either nHA or Sr-nHA nanoparticles incorporation into CDH would significantly improve the rheological and mechanical properties (P < 0.05). The Sr2+ released from the Sr100nHA/CDH was in the range of optimal concentration for pro-osteogenesis. The addition of Sr-nHA significantly enhanced the cell proliferation and osteogenic differentiation of osteoblasts (P < 0.05). The Sr100nHA/CDH exerted the highest promotion on the polarization of macrophages toward the M2 phenotype. The new bone formation of Sr100nHA/CDH was 2.5-fold and 2-fold higher than that of CDH at 4 and 8 weeks, respectively (P < 0.05). HE staining, Masson's trichrome staining, and immunofluorescence staining of OCN results also confirmed that Sr100nHA/CDH had superior bone regeneration compared to other hydrogels in vivo. In conclusion, this novel in situ gelling hydrogel based on injectable and load-bearing 100% Sr-substituted nHA in CDH is expected to have wide orthopedic, dental, and craniofacial applications to enhance bone regeneration.

[Research progress on chitosan composite scaffolds in bone tissue engineering].

Bone tissue engineering is a scientific field devoted to the development of materials that can repair or replace human bone tissue with biological and engineering methods. The stent, which provides structural support and adhesion sites for cell and tissue growth, is one of the key elements in tissue engineering. The scaffold may comprise metal, polymer, and ceramic biomaterial. The polymer scaffold is widely used due to its biocompatibility, biodegradability, and mechanical stability. Chitosan, as a natural polymer, is derived from chitin and has played a particularly important role in bone tissue engineering over the past two decades. In recent years, chitosan composites and their application in bone tissue engineering have received considerable attention due to their small foreign body reaction, excellent antibacterial properties, plasticity, suitability for inward cell growth, and bone conduction. This review will discuss the biocompatibility and osteogenesis research in vivo and in vitro of several common chitosan composites in bone tissue engineering.