Saverio Ceraulo

Background. The mesiodens is a supernumerary tooth located at the midline of the maxilla and represents the most common form of hyperdontia. When symptomatic or threatening the eruption or alignment of adjacent permanent incisors, surgical removal is indicated; however, the literature reports a wide array of surgical techniques without an established standard of care. Objectives. This review aims to evaluate the surgical techniques reported for mesiodens removal, analyzing their outcomes, complications, and predictability, to provide a reference framework for clinical decision-making. Methods. The review followed the PRISMA 2020 guidelines and it was retrospectively registered in PROSPERO (CRD420261462413) on 3 September 2026, after study selection had begun. A systematic search was conducted across PubMed, Scopus, and Web of Science for studies published between 2016 and 2026 the searches being run between January and June 2026 without restriction of language or publication status, with predefined eligibility criteria and methodological quality assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Results. Thirty studies were included, predominantly case reports and case series, with only one randomized controlled trial and one comparative cohort study; consequently, the synthesis remained descriptive. The pooled surgical population comprised 845 patients, mostly pediatric, with a marked male predominance. Cone beam computed tomography (CBCT) was used for three-dimensional localization and surgical planning in 73.3% of studies. Surgical approaches were heterogeneous, including palatal, labial/buccal, nasal floor/transnasal, and endoscopic routes. Extraction was performed freehand in 80.0% of studies and with a surgical guide or dedicated plate in 16.7%. Where reported, outcomes were favorable: adjacent teeth were preserved in all 19 studies documenting this outcome, while intraoperative and postoperative complications were described in two of 20 and in three of 23 studies respectively. Conclusions. Surgical removal appears feasible and has been reported with generally favorable outcomes in the published literature; however, the evidence base consists predominantly of case reports and small case series, with important risks of selection and publication bias. The reported complication frequencies should therefore not be interpreted as the true complication rate of mesiodens surgery, and the available evidence is insufficient to formulate an evidence-based clinical guideline. Prospective comparative studies with standardized inclusion criteria and outcome definitions are warranted.

Background/Objectives: The stability of complete dentures is strongly influenced by the biomechanical properties of the oral mucosa, whose heterogeneity results in non-uniform load distribution, while its clinical evaluation remains predominantly qualitative. This article proposes a theoretical differential hypothesis aimed at providing a conceptual mathematical framework for interpreting the relationship between mucosal resilience and load distribution in complete dentures. Methods: The denture-mucosa system was represented along a one-dimensional coordinate, defining resilience R(x) and pressure P(x) as continuous functions related by a first-order differential equation, interpreted through elementary principles of differential calculus. Results: A theoretical simulation based on physiological parameters (F = 50 N, Young’s modulus 19.75 MPa, R = 2 mm) highlights that areas of thinner mucosa tend to behave as stress concentration points, while spatial variability of resilience generates deformation gradients potentially associated with prosthetic instability. Conclusions: The model, although simplified and non-predictive, provides a coherent interpretative framework and can support the integration of biomechanical parameters into clinical reasoning and prosthetic planning. No clinical recommendations should be derived from this model until experimental validation has been performed.

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6–11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.

Background: Potentially malignant oral disorders (OPMDs) and oral carcinomas represent a significant oncological concern in incarcerated populations, where multiple modifiable risk factors such as tobacco use, illicit drug consumption, oncogenic human papillomavirus infections, and poor oral hygiene coexist with limited access to preventive and routine dental care. This combination may increase the risk of delayed diagnosis and malignant transformation. Objective: This PRISMA-compliant systematic review aimed to evaluate the prevalence of OPMDs and associated risk factors in prison populations, with a particular focus on identifying gaps in the current evidence. Methods. A systematic literature search was conducted in PubMed, Scopus and Cochrane Library using predefined search strategies. The final search yielded 24 records, which were screened according to PRISMA 2020 guidelines. After title and abstract screening, 10 full-text articles were assessed for eligibility, and 5 cross-sectional studies were included in the qualitative synthesis following independent review. Results: The included studies revealed a substantial burden of oral mucosal lesions in incarcerated populations. Premalignant lesions were reported in a significant proportion of inmates, with oral submucous fibrosis particularly prevalent in some cohorts. Additionally, a high prevalence of oral high-risk HPV infection and widespread oral manifestations were observed. Tobacco use, often combined with betel quid, alcohol, or illicit drugs, emerged as the primary and consistently associated risk factor for oral lesions. Conclusions: Prison populations appear to represent a high-risk group for OPMDs due to the combined effect of behavioral and structural risk factors. However, the limited number of available studies, their cross-sectional design, and methodological heterogeneity prevent definitive conclusions. Further longitudinal and methodologically robust studies are needed to better define prevalence patterns and support targeted screening and prevention strategies in correctional settings.

Background: Nylon-based removable partial dentures, such as Valplast^® (Valplast International Corp, Westbury NY, USA), have been proposed as a valuable alternative to acrylic resin prostheses, particularly following oral surgical extractions and in patients with suspected methacrylate hypersensitivity. This review aimed to evaluate the clinical indications guiding the use of nylon-based prostheses after oral surgical extractions and to investigate their prevalence in patients with documented acrylic allergies. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in six databases (PubMed, Scopus, Embase, Google Scholar, LILACS, and Cochrane Library) for studies published between 2015 and 2025. Eligible studies were critically appraised using the Joanna Briggs Institute (IBI) tools. Results: Nine studies met the inclusion criteria, all of which were low-level evidence (six case reports and three case series), comprising a total of 11 patients (mean age 43 years). Nylon-based prostheses were used in both maxillary and mandibular arches, with rehabilitation motivated by esthetic and functional reasons. Outcomes were generally favorable, with patients reporting satisfaction in terms of comfort, function, and esthetics. Conclusions: Current evidence supporting the use of nylon-based removable partial dentures remains extremely limited and is based exclusively on case reports and small case series. While this type of prostheses represents a viable post-surgical rehabilitation option, primarily chosen for esthetic and functional benefits, evidence on their use in patients with documented acrylic hypersensitivity remains lacking. The low quality and limited number of studies highlight the need for prospective, controlled, and long-term research to clarify the role of nylon prostheses in post-surgical oral rehabilitation and to define their effectiveness in patients with material allergies.

Background/Objectives: This retrospective study aimed to evaluate the five-year clinical performance of removable partial dentures (RPDs) made of chromium–cobalt–molybdenum alloy, comparing two different post-casting cooling methods: slow furnace cooling (LRF) and room temperature air cooling (RATA). The investigation aimed to determine whether LRF treatment could reduce the incidence of technical complications, such as fractures and clasp deformations, particularly on RPD with thin clasps for aesthetic reasons. Methods: In total, 22 RPDs were examined, 11 of which were treated with LRF (test group) and 11 with RATA (control group). The prostheses in the LRF group had clasps intentionally reduced by 2/3 tenths of a millimeter compared to those in the RATA group. All the prostheses were made and evaluated by the same operator, who analyzed the presence of changes, fractures, or clasp widening after five years. Statistical analysis was performed using Fisher’s exact test with a significance level of p < 0.05. Results: Clinical data showed a lower complication rate in the LRF group compared to the RATA group in all parameters evaluated: prosthesis modification (9.1% vs. 18.2%), clasp fractures (9.1% vs. 36.4%), and enlarged clasps (54.4% vs. 72.7%). However, the statistical comparison between the two groups did not show significant differences, p-value ˃ 0.05 for all parameters. Conclusions: Despite the lack of statistical significance, likely due to the limited size of the cambium and the confounding variable of clasp thickness, clinical trends indicate a potential superiority of the LRF method in the parameters examined, such as modification prosthesis, fractured clasp, and enlarged clasp. The reduction in complication rates in the LRF group suggests that the superior mechanical properties conferred by this treatment may compensate for the potential structural weakening caused by clasp thickness. Future studies with a larger sample size and a prospective design will be needed to validate these results and confirm LRF as the preferred protocol for the production of aesthetic RPD.

Background: Impaction of maxillary canines is a frequent clinical challenge in orthodontics. Early diagnosis is key to effective management. Methods: This narrative review included studies published from 2004 to 2024. An electronic search was conducted in PubMed, Scopus, and Google Scholar (September–November 2024), using predefined eligibility criteria. The selection and drafting were completed in the following months. Studies involving orthopedic, orthodontic, or surgical-orthodontic management of impacted maxillary canines were included. Case reports and procedures limited to avulsion or transplantation were excluded. Results: A total of 10 studies were analyzed, comprising 5529 patients, of whom 2530 met the criteria for treatment-specific analysis. Surgical exposure with orthodontic traction was the most frequent treatment (72%), followed by monitoring (12%), maxillary expansion (6%), and extractions (10%). Interceptive approaches were mainly applied in patients aged 7–18 years, with favorable outcomes especially before age 12. In adults, more invasive treatments were required, often with reduced success rates. Conclusions: Early diagnosis and interceptive extraction of deciduous canines reduce treatment complexity and improve success. Therapeutic outcomes are strongly influenced by patient age, tooth position, and angulation. A structured, radiographically guided approach, supported by the proposed decision-making flowchart, may optimize clinical outcomes. However, heterogeneity of included studies and lack of long-term follow-up limit the strength of available evidence.

Background/Objectives: Maxillary defects, whether congenital or acquired, can compromise chewing, speech, and aesthetics. This systematic review aimed to evaluate the application and characteristics of definitive palatal obturators in the rehabilitation of such defects, analyzing techniques of fabrication, materials, outcomes of the fabrication, and limitations reported in the literature. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and was registered in PROSPERO (ID: 1011648). A comprehensive search was performed in PubMed, Scopus, Lilacs, and Google Scholar for studies published from 1 January 2014 to 1 January 2025. Inclusion criteria comprised adult patients treated with definitive palatal obturators and with reported follow-up. Exclusion criteria included studies on children, animals, or lacking patient data. Two reviewers independently screened studies and assessed eligibility. Bias was evaluated qualitatively across five domains. No meta-analysis was conducted; data were synthesized descriptively using charts and tables. The study was funded by the Italian Ministry of Health—Current Research IRCCS. Results: A total of 59 studies involving 83 patients (46 males, 37 females; mean age 54.6 ± 13.8 years) were included. Mucormycosis and squamous cell carcinoma were the primary causes of defects. Conventional impressions using alginate and silicone were most common, while digital techniques were reported in only 6.6% of cases. All definitive obturators were fabricated using acrylic resin, with some featuring hollow bulbs, velopharyngeal extensions, or magnetic retention. Multiple sources of bias were observed. Conclusions: Definitive palatal obturators provide effective functional and aesthetic rehabilitation for maxillary defects. However, evidence is limited by methodological weaknesses, lack of standardization, and underutilization of digital technologies. Future studies should focus on improving reporting quality, adopting innovative fabrication protocols, and generating higher-level clinical evidence to support best practices.

(1) Aim: To compare transverse dimensions measured on AI-generated intra-oral models and conventional digital intra-oral models. (2) Methods: A group of 38 patients treated with clear aligners was selected retrospectively from those whose records featured both AI-generated and conventional digital intra-oral models taken at the same timepoint. Transverse dimensions (inter-canine, inter-premolar, and inter-molar distances) on both upper and lower arches were evaluated and compared. Intra-class correlation index and paired t-test were applied to test the repeatability of measurements and statistically significant differences, respectively. Statistical significance was set at 0.05. (3) Results: Intra-class correlation index showed good repeatability. Paired t-test showed differences in measurements of the distances between the thicket area of gingiva on the palatal side of the upper first molar (p = 0.002), the gingival margin of the lower first molar (p = 0.014), and the mesio-vestibular cusps of the lower first molars (p = 0.019). (4) Conclusions: Transverse measurements were similar on AI-generated and conventional intra-oral .stl renderings. Statistical differences were found on posterior areas of both upper and lower dental arches, but are unlikely to be clinically significant.

Background: Technological progress in the field of prosthetic dentistry has changed the workflow, optimizing times and increasing the possible choices of prosthetic rehabilitation. Methods: The adaptability of three resin plates to the plaster model was evaluated by visual evaluation and by filling out a questionnaire in which two areas present in three silicone impressions obtained with three different construction methods were selected, including the traditional method, CAD/CAM method for milling, and CAD/CAM method for addition. Results: The results showed that although silicone 3 obtained with the additive method had better performances in the selected areas, the p-value of 0.735 was >0.05, and therefore there are no statistically significant differences between the different silicone impressions. Furthermore, a poor agreement between the evaluators was found (k 0.184). Conclusions: This work conducted in vitro highlights an important aspect of the choice of material used for impressions in cases of prosthetic relining. More in-depth studies with larger samples and objective measurement methods will be needed to compare fit data across different prosthetic construction modalities.