Remus-Christian Bratu

Background and Objectives: The primary objective was to compare 12-month percentage total body weight loss (%TBWL) after endoscopic sleeve gastroplasty (ESG) and laparoscopic sleeve gastrectomy (LSG); secondary objectives were to compare metabolic, safety, and reflux outcomes, and an exploratory objective was to describe early predictors of suboptimal response. Materials and Methods: This retrospective single-center cohort included 28 ESG and 31 LSG patients treated between January 2019 and December 2022. The primary outcome was %TBWL at 12 months. Because the groups overlapped only within a limited body mass index (BMI) range, the adjusted comparison was repeated in patients with a BMI of 35–44.9 kg/m², in whom both procedures were performed. Results: Baseline BMI was lower in the ESG group (36.8 versus 44.2 kg/m²), and class III obesity was present in 14.3% of ESG and 77.4% of LSG patients. Twelve-month %TBWL was 17.1% after ESG and 30.6% after LSG. The multiple-imputation adjusted difference favored LSG by 14.9 percentage points (95% confidence interval [CI] 11.0–18.8; p < 0.001) and 13.9 points (95% CI 9.2–18.6) in the BMI-overlap subset. Inverse probability weighting retained only 25 patients with residual imbalance and is reported solely as a supplementary sensitivity analysis. In secondary analyses, LSG was associated with larger reductions in glycated hemoglobin and alanine aminotransferase. Median hospital stay was shorter after ESG (1.2 versus 2.9 days). New-onset or worsened reflux occurred in 14.3% and 32.3%, respectively (log-rank p = 0.140; unadjusted hazard ratio 2.33, 95% CI 0.73–7.45; exploratory covariate-adjusted and Firth-penalized estimates were imprecise). Serious adverse events occurred in 3.6% and 6.5%. In an exploratory, internally validated model, 3-month weight loss was associated with suboptimal 12-month response (optimism-corrected area under the curve 0.878). Conclusions: LSG was associated with greater weight loss and selected metabolic improvements, whereas ESG was associated with shorter hospitalization. Because the groups differed substantially at baseline, overlapped only within a narrow BMI range, and were small, the ESG–LSG comparison is exploratory: these associations apply to that overlap zone, should not be interpreted as comparative-effectiveness estimates, and provide limited evidence for clinical procedure selection. Reflux comparisons and the prediction model are exploratory and require confirmation in larger cohorts.

The relationship between active Helicobacter pylori infection and clinical oral findings remains uncertain. This study compared oral mucosal lesions, oral symptoms and gingival bleeding between adults with and without active infection.This retrospective cross-sectional study included 61 adults examined between March and September 2025 and selected nonconsecutively according to their willingness to participate (83 eligible patients approached; 22 declined). Participants referred for non-invasive H. pylori testing were classified as infected (n = 29) or test-negative (n = 32) by urea breath or monoclonal stool antigen testing. Recorded oral examinations included gingival screening of 318 index teeth and 1272 sites. Firth penalized logistic regression evaluated mucosal lesions; mixed models and generalized estimating equations addressed clustered gingival outcomes. At least one mucosal lesion was present in 55.2% of infected and 21.9% of test-negative participants (difference 33.3 percentage points, 95% confidence interval [CI] 8.9–53.0; p = 0.007). The adjusted odds ratio was 5.68 (95% CI 1.67–22.84; p = 0.005; 4.61 after shrinkage for optimism). Oral burning was reported by 31.0% versus 3.1% (9 versus 1 participant; p = 0.004), whereas halitosis, dysgeusia and xerostomia did not differ significantly. The adjusted site-level odds ratio for bleeding on probing was 1.93 (95% CI 1.15–3.25) and was attenuated after exclusion of current smokers (1.55; 95% CI 0.91–2.67). Active H. pylori infection was associated with the presence of oral mucosal lesions in this small sample with a test-negative comparator group; the associations with oral burning and gingival bleeding rested on few events or were sensitive to smoking status and should be regarded as hypothesis-generating. The cross-sectional design cannot establish causation, and larger longitudinal studies with confirmed infection status are needed.

Background and Objectives: Orthodontic auxiliaries create plaque-retentive niches that may amplify biofilm accumulation and inflame adjacent soft tissues. While cross-sectional comparisons suggest higher palatal burden beneath acrylic elements, less is known about real-world patterns accumulated across years of routine care. We retrospectively evaluated periodontal and palatal outcomes, and, in a microbiology sub-sample, site-specific colonization, across three device types: molar bands, Nance buttons, and removable acrylic plates. Methods: We reviewed 2022–2025 records from a university orthodontic service, including consecutive patients aged 18–30 years with documented pre-placement and 6-month follow-up indices. Groups were bands (n = 92), Nance (n = 78), acrylic (n = 76). Standardized charted measures were abstracted: Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP%), probing depth (PD), and palatal erythema grade (0–3). A laboratory sub-sample (n = 174 visits) had archived swabs cultured for total aerobic counts (log₁₀ CFU/cm²) at the device, adjacent enamel, and palatal mucosa; Streptococcus mutans burden was available from qPCR (log₁₀ copies/mL). Results: Baseline characteristics were similar, except for longer wear at follow-up in Nance (10.1 ± 4.0 months) vs. bands (8.7 ± 3.2) and acrylic (6.9 ± 3.0; p < 0.001). At 6 months, device type was associated with greater worsening of PI and GI (both p < 0.001) and with higher palatal erythema (bands 0.7 ± 0.5; Nance 1.6 ± 0.8; acrylic 1.9 ± 0.7; p < 0.001). Microbiologically, palatal mucosal colonization was lowest with bands (3.3 ± 0.5), higher with Nance (4.9 ± 0.6), and highest with acrylic (5.0 ± 0.7; p < 0.001); S. mutans mirrored this gradient (p < 0.001). Palatal CFU correlated with erythema (ρ = 0.6, p < 0.001) and ΔGI (ρ = 0.5, p < 0.001). In adjusted models, acrylic (OR 6.7, 95% CI 3.5–12.8) and Nance (OR 4.9, 2.5–9.3) independently predicted erythema ≥2; recent prophylaxis reduced odds (OR 0.6, 0.3–0.9). Conclusions: In this single-center cohort, palate-contacting designs were associated with higher palatal biomass and erythema than bands. These associations support device-tailored hygiene considerations and proactive palatal surveillance, particularly for acrylic components.

Background: Orthodontic auxiliaries can create plaque-retentive niches that inflame adjacent soft tissues. We compared bacterial colonization on molar bands, Nance buttons, and acrylic plates and assessed associated periodontal and palatal tissue responses in adolescents. Methods: In a cross-sectional study (n = 128; 10–17 years), clinical indices (Plaque Index, Gingival Index, bleeding on probing, probing depth) were recorded at device-influenced teeth. Palatal fibromucosa under palate-contacting devices was graded 0–3 (0 = none, 1 = mild/diffuse, 2 = moderate/confluent, 3 = marked with papillary hyperemia). Swabs from device surfaces, adjacent enamel, and palatal mucosa were cultured for total aerobic counts (log₁₀ CFU/cm²); Streptococcus mutans burden was quantified by qPCR (log₁₀ copies/mL). Group differences and adjusted associations were analyzed. Results: Palate-contacting devices harbored greater palatal biofilm and presented higher soft-tissue inflammation than bands. In adjusted models, device type (Nance, acrylic) remained associated with higher Gingival Index independent of measured behaviors and wear duration. Palatal colonization tracked closely with palatal erythema, supporting a local dose–response at the palatal interface. Conclusions: Appliance design is associated with distinct colonization patterns and soft-tissue responses; palate-covering acrylic components warrant device-specific hygiene and routine palatal inspection. Selecting designs with better cleansability and reinforcing plate-specific cleaning may mitigate palatal inflammation during treatment.

Background and Objectives: The main objectives of our study were to assess sexual dimorphism and to compare the facial height, as well as the anteroposterior width of the upper airway, within adult Caucasians diagnosed with skeletal Class I and skeletal Class III malocclusion, based on a number of angular and linear cephalometric parameters. Materials and Methods: One hundred lateral cephalograms were selected from orthodontic adult Caucasian patients from western Romania. Several angular parameters (SNA, SNB, ANB, FMA, Y–FH, Ba–S–PNS and NL–ML angles) and linear parameters (total, upper and lower anterior facial height—TAFH, UAFH, LAFH; total posterior facial height—TPFH) were analysed for each case. The upper airway width parameters included the width of the nasopharynx, as well as the upper, middle and lower pharyngeal airway width (UPAW, MPAW and LPAW). Results: Distinct sexual dimorphism was observed regarding the vertical cephalometric parameters within both Class I and Class III groups, with males exhibiting significantly larger facial height parameters, while females demonstrated larger nasopharyngeal depth angles (Ba–S–PNS). The Y–FH angle had significantly higher values in Class I than in Class III subjects, regardless of sex. Upper airway dimensions showed sexual dimorphism specifically in Class III subjects, with females exhibiting larger UPAW values than males. The inter-class comparisons showed larger values for LPAW, especially in females. Correlation analyses revealed no statistically significant relationships between the vertical and the upper airway parameters in Class I subjects. UPAW showed a tendency to decrease in Class III subjects as TAFH and LAFH increased. Ba–S–PNS showed consistent negative correlations with the vertical dimensions in both groups. Conclusions: These findings suggest that skeletal Class I and Class III malocclusions exhibit not only different sagittal relationships, but also distinctive, sex-related vertical skeletal patterns within each group, and therefore it would be advised that male and female patients should be diagnosed and treated according to separate protocols. In our population, Class III males are more likely to require orthognathic surgery, in addition to orthodontic treatment, with a more reserved prognosis and they might have a higher risk of OSA or other respiratory disorders in comparison with Class III females.

Chlorhexidine (CHX) represents one of the most commonly used antiseptics in dentistry and other medical–pharmaceutical fields due to its broad-spectrum antimicrobial activity. However, the potential toxic events arising from its common use in practice has become a subject of increasing concern. Thus, the present study was designed to investigate the potential toxicity of CHX digluconate at concentrations covering its antibacterial properties (0.0002–0.2%) in HGF primary gingival fibroblasts, HaCaT immortalized human keratinocytes, and JB6 Cl 41-5a epidermal cells, as well as its irritant action in ovo. Our results indicate that CHX exerted a concentration- and time-dependent cytotoxicity in all cell lines, which was evidenced by the reduction in cell viability, number, and confluence, damaged cell membrane integrity, impaired cell morphology, and specific apoptotic nuclear shape. The highest cytotoxicity was caused by CHX digluconate 0.02% and 0.2%, concentrations, at which an irritant effect on the chorioallantoic membrane was also observed. The novel findings revealed in this research contribute to the overall safety profile of CHX and stand as a basis for further investigations in this regard.