Odontologia

Guided Cavity Preparation to Access an Invagination and Preserve Pulp Vitality of an Immature Maxillary Lateral Incisor With Type IIIa Dens Invaginatus: Technical Overview and a Case Report With 3-Year Follow-Up

2026-03-25T10:29:04Z

Guided Cavity Preparation to Access an Invagination and Preserve Pulp Vitality of an Immature Maxillary Lateral Incisor With Type IIIa Dens Invaginatus: Technical Overview and a Case Report With 3-Year Follow-Up Abella Sans, Fransesc; Nagendrababu, Venkateshbabu; Suresh, Nandini; Garcia Font, Marc; Dummer, Paul Aim: Dens invaginatus (DI) is a developmental anomaly often associated with caries and periapical pathosis. This report de-scribes guided access and filling of an infected invagination in a maxillary lateral (tooth #22) with long-term preservation of pulpvitality.Summary: A 9-year-old male presented with a palatal sinus tract associated with immature tooth 22. Based on clinical andradiographic examination, a type IIIa DI with a pseudo-foramen midway along the mesial aspect of the root was identified. Thetooth had a healthy pulp and peri-invagination periodontitis. A guided endodontic cavity was prepared to selectively access theinvagination without compromising the pulp and the invagination filled with a bioceramic calcium silicate–based material. At36 months the tooth was asymptomatic, and the pulp tested positive. Radiographically, root development was complete with bonyhealing of the lesion. This case report highlights the effectiveness of guided cavity preparation to access an invagination in animmature tooth with DI while preserving pulp vitality.

Evaluating Guideline Adherence in Gemini-Powered Dental Trauma Workflows: Standalone Gemini Chat vs. Document-Grounded NotebookLM

2026-03-25T10:51:05Z

Evaluating Guideline Adherence in Gemini-Powered Dental Trauma Workflows: Standalone Gemini Chat vs. Document-Grounded NotebookLM Dufey Portilla, Nicolás Armando; Abella Sans, Fransesc; Durán-Sindreu Terol, Fernando Salvador; Salagaray, Maite; Nagendrababu, Venkateshbabu; Abbott, Paul V.; Levin, Liran; Garcia Font, Marc Aim: The aim of this study was to compare the accuracy and inter-account consistency of two Google Gemini–powered, user-facing workflows for dental trauma decision support: standalone Gemini chat and NotebookLM, a document-grounded workflow that generates responses grounded in uploaded European Society of Endodontology and International Association of Dental Traumatology guideline documents, when answering dichotomous (yes/no) clinical questions on the management of traumatized permanent teeth. Methodology: A cross-sectional simulation was conducted using 99 dichotomous (yes/no) questions derived from the European Society of Endodontology and International Association of Dental Traumatology guidelines. Three academic endodontists submitted each question to Gemini and NotebookLM using three independent Google accounts, generating 297 responses per workflow. Accuracy was defined as exact agreement with guideline-based answers, and consistency as the proportion of identical responses across the three trials. Statistical analyses included Wald and Wilson 95% confidence intervals, Fleiss' kappa for inter-account agreement, and Pearson's chi-squared tests to compare proportions. Results: Gemini demonstrated an overall accuracy of 83.83% (95% CI: 75.08–90.47) and a consistency of 74.74% (κ = 0.84).NotebookLM showed higher accuracy (92.93%; 95% CI: 85.97–97.11) and perfect consistency (100%; κ = 1.00). While the difference in accuracy did not reach statistical significance (p = 0.076), NotebookLM exhibited significantly greater consistency(p < 0.001). Conclusions: The responses generated from the guidelines were highly consistent with both workflows. Document groundingmay enhance repeatability and alignment with guideline-derived decision points for structured dichotomous inquiries, as evidenced by NotebookLM's ability to achieve complete inter-account consistency and to quantitatively increase accuracy. Theseresults are the outcome of workflow-level benchmarking; therefore, clinical utility cannot be inferred solely from them; professional oversight and additional validation remain necessary before any clinical application. The author, N. Dufey-Portilla, thanks the National Agency for Researchand Development (ANID) for its support through the DOCTORADOBECAS CHILE/2025 - 72250040 Scholarship Program.

Unwanted creaniofacial fractures in MARPE/ MASPE patients: a hidden risk?

2026-03-25T10:51:59Z

Unwanted creaniofacial fractures in MARPE/ MASPE patients: a hidden risk? Walter Solana, André; Winsauer, Heinz; Crespo, Eduardo; Arcos, Ignacio; Valls-Ontañón, Adaia; Puigdollers, Andreu; Hernandez Alfaro, Federico Background Miniscrew-assisted palatal expansion techniques such as MARPE (Miniscrew-Assisted Rapid Palatal Expansion) and MASPE (Miniscrew-Assisted Slow Palatal Expansion) represents non-surgical alternatives for the correction of transverse maxillary deficiencies in adults. However, concerns have arisen regarding their potential to cause craniofacial complications due to the high forces applied for midpalatal suture opening in skeletally mature patients. Methodology This article aims to present and describe isolated clinical cases of cranialfacial complications observed in adult patients following MARPE and MASPE procedures, and to discuss the potential biomechanical mechanisms behind these events. Eleven clinical cases involving adult patients who underwent skeletal midface expansion with miniscrew-assisted devices are presented. All cases exhibited craniofacial unwanted dislocations identified through CBCT imaging, including zygomatic fractures, parasutural bone fractures, and asymmetrical disjunction of craniofacial sutures. These events were retrospectively documented through clinical follow-up and radiographic analysis. Results Among the eleven cases presented, complications included seven asymmetric fractures of the frontonasal process, two orbital fractures, one zygomatic bone fracture, and one parasagittal fracture of the palatine bone. These complications were primarily observed in patients who underwent MARPE with rapid activation protocols. One minor complication occurred in a MASPE case, where the patient followed the prescribed slow activation schedule. Conclusion Non surgical mid facial expansion is a potential source of unwanted and unpredicted dislocations in the craneofacial complex. According to this report the observed complications do not seem to be age related and are difficult to predict from the CBCT. A close clinical follow up including force monitoring and force limitation should be mandatory when performing MARPE. MASPE and minimally invasive SARPE could be alternatives to minimise the incidence of creaniofacial complications

Is efficacy of miniscrew-assisted rapid palatal expansion in mid to late adolescents and young adults related to craniofacial sutures opening? A systematic review and meta-analysis

2026-03-05T03:00:45Z

Is efficacy of miniscrew-assisted rapid palatal expansion in mid to late adolescents and young adults related to craniofacial sutures opening? A systematic review and meta-analysis Lazaro, Aida; Hernández-Alfaro, Federico; Puigdollers, Andreu; Giralt Hernando, Maria; Elnayef, Basel; Valls-Ontañón, Adaia Background: Transverse maxillary deficiency is a relatively common type of malocclusion, that if left untreated will probably affect the permanent dentition. Recent investigations have proposed the use of bone-supported miniscrews around the midpalatal suture to expand the palate in late adolescents. The aim of this systematic review was to assess the efficacy of the Miniscrew Assisted Rapid Palatal Expansion (MARPE) technique in young adult patients, by quantifying skeletal expansion in relation to the age of the patient, as well as the impact upon other craniofacial sutures, and to describe the possible dental side effects. Material and Methods: An electronic and manual search was conducted, in which 17 were included in the study. Results: The estimated mean palatal opening width and nasal cavity width was 2.99 ± 0.33 mm and 2.24 ± 0.17 mm, respectively. A significant association was observed between midpalatal and pterygoid suture opening (p=0.010). No association was found between age and the MARPE technique (p=0.701). Conclusions: The results of this study show that the MARPE technique produces significant opening width in young adults at both at midpalatal suture and nasal cavity level, and apparently only significantly widens the pterygoid suture. Greater dental side effects are directly associated to a reduced midpalatal suture opening width.