The Effects of Ultrasonic Scaling and Air-Abrasive Powders on the Topography of Implant Surfaces: Scanning Electron Analysis and In Vitro Study.

OBJECTIVES: This in vitro study aimed to investigate the impact of bicarbonate air-abrasive powders and ultrasonic scaling with stainless steel tips on the micro- and nanotopography and roughness of three different implant-abutment junction titanium surfaces. MATERIALS AND METHODS: Three types of sterile and decontaminated titanium surfaces (RS, UTM, XA) were used for analysis. Nine disks per surface type were subjected to micro- and nanotopography analysis, scanning electron microscopy (SEM), roughness analysis, and fibroblast cultivation. Ultrasonic debridement and air polishing were performed on the surfaces. Human dermal fibroblasts were cultured on the surfaces for 5 days. STATISTICAL ANALYSIS: Data analysis adhered to ISO 25178 standards for surface texture assessment. SEM micrographs were used to reconstruct areas for extracting roughness parameters. Excel and Mex 6.0 software were utilized for quantitative and stereoscopic analysis. RESULTS: The study found varying effects on surface roughness posttreatment. RS Disco samples exhibited higher surface roughness compared with UTM and XA samples, both in average and nanoscale roughness. Decontamination led to increased surface roughness for all samples, particularly RS Disco. Fibroblast growth tests revealed enhanced cell network formation on decontaminated discs, possibly due to increased nanoscale roughness or the presence of bicarbonate salts. CONCLUSION: The study underscores the complex interplay between surface topography, microbial biofilm, and treatment efficacy in peri-implant disease management. While smoother surfaces may resist biofilm accumulation, increased nanoscale roughness postdecontamination can enhance fibroblast attachment and soft tissue integration. This dichotomy highlights the need for tailored treatment protocols that consider material-specific factors, emphasizing that successful implant therapy should balance microbial control with conducive surface characteristics for long-term osseointegration and soft tissue stability.

Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses.

Maxillary sinus augmentation is one of the most predictable procedures for the rehabilitation of the posterior maxilla. The current overview aimed to summarize the findings provided by systematic reviews (SRs) and meta-analyses on the effectiveness of autologous platelet concentrates (APCs) in sinus lift and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs and meta-analyses addressing the effectiveness of APCs in sinus lift technique were included. Clinical, radiographic and histomorphometric findings were considered for APCs as solely grafting materials and APCs in combination with biomaterials. Outcomes were implant survival rate (ISR), implant stability (IS), implant failure (IF), postoperative complications, histomorphometric findings, radiographic bone gain, bone volume and bone density. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Thirty SRs were included. The methodological quality of the included reviews ranged from critically low (3 studies) to high (9 studies). The included SRs showed favorable clinical outcomes, short-term new bone formation and no biological complications when APCs were used both as solely graft material or in combination with other biomaterials. However, no significant additional effects in the long-term period were observed. APCs did not add any further positive effects compared to the physiological healing derived by the natural blood clot. The current overview of SRs highlighted the need for high-quality SRs evaluating the role of APCs in sinus lift though network meta-analyses, in order to identify the most powerful material for sinus lift augmentation. The use of APCs improves the healing of soft tissues and the postoperative quality of life in the short-term period. Thus, its application can be recommended.

Influence of crestal and sub-crestal implant position on development of peri-implant diseases: a 5-year retrospective analysis.

OBJECTIVES: The aim of the present study was to evaluate the influence of crestal and subcrestal implant position on development of peri-implant diseases. MATERIALS AND METHODS: The study was designed as a retrospective clinical and radiographic analysis. Implant-supported fixed dental prostheses were allocated in two groups: with the shoulder (i) placed in sub-crestal level and (ii) placed at bone level. For each patient, the following clinical variables were assessed: FMPS, FMBS, PlI, BOP, and PD. After prothesis delivery, an intraoral radiograph was obtained; this exam was performed also at 5 years of observation period. RESULTS: No statistically significant difference was found in terms of FMPS and FMBS at baseline and after 5 years follow-up (P < 0.05). A statistically significant difference was assessed between PD of control group and test group (P = 0.042). Patient-based analysis showed a 25.6% of peri-implant mucositis and 32.6% of peri-implantitis for implants placed with the shoulder in crestal position, while for implants inserted in sub-crestal position the percentage of peri-implant-mucositis and peri-implantitis were 19%; no statistically significant difference was found between groups after 5 years (P < 0.05). CONCLUSIONS: Within the limitation of the present study, the clinical and radiographic outcomes showed that the percentage of peri-implant mucositis and peri-implantitis was not statistically significant for both groups after 5 years follow-up. CLINICAL RELEVANCE: The outcomes of present study clinically demonstrated that a deep position of implant shoulder did not provide any benefits. On the contrary, it may be considered a possible risk indicator for implant diseases.

The Effectiveness of Autologous Platelet Concentrates in the Clinical and Radiographic Healing after Endodontic Surgery: A Systematic Review.

Regenerative techniques are increasingly applied in endodontic surgery, but different materials may have varying impacts on soft and hard tissue healing. This systematic review aims to evaluate the effectiveness of autologous platelet concentrates (APCs) in clinical and radiographic healing after endodontic surgery. The data for this systematic review were processed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for improving the reporting of systematic reviews and meta-analyses. A literature search was conducted until October 2023 on PubMed, Scopus, and Cochrane Databases. Randomized controlled trials and controlled clinical trials addressing the use of APCs in patients who presented persistent periapical lesions and needed periapical surgery were included. Dual publications, narrative reviews, systematic reviews, case series, questionnaires, animal studies, case reports, letters to the editor, in vitro studies, and abstracts were excluded. In total, the search resulted in 14 papers. Clinical and radiographical findings were reported, showing that when APCs were used, patients exhibited less pain and swelling and a greater reduction of apical radiolucency after 12 months follow-up on average. However, the moderate/high risk of bias of included studies and their high heterogeneity, do not allow one to draw definitive conclusions on the effectiveness of APC after endodontic surgery.

Critical Overview on Pure Chitosan-based Scaffolds for Bone Tissue Engineering: Clinical insights in Dentistry.

Bone Tissue Engineering (BTE) is a field of regenerative medicine continuously improving, thanks to the development of new biomaterials used as grafts or scaffolds for repairing bone defects. In recent years, chitosan, a natural biopolymer extracted mainly from crustacean shells, has demonstrated unique and desirable characteristics for BTE applications, such as: biocompatibility, biodegradability, and osteoconductive behavior. Additionally, the presence of numerous active amine groups in its chemical structure allows it to be easily modified. Data suggest that chitosan scaffolds are highly biomimetic, and show an interesting bioactivity, and antibacterial behavior. We have demonstrated, in a critical overview, how chitosan-based scaffolds may hold great interest for BTE applications in medical and dental applications. Future research should be focused on the use of chitosan-scaffolds combined with other biomaterials or bioactive molecules, to increase their overall regenerative potential, also in critical-sized defects. In conclusion, chitosan can be considered a promising biomaterial in BTE and clinical dentistry.

Full Digital Workflow for Mandibular Ameloblastoma Management: Showcase for Technical Description.

This is a showcase for technical description of a full digital workflow aimed to reconstruct and prosthetically rehabilitate the mandible after surgical resection. The surgery was performed following a computer-aided design and computer-aided manufacturing (CAD-CAM) guided workflow, using 3D reconstruction of the mandible and the fibula. After 2 years, when the ossification of the flap was reached and verified by a computed tomography (CT) scan, surgery was performed using a two-step implant rehabilitation, with successful outcomes.

Advances in Dental Implants, Tissue Engineering and Prosthetic Materials.

Scientific research has achieved numerous milestones in the field of materials applied to medicine for biomedical prosthetics [...].

The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials.

One of the common challenges in oral surgery is dealing with patients who are taking oral anticoagulant/antiaggregant drugs. Several local hemostatic agents have been proposed as an alternative to conventional suturing. Among these, autologous platelet concentrates (APCs) have been widely used to decrease the risk of hemorrhage after dental extraction. Nevertheless, there is a lack of consensus regarding the superiority of any one specific hemostatic agent over the others. This systematic review is aimed at evaluating the effectiveness of APCs as hemostatic agents after tooth extraction in patients on anticoagulant therapy. A literature search was conducted of articles published before March 2023 on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies on the use of APCs in patients undergoing dental extractions and being treated with anticoagulant drugs were included. Only randomized, controlled trials (RCTs) published up to March 2023 were included; the outcomes assessed were the time to hemostasis, the presence of post-operative bleeding and pain, and the effectiveness of wound healing. The risk of bias for each RCT was assessed by using the 'risk of bias' tool (RoB 1.0). The research revealed 6 RCTs. The findings indicated that patients on anticoagulant therapy who received APCs without discontinuing their medication experienced a decreased post-operative bleeding, a shorter hemostasis time, reduced pain, and accelerated wound healing. However, due to the high/unclear risk of bias of the studies included, no definitive conclusions can be drawn on the superiority of APCs as hemostatic agents over other similar products. Additional studies are required to validate these findings.

Unlocking the Potential of Dental-Derived Mesenchymal Stem Cells in Regenerative Medicine.

Over the past few decades, life expectancy has been increasing in several countries [...].

PReferentially Expressed Antigen in MElanoma (PRAME): preliminary communication on a translational tool able to early detect Oral Malignant Melanoma (OMM).

Oral malignant melanoma (OMM) has a prevalence less than 1% of all melanomas and it commonly develops on the oral mucosa following a slow and unspecific transformation of unstable melanocytic lesions, often resulting in a diagnostic delay. The marker PReferentially Expressed Antigen in MElanoma (PRAME) seems to be a valid tool to investigate the biological and histological nature of cutaneous melanocytic lesions, but to date its use to characterize pigmented lesions in the oral cavity is largely unexplored. The aim of this study was to create preliminary knowledge on the PRAME expression in OMM, and to compare its expression respect to other dysplastic pigmented lesions of the oral cavity. Interestingly, PRAME has been demonstrated to be reliable in the clinical conditions investigated in our pilot study; in fact, it has clearly differentiated the cases of Melanoma, which showed diffuse and intense positivity (score 6+/7+) to PRAME, from the other melanocytic nevi, which resulted to be mainly negative to PRAME. This means a better differential diagnosis, a reliable early diagnosis and a proper clinical/surgical management of the oncological lesions. In conclusion, PRAME can be a valid qualitative marker for differential diagnosis, not only in cutaneous melanomas, but also in malignant melanoma of the entire head and neck area.

Comparative in vitro study on biomechanical behavior of zirconia and polyetheretherketone biomaterials exposed to experimental loading conditions in a prototypal simulator.

Zirconia and polyetheretherketone (PEEK) are two biomaterials widely investigated as substitute for metals in oral prosthetic rehabilitation. To achieve a proper biomechanical behavior, the prosthetic biomaterials must ensure a good resistance to loads, as this is a crucial characteristic enabling their use in dental applications. The aim of this study was to investigate differences in the fracture resistance of different biomaterials in an experimental environment: fixed partial dentures (FPDs) screwed in a prototype of biomimetic mandible. 10 Samples of FPDs were allocated in 2 groups (A and B): Group A (n=5) involved FPDs in zirconia-ceramic, and Group B (n=5) involved FPDs in PEEK-composite. The samples were loaded by means of a three-point bending mechanical test, and the load to fracture has been evaluated generating a point-by-point graphics (speed/load and time/deformation). The samples were further analyzed by micro-computed tomography (micro-CT) and described under experimental loading conditions. Zirconia-ceramic FDPs were the samples reporting the worst results, showing a lower value of vertical displacement with respect to PEEK-based samples. The micro-CT results have further confirmed the preliminary results previously described. This in vitro study aims to give analytic data on the reliability of PEEK as a reliable and strong biomaterial for prosthetic treatments.

Extra-short (4-mm) implants placed after regenerative failures in the posterior atrophic mandible: A retrospective study.

PURPOSE: To explore whether extra-short (4-mm) implants could be used to rehabilitate sites where regenerative procedures had failed in order to avoid additional bone grafting. MATERIALS AND METHODS: A retrospective study was conducted among patients who had received extra-short implants after failed regenerative procedures in the posterior atrophic mandible. The research outcomes were complications, implant failure and peri-implant marginal bone loss. RESULTS: The study population was composed of 35 patients with 103 extra-short implants placed after the failure of different reconstructive approaches. The mean follow-up duration was 41.3 ± 21.4 months post-loading. Two implants failed, leading to a failure rate of 1.94% (95% confidence interval 0.24%-6.84%) and an implant survival rate of 98.06%. The mean amount of marginal bone loss at 5 years post-loading was 0.32 ± 0.32 mm. It was significantly lower in extra-short implants placed in regenerative sites that had previously received a loaded long implant (P = 0.004). Failure of guided bone regeneration before placement of short implants tended to lead to the highest annual rate of marginal bone loss (P = 0.089). The overall rate of biological and prosthetic complications was 6.79% (95% confidence interval 1.94%-11.70%) and 3.88% (95% confidence interval 1.07%-9.65%), respectively. The success rate was 86.4% (95% confidence interval 65.10%-97.10%) after 5 years of loading. CONCLUSIONS: Within the limitations of this study, extra-short implants seem to be a good clinical option to manage reconstructive surgical failures, reducing surgical invasiveness and rehabilitation time.

A Cross-Sectional Study on Cognitive Vulnerability Patterns in Dental Anxiety: The Italian Validation of the Dental Fear Maintenance Questionnaire (DFMQ).

Dental anxiety is a crucial problem for dentistry because it may represent a significant risk to oral health. Within the framework of the Cognitive Vulnerability Model (CVM), which sheds light on the cognitive vulnerability patterns that may cause dental anxiety, this study aimed to assess the psychometric characteristics of the Italian version of the Dental Fear Maintenance Questionnaire (DFMQ). The DFMQ is a 32-item questionnaire that assesses four cognitive vulnerability patterns, i.e., dangerousness, disgust, unpredictability, and uncontrollability. In a sample of 200 dental patients who had accessed public-university-hospital dental surgery, this study assessed the model fit of the DFMQ and different types of validity (i.e., predictive, convergent, construct, and discriminant validity). In addition, potential differences between DFMQ dimensions were assessed based on gender (men vs. women) and age ranges. All indicators of cognitive vulnerability were significantly associated with high dental anxiety when each variable was included independently. In contrast, when the DFMQ subscales were considered together, only unpredictability and uncontrollability were found to be associated with high dental anxiety. Women had higher scores for unpredictability, uncontrollability, and general dangerousness than men. In addition, older patients had higher scores for some vulnerability cognitive patterns than younger patients. This study provides Italian dentists and researchers with a valid questionnaire to assess cognitive factors associated with dental anxiety.

Odontogenic keratocystic can be misdiagnosed for a lateral periodontal cyst when the clinical and radiographical findings are similar.

Lateral periodontal cyst (LPC) and odontogenic keratocystic (OK) are two osteolytic lesions of the jaw with different local invasiveness and percentage of recurrence. The aim of this study was to highlight the attention on the differential diagnosis of these lesions that sometimes can have unexpected location and can lead doubts on diagnosis, therapy, and follow-up. A 34-year-old man presented to our department with a complaint of soft pain in the vestibular aspect of left mandibular second premolar and left mandibular first molar. Vital teeth in the left mandible, no mucosal swelling, and no drainage were observed. The CBCT showed a well circumscribed hypodensity area, extending between 3.5 and the apex of mesial root of 3.6. No displacement and no resorption of the roots were notified. Upon clinical and radiographical examination, a provisional diagnosis of LPC was made and enucleation of the lesion and histological examination were planned. Histologically, a cystic wall partially lined by a keratinizing squamous epithelium was observed. Surrounding and within the lesion, there was a chronic inflammatory infiltrate also of granulomatous type and with cholesterol clefts. Based on these findings, the diagnosis of odontogenic keratocystic was done. Radiolucent lesions in the premolar and canine region are frequently clinically and radiographically misdiagnosed. The identification of keratocyst in a location preoperatively favoring a lateral periodontal cyst should be suspected and biopsy must be considered in all cases to establish the nature of the lesion, the best surgical treatment, and the follow-up appointments.

Influence of the Antithrombotic Therapy in the Healing of Simple Post-Extraction Sockets: A Randomized Clinical Trial.

Background: An adequate blood supply plays a leading role in the healing process of the post-extractive socket; its coagulation leads to fibrin clot formation, which acts as a physical barrier able to prevent postoperative bleeding and microbial infection. The purpose of this study was to evaluate the effectiveness of antiaggregant drugs in healing post-extraction sockets compared to natural wound healing. Methods: This was a single-center prospective clinical trial. Extraction sockets allocated in healthy patients and in patients assuming antiplatelet drugs were considered. Thirty consecutive patients under (treated with/in treatment with) oral antiplatelet treatment were enrolled in the test group. In order to provide a control group, 30 consecutive patients meeting all the exclusion and inclusion criteria were enrolled. The extraction of the mono-radicular tooth was atraumatically performed without gingivoplasty or osteotomy procedures that could influence the healing process. Photographs were obtained before and immediately after surgery and at 3-, 7-, 14- and 28-days follow-up. Results: All patients assumed the prescribed therapy and their post-operative recovery was uneventful without any kind of post-extractive complications. The results of inter-group comparison show that on the third and seventh days of follow-up, the antiplatelet group expressed a statistically significant higher level of healing compared to the control group (p < 0.05), while no statistically significant differences were recorded at 14- and 28-days follow-up. Conclusions: Patients treated with antiplatelet agents seemed to show that this therapy can positively affect the healing process after tooth extractions.

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta-analyses.

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a-prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration.

Narrow-diameter versus standard-diameter implants placed in horizontally regenerated bone in the rehabilitation of partially and completely edentulous patients: A systematic review.

PURPOSE: The present systematic review and meta-analysis aimed to investigate the available evidence in the literature to answer the following focused question: In partially edentulous arches with reduced bone width, do implants placed after horizontal bone augmentation exhibit differences in survival and success rate compared to narrow-diameter implants placed in native bone? MATERIALS AND METHODS: A population, intervention, comparison and outcome question was defined and an electronic search was conducted using the MEDLINE (via PubMed) and Cochrane Oral Health Group databases to identify all studies analysing the use of standard-diameter implants inserted in regenerated bone or narrow-diameter implants for the rehabilitation of partially or completely edentulous atrophic maxillae and mandibles. Inclusion criteria and quality assessments were established, and studies were selected on this basis. RESULTS: Twenty-four studies met the inclusion criteria and were analysed cumulatively. A comparative meta-analysis was not possible due to the lack of studies directly comparing the two rehabilitation methods in question. A cumulative implant survival rate of 97.80% (1246/1274; pooled proportion 0.984, 95% confidence interval 0.977-0.991) was reported for the narrow implants placed in atrophic ridges, while similar results were obtained for the standard-diameter implants placed in regenerated bone, with a cumulative implant survival rate of 97.94% (1332/1360; pooled proportion 0.983, 95% confidence interval 0.976-0.990). CONCLUSIONS: The present systematic review found high and comparable survival rates between narrow- and standard-diameter implants placed in regenerated bone; however, well-designed randomised controlled trials are required to support the hypothesis that both treatment strategies are successful in comparable circumstances.

The effect of the COVID-19 outbreak on the periodontal status of patients with periodontitis in supportive therapy: a retrospective study.

OBJECTIVE: The aim of this study was to assess the impact of lockdown due to the coronavirus COVID-19 pandemic on the periodontal status of patients with periodontitis in supportive periodontal therapy. METHOD AND MATERIALS: A retrospective analysis of patients affected by periodontitis stage III-IV-grade A, B, and C, who had their supportive periodontal therapy to September 2020, after a period of 6 months from the planned maintenance recall (March 2020) was performed. Clinical parameters full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and probing depth (PD) were evaluated. Patients were assigned to three groups: A (nonsmokers); B (< 10 cigarettes/day); and C (> 10 cigarettes/day). Statistical analysis was used to compare intra-group and inter-group differences. RESULTS: In total, 55 subjects with the mean age of 47.7 ± 7.0 years were enrolled. The number of participants in group A and group B decreased, respectively, from 25 (45.5%) to 20 (36.4%) and from 17 (30.9%) to 13 (23.6%). The C group increased from 13 (23.6%) to 22 (40.0%). A statistically significant increase in mean FMPS was recorded in group A (from 22.5 ± 3.5 to 30.0 ± 28.3; P < .0001); group B (from 22.5 ± 12.7 to 42.5 ± 3.5; P < .0001); and group C (from 22.5 ± 25.5 to 42.5 ± 10.6; P < .0001). A statistically significant increase in mean FMBS was recorded in group A (from 15.0 ± 7.1 to 25.0 ± 21.2; P < .0001); group B (from 15.0 ± 0.0 to 37.5 ± 3.5; P < .001); and group C (from 12.5 ± 3.5 to 30.0 ± 7.1; P < .0001). A statistically significant increase in mean PD was recorded in group A (from 4.48 ± 0.5 to 5.25 ± 1.2; P < .001); in group B (from 4.71 ± 0.7 to 5.38 ± 1.31; P < .0001); and group C (from 6.00 ± 0.0 to 7.09 ± 1.1; P < .0001). CONCLUSIONS: Within the limitations of this study the results showed that the pandemic period resulted in an increase in probing depth for the patients in regular SPT, possibly due to increased tobacco consumption.

COVID-19 Infection in Children, Infants and Pregnant Subjects: An Overview of Recent Insights and Therapies.

BACKGROUND: The SARS-CoV-2 pandemic has involved a severe increase of cases worldwide in a wide range of populations. The aim of the present investigation was to evaluate recent insights about COVID-19 infection in children, infants and pregnant subjects. METHODS: a literature overview was performed including clinical trials, in vitro studies, reviews and published guidelines regarding the present paper topic. A descriptive synthesis was performed to evaluate recent insights and the effectiveness of therapies for SARS-CoV-2 infection in children, infants and pregnant subjects. RESULTS: Insufficient data are available regarding the relationship between COVID-19 and the clinical risk of spontaneous abortion and premature foetus death. A decrease in the incidence of COVID-19 could be correlated to a minor expression of ACE2 in childrens' lungs. At present, a modulation of the dose-effect posology for children and infants is necessary. CONCLUSIONS: Pregnant vertical transmission has been hypothesised for SARS-CoV-2 infection. Vaccines are necessary to achieve mass immunity for children and also pregnant subjects.

The role of cognitive and non-cognitive factors in dental anxiety: A mediation model.

Dental anxiety is a crucial problem for dentistry because it may represent a significant risk to oral health. Different factors, whether non-cognitive (e.g., traumatic dental events) or cognitive (e.g., the patient's subjective perceptions), may cause dental anxiety. However, previous studies have assessed these factors as independent predictors of dental anxiety, without providing any exploration of potential mediational pathways. The current study assessed the role of certain cognitive dimensions (i.e., the dentist's perceived professionalism and communicational attitudes, and the patient's perceived lack of control) as mediators between traumatic dental events and dental anxiety. The sample comprised 253 patients who had accessed a public university hospital dental surgery. The mediation analysis used a structural equation modeling. Traumatic dental events were positively associated with dental anxiety but, among the cognitive factors, only lack of control was. Furthermore, lack of control mediated the relationship between traumatic dental events and dental anxiety, although this mediation was only partial. This study sheds light on the mechanisms through which non-cognitive and cognitive factors may affect dental anxiety. The clinical implications for dental practice, in terms of improving the psychological well-being of patients, are discussed.