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25 August 2026, Volume 35 Issue 4 Previous Issue   

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Expert Consensus

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Expert consensus on combined periodontal and endodontic management of multiple idiopathic cervical root resorption Ran Shujun, Dong Jiachen, Yan Fuhua, Yang Jian, Ge Shaohua, Zhao Jin, Zhao Chuanjiang, Pan Yihuai, Zhao Lei, Du Yi, Cao Zhengguo, Huang Xiaojing, Tian Beimin, Yu Jinhua, Deng Hui, Cheng Lei, Zhu Guangxun, Wang Li, Sun Xiaoyu, Chen Zhu, Huang Zhengwei, Song Zhongchen 2026, 35 (4):  337-347.  doi: 10.19439/j.sjos.2026.04.001 Abstract ( 15 )   PDF (1683KB) ( 21 )   Multiple idiopathic cervical root resorption (MICRR) is a rare, idiopathic condition characterized by multiple resorptive lesions in the cervical region of teeth. It manifests as progressive, painless hard tissue loss, often accompanied by periodontal tissue destruction, which may ultimately lead to tooth fracture, loosening, or even exfoliation. In early stages, MICRR is typically asymptomatic and is often incidentally detected through imaging as characteristic "concave" resorptive defects in the cervical area. Currently, no specific treatment is available. The rarity, insidious nature, invasiveness and multiplicity of MICRR highlight the need for enhanced clinical awareness from both periodontal and endodontic perspectives, enabling early interdisciplinary diagnosis and coordinated intervention. Based on a review of relevant literature and expert discussion, this article aimed to improve understanding of the etiology and pathogenesis of MICRR, establish diagnostic criteria, and propose treatment and follow-up strategies, thereby providing a reference for clinicians in the early diagnosis, clinical management and prevention of MICRR. References | Related Articles | Metrics

Original Articles

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The effect of TRPV4 on the formation of fibrous tissue around the implant Shi Zhongtao, Qiu Dan, Sun Xiaojuan, Chen Zhibing, Wang Shihan, Zhang Yuxiong, Zhang Li 2026, 35 (4):  348-358.  doi: 10.19439/j.sjos.2026.04.002 Abstract ( 13 )   PDF (3664KB) ( 17 )   PURPOSE: To investigate the effect of transient receptor potential vanilloid 4(TRPV4) on the healing of fibroblasts around the implant under different conditions, and to explore the regulatory mechanism of TRPV4 in the process of inflammation and fibrosis. METHODS: In vitro, mouse fibroblasts were randomly divided into three groups, i.e., NC group (cultured on ordinary 6-well plate), B14 group (cultured on 6-well plate hard matrix glass), BH14 group (cultured on glass plate with TRPV4 inhibitor HC-067047), and the expression level of TRPV4 was detected by PCR. TRPV4 gene knockout mice [TRPV4(-/-) group, n=20] and wild-type TRPV4 mice [TRPV4 (+/+) group, n=20] were used to establish the model of implant in vivo. The mice were randomly divided into two subgroups: implant group and peri-implantitis group. The soft tissue healing around the implant was observed at different time points after operation. Micro-CT scan was used to evaluate the osseointegration of implants. The inflammatory infiltration and soft tissue damage around the implant were observed by HE staining. The changes of collagen fibers in each group were detected by Masson staining. The expression of macrophage CD68 and myofibroblasts (α-SMA) was detected by IHF. PCR and ELISA were used to detect the expression levels of related inflammatory factors. The changes of epithelial structure, fibroblasts and extracellular matrix were observed under transmission electron microscope. RESULTS: The soft tissue repair of TRPV4(+/+) mice was slower than that of TRPV4(+/+) mice from 7 days to 30 days after implantation, with persistent inflammation and obvious fibrosis. TRPV4(-/-) mice showed faster soft tissue healing, significantly reduced inflammation and lower fibrosis. Consistent findings were observed after 30 days. IHF results showed that TRPV4 promoted macrophage activation and fibroblasts to myofibroblasts (a-SMA) transformation under inflammatory conditions, which promoted fibrosis progression. The correlation between the expression of TRPV4 and the expression levels of YAP/TEAD related proteins was observed, suggesting that TRPV4 may regulate the fibrosis process through the YAP/TEAD signaling pathway. CONCLUSIONS: TRPV4 plays a negative regulatory role in the healing process of peri-implant soft tissue by promoting inflammation and fibrosis. The results suggest that TRPV4 can be used as a potential therapeutic target, and inhibition of TRPV4 may accelerate the healing of peri-implant soft tissue and reduce fibrosis. References | Related Articles | Metrics

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Effect of Er,Cr:YSGG laser combined with guided bone regeneration technique on osteogenesis at the extraction site of periodontitis rats and its regulatory mechanism via the Wnt/β-catenin pathway Guo Yanwei, Zhang Guangde, Kong Lingbin, Yang Shimao 2026, 35 (4):  359-369.  doi: 10.19439/j.sjos.2026.04.003 Abstract ( 16 )   PDF (2822KB) ( 10 )   PURPOSE: To investigate the synergistic effect of Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet (Er,Cr:YSGG) laser combined with guided bone regeneration (GBR) on osteogenesis at the extraction site in rats with severe periodontitis, as well as its regulatory mechanism on the Wnt/β-catenin signaling pathway. METHODS: A total of 60 SD rats were used to establish a severe periodontitis model, and 50 rats were successfully modeled. They were randomly divided into 5 groups (n=10 in each group), group A (blank control, simple teeth extraction), group B (teeth extraction+Er,Cr:YSGG laser irradiation), group C (teeth extraction+bone powder+barrier membrane), group D (teeth extraction+Er,Cr:YSGG laser irradiation +bone powder), and group E (teeth extraction+Er,Cr:YSGG laser irradiation+GBR). At 4 and 8 weeks postoperatively, 5 animals from each group were sacrificed for subsequent experiments. CBCT was performed to detect bone mineral density (BMD) and bone volume/total volume (BV/TV). Histological observation was conducted. Enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qPCR) were used to detect β-catenin, Runx2 and other related factors. Meso scale discovery (MSD) technology was employed to determine the nuclear translocation of β-catenin and the phosphorylation level of GSK-3β. RESULTS: CBCT results showed that at 4 weeks postoperatively, the extraction sockets in groups A and B presented with a large area of low-density shadow, a small amount of fibrous callus was observed in group C and D, while group E had higher density of fibrous callus and local high-density shadow. At 8 weeks postoperatively, the bone defect still accounted for 60%-70% of the extraction socket in group A and B; new bone increased but bone powder was not fully degraded in group C and D; in group E, bone powder was basically degraded and new bone fused well with the surrounding bone. In terms of bone parameters, BMD and BV/TV in all groups increased with time. The BMD and BV/TV in group E were 0.51 g/cm3 and 36.14% at 4 weeks postoperatively and 0.57 g/cm3 and 43.23% at 8 weeks postoperatively, which were significantly higher than those in other groups at all time points(P<0.05). The nuclear translocation rate of β-catenin in group E reached 58.7% at 8 weeks postoperatively, with high expression of osteogenic factors, while the levels of Dickkopf-related protein 1(DKK-1, 45.32 pg/mL) and phosphorylated GSK-3β/GSK-3β (0.21) were the lowest (P<0.05). Histological results showed that group E had dense new bone and less inflammation, and the intergroup difference in osteogenic effect was group E > groups C/D > group B > group A. CONCLUSIONS: Er,Cr:YSGG laser combined with GBR can down-regulate DKK-1 expression, inhibit GSK-3β activity, relieve the inhibition of the Wnt/β-catenin pathway and promote osteogenesis. This study can provide experimental evidences for the clinical treatment of periodontal bone defects. References | Related Articles | Metrics

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Evaluation of the effect of the connective tissue graft wall technique combined with bone grafting in managing infrabony defects with keratinized tissue deficiency Chen Tinglan, Wen Jiahuan, Li Mengdi, Song Zhongchen, Ni Jing 2026, 35 (4):  370-375.  doi: 10.19439/j.sjos.2026.04.004 Abstract ( 12 )   PDF (1107KB) ( 8 )   PURPOSE: To evaluate the clinical effect of the connective tissue graft wall technique (CTGWT) combined with bone grafting on keratinized gingiva widening and periodontal bone regeneration in the treatment of infrabony defects with insufficient(< 2 mm) keratinized gingiva width (KGW). METHODS: Seven patients with infrabony defects and KGW less than 2 mm, who were treated at the Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine between September 2018 and May 2023, were included. All patients underwent CTGWT combined with bone grafting. The infrabony defect depth (IBD), KGW, probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (REC), interdental papilla height (IP), plaque index (PLI), and bleeding index (BI) were compared before and after treatment. RESULTS: All patients were followed up for more than 12 months postoperatively. Radiographic findings showed a mean reduction in IBD of (3.97±1.96) mm, which was statistically significant (P<0.05). Regarding clinical parameters, KGW increased by (1.71±0.49) mm, PPD decreased by (3.21±0.76) mm, and CAL decreased by (3.57±0.79) mm; all these changes were statistically significant (P<0.05). In contrast, no significant changes were observed in REC, IP, PLI, or BI during the postoperative follow-up period. CONCLUSIONS: For infrabony defects accompanied by insufficient keratinized gingiva, CTGWT combined with bone grafting can significantly promote KGW as well as periodontal bone regeneration. References | Related Articles | Metrics

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Evaluation of the efficacy of Ceramage polymeric porcelain inlay and bulk block resin in the restoration of pulpless molars Feng Yanhui, Zhu Rui 2026, 35 (4):  376-381.  doi: 10.19439/j.sjos.2026.04.005 Abstract ( 9 )   PDF (753KB) ( 10 )   PURPOSE: To evaluate the efficacy of Ceramage polymeric porcelain inlay and bulk block resin in the restoration of pulpless molars. METHODS: Sixty-eight patients with pulpeless molars admitted to the First Hospital of Yulin from March 2022 to December 2023 were selected, with 68 affected teeth. The patients were divided into the experimental group and the control group by the odd-even number method, with 34 cases in each group. The control group was repaired with bulk block resin, while the experimental group was repaired with Ceramage polymeric porcelain inlay. After 12 months of follow-up, the restoration effect and periodontal health indexes of the two groups were compared. RESULTS: Six months after restoration, there was no significant difference between the two groups in terms of the color of restorations, marginal adaptation, marginal staining, restoration wear, restoration retention, secondary caries degree, proximal contact, gingival index(GI), plaque index(PI), tooth mobility and alveolar bone resorption(P>0.05). At 12 months after restoration, there were no significant differences in the color, edge fit, edge coloration, restoration retention and proximity relationship between the two groups (P>0.05). The wear of the prosthesis, the degree of secondary caries, PI and the degree of alveolar bone resorption in the experimental group were significantly lower than those in the control group (P<0.05), and the load of tooth fracture resistance was significantly higher than that in the control group (P<0.05). CONCLUSIONS: The dental restoration effect of Ceramage polymeric porcelain inlay for pulpless molars is good, long-lasting and stable. References | Related Articles | Metrics

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Influences of different timing of fixed orthodontics on enamel demineralization and periodontal conditions Huang Jun, Wang Kun, Xiao Lin 2026, 35 (4):  382-387.  doi: 10.19439/j.sjos.2026.04.006 Abstract ( 12 )   PDF (780KB) ( 13 )   PURPOSE: To evaluate the effects of different timing of fixed orthodontics on enamel demineralization and periodontal conditions. METHODS: A total of 180 patients with fixed orthodontic treatment admitted from January 2021 to December 2023 were selected and divided into three groups according to the duration of orthodontic treatment: group A (n=60) with a treatment period of less than 6 months, group B (n=60) with a treatment period between 6 to 12 months, and group C (n=60) with a treatment period between 12 to 18 months. The enamel demineralization was evaluated by International Caries Detection and Assessment System (ICDAS), and ICDAS score was obtained. The periodontal status was evaluated by bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) and plaque index (PI). The correlation between enamel demineralization (ICDAS score) and changes of periodontal status (BOP, PD, CAL, PI) was analyzed by Pearson correlation analysis. The influencing factors of enamel demineralization in patients undergoing fixed orthodontics were analyzed by multivariate logistic regression analysis. RESULTS: There was no significant difference in the severity of enamel demineralization among the three groups (P>0.05). The total incidence of enamel demineralization (group A < group B < group C) was significantly different from the ICDAS score (group A < group B < group C)(P<0.05). There were significant differences in BOP, PD, CAL and PI among the three groups, and all were group A < group B < group C(P<0.05). ICDAS score was moderately positively correlated with BOP and PD, weakly to moderately positively correlated with CAL, and highly positively correlated with PI (P<0.05). The correction time, PI, frequency of high-glucose diet and local application of fluoride were independent influencing factors of enamel demineralization in patients undergoing fixed orthodontics (P<0.05). CONCLUSIONS: A long duration of fixed orthodontics will increase the risk of enamel demineralization and affect periodontal health of patients. PI, frequency of high-glucose diet and local application of fluoride can affect enamel demineralization. Personalized plans and regular follow-up programs should be formulated based on the individual conditions of patients, and oral hygiene guidance and prevention should be strengthened. References | Related Articles | Metrics

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Evaluation of the effect of medical collagen sponge in minimally invasive extraction of impacted mandibular teeth Lyu Limin, Ding Youbiao, Liu Ran 2026, 35 (4):  388-392.  doi: 10.19439/j.sjos.2026.04.007 Abstract ( 16 )   PDF (618KB) ( 8 )   PURPOSE: To evaluate the effect of medical collagen sponge in minimally invasive extraction of impacted mandibular teeth. METHODS: A total of 88 patients with impacted mandibular teeth admitted from December 2021 to December 2024 were selected and randomly divided into the control group (n=44) and the experimental group (n=44) by envelope lottery. Both groups adopted the method of high-speed turbine drilling for tooth separation and minimally invasive tooth augmentation to extract the affected teeth. The extraction wounds of the control group were treated conventionally, while those of the experimental group were covered with medical collagen sponges. Postoperative bleeding status, visual analogue scale (VAS) scores of pain, degree of mouth opening limitation, inflammatory cytokine levels and complications were compared between the two groups. RESULTS: The proportion of significant bleeding in the experimental group was significantly lower than that in the control group, while the proportion of no bleeding was significantly higher than that in the control group (P<0.05). At 24 and 72 hours after the operation, the pain VAS score of the experimental group was significantly lower than that of the control group (P<0.05). The proportion of normal postoperative opening restriction in the experimental group was significantly higher than that in the control group, and the proportion of severe restriction was significantly lower than that in the control group (P<0.05). Levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8) in the experimental group were significantly lower than those in the control group (P<0.05). The incidence of complications in the experimental group was also significantly lower (P<0.05). CONCLUSIONS: Medical collagen sponge is applied in minimally invasive extraction of impacted mandibular teeth with good outcomes. It not only has excellent effects in hemostasis, pain relief and relief of restricted opening, but also can effectively inhibit postoperative inflammatory responses and reduce the incidence of complications. References | Related Articles | Metrics

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Evaluation of the application of low-friction self-locking bracket system combined with micro-implant anchorage in the treatment of adult bimaxillary protrusion Song Jianwei, He Zhengquan, Liu Xingyu, Zhou Hong, Wang Ning, Deng Mingsi 2026, 35 (4):  393-398.  doi: 10.19439/j.sjos.2026.04.008 Abstract ( 10 )   PDF (836KB) ( 7 )   PURPOSE: To evaluate the effect of the low-friction self-locking bracket system combined with micro-implant anchorage in the treatment of adult bimaxillary protrusion. METHODS: A total of 106 patients with bimaxillary protrusion admitted to Changsha Stomatological Hospital from March 2020 to March 2025 were selected and divided into the control group and the experimental group by blind computer random sequence, with 53 cases in each group. The control group was treated with the low-friction self-locking bracket system, while the experimental group was treated with the low-friction self-locking bracket system combined with micro-implant anchorage. The treatment duration, cephalometric angle parameters, cephalometric linear parameters, soft tissue cephalometric parameters, periodontal indices, periodontal microenvironmental inflammatory markers and the occurrence of complications were compared between the two groups. RESULTS: The time for closing the tooth extraction gap and the orthodontic treatment time in the experimental group were significantly shorter than those in the control group (P<0.05). After treatment, the difference in the increase of U1-L1 in the experimental group was significantly higher than that in the control group, and the differences in the reduction of the SNA Angle and L1-MP Angle were significantly higher than those in the control group (P<0.01). The UL-E lines and LL-E lines in both groups were significantly reduced, and those in the experimental group were even smaller (P<0.05). After treatment, the chin groove inclination angle, nasolabial angle and chin labial groove depth in both groups increased significantly, and those in the experimental group were larger (P<0.05); the U1-NA and U1-APo levels in both groups were significantly decreased, and those in the experimental group were even lower (P<0.05). After treatment, the scores of gingival index (GI), plaque index (PLI) and sulcus bleeding index (SBI) in both groups decreased significantly, and those in the experimental group were even lower(P<0.05). During the treatment period, no serious complications occurred in either group. CONCLUSIONS: The low-friction self-locking bracket system combined with micro-implant anchorage can shorten the treatment time while improving facial aesthetics in the treatment of adult bimaxillary protrusion. References | Related Articles | Metrics

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Association between periodontal abnormality phenotypes based on previous oral records and heart failure-related events in patients with type 2 diabetes mellitus: implications for nursing assessment Shi Wenwen, Guo Yufei, Zhou Ying, Wang Jie, Guo Shouyu, Dang Zhaohua 2026, 35 (4):  399-406.  doi: 10.19439/j.sjos.2026.04.009 Abstract ( 9 )   PDF (1008KB) ( 8 )   PURPOSE: To investigate the association between oral health abnormality phenotypes based on previous oral health records and heart failure(HF)-related events during follow-up in patients with type 2 diabetes mellitus (T2DM), and to explore their implications for nursing assessment. METHODS: A single-center retrospective cohort study was conducted involving 120 patients with T2DM. According to baseline oral examination records, including periodontal pocket probing depth, gingival bleeding, oral hygiene index (OHI), plaque index (PLI), and tooth loss, the patients were classified into three groups: no obvious periodontal abnormality, mild periodontal pocket deepening, and marked periodontal pocket deepening. General clinical data, oral health indicators, inflammatory markers, lipid profiles, and renal function indicators were collected. Correlation analysis, Kaplan-Meier analysis, and Cox proportional hazards regression models were used to evaluate the relationship between oral health abnormality phenotypes and HF-related events. RESULTS: During follow-up, a total of 46 patients developed HF-related events, with an incidence rate of 38.33%. Kaplan-Meier analysis showed a statistically significant difference in HF event-free survival among the three groups(P=0.019). Oral health indicators were positively correlated with inflammatory markers and negatively correlated with estimated glomerular filtration rate (eGFR) (P<0.05). Cox regression analysis showed that oral health abnormality phenotype stratification was associated with HF-related events in the unadjusted model and the age-adjusted model. However, after further adjustment for eGFR, this association was markedly attenuated, and the model estimates became unstable. Sensitivity analysis showed that no stable association was observed between oral health abnormality phenotype stratification and HF-related events in the subgroup with eGFR ≥60 mL/(min·1.73 m2). CONCLUSIONS: Oral health abnormality phenotypes based on previous oral health records showes a potential association with HF-related events in patients with T2DM, but this relationship is substantially influenced by renal function status. Oral health abnormalities may more likely reflect an overall adverse clinical condition characterized by renal impairment, increased inflammatory burden, and metabolic disturbance. Therefore, oral health status may serve as a useful clue for comprehensive nursing assessment in chronic disease management. However, the current evidence is insufficient to support it as a stable independent predictor of HF-related events. References | Related Articles | Metrics

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Quantitative measurement and analysis of sensory function in patients with temporomandibular disorder Lu Wenting, Hou Lili 2026, 35 (4):  407-412.  doi: 10.19439/j.sjos.2026.04.010 Abstract ( 13 )   PDF (765KB) ( 7 )   PURPOSE: To measure and analyze the changes in quantitative sensory function in patients with temporomandibular disorder (TMD) and masticatory muscle pain, and to analyze its relationship with pain perception and dysfunction, so as to provide a basis for personalized treatment of patients with masticatory muscle pain. METHODS: Fifty TMD patients with masticatory muscle pain were selected as the experimental group, and 50 gender and age matched TMD patients without masticatory muscle pain were selected as the control group. All participants underwent comprehensive quantitative sensory test, including cold detection thresholds(CDT), warm sensation thresholds(WDT), cold pain thresholds (CPT), hot pain thresholds(HPT), and pressure pain thresholds (PPT). In addition, pain questionnaire surveys and mandibular function impairment questionnaire(MFIQ) assessments were conducted. RESULTS: The CDT, WDT, CPT, HPT, and PPT of TMD patients were significantly lower than those of the control group(P<0.05). The pain questionnaire scores and MFIQ scores of myalgia patients were significantly higher than those of the control group (P<0.05). The results of quantitative sensory testing were negatively correlated with pain questionnaire scores and MFIQ scores. CONCLUSIONS: Patients with masticatory muscle pain show decreased thresholds in multiple sensory dimensions, indicating that sensory pain phenomena are widespread. These sensory function abnormalities may be related to the patients' pain perception and functional disorders. Quantitative sensory test can provide in-depth insights into the pathophysiological mechanisms of masticatory muscle pain and offer a basis for the development of personalized treatment strategies. References | Related Articles | Metrics

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Prognostic impact of HPV and adjuvant therapy interaction in oral squamous cell carcinoma Gao Xiaoqian, Bai Jinxi, He Yue, Lin Lu 2026, 35 (4):  413-419.  doi: 10.19439/j.sjos.2026.04.011 Abstract ( 11 )   PDF (893KB) ( 7 )   PURPOSE: To investigate the impact of human papillomavirus (HPV) infection on postoperative recurrence in patients with oral squamous cell carcinoma(OSCC), and to analyze its interaction with adjuvant radiotherapy and chemotherapy as well as the predictive value for recurrence. METHODS: A retrospective case-control study was conducted involving 168 postoperative OSCC patients from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Univariate and multivariate logistic regression analyses were used to assess the association between HPV infection, confounding factors and postoperative recurrence. Interaction analysis was performed to clarify the synergistic effect of HPV with radiotherapy and chemotherapy, and recurrence prediction models were constructed and validated. RESULTS: Univariate analysis showed that HPV positivity (OR=0.46, 95%CI: 0.21-0.98) and adjuvant radiotherapy (OR=0.48, 95%CI: 0.24-0.93) were negatively correlated with recurrence risk. Multivariate analysis confirmed that HPV positivity (OR=0.37, 95%CI: 0.16-0.88) and adjuvant radiotherapy (OR=0.30, 95%CI: 0.13-0.67) remained protective factors against recurrence, while adjuvant chemotherapy increased recurrence risk (OR=3.76, 95%CI: 1.50-9.41). A significant additive interaction was observed between HPV positivity and adjuvant radiotherapy, and combined intervention further reduced recurrence risk (OR=0.06, 95%CI: 0.01-0.38), with no significant interaction with adjuvant chemotherapy. Prediction models showed that the AUC of the basic clinical feature model was 0.859, which increased to 0.887 after adding HPV status, and achieved the best predictive performance after introducing the HPV-radiotherapy interaction term (AUC=0.894, compared with the basic model, P=0.031 6). The interaction term was the variable with the highest predictive value in the model. CONCLUSIONS: HPV positivity is an important protective factor against postoperative recurrence in OSCC patients, and exhibits a synergistic effect when combined with adjuvant radiotherapy. The prediction model integrating HPV status and its interaction with radiotherapy has the optimal recurrence predictive efficacy. References | Related Articles | Metrics

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Current status and influencing factors of anxiety symptoms among dental students: an analysis based on a survey report from Shanghai Jiao Tong University School of Medicine Wang Suping, Liu Yujie, Wang Jie, Ge Yun, Cai Yudian, Yao Bilian, Zhu Weiyan 2026, 35 (4):  420-425.  doi: 10.19439/j.sjos.2026.04.012 Abstract ( 15 )   PDF (767KB) ( 9 )   PURPOSE: To investigate the prevalence of anxiety symptoms and associated factors among dental students, and to provide evidence for developing targeted mental health intervention strategies. METHODS: A cross-sectional survey was conducted among dental students at Shanghai Jiao Tong University School of Medicine using stratified sampling from November to December 2025. The data were collected via electronic questionnaires. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale (GAD-7), and sleep status was evaluated using the Insomnia Severity Index (ISI). Demographic characteristics, academic factors and lifestyle information were also collected. Logistic regression models were used to examine the associations between the factors and anxiety symptoms. RESULTS: A total of 99 dental students were included, and the detection rate of anxiety symptoms was 11.1%. Univariate analysis showed that gender, academic pressure, and sleep status were associated with anxiety symptoms (P<0.05). Multivariate logistic regression analysis indicated that high academic pressure (OR=5.610, 95%CI: 1.002-31.477) and poor sleep status (OR=1.300, 95%CI: 1.082-1.560) were independent associated factors for anxiety symptoms. CONCLUSIONS: A certain proportion of dental students suffer from anxiety symptoms, academic pressure and sleep status are key associated factors. Comprehensive interventions are recommended by optimizing the academic environment and improving sleep habits to promote the mental health of dental students. References | Related Articles | Metrics

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The prevalence of sleep disorders and related factors in patients with oral and maxillofacial malignant tumors Yang Ying, Hao Guihua, Zhao Xiaomei, Gan Xing, Hou Lili 2026, 35 (4):  426-432.  doi: 10.19439/j.sjos.2026.04.013 Abstract ( 11 )   PDF (740KB) ( 8 )   PURPOSE: To investigate the current status of sleep disorders in patients with oral and maxillofacial malignant tumors and analyze the influencing factors, so as to provide a basis for clinical intervention. METHODS: A convenience sampling method was used to recruit 487 patients with oral and maxillofacial malignant tumors in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2023 to December 2024. The Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck 35 (EORTC QLQ-H&N35) were used to evaluate sleep quality, psychological state, and symptom burden. Spearman rank correlation analysis and multivariate logistic regression analysis were used to explore the correlation. RESULTS: 84.6% of the patients had sleep disorders, and the use rate of hypnotic drugs in the recurrence group was significantly higher than that in the primary group (P<0.05). The total PSQI score in the recurrence group was positively correlated with sensory perception and dry mouth (P<0.05). The total PSQI scores of the two groups were positively correlated with pain, swallowing, speech, eating during social communication, dental problems, mouth opening, social interaction, disease perception, and the use of painkillers (P<0.05), and negatively correlated with weight loss (P<0.05). Multivariate logistic regression analysis showed that unemployment, smoking, anxiety, oral pain, speech disorders, dental problems, and disease perception were risk factors for sleep disorders in newly diagnosed patients; unemployment, swallowing disorders, and disease perception were risk factors for sleep disorders in recurrent patients. CONCLUSIONS: The incidence of sleep disorders in patients with oral and maxillofacial malignant tumors is high, which is closely related to psychological state, oral dysfunction, and disease perception. Early intervention in symptom clusters is needed clinically to improve sleep quality and quality of life. References | Related Articles | Metrics

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Three-dimensional evaluation of the effects of maxillary sagittal rotation on nasolabial soft tissue in skeletal Class Ⅲ malocclusion Quan Huixin, Huang Yuefei, Naibi Mawumaier, Xiao Di 2026, 35 (4):  433-439.  doi: 10.19439/j.sjos.2026.04.014 Abstract ( 15 )   PDF (1291KB) ( 8 )   PURPOSE: To investigate the correlation between maxillary sagittal rotation and nasolabial soft tissue morphological changes during bimaxillary orthognathic surgery in patients with skeletal Class III malocclusion through accurate three-dimensional CT measurements in a small homogeneous patient cohort, so as to provide clinical evidence for surgical planning and postoperative soft tissue prediction. METHODS: A retrospective study was conducted on 21 patients with skeletal Class III malocclusion who underwent bimaxillary orthognathic surgery at our hospital from January 2017 to December 2024. Maxillofacial CT data were collected at 1 week preoperatively, 3-5 days postoperatively (after removal of drainage devices, defined as short-term postoperatively), and 12 months postoperatively, and imported into Mimics 21.0 software for three-dimensional reconstruction. The APP plane [constructed based on point A and the midpoints of the posterior edges of bilateral maxillary palatal plates PNS(l, r) on three-dimensional models] was innovatively introduced to quantify maxillary sagittal rotation, and three-dimensional displacements of hard and soft tissue landmarks were measured. The overall correlation between maxillary sagittal rotation and nasolabial soft tissue changes was observed. The patients were further divided into clockwise rotation group and counterclockwise rotation group according to postoperative changes in the APP-FH angle. Paired t test, Pearson/Spearman correlation analysis, and partial correlation analysis were performed using SPSS 27.0 software package. The confounding influence of mandibular movement on soft tissue was eliminated by controlling mandibular plane angle(MPA) and mandibular body length (Go-Gn). RESULTS: The APP plane showed favorable stability at different postoperative time points and could accurately reflect the magnitude of maxillary sagittal rotation. The maxillary rotation amount (ΔAPP-FH) was moderately negatively correlated with the horizontal displacement of Point AI(alar point) and Point Cm (columella point)(P<0.05). Partial correlation analysis indicated that this effect was jointly influenced by anteroposterior mandibular movement. Clockwise maxillary rotation independently affected the vertical displacement of point AI and the sagittal displacement of point Ch (cheilion) and point LL' (lower lip edge) (P<0.05). No significant correlation was found between counterclockwise maxillary rotation and soft tissue changes(P>0.05). CONCLUSIONS: The APP plane is a reliable osseous reference plane for evaluating maxillary sagittal rotation. Clockwise maxillary rotation exerts significant influence on nasolabial soft tissue independent of mandibular movement, whereas counterclockwise rotation shows no significant effect on soft tissue. References | Related Articles | Metrics

Dental Education

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Application of an artificial intelligence-assisted diagnostic system for lymph nodes in head and neck imaging teaching Yang Gongxin, Dai Xiaoqing, Wang Jingbo, Wu Zhihan, Tao Xiaofeng, Zhu Ling 2026, 35 (4):  440-444.  doi: 10.19439/j.sjos.2026.04.015 Abstract ( 9 )   PDF (768KB) ( 10 )   PURPOSE: To explore the feasibility and effectiveness of a CT-based artificial intelligence (AI) assisted diagnostic system for cervical lymph node recognition in oral and maxillofacial head and neck imaging education. METHODS: A total of 33 students from College of Stomatology, Shanghai Jiao Tong University were selected as study participants. The students were randomly divided into group A and B, and tasked with reviewing the anatomy of cervical lymph nodes in contrast-enhanced CT images of two patients. Group A performed manual annotation, while group B used AI-assisted annotation, and then the groups crossed over to annotate the next patient. The annotation results of senior radiologists were used as the gold standard to compare the recall rate and accuracy between the manual annotation group and the AI-assisted annotation group. Additionally, a teaching quality questionnaire was used to assess students' learning experiences, focusing on the effectiveness of AI in enhancing engagement and comprehension. RESULTS: Statistical analysis showed that the average recall rate for manual annotation was 31.0%, whereas the recall rate increased to 63.9% with AI assistance. All students completed the teaching questionnaire, and 93.9% of them believed that the AI-assisted diagnostic system stimulated their interest in learning, deepened their understanding of theoretical knowledge, and facilitated their study of head and neck imaging anatomy. Furthermore, students reported that AI assistance helped in reducing cognitive load, allowing them to focus more on understanding the complex anatomical relationships rather than manual tasks. CONCLUSIONS: The AI-assisted diagnostic system for cervical lymph nodes has significant educational advantages in oral and maxillofacial head and neck imaging teaching. It effectively improves medical students' understanding of head and neck imaging anatomy, reduces cognitive load, and enhances learning outcomes. This study demonstrates the high application value of integrating AI into radiology education, providing a model for future educational innovations and reforms. References | Related Articles | Metrics

Case Reports

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Digital technology-assisted direct bonding restoration with composite resin for maxillary anterior diastema accompanied with malocclusion: a case report Xu Laijun, Chen Tao, He Daiyao, Le Liuxin, Sun Lizhong 2026, 35 (4):  445-448.  doi: 10.19439/j.sjos.2026.04.016 Abstract ( 10 )   PDF (1661KB) ( 139 )   The development and clinical application of digital technology have made it possible to accurately restore anterior diastema with malocclusion using composite resin. This paper reported a complex case of digital technology-assisted direct bonding restoration with composite resin for maxillary incisor diastema accompanied by abnormal axial inclination, midline deviation, and irregular alignment. In this case, the patient presented multiple dental aesthetic defects, including uneven diastema width, misaligned maxillary and mandibular midlines, and irregular anterior tooth arrangement. Through aesthetic design with digital technology and effect prediction using 3D models, the problems of excessive dental diastema and malocclusion in the patient were successfully solved with the assistance of a lingual silicone rubber guide. This case provides a reference for the treatment of patients with dental aesthetic defects accompanied by malocclusion. References | Related Articles | Metrics