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Oral submucous fibrosis (OSF) is a collagen deposition disorder that affects a patient’s oral function and quality of life. It may also potentially transform into malignancy. This review summarizes the risk factors, pathogenic mechanisms, and treatments of OSF based on clinical and bio-molecular evidence. Betel nut chewing is a major risk factor that causes OSF in Asia. However, no direct evidence of arecoline-induced carcinogenesis has been found in animal models. Despite identification of numerous biomarkers of OSF lesions and conducting trials with different drug combinations, clinicians still adopt conservative treatments that primarily focus on relieving the symptoms of OSF. Treatments focus on reducing inflammation and improving mouth opening to improve a patient’s quality of life. In conclusion, high-quality clinical studies are needed to aid clinicians in developing and applying molecular biomarkers as well as standard treatment guidelines.

Resolving late failure of dental implant is difficult and costly; however, only few reviews have addressed the risk factors associated with late failure of dental implant. The aim of this literature review was to summarize the influences of different potential risk factors on the incidence of late dental implant failure. The protocol of this systematic review was prepared and implemented based on the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) guideline. In December 2018, studies published within the previous 10 years on late dental implant failure were selected by fulfilling the eligibility criteria and the risk factors identified in qualified studies were extracted by using a predefined extraction template. Fourteen eligible studies were assessed. The common risk factors for late failure were divided into three groups according to whether they were related to (1) the patient history (radiation therapy, periodontitis, bruxism and early implant failure), (2) clinical parameters (posterior implant location and bone grade 4) or (3) decisions made by the clinician (low initial stability, more than one implant placed during surgery, inflammation at the surgical site during the first year or using an overdenture with conus-type connection). Clinicians should be cautions throughout the treatment process of dental implant—from the initial examination to the treatment planning, surgical operation and prosthesis selection—in order to minimize the risk of late failure of dental implant.

Segmental mandibular reconstruction is challenging. This in-vitro study compared the biomechanics of two 3D-printed porous Ti-6Al-4 V implants (Quad-diametral-cross, Hex-vase) versus a solid implant using a dual-material 3D-printed mandibular model and strain gauges. A 100 N static load was applied. Under eccentric loading, the solid implant generated extremely high tensile strain (871.67 µε), while porous designs reduced peak strains. The Hex-vase design transmitted the highest compressive strain (-795.85 µε), 65% greater in magnitude than the solid, suggesting improved mechanical stimulus transfer to peri-implant bone. The QDC design provided a moderate environment, suitable for compromised bone. Porous implants are biomechanically superior, offering customizable solutions to mitigate stress shielding.

Objective This study proposed a new classification method of bone quantity and quality at the dental implant site using cone-beam computed tomography (CBCT) image analysis, classifying cortical and cancellous bones separately and using CBCT for quantitative analysis. Methods Preoperative CBCT images were obtained from 128 implant patients (315 sites). First, measure the crestal cortical bone thickness (in mm) and the cancellous bone density [in grayscale values (GV) and bone mineral density (g/cm 3 )] at the implant sites. The new classification for bone quality at the implant site proposed in this study is a “nine-square division” bone classification system, where the cortical bone thickness is classified into A: > 1.1 mm, B:0.7–1.1 mm, and C: < 0.7 mm, and the cancellous bone density is classified into 1: > 600 GV (= 420 g/cm 3 ), 2:300–600 GV (= 160 g/cm 3 –420 g/cm 3 ), and 3: < 300 GV (= 160 g/cm 3 ). Results The results of the nine bone type proportions based on the new jawbone classification were as follows: A1 (8.57%,27/315), A2 (13.02%), A3 (4.13%), B1 (17.78%), B2 (20.63%), B3 (8.57%) C1 (4.44%), C2 (14.29%), and C3 (8.57%). Conclusions The proposed classification can complement the parts overlooked in previous bone classification methods (bone types A3 and C1). Trial registration The retrospective registration of this study was approved by the Institutional Review Board of China Medical University Hospital, No. CMUH 108-REC2-181.

Background The intersection of medicine and law necessitates enhanced medical–legal literacy among physicians to safeguard patient safety and uphold ethical standards. Traditional pedagogical approaches in medical–legal education often fail to engage students. Thus, innovative methods such as case-based and interdisciplinary learning must be explored. This study was conducted to investigate the benefits of integrating role-playing into the medical–legal curriculum at China Medical University, Taiwan. Specifically, we analyzed the effects of this integration on students’ understanding of medical law and their learning motivation and learning outcomes. Methods This 16-week study included 98 fourth-year dental students who had taken the Medicine and Law Course between 2022 and 2023. A role-playing-based courtroom drama was designed to improve the students’ learning outcomes through practical engagement. This study was conducted in three stages. In Stage 1, the students engaged in guided reading in medical ethics and basic legal concepts. In Stage 2, they participated in an in-depth case analysis of medical lawsuits to identify judicial oversights and understand medical negligence. In Stage 3, they acted in the courtroom drama. Dentists, lawyers, and judges facilitated these activities and provided feedback after the drama. Intervention efficacy was assessed by evaluating the students’ learning motivation and comprehension levels. Results The drama substantially enhanced the students’ understanding of legal problems in clinical practice, as indicated by high mean scores in appreciating the significance of law, adherence to legal norms, and prevention of medical disputes. Postdrama assessments revealed considerable improvements in the students’ knowledge of judicial procedures and professional responsibilities. The intervention effectively augmented student engagement and realism in learning environments. Conclusions A multifaceted learning approach can foster cognitive, emotional, and practical skills essential for managing medical disputes. Role-playing may improve students’ learning motivation, understanding, and attitudes toward medical law, thereby transforming medical–legal education.

Advancements in technology have improved healthcare quality but shifted the focus to efficiency, negatively impacting patient- doctor relationships. This study proposes integrating social-emotional learning (SEL) into medical education to address this issue. Social-emotional learning (SEL) is based on social learning theory and has a focus on emotion management, stress management, empathy, and social skills. Through SEL, students can develop social and emotional skills by observing, interacting with, and imitating others. Incorporating SEL into medical education would ensure that physicians develop the social and emotional skills necessary to form positive relationships with patients and to cope with the emotional demands of medical work. SEL comprises six domains, namely, the cognitive, emotion, social, values, perspective, and identity domains. These six domains are closely related to the six core competencies the Accreditation Council for Graduate Medical Education (ACGME) indicated every doctor should possess, which indicates that the domains of SEL are highly relevant within the context of medical education. Furthermore, SEL can lead to the development of empathy, which can improve physicians' ability to understand patients' perspectives and emotions, and resilience, which can enable physicians to more effectively cope with the demands of their work, and it can lead to holistic development, with doctors gaining an understanding of both the technical and humanistic aspects of their work. Incorporating SEL in medical education would enable doctors to develop key social and emotional skills that would improve their ability to provide holistic medical services and therefore would improve overall medical systems.

Pain within the trigeminal system, particularly dental pain, is poorly understood. This study aimed to determine whether single or multiple dental pulp injuries induce persistent pain, its association with trigeminal central nociceptive pathways and whether electroacupuncture (EA) provides prolonged analgesic and neuroprotective effects in a persistent dental pain model. Models of single dental pulp injury (SDPI) and multiple dental pulp injuries (MDPI) were used to induce trigeminal neuropathic pain. The signs of dental pain-related behavior were assessed using the mechanical head withdrawal threshold (HWT). Immunofluorescence and western blot protocols were used to monitor astrocyte activation, changes in apoptosis-related proteins, and GABAergic interneuron plasticity. SDPI mice exhibited an initial marked decrease in HWT from days one to 14, followed by progressive recovery from days 21 to 42. From days 49 to 70, the HWT increased and returned to the control values. In contrast, MDPI mice showed a persistent decrease in HWT from days one to 70. MDPI increased glial fibrillary acidic protein (GFAP) and decreased glutamine synthetase (GS) and glutamate transporter-1 (GLT1) expression in the Vi/Vc transition zone of the brainstem on day 70, whereas no changes in astrocytic markers were observed on day 70 after SDPI. Increased expression of cleaved cysteine-aspartic protease-3 (cleaved caspase-3) and Bcl-2-associated X protein (Bax), along with decreased B-cell lymphoma/leukemia 2 (Bcl-2), were observed at day 70 after MDPI but not after SDPI. The downregulation of glutamic acid decarboxylase (GAD65) expression was observed on day 70 only after MDPI. The effects of MDPI-induced lower HWT from days one to 70 were attenuated by 12 sessions of EA treatment (days one to 21 after MDPI). Changes in astrocytic GFAP, GS, and GLT-1, along with cleaved caspase-3, Bax, Bcl-2, and GAD65 expression observed 70 days after MDPI, were reversed by EA treatment. The results suggest that persistent dental pain in mice was induced by MDPI but not by SDPI. This effect was associated with trigeminal GABAergic interneuron plasticity along with morphological and functional changes in astrocytes. EA exerts prolonged analgesic and neuroprotective effects that might be associated with the modulation of neuron-glia crosstalk mechanisms.

Background The popularity of dental implant surgeries, particularly in the maxillary anterior region, is growing, and understanding variations in relevant anatomical structures such as the canalis sinuosus (CS) and its accessory canals (ACs) is critical to avoid complications, including nerve injury and tissue necrosis. This study determined the prevalence, diameter, location, and anatomical variations of the CS and AC in a Taiwanese population by using cone beam computed tomography (CBCT). Methods CBCT data were collected from 240 participants (aged 20–80 years, with an equal sex distribution) at China Medical University Hospital. Medical imaging software was used to analyze the number, diameter, and spatial relationships of the CS and ACs relative to adjacent teeth. Two diameter thresholds (≥ 0.5 and ≥ 1 mm) were applied. The participants were divided into three age groups for comparison, and statistical analysis was performed using SPSS. Results The results revealed that the prevalence of ACs was 80.4% and 51.7% when the threshold was ≥ 0.5 and ≥ 1 mm, respectively. At both thresholds, men a had significantly higher prevalence of ACs and larger average diameters than did women. Although younger adults had a greater number of ACs, the largest average diameters were observed in the older group, suggesting an age-related increase in canal size. The most common AC location was between the lateral incisor and canine. No significant differences were observed between the left and right sides. Conclusions This study revealed distinct age- and sex-related differences in the CS and ACs in the Taiwanese population. CBCT is a valuable tool for accurately identifying these anatomical structures that can improve implant planning and reduce the risk of surgical complications.

Dental implant surgery is a common treatment for missing teeth. Its survival rate is considerably affected by host bone quality and quantity, which is often assessed prior to surgery through dental cone-beam computed tomography (CBCT). Dental CBCT was used in this study to evaluate dental implant sites for (1) differences in and (2) correlations between cancellous bone density and cortical bone thickness among four regions of the jawbone. In total, 315 dental implant sites (39 in the anterior mandible, 42 in the anterior maxilla, 107 in the posterior mandible, and 127 in the posterior maxilla) were identified in dental CBCT images from 128 patients. All CBCT images were loaded into Mimics 15.0 to measure cancellous bone density (unit: grayscale value (GV) and cortical bone thickness (unit: mm)). Differences among the four regions of the jawbone were evaluated using one-way analysis of variance and Scheffe’s posttest. Pearson coefficients for correlations between cancellous bone density and cortical bone thickness were also calculated for the four jawbone regions. The results revealed that the mean cancellous bone density was highest in the anterior mandible (722 ± 227 GV), followed by the anterior maxilla (542 ± 208 GV), posterior mandible (535 ± 206 GV), and posterior maxilla (388 ± 206 GV). Cortical bone thickness was highest in the posterior mandible (1.15 ± 0.42 mm), followed by the anterior mandible (1.01 ± 0.32 mm), anterior maxilla (0.89 ± 0.26 mm), and posterior maxilla (0.72 ± 0.19 mm). In the whole jawbone, a weak correlation (r = 0.133, p = 0.041) was detected between cancellous bone density and cortical bone thickness. Furthermore, except for the anterior maxilla (r = 0.306, p = 0.048), no correlation between the two bone parameters was observed (all p > 0.05). Cancellous bone density and cortical bone thickness varies by implant site in the four regions of the jawbone. The cortical and cancellous bone of a jawbone dental implant site should be evaluated individually before surgery.

Objective The study objective was to investigate four common occlusal modes by using the finite element (FE) method and to conduct a biomechanical analysis of the periodontal ligament (PDL) and surrounding bone when orthodontic force is applied. Materials and methods A complete mandibular FE model including teeth and the PDL was established on the basis of cone-beam computed tomography images of an artificial mandible. In the FE model, the left and right mandibular first premolars were not modeled because both canines required distal movement. In addition, four occlusal modes were simulated: incisal clench (INC), intercuspal position (ICP), right unilateral molar clench (RMOL), and right group function (RGF). The effects of these four occlusal modes on the von Mises stress and strain of the canine PDLs and bone were analyzed. Results Occlusal mode strongly influenced the distribution and value of von Mises strain in the canine PDLs. The maximum von Mises strain values on the canine PDLs were 0.396, 1.811, 0.398, and 1.121 for INC, ICP, RMOL, and RGF, respectively. The four occlusal modes had smaller effects on strain distribution in the cortical bone, cancellous bone, and miniscrews. Conclusion Occlusal mode strongly influenced von Mises strain on the canine PDLs when orthodontic force was applied. Clinical relevance When an FE model is used to analyze the biomechanical behavior of orthodontic treatments, the effect of muscle forces caused by occlusion must be considered.