Pedro Campos Lopes

White spot lesions (WSLs) are non-cavitated enamel lesions for which treatment success depends not only on initial lesion arrest or aesthetic improvement but also on long-term stability. This systematic review aimed to evaluate the long-term clinical, aesthetic, and remineralization outcomes of WSL treatments, with particular emphasis on treatment longevity and biomaterial-based approaches. A systematic search was conducted in PubMed, Scopus, and the Cochrane Library. Randomized controlled trials involving permanent teeth with ICDAS-assessed WSLs and a minimum follow-up of 12 months were eligible. Interventions included resin infiltration, fluoride-based therapies, remineralizing gels, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) formulations, hydroxyapatite, self-assembling peptides, microabrasion, bleaching, and combined approaches. Risk of bias was assessed using the Cochrane Risk-of-Bias 2 tool. Due to substantial clinical and methodological heterogeneity, a conventional pooled meta-analysis was not considered appropriate. Nine publications representing eight independent randomized controlled trials, with follow-up periods of 12–36 months, were included. Resin infiltration demonstrated the most consistent long-term aesthetic benefits and sustained reductions in visible WSL area. Non-invasive approaches, including fluoride-based therapies and remineralizing gels, generally improved outcomes from baseline; however, the additional benefits of specific formulations, including CPP-ACP/CPP-ACPF and fluoride-containing gels or varnishes, were inconsistent compared with conventional fluoride toothpaste. Limited quantitative comparisons favored resin infiltration over fluoride varnish, CPP-ACP, and fluoride toothpaste for lesion-area reduction. The certainty of evidence was low for aesthetic outcomes and very low to low for remineralization and lesion progression outcomes. Resin infiltration showed the most consistent long-term clinical and aesthetic benefits, maintained for up to 24 months. Non-invasive strategies may support lesion regression and remineralization, but their additional long-term benefits remain uncertain and appear dependent on formulation and treatment protocol. However, direct evidence of treatment durability was limited, as several trials assessed long-term effectiveness during continuous or repeated treatment rather than the maintenance of an initially achieved response. Recurrence and retreatment were inconsistently reported, and prevention of new WSLs represented a distinct clinical outcome. Further well-designed trials with standardized outcomes and longer follow-up are needed to establish the comparative effectiveness and longevity of biomaterial-based treatments for WSLs.

Background/Objectives: Oral health literacy (OHL) and oral health outcomes are socially patterned. This article proposes the Model of Stratified Oral Health Literacy (MELSO) to specify how educational resources and service conditions may shape the development and use of OHL. Methods: A narrative conceptual synthesis integrated health literacy theory, social determinants frameworks, and educational perspectives into five interrelated levels. No new participant data were collected or analysed. Results: MELSO links structural context, educational and cultural capital, functional, interactive, and critical OHL, self-management behaviours, and oral health outcomes. Its proposed added value is the joint specification of educational mediation, access-related moderation, and competency-specific associations within oral health. Five testable hypotheses and a staged strategy for measurement development and empirical evaluation are presented, including comparisons with simpler models. Conclusions: MELSO is a hypothesis-generating framework rather than a validated explanatory model or measurement instrument. Its utility depends on empirical evidence that the proposed relationships are distinguishable, reproducible, and informative beyond existing approaches.

Background/Objectives: Evidence on virtual reality haptic simulators (VRHS) in removable prosthodontics is scarce. This study evaluated whether additional haptic simulator training be-fore conventional phantom-head training improves occlusal rest preparation performance. Methods: Thirty fourth-year dental students were randomized to an Experimental Group (EG; simulator–phantom–simulator) or a Control Group (CG; phantom–simulator). Preparations were scored (0–5) by two calibrated evaluators assessing coded preparations, and execution time was recorded. The main transfer outcome was phantom-based performance; non-parametric tests were used. Student perceptions were collected with a six-item questionnaire. Results: Phan-tom-based scores did not differ significantly between groups (median 4.25 vs. 4.00; p = 0.053). In the final simulator assessment, the EG scored higher than the CG (median 3.00 vs. 2.00; p = 0.047; r = 0.37). Within the EG, simulator scores improved (median 2.00 vs. 3.00; p = 0.003) and execu-tion time decreased by 50.7% (p < 0.001). Twenty students (66.7%) completed the questionnaire; agreement was highest for ease of use and pre-use information (65% each) and lowest for the su-periority of simulated over phantom-based preparation (25%). Conclusions: Additional haptic simulator training did not significantly improve phantom-based performance. The advantages observed on the simulator may reflect greater practice time and interface familiarity. Studies with equivalent training exposure are needed in order to confirm these results.

The continuous evolution of biomaterials has profoundly influenced modern dentistry by providing innovative solutions for disease prevention, minimally invasive treatment, tissue regeneration, and implant rehabilitation

Clear aligner therapy has become increasingly widespread in contemporary orthodontics, relying on composite resin attachments to enhance force transmission and improve the predictability of tooth movement. The physicochemical and mechanical properties of these biomaterials play a crucial role in attachment durability, dimensional stability, and esthetic performance during treatment. This systematic review aimed to evaluate how different composite resin types influence the mechanical, optical, and functional performances of orthodontic attachments used in clear aligner therapy. A systematic literature search was conducted in the PubMed, Scopus, and Cochrane databases for studies published between 2015 and 2025, following PRISMA guidelines. In vitro studies and clinical trials evaluating composite resins used for attachment fabrication were included. Fifteen studies met the eligibility criteria, including eleven laboratory investigations and four clinical studies. The evaluated outcomes comprised shear bond strength, wear resistance, surface roughness, microhardness, color stability, and accuracy of attachment reproduction. Overall, all evaluated composite resins demonstrated shear bond strength values within clinically acceptable ranges. However, significant differences were observed in the material performances depending on the resin composition and viscosity. Nanohybrid and high-viscosity composite resins were generally associated with improved mechanical resistance, reduced wear, and greater dimensional stability, although SBS outcomes should be interpreted in light of the bonding protocols used. In contrast, flowable composite resins showed improved handling and adaptation to attachment molds but presented higher susceptibility to surface degradation and discoloration. The findings suggest that the composition and properties of composite resins significantly influence the mechanical and optical behavior of orthodontic attachments. Optimizing material selection according to biomechanical demands and esthetic requirements may improve attachment longevity and treatment predictability in clear aligner therapy. Clinicians should prioritize nanohybrid or high-viscosity composite resins for high-load attachments and use flowable composite resins materials when adaptation and esthetics are critical.

Background: Haptic simulation technologies are increasingly integrated into preclinical dental education to support procedural skill development. However, the extent to which haptic simulators improve performance compared to traditional phantom-head-based training remains unclear. Our goal is to systematically evaluate the effectiveness of haptic simulators in operative dentistry training, compared with conventional approaches. Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane (2015–2025), complemented by manual searching, to identify studies evaluating virtual reality haptic simulators in preclinical operative dentistry education. The search strategy, structured according to the PICO framework, included preclinical undergraduate dental students, interventions with virtual reality haptic simulators, comparisons with conventional methods, and objective assessment of technical performance. Relevant data were extracted in a standardized manner, and the methodological quality of randomized controlled trials was assessed using RoB 2.0, while non-randomized studies were evaluated using ROBINS-I v2. Results: Of the 66 identified articles, 5 studies were included. The use of virtual reality simulators with haptic feedback in preclinical dental students was associated with increased efficiency in cavity preparation, reflected by reduced execution time and improved learning curves, as well as specific technical gains such as depth control. Overall cavity preparation quality was comparable to that achieved with conventional methods, with virtual reality being well accepted as an effective complementary tool in preclinical operative dentistry education. Conclusions: Haptic simulators appear effective for early preclinical skill development in operative dentistry and may complement traditional instruction. Evidence remains insufficient to confirm superiority over conventional methods or long-term clinical benefit. Higher-quality multicenter randomized trials with standardized performance measures are needed to strengthen the evidence base.

White spot lesions (WSLs) are early clinical stages of enamel demineralization, often related to orthodontic treatment or poor oral hygiene. The use of gels such as fluoride for topical application inhibits demineralization and promotes remineralization of dental tissues through various mechanisms. A variety of therapeutic approaches are available; however, recent research indicates that combined treatment strategies may yield superior clinical outcomes compared to monotherapy. The aim of this study was to critically compare the efficacy of combining multiple treatment techniques for WSLs compared to using these techniques alone. A systematic search was conducted in PubMed, Scopus, and Cochrane databases according to PRISMA guidelines. The PICO strategy was used to formulate the research question: Which clinical approaches combined or isolated (C) influence the treatment and prevention effectiveness (O) of white spot lesions (I) in humans (P) in the last ten years (T)? Inclusion criteria focused on clinical studies from the last ten years evaluating the combined use of at least two treatment techniques for WSL, resulting in a total of 8 randomized controlled trials selected from an initial pool of 1185 articles. Our results suggest that combined treatment strategies, including resin infiltration with fluoride varnish and ozone therapy combined with fluoride application, demonstrated enhanced efficacy in lesion masking and remineralization compared to single-treatment approaches. CPP-ACP and hydroxyapatite-based creams improved aesthetics, particularly when used alongside fluoride varnish. Our study concluded that the combination of remineralization agents like fluoride gel, infiltrative resins, and antimicrobial treatments offers superior outcomes on white spot lesion treatment than using these techniques alone. However, long-term clinical studies are needed to standardize treatment protocols and confirm durability.

Clear aligners are a modern orthodontic solution designed to address dental malocclusions discreetly and effectively. In terms of clinical side effects, the most reported issues among aligner users are mild irritation of the oral mucosa, localized inflammation, and hypersensitivity. The use of advanced polymer materials in clear aligners, such as polyurethane and PET-G, has gained widespread acceptance due to their mechanical properties, biocompatibility, and aesthetic appeal. However, concerns persist regarding their potential to release chemical compounds. Our goal is to understand the impact of clear aligner toxicity on the oral cavity of orthodontic patients. An extensive systematic search was conducted in the electronic databases PubMed, Scopus, and Cochrane to identify articles with relevant data. This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines (PRISMA) to answer a question formulated according to the Population, Intervention, Comparison, and Outcomes. Four hundred and thirteen articles potentially relevant were identified and after applying PRISMA guidelines and inclusion/exclusion criteria, seven articles were included in this review. Our results suggest that clear aligners are generally safe, but concerns remain regarding the chemical leaching of thermoplastic materials, bacterial accumulation due to reduced saliva flow, and mild inflammatory responses. Our review emphasizes that although most materials are biocompatible, some exhibit moderate cytotoxicity, with the potential to impact these patients’ oral health, underscoring the need for continued research and improvements in material composition.

Empathy can lead to a better patient-professional relationship, and this skill that can be learned and trained, and the university is the ideal place to start this training. The aim of this systematic review is to assess whether training and education interventions have an impact on increasing empathy in health students. The acronym PICOS was used to formulate the research question. A high-sensitivity search was made combining indexed terms, entry terms, and Boolean OR/AND in 9 databases, including grey literature and manual search of retrieved articles. Two researchers selected the studies based on previously established eligibility criteria. The risk of bias was verified using the RoB2 tool and a meta-analysis was performed using RevMan 5.4. The analysis included 30 studies in the qualitative synthesis and 20 studies that presented adequate data for the meta-analysis. An overall moderate effect on participants’ empathy was found after the intervention (standardized mean difference 0.45, 95% CI 0.25 to 0.65). However, heterogeneity was high (I2 = 79%). More than half of the studies were considered at high risk of bias. The results suggests that interventions can be effective in increasing empathy. This topic has been in the spotlight in the area of health education in recent years. And more quality studies will be needed, as well as long-term evaluation of interventions to ensure the durability of empathy enhancement. Not applicable.

The use of advanced polymer materials in clear aligners, such as polyurethane and PET-G, has gained widespread acceptance due to their mechanical properties, biocompatibility and aesthetic appeal. However, concerns persist regarding their potential to release chemical compounds. Our goal is to understand the impact of the toxicity of clear aligners on oral cavity of orthodontic patients. An extensive systematic search was conducted in electronic databases PubMed, Scopus and Cochrane, to identify articles with relevant data. This systematic review will be conducted following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines to answer a question formulated according to the Population, Intervention, Com-parison and Outcomes strategy. Four hundred and thirteen articles potentially relevant were identified and after applying PRISMA guidelines 7 articles were included in this review. Our results suggest that clear aligners are generally safe, concerns remain regarding the chemical leaching of thermoplastic materials, bacterial accumulation due to reduced saliva flow, and mild inflammatory responses. Our review empha-sizes that although most materials are biocompatible, some exhibit moderate cytotoxicity, underscoring the need for continued research and improvements in material composition.