Denosumab is a humanized monoclonal antibody targeting receptor activator of nuclear factor-κB ligand (RANKL) and is commonly used in the treatment of osteoporosis and cancer-related bone metastases. However, the persistent use of denosumab has been associated with an increasing incidence of denosumab-related osteonecrosis of the jaw (DRONJ), particularly following tooth extraction. This expert consensus aims to develop clinical management guidelines for the perioperative period of tooth extraction in patients who are currently receiving or have previously received denosumab therapy. The consensus covers the definition, etiology, epidemiology, staging, and risk factors of DRONJ, focusing on preoperative assessment, risk-based prevention strategies, minimally invasive surgical techniques, and postoperative follow-up protocols. The core management strategy for DRONJ emphasizes individualized decision-making based on a comprehensive preoperative assessment of medication history, local infection, and systemic conditions. The main risk factors for DRONJ include high-dose and long-term denosumab therapy, preexisting oral infections, such as periodontitis and periapical periodontitis, and invasive dental procedures, including tooth extraction, diabetes, and concomitant use of glucocorticoids or antiangiogenic agents. Core preventive measures include strict perioperative oral care, risk assessment-based antibiotic prophylaxis, long-term drug holidays, which were developed by dentists and physicians prio-ritizing the primary disease, and minimally invasive surgical techniques for managing trauma, preserving local blood supply, thoroughly removing infected tissues, and ensuring tight wound closure. This consensus highlights the importance of multidisciplinary collaboration between dental and clinical medicine experts in managing DRONJ. High-quality research is necessary to provide an evidence-based foundation for optimizing DRONJ prevention and treatment strategies.

The selection of surgical approaches for mandibular condylar fractures faces dual challenges of anatomical complexity and the risk of complications. This article reviews conventional approaches and proposes a classification system centered on anatomical pathways. In light of the growing emphasis on aesthetic demands and advances in minimally invasive techniques, the evolution and implementation of the “facial scarless” concept are discussed. Particular attention is given to the endoscopic intraoral and retroauricular transmeatal approaches, with analysis of their clinical applications, advantages, and limitations, aiming to provide insights for optimizing individualized surgical strategies in the management of condylar fractures.

Objective This study aims to analyze the related factors of ectopic eruption of adjacent first permanent molars after the restoration of stainless-steel crowns of the second primary molars. Methods The experimental group consisted of 19 patients, and 25 second primary molars with stainless steel crown restorations were examined. The patients presented with ectopic eruption of the corresponding first permanent molars. The control group included 19 patients, from whom 29 second primary molars with stainless steel crown restorations were examined. Notably, the corresponding first permanent molars erupted normally. The panoramic radiographs of all participants were analyzed, and va-riables, such as patient age, gender, ectopic eruption positions of the first permanent molars, and the distal margi-nal adaptation of the stainless-steel crowns, were asses-sed. The tilt angles of the first permanent molars, second primary molars, and the intersection angle between the long axes of the two teeth were measured. Data were subjected to statistical analysis using Pearson’s chi-square test and independent t-tests. Results A significant positive correlation was identified between the distal marginal adaptation of the stainless-steel crowns and the ectopic eruption of the corresponding first permanent molar (OR=9.14, 95% CI: 1.06-79.26, P<0.05). Compared with the control group, the experimental group exhibited a smaller angle between the long axes of the maxillary first permanent molar and the second primary molar (6.51°±4.46°, P<0.05). Additionally, the mandibular first permanent molar had a more pronounced inclination (43.66°±10.56°, P<0.05), and the angle between the long axes of the mandibular first permanent molar and the second primary molar was significantly larger (25.39°±10.79°, P<0.05) in the experimental group. Conclusion Prior to the restoration of second primary molars with stainless steel crowns, evaluating the potential risk of ectopic eruption of the corresponding first permanent molar is essential. This step is particularly important when ectopic eruption is present in the remaining quadrants. When the angle between the long axes of the maxillary first permanent molar and the second primary molar is excessively small, the inclination of the mandibular first permanent molar is extremely large, or the angle between the long axes of the mandibular first permanent molar and the second primary molar is extremely large, the use of stainless-steel crowns should be minimized, or preventive measures should be considered. Special attention must be given to the distal marginal adaptation during stainless steel crown restoration to prevent the formation of steps on the distal surfaces.

Objective This study aimed to evaluate the clinical efficacy of pulpotomy combined with fragment reattachment in treating complicated crown-root fractures of maxillary young permanent anterior teeth. Methods A retrospective analysis of 37 cases of complicated crown-root fractures treated at Shenzhen Children’s Hospital from January 2019 to December 2023 was conducted. Outcomes such as fragment retention rate, pulp survival rate, root development, and periodontal health were assessed, and the influencing factors were analyzed. Results The fragment retention rates were 80.9% at 1 year and 69.5% at 2 years. The remaining crown height (cervical half group vs. incisal half group) emerged as a critical predictor of retention (P<0.05, hazard ratio=7.45, 95% confidence interval: 1.28-43.48). The pulp survival rate reached 91.6% at 1 year, with no significant influencing factors identified. In cases where the fractured crown retained for over one year, teeth at Nolla stage 8 showed significantly greater root elongation and apical foramen narrowing compared to those at Nolla stage 9 (P<0.05), normal periodontal scores were observed in 59.3%. Conclusion Pulpotomy combined with fragment reattachment effectively preserves pulp vitality and restores dental function and morphology in young permanent anterior teeth. The remaining crown height serves as a key prognostic indicator for fragment retention. This approach also promotes root development and demonstrates favorable clinical outcomes.

Objective This study aims to investigate the structural differences, dominant bacterial genera, and potential functions of microbial communities in different oral ecological niches (dorsal tongue, tooth surface, and buccal mucosa) of preschool children to clarify the influence of local microenvironments on microbial colonization and provide a theoretical basis for the microbiota-targeted regulation of pediatric oral diseases. Methods A total of 105 plaque samples were collected from the dorsal tongue, tooth surface, and buccal mucosa of 35 healthy preschool children (aged 4-6 years). High-throughput sequencing of the 16S rRNA gene was performed to analyze the microbial community structure and alpha/beta diversity. Principal coordinate analysis, UPGMA clustering, and LEfSe analysis were used to identify niche-specific dominant genera. PICRUSt2 was applied to predict the potential metabolic functional profiles across niches. Results Spatial hete-rogeneity in microbial composition and structure was observed across the three oral niches. Species richness was significantly higher on the tooth surface and buccal mucosa than on the dorsal tongue. The dominant phyla included Firmicutes, Actinobacteria, Proteobacteria, Bacteroidetes, Fusobacteria, and Patescibacteria. At the genus level, Actinomyces and Corynebacterium were enriched on the tooth surface, Veillonella was enriched on the dorsal tongue, and Streptococcus was predominant on the buccal mucosa. Beta diversity and clustering analyses confirmed distinct microbial community structures among the niches. LEfSe analysis identified several niche-specific genera. PICRUSt2 functional prediction revealed significant differences in amino acid metabolism, carbohydrate metabolism, cell motility, translation, signal transduction, immune system, infectious disea-ses, and membrane transport (P<0.05). Conclusion The dorsal tongue, tooth surface, and buccal mucosa in preschool children harbor distinct microbial communities with different taxonomic composition, diversity, and functional potential. The findings suggest that local microenvironmental factors shape oral microbiota and may contribute to the early onset of oral diseases. This study provides foundational data and theoretical insights for early microbiome-based risk assessment and personalized oral health interventions in children.

Congenital tooth agenesis impairs masticatory function and aesthetics and adversely affects craniofacial development. Although largely considered genetic in origin, its exact etiology remains unclear. This study reports three familial cases of nonsyndromic congenital tooth agenesis (NSTA). Whole genome sequencing (WGS) revealed five pathogenic variants: filamins-B (FLNB) (c.5186C>A, p.Ser1729Ter), methylcrotonyl coenzyme a carboxylase 2 (MCCC2) (c.91C>T, p.Gln31Ter; c.484C>T, p.Gln162Ter; c.340C>T, p.Gln114Ter), laminin subunit alpha 2 (LAMA2) (c.1084A>T, p.Arg362Ter), cathepsin C (CTSC) (c.748C>T, p.Arg250Ter), and chromatin remodeling protein microrchidia family CW-type zinc finger 4 (MORC4) (c.1726C>T, p.Arg576Ter). Among these variants, LAMA2 was associated with a severe tooth agenesis phenotype. The findings offer novel clues toward understanding the etiopathogenesis of this condition.

Hypoxia disrupts oral homeostasis through multiple interconnected pathways, including interference with tooth germ development, impairment of salivary gland function and salivary buffering capacity, compromise of the oral mucosal barrier, imbalance in jawbone and alveolar bone remodeling, and alterations in the diversity and functionality of the oral microbiome. These disturbances collectively contribute to the onset and progression of oral diseases. Moreover, disruption of oral homeostasis may, in turn, affect systemic homeostasis, increasing the risk of disorders in other organ systems through mechanisms involving inflammatory mediator release and microbial translocation. Here, we systematically review the effects and underlying mechanisms of hypoxia exposure on oral homeostasis, and further explore the interconnections between hypoxia-induced oral dysregulation and systemic homeostatic imbalance. This review aims to provide a comprehensive understanding of the regulatory networks linking oral and systemic homeostasis under hypoxia, thereby offering potential insights for maintaining homeostatic balance.

Objective This study aimed to explore the impact of dihydroartemisinin (DHA) on cell proliferation, migration, and invasion in oral squamous cell carcinoma (OSCC). Our findings offer a theoretical foundation for advancing the research and development of novel therapeutic agents for OSCC. Methods Bioinformatics analysis was conducted using the cancer genome database to classify OSCC patients based on the presence or absence of extracapsular spread and metastasis in tumor tissues, and to compare the differences in survival rates among different OSCC cell lines. The cell proliferation of different OSCC cell lines treated with different DHA concentrations was detected by CCK-8 cytoto-xicity assay, and the optimal drug concentration was screened. The CCK-8 cytotoxicity assay was used to detect the cell proliferation of different OSCC cell lines (CAL27, HN30, and SCC9) after treatment with different concentrations of DHA, and to screen out the optimal drug concentration. The effects of DHA on the proliferation of OSCC cells were detected by CCK-8 cell proliferation assay and cell cloning assay. The effect of DHA on the migration and invasion ability of tumor cells was detected by scratch test and Transwell test. A nude mouse subcutaneous tumor model was constructed to study the effects of DHA on OSCC tumor tissues and major organ. Results Bioinforma-tics analysis showed that the survival rate of patients with extracapsular spread and metastasis in tumor tissues was lower than that of patients without such phenomena (P<0.05). According to CCK-8 cytotoxicity results, the maximum safe concentrations for different OSCC cell lines CAL27, HN30, and SCC9 were 20, 10, and 5 μmol/L, respectively. Proliferation and cloning experiments of CCK-8 cells showed that DHA could inhibit the proliferation of three squamous cell lines (P<0.05). Scratch test and Transwell test showed that the migration and invasion levels of CAL27, HN30, and SCC9 cells were significantly decreased under DHA treatment (P<0.05). In vivo experiments showed that the growth rate of tumor tissue significantly decreased after DHA treatment (P<0.05). Conclusion DHA exhibits significant inhibitory effects on the proliferation, migration, and invasion of various OSCC cells and growth of tumor tissues.

Objective To investigate the clinical application safety of dental adhesives and composite resin-based dental materials. Methods A non-targeted screening of migrants from clinically used dentin adhesives and composite resin materials was conducted using gas chromatography-mass spectrometry (GC-MS). Migration media included saliva simulants with pH of 5.5, 6.2, 7.4, and 8.0, 50% ethanol solution, and ultrapure water. By simulating migration under va-rious oral environments, six migrants were detected in the migration media. GC-MS/flame ionization detector was used for quantitative analysis of these migrants, and risk assessment was performed by combining their toxicity data. Results In all six migration media, the exposure levels of monomers and photoinitiators released from four commercially avai-lable resin-based dental materials were all within established safety thresholds. Conclusion This study conducted nontargeted detection and safety assessment of migrants from dental restorative materials. The exposure levels of all detected compounds were below safety limits, providing scientific evidence supporting the clinical safety of composite resin-based dental materials.

Objective This study aimed to explore the role and mechanism of silibinin in renal injury induced by periodontitis. Methods Twenty-four male C57BL/6J mice were randomly divided into three groups: normal control (Control), periodontitis (P), and periodontitis+silibinbin intervention (P+SB). Ligation with 7-0 silk thread around the maxillary second molar’s neck was performed to generate a periodontitis animal model. Hematoxylin-eosin (HE), Masson staining, and micro-CT techniques were used to verify the successful construction of the periodontitis model. Renal injury degree was evaluated by renal histological exa-mination (HE, periodic acid-schiff, and Masson staining), ultrastructure observation under a transmission electron microscope, and blood biochemical index detection. The balance of oxidation and antioxidation in kidney tissue was observed by detecting the index of oxidative stress and MitoSOX Red fluorescence staining. The mRNA expression of mammalian target of rapamycin (mTOR) was detected by quantitative reverse transcription polymerase chain, and the localization and expression of mTOR in mouse kidney was further clarified using immunohistochemical staining. Results Compared with that in the Control group, gingival destruction and inflammation around the second molar were more evident in the P group. The alveolar bone was absorbed remarkably, as characterized by a decrease in bone volume fraction (BV/TV) and trabecular thickness and the widening of trabecular spacing. Renal tissue showed signs of renal injury, such as widening of Bowman space, exfoliation of renal tubular epithelial cells, morphological destruction of foot process, swel-ling of mitochondria, and disappearance of mitochondrial crest, accompanied with a significant increase in malondialdehyde (MDA) level, a decrease in glutathione (GSH) and superoxide dismutase (SOD) activities, and the activation of mTOR signal pathway. In the P+SB group, the destruction of gingiva and alveolar bone was significantly reduced, kidney injury was effectively alleviated, the MDA level decreased, SOD and GSH activities were recovered, and the mTOR signal pathway was significantly inhibited. Conclusion Silibinin can effectively alleviate the oxidative stress injury of kidney and alleviate the renal injury caused by periodontitis by regulating the mTOR signal pathway.

Objective To investigate the biomechanical behavior of three distinct types of narrow-diameter implants (NDIs) supporting a single-cantilever fixed bridge for mandibular central incisors using three-dimensional finite element analysis. Methods Three commonly used NDIs were selected: group Z1, Osstem one-piece implant with a dia-meter of 2.5 mm; group Z2, Anthogy Morse taper connected two-piece implant with a diameter of 2.8 mm; group Z3, Nobel Active screw-retained two-piece implant with a diameter of 3.0 mm. The three-dimensional finite-element model of cantilever fixed bridge supported by NDIs was constructed using finite element software. Vertical loads of 65 and 130 N and 45° oblique load were applied. von Mises stress of the implants and metal components, principal stress of the bone tissue, and stress distribution cloud map were calculated and analyzed. Results Under vertical load, only Z3 group implant reached a von Mises stress peak of 1 004.5 MPa at a load of 130 N, exceeding the material’s yield strength. Under the 45° oblique load, the von Mises stress peaks of all three groups of NDIs excee-ded the material’s yield strength. The stress cloud map revealed that the implant neck and surrounding bone tissue were the stress concentration areas. Conclusion All three NDIs groups proved theoretically feasible under a 65 N axial load, with this study delineating the biomechanical safety boundary and highlighting the important risks posed by excessive or oblique loading.

Objective This study aimed to review and summarize the clinical presentation and pathological features of localized juvenile spongiotic gingival hyperplasia (LJSGH) to enhance pediatric dentists’ understanding of this condition. Methods A retrospective analysis was conducted on the clinical and pathological data of patients with LJSGH diagnosed in the Department of Oral Pathology, Tianjin Stomatological Hospital from January 2019 to December 2024. Results Twelve cases were retrieved, the male-to-female ratio was 1.4∶1, and nine of the cases were children and adolescents (<18 years old). The typical clinical presentation was characterized by erythematous, hyperplastic gingiva exhibiting a papillary or granular appearance. The lesion was predominantly solitary and primarily located on the labial gingiva of the maxillary anterior region. The typical histopathological features were as follows: the superficial epithelium of the lesional area consisted of nonkeratinized stratified squamous epithelium with intercellular edema and spongiosis; irregular elongation of rete ridges; neutrophil infiltration in the superficial epithelial layer; marked vascular dilation and congestion in the subepithelial papillary layer; and a distinct boundary between the lesional epithelium and adjacent normal mucosal epithelium. CK19 exhibited strong positive expression throughout the lesion epithelium. By contrast, only the basal layer showed a strong positive expression in normal gingival tissues. Conclusion LJSGH exhibits distinctive clinical features, and its diagnosis can be confirmed through histopathological examination. The fin-dings of this study contribute to enhancing pediatric dentists’ understanding and recognition of LJSGH.

Objective This study aimed to explore the clinical efficacy of stabilization splint (SS) and the characteristics of cone beam computed tomography (CBCT) imaging changes by analyzing the CBCT images and clinical symptoms of patients with temporomandibular joint osteoarthritis (TMJOA) complicated with chewing side preference before and after treatment with SS. Me⁃thods　A retrospective analysis was conducted on 74 TMJOA patients (aged 18-40 years) who visited the Department of Stomatology, First Medical Center, Chinese PLA General Hospital from June 2021 to January 2025. Among them, 31 patients had no chewing side preference (mean age: 29.81±2.99 years), and 43 patients had chewing side preference (mean age: 30.88±5.65 years). The CBCT imaging features and clinical symptoms of the two groups at the initial visit and follow-up (6 months later) were observed and analyzed. SPSS 27.0 software was used for data analysis. Results Comparison of patients without chewing side preference before and after SS treatment: the incidence of pain decreased from 100% to 3.23%, limited mouth opening from 96.77% to 3.23%, and joint noise from 80.65% to 38.71%, with statistically significant differences (P<0.05). CBCT showed that the ipsilateral posterior joint space and superior joint space increased significantly (P<0.05), whereas no significant differences were observed in the temporomandibular joint (TMJ) indices between the two sides (P>0.05). Comparison of patients with chewing side preference before and after SS treatment: the incidence of pain decreased from 100% to 4.65%, limited mouth opening from 88.37% to 2.33%, and joint noise from 79.07% to 39.53%, with statistically significant differences (P<0.05). CBCT showed that the medial-lateral diameter of the condyle, anterior-posterior diameter of the condyle, intra-articular space, posterior joint space, superior joint space, slope of the articular eminence, and condylar height on the habitual chewing side increased significantly (P<0.05). Moreover, the medial-lateral diameter of the condyle, anterior-posterior diameter of the condyle, intra-articular space, posterior joint space, and superior joint space on the non-habitual chewing side increased significantly (P<0.05). The posterior joint space, intra-articular space, and condylar height on the habitual chewing side were significantly larger than those on the non-habitual chewing side (P<0.05). Comparison between patients with and without chewing side preference after SS treatment: no significant differences were found in pain, limited mouth opening, and joint noise between the two groups (P>0.05). Conclusion SS is effective in treating patients suffering from TMJOA with or without chewing side preference because it can effectively relieve joint pain, significantly improve mouth opening, and reduce the incidence of joint noise to a certain extent. Chewing side preference is closely related to the progression of TMJOA. Patients with TMJOA are recommended to receive early intervention with SS treatment, which is particularly important for those cases complicated with chewing side preference.

Objective By comparing deep learning and habitat analysis models based on contrast-enhanced CT (CECT), this study explores a novel approach to predict cervical lymph node metastasis and pathological subtypes in oral squamous cell cancer (OSCC). Methods CECT images from patients diagnosed with OSCC by paraffin pathology were retrospectively collected. A total of 107 patients underwent primary lesion resection and cervical lymph node dissection. Region-of-interest images under CECT were divided into three regions using K-means clustering, and feature selection was performed through a fully connected neural network to construct a habitat analysis model. A clinical model was constructed using nine clinical features, including age, gender, and tumor location. With pathological subtypes and lymph node metastasis (LNM) as study endpoints, the predictive capabilities of the clinical model, deep learning model, habitat analysis model, and combined clinical + habitat model were compared using confusion matrices and receiver operating characteristic (ROC) curve. Results The habitat-clinical combined model exhibits superior predictive performance: in the prediction of lymph node metastasis, the area under the receiver operating characteristic curve (AUC) reaches 0.97. In the prediction of pathological typing, the AUC values are 1.00 for well-differentiated type, 0.94 for moderately differentiated type, and 1.00 for poorly differentiated type. This combined model outperforms the standalone clinical and habitat models in predicting pathological typing and lymph node metastasis. Conclusion The habitat-clinical integrated model exhibits superior predictive efficacy in evaluating LNM and pathological classification in oral carcinoma.

Conventional submandibular gland resection is typically performed via a lateral cervical open approach, which inevitably leaves a visible scar. As a leading advancement in minimally invasive techniques, robotic-assisted surgery shows significant potential for clinical application. To date, only a limited number of robot-assisted submandibular gland resections have been reported globally, and most were conducted using the Da Vinci Surgical System. No cases involving a domestically developed Chinese robotic system have been documented in either domestic or international lite-rature. Using nearly 100 cases of endoscopic submandibular gland resection through retroauricular hairline approach as basis, we successfully performed three cases of submandibular gland resection with the assistance of a domestically developed multi-arm universal surgical robot. All procedures were completed without intraoperative conversion. Postoperative recovery was uneventful, with no complications including facial nerve palsy, tongue numbness, or impaired tongue mobility. The incisions were well concealed, achieving satisfactory aesthetic outcomes. This preliminary study demonstrates the feasibility of utilizing a Chinese-developed robotic system for submandibular gland resection.

The removal of a full crown typically requires considerable chairside time, and the interface between zirconia and resin cement in zirconia restoration is difficult to discern. A high-speed dental handpiece may damage residual dental tissue, thereby affecting the final outcome. The article presents a case after a restoration involving a fiber post, resin core, and zirconia full crown. For esthetic purposes, the removal of the full crown is necessary. An Er:YAG laser was used to completely remove the intact crown, which was then used as temporary restoration. A satisfactory esthetic result was attained after the final restoration. The case suggests that crown extraction with an Er:YAG laser is a safe and effective technique.