Angelo Aliberti

Background/Objectives: Antibiotic prescribing remains common in oral surgery and implant dentistry, although indications, regimens, and supporting evidence vary across procedures and patient populations. This comprehensive narrative review evaluated prophylactic and therapeutic antibiotic use within an antimicrobial stewardship framework and examined the transition from procedure-based prescribing toward risk-adapted decision-making. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to 15 September 2026 using a structured modular strategy, complemented by reference-list screening and targeted searches. Evidence addressing clinical indications, antimicrobial regimens, patient-related factors, antibiotic-related harms, resistance, microbiome and resistome alterations, antibiotic-sparing approaches, and stewardship was qualitatively synthesized. Study selection was independently performed by two reviewers, and extracted information was cross-checked. Results: Antibiotic benefit varied across clinical indications. Prophylaxis reduced selected postoperative outcomes in third-molar surgery and conventional implant placement, whereas evidence was less certain for reconstructive procedures and medically complex patients. Routine postoperative continuation did not provide a consistent additional benefit across several surgical settings. Patient vulnerability alone did not establish greater prophylactic benefit, while preventive indications differed according to the complication addressed. Adverse drug reactions, resistance selection, and microbiome and resistome alterations broadened the consequences relevant to antimicrobial exposure. Stewardship interventions improved prescribing outcomes, although evidence concerning appropriateness and longer-term outcomes remained limited. Conclusions: Antibiotic prescribing should be guided by indication and expected clinical benefit rather than by procedural complexity or patient vulnerability alone. Risk-adapted decision-making can support proportionate antimicrobial exposure while remaining anchored to indication-specific evidence and established clinical guidance.

Introduction: Resin-based dental materials have substantially improved contemporary dental care while raising interest in their long-term biological safety. Attention has focused on bisphenol A (BPA), which may be associated with dental materials through BPA-derived monomers, residual impurities, or degradation processes. This narrative review critically synthesizes current evidence regarding BPA in dentistry, focusing on its origin and availability, biological implications, clinical relevance, and regulatory perspectives. Methods: A comprehensive narrative review was conducted through a structured search of PubMed/MEDLINE, Scopus, and Web of Science from database inception to 15 July 2026. Experimental, clinical, human biomonitoring, review, and relevant regulatory evidence published in English was integrated across defined thematic domains. Results: BPA availability from resin-based dental materials may reflect distinct processes, including elution of pre-existing impurities and BPA formation through chemical or biologically mediated degradation of susceptible BPA-derived monomers. Incomplete polymerization may increase the availability of residual resin constituents but does not itself generate free BPA, while ageing and wear may facilitate constituent release without necessarily producing BPA. Reported BPA concentrations vary according to material composition, experimental conditions, analytical methods, and sampling strategies. Human biomonitoring studies indicate that the largest post-treatment changes generally occur during early sampling periods, although their magnitude and temporal pattern vary with the procedure, treatment burden, biological matrix, sampling interval, and background environmental exposure. Available human evidence remains insufficient to establish a causal relationship between BPA exposure specifically attributable to dental materials and clinically relevant systemic adverse health outcomes. However, the absence of demonstrated long-term adverse outcomes should not be interpreted as definitive evidence of long-term safety, because longitudinal studies evaluating clinically relevant systemic outcomes remain limited. Conclusions: Current evidence supports a balanced and precautionary interpretation of BPA in dentistry. Clinical decision-making should consider the overall biological and clinical performance of dental materials while minimizing avoidable exposure whenever reasonably achievable. Analytical detection or experimental biological activity should not, in isolation, be interpreted as evidence of clinically meaningful harm; conversely, the absence of demonstrated adverse outcomes does not establish definitive long-term safety. Further longitudinal studies are required, particularly under repeated or cumulative exposure conditions and in potentially susceptible populations.

Background/Objectives: The management of edentulism and severe alveolar bone loss in older adults remains a significant challenge in implant dentistry. Given the potential biological and therapeutic burden associated with extensive regenerative procedures, increasing interest has been directed toward treatment strategies that utilize available anatomy and reduce surgical complexity. This narrative review examined contemporary augmentation-avoidance approaches for implant rehabilitation in geriatric patients. Methods: A structured narrative literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science, including studies published up to 30 May 2026. Clinical studies, systematic, umbrella and narrative reviews, meta-analyses that evaluate augmentation-avoidance approaches in implant dentistry were considered. The review examined evidence relevant to older adults, including clinical, prosthetic, functional, and patient-centered outcomes. Results: The available literature describes multiple strategies for managing reduced bone availability, including short and ultra-short implants, narrow-diameter implants, tilted implant concepts, pterygoid and trans-sinus implants, zygomatic implants, immediate loading protocols, flapless and computer-guided surgery, and implant-retained overdentures. These approaches have broadened the range of treatment options available for patients with reduced bone availability and may reduce the need for extensive regenerative procedures in selected clinical situations. In addition to implant and prosthetic outcomes, increasing attention has been directed toward oral health-related quality of life, masticatory function, treatment satisfaction, and maintenance requirements. However, evidence specifically focused on geriatric populations remains limited. Conclusions: Contemporary implant dentistry offers several alternatives to extensive bone regeneration in carefully selected geriatric patients, although current evidence is largely extrapolated from mixed adult populations. Treatment planning should integrate anatomical conditions with systemic health, functional status, frailty-related factors, and long-term maintenance considerations. Further geriatric-focused research is needed to support patient-centered decision-making and optimize long-term rehabilitation outcomes in aging populations.

Background and Objectives: Zygomatic implants have progressively become a widely adopted graft-free treatment option for the rehabilitation of severe maxillary atrophy. However, the expansion of their clinical indications has generated debate regarding patient selection, treatment hierarchy, and potential overtreatment. This review aimed to critically analyze current evidence regarding the use of zygomatic implants in the rehabilitation of the atrophic maxilla. Methods: A comprehensive narrative review of the literature was conducted through searches of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Relevant clinical studies, systematic and narrative reviews, and consensus statements published in English up to 27 March 2026 were critically analyzed to provide a comprehensive narrative synthesis focusing on treatment indications, surgical protocols, complications, patient-reported outcomes, and evidence gaps. Results: The reviewed literature consistently reported high implant survival rates and highlighted the role of zygomatic implants in reducing the need for extensive grafting procedures in selected patients with severe maxillary atrophy. The most frequently reported complications included sinus-related disorders, soft-tissue complications, prosthetic problems, and challenges associated with the management of implant failure. Different surgical approaches, including intra-sinus, sinus-slot, and extra-sinus techniques, were described. However, substantial heterogeneity emerged regarding treatment algorithms, complication reporting, success criteria, and patient-reported outcome assessment. Conclusions: Zygomatic implants represent an established treatment option associated with high reported implant survival in selected patients with severe maxillary atrophy, particularly when conventional implant placement would require extensive reconstructive procedures. However, in borderline clinical situations characterized by partial residual bone availability, treatment planning should also consider less invasive alternatives, including short implants, tilted implants, regenerative procedures, or customized subperiosteal implants, according to individual anatomical, prosthetic, and patient-related factors. Greater standardization of indications, complication reporting, and patient-reported outcome assessment is needed to better define the role of zygomatic implants within evidence-based treatment planning for the atrophic maxilla.

Background: Artificial intelligence (AI) is increasingly being integrated into implant dentistry, where clinical decision-making depends on the interpretation of complex radiographic and patient-specific data. Although multiple applications have been proposed across diagnostic imaging, treatment planning, intraoperative support and outcome prediction, their clinical validity and real-world applicability remain incompletely defined and their use raises relevant medico-legal considerations. Methods: A narrative review was conducted through a structured search of PubMed/MEDLINE, Scopus, and Web of Science, including English-language studies published between 2010 and February 2026. Clinical and experimental studies, as well as relevant reviews addressing AI applications in implant dentistry, were included. A qualitative thematic synthesis was performed due to methodological heterogeneity. Results: AI applications are mainly concentrated in diagnostic imaging, particularly CBCT analysis, where high levels of performance are consistently reported. In treatment planning, systems support specific decision-making tasks rather than comprehensive strategies, while intraoperative applications are integrated into navigation and robotic systems to improve procedural accuracy. Predictive models for implant outcomes have been developed, although their reliability remains influenced by dataset variability and study design. Conclusions: AI currently represents a supportive tool in implant dentistry, with greater applicability in standardized tasks. Its integration into complex clinical decision-making remains limited, highlighting the need for clinically oriented validation and cautious implementation in practice.

Background: Bisphenol A (BPA) release from resin-based dental materials is a growing concern due to its potential endocrine-disrupting effects, particularly in pediatric patients. This in vitro study evaluated cumulative BPA release and elution kinetics from commonly used pediatric resin-based materials, due to the limited evidence available. Methods: Three restorative materials (Clearfil Majesty ES-2, Estelite Sigma Quick, and Stela Automix) and one orthodontic material (Transbond XT) were investigated. Eighteen disk-shaped specimens (5.5 mm in diameter and 2 mm in thickness) were prepared for each material and immersed in artificial saliva (pH 6.8) at 37 °C for 1, 7, and 28 days. BPA concentrations were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). BPA release kinetics were evaluated during the early (1–7 days) and late (7–28 days) release phases. Results: All investigated materials released measurable BPA concentrations, with cumulative BPA release progressively increasing up to 28 days. Clearfil Majesty ES-2 and Estelite Sigma Quick exhibited the highest cumulative BPA concentrations, whereas Stela Automix showed markedly lower values. Transbond XT also demonstrated measurable BPA release. For all materials, BPA release kinetics were significantly higher during the early phase than during the late phase (p < 0.001), indicating a non-linear release behavior over time. Conclusions: BPA release from pediatric restorative and orthodontic resin-based materials is material-dependent and characterized by progressive cumulative accumulation associated with significantly higher early-phase release rates. These findings highlight the importance of assessing the safety of resin-based materials used in pediatric dentistry.

Maxillary canine impaction is a common clinical condition often requiring a combined surgical–orthodontic approach; however, the effect of different surgical strategies on periodontal outcomes remains unclear. This systematic review aimed to evaluate periodontal outcomes following treatment of impacted maxillary canines, with particular focus on the influence of surgical technique (open vs. closed) and impaction site (palatal vs. buccal). A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to January 2026 in accordance with PRISMA guidelines, and the protocol was registered in PROSPERO. Randomized controlled trials, controlled clinical studies, observational studies, case series, and case reports reporting periodontal parameters were included. Primary outcomes comprised probing pocket depth, keratinized tissue width, gingival thickness, plaque and bleeding indices, and gingival recession. Twenty-seven studies were included. Overall, treated canines were associated with periodontal conditions comparable to normally erupted teeth, with probing depths generally within physiological limits and minimal gingival recession. Buccally impacted canines tended to show slightly reduced keratinized tissue compared with palatal impactions, although without clear clinical relevance. No consistent superiority of open or closed techniques was identified. Surgical–orthodontic treatment is generally associated with favorable periodontal outcomes, and treatment selection should be individualized according to anatomical and orthodontic factors.

Root canal disinfection remains challenging due to anatomical complexity and the limitations of mechanical instrumentation. Evidence on irrigation is often fragmented and focused on isolated outcomes, limiting clinically integrated protocols. This narrative review provides a clinically oriented interpretation of contemporary irrigation and activation strategies, introducing a substrate-centered perspective emphasizing dentin modification and material interaction. A structured narrative search was conducted in PubMed, Scopus, and Web of Science up to February 2026 using keywords related to irrigants, irrigation protocols, activation techniques, and dentin–material interactions. Studies were selected based on clinical relevance, including complex anatomy, mature biofilms, and realistic irrigation sequences. Irrigation effectiveness is determined by the interplay between irrigant chemistry, fluid dynamics, and activation-mediated distribution within the root canal system, as well as by irrigation-induced dentin modifications influencing the dentin–material interface. Sodium hypochlorite and chelating agents remain central, although their performance depends on delivery and activation. Activation enhances irrigant exchange, biofilm disruption, and penetration into complex regions. Irrigation also induces physicochemical changes in dentin, affecting sealer penetration and interfacial stability. It should not only be considered a disinfection step but also a substrate-conditioning phase linking cleaning to obturation, with implications for treatment predictability and long-term outcomes.

Resin-based dental composites are widely used in restorative dentistry; however, concerns persist regarding their potential release of Bisphenol-A (BPA), a compound with recognized endocrine-disrupting activity. This in vitro study evaluated the time-dependent release of BPA from four contemporary resin-based dental filling composites immersed in artificial saliva under different thermal conditions. Disk-shaped specimens (5.5 mm diameter and 2 mm thickness) of Estelite Sigma Quick, Clearfil Majesty ES-2, Omnichroma Flow, and Luna 2 were incubated in artificial saliva at physiological pH (6.8) at 37 °C and 44 °C. BPA concentrations were quantified after 1, 7, and 28 days using a validated UHPLC–MS/MS method. BPA release was observed for all materials except Luna 2, for which it remained below the limit of quantification (LOQ) at all time points and temperatures. Across all BPA-releasing composites, the highest concentrations were observed after 1 day of immersion, particularly at 44 °C. Estelite Sigma Quick exhibited the highest BPA release, followed by Clearfil Majesty ES-2 and Omnichroma Flow. BPA release decreased progressively over time for all materials. Statistical analysis confirmed significant effects of material type, temperature, and exposure duration on BPA release (p < 0.001). Within the limitations of this in vitro study, BPA release appears to be material-dependent and influenced by thermal conditions and immersion time. Although absolute BPA concentrations were low, these findings highlight the importance of material-specific evaluation and continued monitoring of potential sources of cumulative BPA exposure from restorative dental materials.