María León-López

Background: Eating disorders (EDs), primarily anorexia nervosa, bulimia nervosa, and related risk behaviors, are complex biopsychosocial conditions frequently accompanied by stomatognathic alterations. Systemic malnutrition and chronic purging behaviors significantly impact oral tissues, giving dental practitioners a valuable opportunistic position for early recognition. Objective: We aimed to systematically evaluate and quantitatively synthesize stomatognathic manifestations in children and adolescents with clinically diagnosed eating disorders compared to those with screening-identified eating-disorder risk. Material and Methods: A systematic review and stratified meta-analysis were conducted according to PRISMA 2020 guidelines (PROSPERO: CRD420261490862). Comprehensive searches were executed across PubMed, Scopus, and Embase on 24 July 2026. Eligible primary studies evaluated oral outcomes in pediatric cohorts aged nine to eighteen years. Studies were stratified into clinical diagnoses and screening-defined at-risk cohorts, utilizing random-effects meta-analyses and GRADE assessments. Results: A total of twelve studies were included (nine comparative studies with healthy controls and three single-arm descriptive case series; seven comparative studies contributed to quantitative meta-analyses). In the stratified meta-analysis for erosive tooth wear (four studies, N = 1030), patients with clinically diagnosed anorexia nervosa exhibited an individual study odds ratio of 7.72 (95% CI: 2.24–26.64), whereas screening-positive community cohorts showed a pooled odds ratio of 3.50 (95% CI: 1.49–8.23; three studies); between-group differences remain descriptive. For caries experience (three studies, N = 392), clinically diagnosed patients showed elevated DMFT scores in a single study (MD = +1.90), whereas screening-identified school cohorts showed no statistically significant elevation (pooled MD = +0.88, 95% CI: −0.95 to 2.71), with high heterogeneity (I² = 86.8%). Unstimulated whole salivary flow rate was significantly reduced in diagnosed clinical anorexia (two studies, N = 156, MD = −0.20 mL/min); however, both studies originated from a single specialized center in Poznan, Poland, precluding multicenter generalization. In nationwide survey data, adolescents exhibiting unhealthy weight control showed no statistically significant differences in poor subjective oral health. Conclusions: Stomatognathic manifestations in children and adolescents vary descriptively across clinical diagnostic and screening-risk cohorts, characterized primarily by erosive tooth wear and resting salivary hypofunction in diagnosed anorexia nervosa. Although the certainty of evidence remains very low across evaluated outcomes and erosive tooth wear is etiologically multifactorial rather than pathognomonic, dental practitioners occupy a valuable position for recognizing suspicious non-carious wear, prioritizing conservative preventive stabilization, and coordinating prompt interdisciplinary referral with pediatric medical and mental health teams.

Background/Objectives: Platelet-rich fibrin (PRF) and its derivatives have been proposed as biological adjuncts to enhance tissue healing following endodontic microsurgery (EMS). However, current evidence regarding their effects on postoperative recovery and long-term bone regeneration remains inconsistent. This study aimed to evaluate the efficacy of PRF and its derivatives as adjuncts in endodontic microsurgery by separately assessing patient-centered postoperative outcomes and radiographic and volumetric bone-healing outcomes through a systematic review and meta-analysis. Methods: This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261400163). Randomized controlled trials and comparative clinical studies evaluating PRF or its derivatives as adjuncts to EMS were eligible. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and reference lists were searched from inception to April 2026. Outcomes included postoperative pain, edema, quality of life, clinical–radiographic healing, CBCT volumetric bone regeneration, bone density, and outcomes in complex defects. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed where appropriate, and certainty of evidence was evaluated using the GRADE approach. Results: Seventeen clinical reports corresponding to sixteen independent datasets were included. PRF and its derivatives improved early postoperative recovery, particularly postoperative pain during the first postoperative week. Meta-analysis demonstrated a significant reduction in early postoperative pain favoring PRF-based interventions (SMD/Hedges g = −0.62; 95% CI, −1.03 to −0.21; p = 0.003). Evidence regarding long-term bone regeneration and clinical–radiographic healing remained heterogeneous and inconclusive. CBCT-based studies suggested accelerated early bone healing, although no consistent superiority was demonstrated at 6–12 months. The certainty of evidence ranged from moderate for postoperative pain to very low for volumetric bone regeneration. Interpretation of the findings is limited by clinical and methodological heterogeneity and the small number of studies available for several outcomes. Conclusions: The available evidence suggests that PRF may improve early postoperative recovery and soft-tissue healing after endodontic microsurgery. However, current evidence does not support PRF as a predictable substitute for bone grafts or regenerative biomaterials in large or non-contained defects. Well-designed CBCT-based randomized clinical trials with standardized outcome measures are needed.

Background: Condensing osteitis is a radiopaque periapical condition associated with chronic low‐grade inflammatory stimuli of endodontic origin. Despite being frequently observed in dental practice, its reported prevalence varies considerably due to methodological and diagnostic inconsistencies across studies. Objectives: This systematic review and meta‐analysis aimed to estimate the pooled prevalence of condensing osteitis in dentate populations undergoing radiographic examination. Methods: A comprehensive search was conducted in PubMed/MEDLINE, Scopus, Web of Science and Embase up to March 2026. Observational studies reporting the prevalence of condensing osteitis were included. Data extraction and risk of bias assessment were performed using the Joanna Briggs Institute checklist. A random‐effects meta‐analysis with logit transformation was applied. Heterogeneity was assessed using the I ² statistic. Subgroup and sensitivity analyses were conducted and certainty of evidence was evaluated using GRADE. Results: Ten studies including 17 285 individuals were analysed. Based on patient‐level data, the pooled prevalence of condensing osteitis was 3.9% (95% CI: 2.8%–4.9%). Substantial heterogeneity was observed ( I ² = 96%). Subgroup analyses based on age and diagnostic criteria did not explain the heterogeneity. Sensitivity analysis confirmed the robustness of the findings. No evidence of publication bias was detected (Egger's test, p = 0.761). The overall certainty of evidence was rated as very low. Conclusions: Condensing osteitis is a radiographically detectable periapical finding with an estimated prevalence of approximately 4%. However, variability in diagnostic criteria and study methodologies limits the reliability of prevalence estimates. Standardised diagnostic definitions and improved methodological consistency are needed in future research. Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD420261354628.

Background/Objectives: Activated irrigation techniques improve intracanal disinfection, but their impact on the clinical and radiographic healing of apical periodontitis remains unclear. This systematic review and meta-analysis evaluated the efficacy of passive ultrasonic irrigation (PUI) and laser-assisted irrigation (LAI), without adjunctive systemic antibiotics, on periapical healing compared with conventional irrigation in adult patients. Methods: Following PRISMA guidelines and prospective registration in PROSPERO (CRD420261413401), PubMed, Scopus, Embase, and Web of Science were searched up to February 2026. Randomized controlled trials (RCTs) involving adults with apical periodontitis comparing PUI or LAI against conventional syringe irrigation—with a minimum of 6 months follow-up—were included. Risk of bias was assessed using RoB 2, evidence certainty via GRADE, and a random-effects meta-analysis calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of 1115 records identified, five randomized controlled trials involving 451 teeth fulfilled the eligibility criteria and were included in the qualitative synthesis and quantitative meta-analysis. Activated irrigation significantly increased periapical healing probability compared with conventional irrigation (OR = 2.25; 95% CI: 1.29–3.93; p = 0.004), with no statistical heterogeneity (I² = 0%). Subgroup analyses showed significant benefits for both PUI (OR = 1.95; 95% CI: 1.08–3.54) and LAI (OR = 6.77; 95% CI: 1.63–28.12). The overall certainty of evidence was moderate due to risk of bias concerns. Conclusions: Activated irrigation techniques (PUI and LAI) were significantly associated with improved clinical and radiographic healing of apical periodontitis compared with conventional irrigation alone. Enhanced intracanal disinfection contributes to a more predictable resolution of periapical lesions without adjunctive systemic antibiotics. Further high-quality RCTs with standardized protocols and long-term CBCT-based follow-up are required to confirm these findings.

Background: Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists. Methods: A systematic search of MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest (2015–2025) was performed according to PRISMA guidelines. Observational studies reporting the proportion of dentists prescribing systemic antibiotics for pulpitis were included. Random-effects meta-analyses estimated pooled prevalence for all clinicians, general dental practitioners (GDPs), and endodontists (ENs). Risk of bias was assessed using a modified Newcastle–Ottawa Scale, and certainty of evidence was rated with GRADE. Results: Twelve cross-sectional studies met the inclusion criteria, including 3189 dentists. The overall pooled prevalence of antibiotic prescribing for pulpitis was 19.2% (95% CI: 10.4–32.6%), with very high heterogeneity (I² = 98%). GDPs exhibited significantly higher prescribing rates (26.9%, 95% CI: 14.9–43.5%; I² = 98%) compared with ENs (5.1%, 95% CI: 1.2–19.2%; I² = 92%). Sensitivity analysis excluding two high-prevalence studies reduced the pooled estimate to 13.3% (95% CI: 8.0–21.3%) but heterogeneity remained substantial (I² = 95%). Most studies showed moderate-to-high risk of bias, and the certainty of evidence was graded as very low due to inconsistency, indirectness, imprecision, and potential publication bias. Conclusions: Approximately one in five dentists prescribe antibiotics for pulpitis, despite strong guideline recommendations against their use. However, certainty of evidence was very low. Marked variability across regions and clinical profiles highlights persistent gaps in diagnostic accuracy, access to emergency dental care, and antibiotic stewardship. Targeted education, improved urgent care pathways, and strengthened antimicrobial stewardship programs are needed to reduce unnecessary antibiotic use in pulpitis.

Background: Chronic kidney disease (CKD) has been increasingly associated with oral chronic inflammatory conditions, including periodontitis (PD) and apical periodontitis (AP). Both share common pathophysiological pathways involving systemic inflammation, immune dysregulation, and oxidative stress. This systematic review and meta-analysis aimed to synthesize current evidence on the association between CKD and chronic oral inflammatory diseases. Methods: The PRISMA guidelines were followed and the proto-col was registered in PROSPERO: CRD420251167323. A comprehensive electronic search was conducted in PubMed, Scopus, Web of Science, and ProQuest up to September 2025. Observational studies reporting prevalence of chronic oral inflammatory diseases in CKD patients and controls subjects were included. The Newcastle–Ottawa scale was used for assessing risk of bias. Pooled odds ratios (ORs) were calculated using a random-effects model. Results: Seven studies published between 2011 and 2025, including 13,139 participants, met the inclusion criteria. CKD patients had significantly higher prevalence of oral inflammatory disease than controls (OR = 4.2; 95% CI = 2.5–7.2; p < 0.00001). Heterogeneity was high (I² = 83.0%). Subgroup analysis showed an OR of 4.3 (95% CI = 2.6–7.0; p < 0.0001) for AP and 4.3 (95% CI = 2.2–8.7) for PD. The overall risk of bias was moderate, and the certainty of evidence according to GRADE was rated as low. Conclusions This systematic review and meta-analysis highlight a potential link between chronic oral inflammatory disease, including both AP and PD, and chronic kidney disease (CKD). However, the certainty of the evidence is low, and substantial heterogeneity exists across studies.

Background. Post-treatment apical periodontitis (PAP) is a frequent consequence of root canal treatment (RCT) failure, often caused by untreated missed canals in root-filled teeth (RFT). While cone-beam computed tomography (CBCT) has been used to find these missed canals, the results are controversial. This systematic review and meta-analysis investigates the association between PAP in RFT and missed canals detected via CBCT. Methods. Two independent reviewers searched PubMed, Scopus, Dialnet, and SciELO for relevant articles published up until 17 February 2025. The main outcome was the prevalence of PAP in RFT with and without missed canals detected via CBCT. The overall odds ratio (OR) was calculated using a binary random effects model meta-analysis (OpenMeta Analyst). Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty was evaluated using GRADE. Results. Eight cross-sectional studies (9983 RFT) were included in the review. The pooled prevalence of PAP was significantly higher in RFT with missed canals (85.1%) than those without (56.3%). The meta-analysis showed a strong association between missed canals and PAP (OR = 7.17, 95% CI = 4.55–11.29), indicating a sevenfold increased likelihood. Maxillary molars, especially first molars, most commonly had missed canals. Heterogeneity was high (I² = 86%), and evidence certainty was low, due to methodological limitations. Conclusions. Untreated missed canals significantly increase the likelihood of PAP in RFT, highlighting the need for thorough canal detection and treatment. Clinicians should prioritize anatomical knowledge and advanced imaging to minimize treatment failure.

Background: Dental caries is one of the most common oral infections observed worldwide. It is defined as a multifactorial dynamic disease-causing mineral loss of dental hard tissue, which is identified by the caries lesion. Treatment of the caries lesion involves filling the cavity or removing the damaged tooth. Then, the decayed, missing, and filled teeth (DMFT) index is the simplest and most commonly used index to assess the dental caries status. Salivary glands are estrogen dependent and, after menopause, the changes in salivary flow and saliva consistency produce xerostomia, hyposiale, or dryness, common findings among postmenopausal women. Since saliva plays a fundamental role in caries prevention, the postmenopausal decline in salivary secretion may contribute to increased caries incidence. The aim of this systematic review and meta-analysis was to answer the following PICO question: In adult women (P), does the presence of menopause (I), compared to its absence (C), influence dental caries status, assessed using the DMFT index (O)? Methods: The study adhered to PRISMA guidelines. A systematic search was conducted in PubMed/MEDLINE, Scopus, and EMBASE databases. For each study, characteristics and mean difference (MD) with 95% CI were extracted. Meta-analyses were performed using the Revman software (v. 5.4) to calculate pooled MD and 95% CI. Random-effects model meta-analysis was performed. Risk of bias was evaluated using the Newcastle–Ottawa Scale adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I² test was used. The certainty level of the evidence was determined through the GRADE approach. Results: Seven studies fulfilled the inclusion criteria, including 4396 postmenopausal women and 5131 control women. Meta-analysis showed an overall MD = 3.13 (95% CI = 2.12–4.15; p < 0.00001), which suggest that postmenopausal women had a DMFT index 3 units higher than the control group. Conclusions: Menopause was significantly associated with worse dental caries status, probably due to declining estrogen levels affecting salivary function. Further research is needed to confirm mechanisms and evaluate preventive strategies like hormone replacement therapy.

Background: Atherosclerosis is a chronic and progressive condition of the arteries, characterized by the thickening and hardening of their walls due to the formation of atherosclerotic plaques. Low-grade inflammation is implicated in the pathogeny of atherosclerosis. Chronic apical periodontitis (CAP), the chronic inflammation around the root apex of infected teeth, is associated with a low-grade inflammatory state, and thus a connection between atherosclerosis and CAP has been suggested. The aim of this study was to conduct a systematic review with meta-analysis to answer the following PICO question: In adult patients, does the presence or absence of atherosclerosis affect the prevalence of CAP? Methods: The PRISMA guidelines were followed to carry out this systematic review, which was registered in PROSPERO (651359). A bibliographic search was performed in PubMed-MEDLINE, Embase, and Scielo. The inclusion criteria selected studies presenting data on the prevalence of CAP in patients diagnosed with atherosclerosis and control patients. The statistical analysis was carried out using RevMan software v.5.4. The study characteristics and risk ratios with 95% confidence intervals (CIs) were extracted. Random-effects meta-analyses were performed. Risk of bias was assessed using the Newcastle-Ottawa scale, which was adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I2 test was used. The quality of the evidence was evaluated using GRADE. Results: The search strategy recovered 102 articles, and only five met the inclusion criteria. Meta-analysis showed an overall OR = 2.94 (95% CI = 1.83–4.74; p < 0.01) for the prevalence of CAP among patients with atherosclerosis. The overall risk of bias was moderate. The quality of the evidence showed a low level of certainty. Conclusions: Patients with atherosclerosis are almost three times more likely to have CAP. This finding supports the hypothesis that chronic inflammatory processes in the oral cavity could significantly impact cardiovascular health, emphasizing the importance of an integrated approach to oral and systemic health care. This result should be translated to daily clinical practice, and the healthcare community should be aware of this association and suspect atherosclerotic pathology in patients who show a high prevalence of CAP. Likewise, patients with atherosclerosis should be monitored in the dental clinic for CAP.

Background. Knowing how Endodontics is currently being taught in undergraduate dentistry studies is of great interest to determine whether new teaching methodologies, new materials and contemporary techniques, as well as new diagnostic and therapeutic criteria, are being incorporated in the teaching of dental students. The aim of this systematic review was to analyze current undergraduate endodontic teaching worldwide. Methods. A literature search was conducted to identify articles about undergraduate endodontic teaching, using the following combinations of keywords: (Endodontics OR endodontology) AND (teaching OR training OR education OR curriculum) AND (undergraduate OR pre-graduate) AND (evaluation OR assessment) AND (dental schools OR dental faculty). Considering that the aim of the review was to analyse the current teaching of Endodontics, the inclusion criteria established were: 1) studies published in the last 10 years, 2) in which those responsible for teaching Endodontics reported some data about the undergraduate training of Endodontics, 3) in dental schools around the world. Results. The search yielded 124 articles related to the teaching of Endodontics. After applying the inclusion criteria, fourteen articles were includes in the systematic review. The data provided were extracted and organized into five sections: 1) General characteristics of teaching Endodontics in the dental curriculum, 2) Teaching methodology in endodontic training, 3) Root canal treatment protocol used in undergraduate endodontic teaching, 4) Use of contemporary materials and technologies in endodontic training, and 5) Assessment methodology in endodontic training. Conclusions. The data found in the published studies show great consistency and, compared with the data found in studies carried out decades ago, allow us to conclude that the quality of current endodontic teaching in dental schools around the world has increased substantially. However, there is stillroom for improvement in some aspects, especially the incorporation of new technologies and materials into the teaching of Endodontics at the undergraduate level. This is the case of magnification, ultrasound and CBCT. The publication by the European Society of Endodontology of the Undergraduate Curriculum Guidelines for Endodontology, with numerous recommendations on the scope of endodontic education, may be the appropriate instrument to continue improving and homogenizing undergraduate teaching of Endodontics throughout the world.