Byron Velasquez Ron

Background: Although toothbrushing is widely recognized as a cornerstone of caries prevention, oral hygiene has traditionally been assessed using self-reported frequency or categorical plaque indices. Evidence regarding the relationship between objectively quantified brushing efficacy and cumulative caries severity remains limited. This study evaluated the association between a quantitative brushing efficacy index and dental caries severity among schoolchildren. Methods: A cross-sectional analytical study was conducted among 200 schoolchildren examined during a community dental campaign in 2025. Caries was assessed using Decayed, Missing, and Filled Teeth indices following Word Health Organization criteria. Severe caries was defined as Decayed, Missing, and Filled Teeth ≥ 5. Oral hygiene was measured using a brushing efficacy index, expressed as the percentage of biofilm removed after supervised brushing. Associations were evaluated using chi-square tests and logistic regression models adjusted for age and sex. Results: Caries prevalence was 95.5%, with a mean Decayed, Missing, and Filled Teeth of 4.99 ± 2.96. Severe caries was observed in 49% of participants. No statistically significant differences were found across tertiles of brushing efficacy (χ² (2) = 2.18; p = 0.336). In regression analysis, each 10% increase in brushing efficacy was not significantly associated with severe caries (adjusted OR = 0.92; 95% CI: 0.81–1.03; p = 0.154). Conclusions: Dental caries prevalence was high in this population, and nearly half of the participants presented severe caries. Quantitative brushing efficacy was not significantly associated with severe dental caries after adjustment for age and sex.

Background: Freehand direct composite resin veneers offer a minimally invasive approach for managing aesthetic alterations in anterior teeth; however, their long-term colour alteration and surface performance remain uncertain. This systematic review evaluated colour alteration, marginal discolouration, and surface-quality deterioration after at least 24 months of clinical service. Methods: MEDLINE/PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched. Randomised and non-randomised trials and longitudinal clinical studies evaluating freehand direct anterior composite restorations were eligible. Risk of bias was assessed using RoB 2 and the JBI cohort checklist. Single-arm proportions were pooled separately using random-effects models with Freeman–Tukey transformation. Logit-REML models, binomial-normal generalised linear mixed models, Hartung–Knapp adjustments, leave-one-out analyses, and influence diagnostics were used as sensitivity analyses. Results: Eight studies were included. Colour alteration was evaluated in 893 restorations, with a pooled proportion of 14% (95% CI: 5–26%; I² = 95.0%). Marginal discolouration involved 566 restorations and yielded a pooled proportion of 21% (95% CI: 10–34%; I² = 91.8%). Surface-quality deterioration was assessed in 896 restorations, with a pooled proportion of 21% (95% CI: 9–35%; I² = 95.6%). GLMM estimates were 11%, 19%, and 18%, respectively. Hartung–Knapp and leave-one-out analyses produced compatible results, although prediction intervals were wide. No study materially altered the overall interpretation. Conclusions: The pooled proportions of recorded aesthetic deterioration were 14% for colour alteration, 21% for marginal discolouration, and 21% for surface-quality deterioration. However, between-study heterogeneity was substantial, and prediction intervals were wide (0–63%, 0–68%, and 0–74%, respectively), indicating considerable variability in the outcomes expected across clinical settings. Absence of recorded deterioration should not be interpreted as equivalent to overall aesthetic success or clinical acceptability. Accordingly, the pooled estimates should be interpreted cautiously and primarily as average estimates across heterogeneous clinical settings.

Background: Palatal graft harvesting can cause pain, bleeding, and delayed healing, with postoperative recovery varying across patients and over time. Topical hyaluronic acid (HA) may reduce donor-site morbidity and promote tissue repair. Identifying the postoperative time points and clinical domains in which HA may provide benefit could support more informed, patient-centered postoperative management. Objective: To evaluate the time-specific effects of topical HA on palatal wound healing and postoperative morbidity after autogenous gingival graft harvesting and to examine their clinical implications for postoperative care. Methods: Randomized clinical trials comparing topical HA with placebo, no application, or standard care were reviewed. Separate random-effects meta-analyses were performed at each postoperative time point using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Between-study variance was estimated using REML. Leave-one-out, Hartung–Knapp, and formulation-based sensitivity analyses were performed. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Eight randomized trials were included. HA increased complete epithelialization at day 14 (RR = 2.11; 95% CI, 1.13–3.94) and day 21 (RR = 1.62; 95% CI, 1.29–2.03). WHI favored HA at day 7 (MD = 0.58; 95% CI, 0.42–0.75). Pain reductions at days 3 and 7 and bleeding reductions at days 1 and 3 were not statistically significant. Analgesic consumption was lower at day 3 (MD = −0.80; 95% CI, −1.34 to −0.26), while color match favored HA at days 14 and 21. Hartung–Knapp analyses increased uncertainty for WHI, pain, and color match. No result was rated at high overall risk of bias; certainty ranged from low to very low. Conclusions: Topical HA appears to provide its most consistent benefit in accelerating palatal epithelialization and selected healing outcomes rather than uniformly reducing all dimensions of postoperative morbidity. These time- and outcome-specific effects may inform patient-centered and risk-adapted postoperative strategies, particularly when early wound closure is a clinical priority. However, the current aggregate evidence does not permit identification of individual treatment responders. Future adequately powered randomized trials incorporating standardized HA formulations, patient-level characteristics, potential effect modifiers, and harmonized outcome assessment are needed to support precision treatment selection.

Background: Although toothbrushing is widely recognized as a cornerstone of caries prevention, oral hygiene has traditionally been assessed using self-reported frequency or categorical plaque indices. Evidence regarding the relationship between objectively quantified brushing efficacy and cumulative caries severity remains limited. This study evaluated the association between a quantitative brushing efficacy index and dental caries severity among schoolchildren. Methods: A cross-sectional analytical study was conducted among 200 schoolchildren examined during a community dental campaign in 2025. Caries was assessed using Decayed, Missing, Filled Teeth indices following Word Health Organization criteria. Severe caries was defined as Decayed, Missing, Filled Teeth ≥5. Oral hygiene was measured using a brushing efficacy index, expressed as the percentage of biofilm removed after supervised brushing. Associations were evaluated using chi-square tests and logistic regression models adjusted for age and sex. Results: Caries prevalence was 95.5%, with a mean Decayed, Missing, Filled Teeth of 4.99 ± 2.96. Severe caries was observed in 49% of participants. No statistically significant differences were found across tertiles of brushing efficacy (χ² (2) =2.18; p=0.336). In regression analysis, each 10% increase in brushing efficacy was not significantly associated with severe caries (adjusted OR=0.92; 95% CI: 0.81–1.03; p=0.154), although a protective trend was observed. Conclusions: This population exhibited an extremely high burden of dental caries. Quantitative brushing efficacy showed a non-significant protective trend, suggesting that in high-risk contexts, caries severity is influenced by multifactorial determinants beyond isolated oral hygiene performance.

Background/Objectives: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the periodontal supporting tissues. Regenerative responses may vary according to patient-related biological characteristics, periodontal defect morphology, the local inflammatory microenvironment, cellular source, biomaterial selection, and delivery strategy. Cell-based regenerative therapies may therefore provide a biological foundation for the future development of personalized periodontal regenerative approaches. This systematic review and meta-analysis evaluated the effectiveness of cell-based therapies for periodontal regeneration and considered how the current evidence may inform future personalized regenerative strategies. Methods: A comprehensive electronic search was conducted in MEDLINE via PubMed, Web of Science, Embase, and the Cochrane Library, with additional searches performed in SciELO and Latindex, in accordance with PRISMA guidelines. Randomized and quasi-randomized controlled clinical trials evaluating cell-based regenerative therapies for periodontal defects were included. The primary outcomes were clinical attachment level (CAL) gain and probing depth (PD) reduction, while radiographic bone regeneration was considered a secondary outcome. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Leave-one-out sensitivity analyses were performed to assess the stability of the pooled estimates. Results: Six clinical trials were included in the qualitative synthesis, and five contributed to the quantitative analysis. Cell-based regenerative therapies showed a small, non-significant effect for CAL gain (SMD = 0.17; 95% CI: −0.12 to 0.45; I² = 0%) and PD reduction (SMD = 0.13; 95% CI: −0.22 to 0.48; I² = 33.0%). Radiographic bone regeneration showed a larger favorable effect, although statistical significance was not reached and substantial heterogeneity was present (SMD = 1.25; 95% CI: −0.08 to 2.58; I² = 88.2%). Leave-one-out analyses did not materially alter the non-significant interpretation for CAL or PD, although some variation in effect magnitude and direction was observed. Radiographic bone regeneration was more sensitive to the exclusion of individual studies. Overall, superiority of cell-based regenerative therapies over control interventions was not demonstrated. Risk-of-bias assessment indicated a low overall risk for most randomized trials, with some concerns in one trial and moderate risk in the quasi-randomized study. Conclusions: Cell-based regenerative therapies showed preliminary but inconclusive signals of benefit for periodontal regeneration. However, no statistically significant superiority over control interventions was demonstrated for CAL gain, PD reduction, or radiographic bone regeneration. Further well-designed clinical trials are required before these approaches can be considered for routine or personalized periodontal regenerative strategies.

Background: Temporomandibular disorders (TMD) comprise a heterogeneous group of musculoskeletal conditions that may manifest during childhood and adolescence. However, standardized information regarding TMD-related clinical findings in pediatric populations remains limited because of methodological heterogeneity and the inconsistent application of validated diagnostic protocols. Objective: The aim of this study was to characterize clinical findings related to temporomandibular disorders in schoolchildren and to explore their potential contribution to individualized assessment strategies within the framework of personalized pediatric oral healthcare. Methods: A multicenter cross-sectional study was conducted in 1052 schoolchildren recruited from participating educational institutions. All participants underwent a standardized clinical examination that included assessment of masticatory muscle tenderness, temporomandibular joint tenderness, joint sounds, pain intensity, and perceived stress using an adapted pediatric DC/TMD protocol. Categorical variables were summarized as frequencies, percentages, and 95% confidence intervals (95% CIs). Associations between categorical variables were evaluated using Pearson’s chi-square test, and multivariable logistic regression was performed to identify factors independently associated with pain. Results: Pain during clinical examination was identified in 111 participants (10.6%; 95% CI: 8.8–12.6%), whereas temporomandibular joint sounds and myofascial pain were detected in 1.4% and 0.3% of participants, respectively. Most pain was classified as mild, and the masseter muscle was the most frequently affected anatomical site. Increasing age and female sex were independently associated with pain. Compared with children aged 4–6 years, participants aged 10–12 years (adjusted OR = 9.61; 95% CI: 2.22–41.51) and 13–16 years (adjusted OR = 35.49; 95% CI: 8.59–146.61) showed significantly greater odds of pain. Female participants also demonstrated higher odds of pain than males (adjusted OR = 7.49; 95% CI: 3.68–15.21; all p < 0.05). Conclusions: Clinically detectable TMD-related findings were generally uncommon among schoolchildren aged 4–16 years and were predominantly mild and muscular. Increasing age and female sex were independently associated with pain, emphasizing the importance of demographic factors in the early clinical expression of TMD. Standardized pediatric clinical examination protocols may facilitate early identification of TMD-related findings and support preventive strategies during childhood and adolescence. These findings support the implementation of individualized clinical assessment strategies for early identification of children at risk of temporomandibular disorders, contributing to personalized preventive and therapeutic approaches in pediatric oral healthcare.

Background: Osteoradionecrosis (ORN) is a severe late complication of radiotherapy for head and neck cancer, associated with impaired bone healing, infection, pain, and exposed bone. Periodontal disease may contribute to ORN by maintaining inflammatory and infectious foci within irradiated tissues with reduced vascularity and repair capacity. Objective: To evaluate whether periodontal disease or poor periodontal status is associated with increased ORN risk in patients with head and neck cancer undergoing radiotherapy. Methods: This systematic review and meta-analysis followed PRISMA 2020 recommendations and was structured according to the PECO framework. Searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, WHO databases, and gray literature. Observational studies involving head and neck cancer patients treated with radiotherapy and reporting periodontal status in relation to ORN were included. Risk of bias was assessed using a domain-based approach. Random-effects models estimated pooled relative effect estimates and ORN prevalence. Results: Six studies were included in the primary association meta-analysis. Periodontal disease was significantly associated with increased ORN risk, with a pooled relative effect estimate of 4.83 (95% CI: 1.96–11.93; p = 0.0006; I² = 50.4%). Seven studies including 1785 patients and 118 ORN events were included in the prevalence meta-analysis, showing a pooled ORN prevalence of 9% (95% CI: 6–13%; I² = 78.0%). Conclusions: The findings suggest that periodontal disease or poor periodontal status may be associated with an increased likelihood of ORN in patients with head and neck cancer undergoing radiotherapy. Given the observational nature of the evidence and the moderate between-study heterogeneity, this association should be interpreted cautiously. Comprehensive periodontal assessment and long-term oral surveillance may be considered as components of multidisciplinary care before and after radiotherapy.

Background: CAD/CAM dental ceramics are widely used for indirect restorations because of their favorable esthetic properties, biocompatibility, and mechanical performance. However, long-term exposure to thermal fluctuations, moisture, and cyclic loading may compromise their structural integrity. This systematic review and meta-analysis evaluated the effect of artificial aging protocols on the mechanical properties of CAD/CAM dental ceramics. Methods: A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, LILACS, Google Scholar, and ProQuest from inception to June 2026. In vitro studies evaluating CAD/CAM ceramics subjected to thermocycling and/or artificial aging protocols were included. The primary outcomes were flexural strength and fracture resistance. Random-effects meta-analyses were performed using standardized mean differences (SMDs) or pooled means with 95% confidence intervals (CIs). Subgroup analyses were conducted according to ceramic category, and sensitivity analyses were performed using a leave-one-out approach. Results: Five studies comprising 16 independent comparisons were included in the flexural strength meta-analysis, while five studies contributed 11 comparisons to the fracture resistance analysis. Artificial aging protocols significantly reduced the flexural strength of CAD/CAM ceramics (SMD = −1.68; 95% CI: −2.28 to −1.08; p < 0.00001). The greatest reduction was observed in zirconia-based ceramics (SMD = −3.31), followed by hybrid/PICN ceramics (SMD = −1.37) and lithium disilicate/lithium silicate ceramics (SMD = −1.25). Feldspathic and glass-based ceramics showed no significant reduction. The pooled fracture resistance after aging was 1312.85 N (95% CI: 1131.59–1494.10 N), indicating that most CAD/CAM ceramics maintained clinically relevant fracture resistance despite aging. Conclusions: Artificial aging protocols adversely affect the flexural strength of CAD/CAM dental ceramics, particularly zirconia-based materials. Nevertheless, fracture resistance generally remains within clinically acceptable ranges. Material composition plays a critical role in determining susceptibility to aging-related degradation, highlighting the importance of ceramic selection for long-term restorative performance.

Background: Temporomandibular disorders (TMD) are multifactorial musculoskeletal conditions frequently associated with chronic pain, inflammation, and functional impairment. Increasing evidence suggests that oxidative stress may contribute to the pathophysiology of TMD, and salivary biomarkers have emerged as a promising non-invasive approach for evaluating these biological alterations. Objective: This systematic review and meta-analysis aimed to systematically evaluate and quantitatively synthesize the available evidence regarding salivary oxidative stress biomarkers in patients with temporomandibular disorders compared with healthy controls. Materials and Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO. Electronic searches were performed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases. Observational studies and clinical trials evaluating salivary oxidative stress biomarkers in patients with TMD were included. The primary biomarkers assessed were malondialdehyde (MDA), total antioxidant capacity (TAC), and catalase activity (CAT). Data extraction and risk of bias assessment were independently performed by two reviewers using the Newcastle–Ottawa Scale and RoB 2 tool when applicable. Random-effects meta-analyses were conducted using weighted or standardized mean differences with 95% confidence intervals. Included studies demonstrated substantial methodological variability regarding TMD diagnostic criteria, saliva collection protocols, biomarker assays, and sampling conditions. Results: Pooled analyses showed significantly elevated salivary malondialdehyde levels in patients with TMD compared with healthy controls, suggesting increased lipid peroxidation and oxidative stress activity. In contrast, total antioxidant capacity and catalase activity demonstrated inconsistent and non-significant findings across studies. Considerable heterogeneity was identified among studies, limiting the comparability and interpretability of pooled estimates. Salivary oxidative stress biomarkers, particularly malondialdehyde, appear to be associated with temporomandibular disorders and may reflect underlying oxidative and inflammatory mechanisms. Conclusions: However, substantial methodological heterogeneity and lack of standardized protocols currently limit their clinical applicability. Future well-designed longitudinal studies using harmonized diagnostic and analytical methodologies are required to clarify their translational value in TMD assessment.