Fabio Massimo Sciarra

Background: Infective endocarditis (IE) is a severe and multifactorial condition historically linked to dental procedures. Current evidence shows that most cases arise from complex host–microbe interactions and biofilm colonization on damaged endothelium or intracardiac/prosthetic material, while the inappropriate use of antibiotics in dentistry promotes antimicrobial resistance. Objectives: To provide a narrative synthesis of contemporary evidence on (i) the relative contribution of dental procedures versus daily oral inflammatory burden to bacteremia and IE risk, (ii) the role of periodontal disease and the oral resistome in AMR, and (iii) the clinical and medico-legal implications of antibiotic prescribing and guideline adherence in dental practice. Materials and Methods: A narrative review was conducted using PubMed, Scopus, ResearchGate, and Google Scholar, complemented by manual screening of reference lists and relevant guideline documents. The search covered approximately the last decade (2015–2025) and included ESC 2023 and AHA 2021 guidance on IE prevention. Search terms combined concepts related to “infective endocarditis”, “antibiotic prophylaxis”, “dentistry/dental procedures”, “periodontitis/periodontal disease”, “bacteremia”, “biofilm”, “oral microbiome/oral resistome”, and “antimicrobial stewardship/antibiotic resistance”, using Boolean operators. Eligible sources included clinical studies, systematic reviews/meta-analyses, consensus statements and guidelines, and selected medico-legal literature relevant to dental decision-making and documentation. Editorials and non-peer-reviewed items without retrievable full text were not considered for evidence synthesis. Results: The reviewed evidence supports that spontaneous bacteremia associated with active periodontitis and daily oral activities may be more frequent than procedure-related bacteremia, suggesting that inflammation control and biofilm management represent a major preventive lever. Antibiotic prophylaxis should be reserved for a limited subset of high-risk cardiac patients as per contemporary ESC/AHA recommendations, whereas routine “defensive” prescribing in low-risk contexts provides minimal expected benefit and carries individual and societal harms (adverse events, microbiome disruption, AMR selection). Integrating periodontal care pathways with risk stratification and targeted antibiotic stewardship can improve patient safety and support public health. Conclusions: Dentistry plays a strategic preventive role in IE and AMR primarily through periodontal inflammation control, asepsis, and prudent antibiotic use. From a medico-legal standpoint, professional liability should be assessed on a process-based standard (risk assessment, adherence to updated guidelines, causal local treatment, informed consent, and traceable follow-up) rather than on outcome-driven hindsight.

Background and Aim: Full‐arch rehabilitation in patients with advanced maxillary atrophy has evolved considerably through the introduction of tilted and pterygoid implants combined with immediate loading protocols. At the same time, digital technologies have transformed prosthetic workflows. Nevertheless, fully digital procedures may still present limitations in edentulous arches because of scanning accuracy, equipment costs, and restricted accessibility in many clinical settings. Case Report: A 68‐year‐old male patient affected by terminal dentition and severe generalized periodontitis underwent staged implant‐supported full‐arch rehabilitation. The maxilla was treated first using immediate postextraction placement of six implants, including tilted posterior and pterygoid implants, followed by immediate loading. Six months later, the mandible was rehabilitated using the same treatment philosophy. Prosthetic rehabilitation was performed through a hybrid analog–digital workflow in which conventional implant impressions were integrated with digital scanning and CAD–CAM manufacturing. Results: All implants obtained adequate primary stability, allowing immediate loading. Clinical and radiographic examinations confirmed successful osseointegration, stable peri‐implant tissues, and absence of biological or mechanical complications throughout the observation period. Definitive CAD–CAM prostheses demonstrated passive fit without requiring intraoral corrections. At 2 years, functional stability, aesthetic integration, and patient satisfaction remained excellent. Conclusions: This case illustrates that a hybrid analog–digital workflow can represent a practical and predictable alternative for full‐arch rehabilitation in complex implant cases. By combining the precision of conventional impressions with the flexibility of digital prosthetic design, the proposed protocol achieved reliable clinical outcomes while remaining suitable for everyday clinical practice. Although further clinical studies are necessary, this approach may provide a practical and clinically applicable strategy that integrates conventional and fully digital rehabilitation protocols.

Artificial intelligence (AI) is profoundly transforming medicine and healthcare, evolving from analytical tools aimed at automating specific tasks to integrated components of complex socio-technical systems. This work presents a conceptual and theoretical review proposing the Model–Context–Relation (M–C–R) framework to interpret how the effectiveness of Artificial Intelligence (AI) in medicine and healthcare emerges from the dynamic alignment among algorithmic, contextual, and relational dimensions. No new patient-level data were generated or analyzed. Through a qualitative conceptual framework analysis, the study integrates theoretical, regulatory, and applicative perspectives, drawing on the Revision of the Semiological Paradigm developed by the Palermo School, as well as on major international guidelines (WHO, European AI Act, FDA). The results indicate that AI-supported processes have been reported in the literature to improve clinical accuracy and workflow efficiency when appropriately integrated, yet its value depends on contextual adaptation and human supervision rather than on algorithmic performance alone. When properly integrated, AI functions as a digital semiotic extension of clinical reasoning and may enhance the physician’s interpretative capacity without replacing it. The M–C–R framework enables understanding of how performance, ethical reliability, and organizational sustainability emerge from the alignment between the technical model, the context of use, and relational trust. In this perspective, AI is conceptualized not as a decision-maker but as an adaptive cognitive partner, fostering a reflective, transparent, and person-centered medicine. The proposed approach supports the design of sustainable and ethically responsible AI systems within a Medicine of Complexity, in which human and artificial intelligence co-evolve to strengthen knowledge, accountability, and equity in healthcare systems.

Antimicrobial resistance (AMR) is widely recognized as a major global public health threat, yet its origins and implications extend beyond the simple misuse or overuse of antibiotics. This study explores AMR as a complex, multifactorial phenomenon shaped by biological, clinical, dental, environmental, and social dynamics, with particular attention to the emerging role of dentistry. A narrative literature review was performed, drawing from textbooks, peer-reviewed articles, and official World Health Organization (WHO) reports, with emphasis on recent findings on periodontal biofilms as reservoirs of resistance genes. The analysis shows that AMR develops through bacterial mutations, horizontal gene transfer, environmental contamination, healthcare-associated practices, and patient behaviors, all of which interact to sustain its spread. Within dentistry, subgingival microresistances are gaining relevance, complicating treatment strategies and underscoring the need for more conscious clinical decision-making. The findings suggest that reducing antibiotic prescriptions or developing new drugs alone will not suffice; instead, a systemic, interdisciplinary approach is required, integrating microbiology, clinical practice, public health, and institutional responsibility. Such awareness is essential to confront the significant clinical, economic, and social implications of AMR and to foster strategies capable of addressing its complex and evolving nature.

Objectives: Digitalization has revolutionized dentistry, introducing advanced technological tools that improve diagnostic accuracy and access to healthcare. This study aims to examine the effects of integrating digital technologies into the dental field, analyzing the associated benefits and risks, with particular paid attention to the therapeutic relationship and decision-making autonomy. Materials and Methods: A literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, complemented by Google Scholar for non-indexed studies. The selection criteria included peer-reviewed studies published in English between 2014 and 2024, focusing on digital dentistry, artificial intelligence, and medical ethics. This is a narrative review. Elements of PRISMA guidelines were applied to enhance transparency in reporting. Results: The analysis highlighted that although digital technologies and AI offer significant benefits, such as more accurate diagnoses and personalized treatments, there are associated risks, including the loss of empathy in the dentist–patient relationship, the risk of overdiagnosis, and the possibility of bias in the data. Conclusions: The balance between technological innovation and the centrality of the dentist is crucial. A human and ethical approach to digital medicine is essential to ensure that technologies improve patient care without compromising the therapeutic relationship. To preserve the quality of dental care, it is necessary to integrate digital technologies in a way that supports, rather than replaces, the therapeutic relationship.

This study aims to assess the possibility of sex discrimination through the combined use of cheiloscopy and palatine rugoscopy. Eighty palate and lip impressions (40 male and 40 female) were analyzed. Palate impressions were acquired both analogically and digitally, while lip impressions were initially analogical and then scanned. Palatine rugae morphology was analyzed, excluding segmental rugae, and lip wrinkles were evaluated in sextants. Palatine rugoscopy did not reveal statistically significant differences between men and women. Cheiloscopy showed no significant differences between the sexes but some within individual sexes. Palatine rugoscopy results did not show sexual dimorphism. Variations in results across studies could be attributed to ethnic or methodological differences. Cheiloscopy failed to produce statistically significant differences between sexes but did show differences within the same sex. Given the lack of significant results in palatine rugoscopy and cheiloscopy, as well as inconsistencies in the literature, it appears that sex discrimination through the simultaneous use of these methods is not feasible. Further research is recommended.

Background: Cheiloscopy, a forensic technique based on the uniqueness of labial traces, has traditionally relied on analog methods. While simple, these methods present significant limitations in terms of precision and reproducibility. The introduction of 3D technology, specifically high-resolution optical scanners, represents a pivotal advancement in overcoming these challenges. Objective: This pilot study aimed to explore the feasibility and potential advantages of 3D cheiloscopy in forensic science by analyzing its precision and repeatability compared to traditional analog methods. Methods: Two participants were selected as a pilot sample, and their lip impressions were captured using both analog techniques and a high-resolution intraoral scanner (Medit i700). A total of 40 samples were collected, equally distributed among operators with varying levels of experience. Surface deviation analysis was performed to compare the methods. Results: The 3D models demonstrated greater uniformity and resolution compared to the analog impressions, which were more prone to errors caused by material quality or operator pressure. Surface deviation analysis showed an average similarity of 70%, with a standard deviation of 0.229 mm. The digital methods also significantly reduced operator-dependent variability. Conclusions: This pilot study highlights the potential of 3D cheiloscopy to improve precision and standardization in forensic applications. While the small sample size limits the generalizability of the findings, the results provide a foundation for further research with larger and more diverse datasets. Future studies should explore the capability of 3D cheiloscopy to accurately match individuals and further validate its applicability in forensic and clinical contexts.

Background: The aim of this experimental work was to evaluate cheiloscopy potential: to confirm the individual uniqueness of lip prints, to verify the presence of recurrent patterns according to the Suzuki and Tsuchihashi classification and to search for characteristics that can be used in establishing the sex of a subject, with a focus on assessing the method's limitations. Methods: Lip prints were taken from a sample of 172 volunteers using liquid lipstick and transparent adhesive tape and were digitally analyzed. Results: 59 prints (35.3%) were not considered for Suzuki and Tsuchihashi classification due to quality errors and the impossibility of visualizing lip wrinkles in one or more sextants. All the digitized prints revealed themselves to be unique after having been analyzed using superimposition. Qualitatively valid prints indicated a prevalence of Type II in both male and female. A major problem was that the analysis of the same print by different operators often resulted in a different attribution of a Type. Conclusions: The potential of cheiloscopy lies mainly in the matching of prints, given their uniqueness, but the absence of a database greatly limits its use. Additionally, its use for sex identification does not seem to be reliable. It is necessary to establish an acquisition protocol for taking and analyzing prints that could reduce the errors committed by the operator.

Aim: The aim of this study is to evaluate the possibility of discriminating between the two sexes through the simultaneous use of cheiloscopy and palatine rugoscopy. Materials and methods: 80 palate and lip impressions (40 male and 40 female) were analyzed. The palate impressions were acquired using both analogue and digital methods. The lip impres-sions were first acquired analogically and then scanned. The morphology of the palatine rugae in the palate impressions was analyzed, with the exclusion of segmental rugae. The lip prints were analyzed in sextants and the morphology of the lip wrinkles was evaluated. Results: Palatine rugoscopy shows that women have more curvy rugae than men and that men have more rugae on the left side than on the right. Cheiloscopy gave no statistically significant re-sults. Discussion: Palatine rugoscopy showed some differences between the sexes, however, these re-sults were not solid enough for reliable sex discrimination. Differences between the results of dif-ferent studies can be attributed to ethnic and methodological variations. Cheiloscopy, on the other hand, did not provide statistically significant results for sex discrimination. Conclusions: Given the scant results obtained from palatine rugoscopy and the lack of statisti-cally relevant results in cheiloscopy, together with a lack of concordance among the data found in literature, it is believed that it is not possible to discriminate between the two sexes by using the two methods contemporarily. Further research is needed.

Background: The aim of this experimental work was to confirm the individual uniqueness of lip prints, to verify the presence of recurrent patterns according to the Suzuki and Tsuchihashi classification and to search for characteristics that can be used in establishing the sex of a subject. Methods: Lip prints were taken from a sample of 172 volunteers using liquid lipstick and transparent adhesive tape and were digitally analyzed. Results: 59 prints (35.3%) were not considered for Suzuki and Tsuchihashi classification due to quality errors and the impossibility of visualizing lip wrinkles in one or more sextants, all the digitized prints revealed themselves to be unique after having been analyzed using superimposition. Qualitatively valid prints indicated a prevalence of Type II in both male and female and the presence of sex-linked features. A major problem was that the analysis of the same print by different operators often resulted in a different attribution of a Type. Conclusions: The potential of cheiloscopy lies mainly in the matching of prints, given their uniqueness, and can be a valid tool in gender determination but the absence of a database greatly limits its use. It is necessary to establish an acquisition protocol for taking and analyzing prints that could reduce the errors committed by the operator.