Evidence-based dentistry最新文献

{"title":"More therapy is not necessarily better: patient education and self-management perform similarly to other conservative interventions for temporomandibular disorders.","authors":"Jens Christoph Türp","doi":"10.1038/s41432-026-01273-5","DOIUrl":"https://doi.org/10.1038/s41432-026-01273-5","url":null,"abstract":"<p><strong>A commentary on: </strong>Ferland G, Vincent R, Desmeules F, Cormier AA, Huon M, Pitance L. Patient Education and Self-Management in Adults With Temporomandibular Disorders: Results From a Systematic Review With Meta-Analysis. J Oral Rehabil. 2026;53:1394-1408. https://doi.org/10.1111/joor.70187 .</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomized controlled trials evaluating patient education and self-management interventions for adults with temporomandibular disorders (TMDs).</p><p><strong>Case selection: </strong>MEDLINE, PubMed, Embase, Cochrane CENTRAL, CINAHL, and PsycINFO were searched from inception to March 2025. Eligible randomized controlled trials included adults diagnosed with TMD according to RDC/TMD or DC/TMD criteria and evaluated patient education and/or self-management interventions, either alone or in combination with another conservative therapy. Forty-seven trials involving 3238 participants were included.</p><p><strong>Data analysis: </strong>Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias tool. Random-effects meta-analyses were performed using standardized mean differences (SMDs) for pain, mandibular function, and health-related quality of life (HRQoL). Certainty of evidence was assessed using the GRADE approach.</p><p><strong>Results: </strong>Other conservative interventions demonstrated greater short-term pain reduction than education/self-management alone (SMD 0.79; 95% CI 0.27 to 1.32) and greater short-term improvement in HRQoL (SMD 0.61; 95% CI 0.20 to 1.01). However, no significant differences were observed for medium-term pain or mandibular function. Adding education/self-management to other conservative interventions did not improve short-term pain outcomes. Similarly, combining education/self-management with oral appliances, manual therapy, exercise, or electrotherapy was not consistently superior to education/self-management alone in reducing medium- and long-term pain or functional limitation. Most included trials exhibited substantial methodological limitations and considerable clinical heterogeneity.</p><p><strong>Conclusions: </strong>Education and self-management appear to provide clinical outcomes comparable to those of many other conservative treatments for TMDs, particularly beyond the short term. While some interventions may offer greater short-term pain relief or HRQoL improvement, the evidence does not support consistent additional benefit from combining education/self-management with other conservative therapies.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic surgery vs dynamic navigation: does greater accuracy make the difference in implant dentistry?","authors":"Paolo Nava, Andrea Laureti, Hamoun Sabri","doi":"10.1038/s41432-026-01267-3","DOIUrl":"https://doi.org/10.1038/s41432-026-01267-3","url":null,"abstract":"<p><strong>A commentary on: </strong>Wei H, Shu Z, Tian M, Ge Y, Li D. The Accuracy of Autonomous Robotic Surgery vs. Dynamic Navigation in Implant Placement: An Open-Label, Double-Arm, Randomized Controlled Clinical Trial. Clin Oral Implants Res. 2025;36:1486 -97 DESIGN: Double-arm, randomized controlled clinical trial comparing the accuracy and early clinical outcomes of autonomous robotic surgery and dynamic navigation for single-tooth implant placement. Both systems used the same optical tracking technology, allowing a more standardized comparison between the two computer-assisted surgical approaches.</p><p><strong>Case selection: </strong>Forty healthy adult patients requiring single implant-supported restoration were included and randomly allocated to either the autonomous robotic surgery group or the dynamic navigation group. Eligible patients presented with adequate soft tissue dimensions, sufficient bone volume, good oral hygiene, and no limitation in mouth opening. Patients with systemic contraindications to implant surgery, conditions or treatments affecting osseointegration, pregnancy or nursing status, recent head and neck radiotherapy, or inability to comply with follow-up were excluded.</p><p><strong>Data analysis: </strong>Implant placement accuracy was assessed by superimposing preoperative and postoperative CBCT scans. The primary outcomes were coronal, apical, and angular deviations between planned and actual implant positions. Secondary outcomes included surgical time, postoperative pain, edema, complications, and early implant success. Between-group comparisons were performed using parametric or non-parametric tests according to data distribution, with additional regression analysis to adjust for baseline variables.</p><p><strong>Results: </strong>Autonomous robotic surgery showed significantly lower angular deviation than dynamic navigation. No statistically significant differences were observed for coronal or apical deviations. Robotic procedures required significantly longer surgical time than dynamic navigation. Postoperative pain, edema, complications, and early implant success were comparable between groups, with all implants meeting success criteria after 3 months of healing.</p><p><strong>Conclusions: </strong>Autonomous robotic surgery may provide superior angular accuracy compared with dynamic navigation when both systems use the same optical tracking technology. However, this advantage was not accompanied by significant improvements in linear accuracy or early clinical outcomes, and robotic surgery required longer operative time. These findings support the potential of autonomous robotic systems for precise implant placement, while emphasizing the need for larger clinical trials, longer follow-up, and evaluation in more complex scenarios before broad clinical superiority can be established.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can dentists recognise the hidden burden of Sjögren disease beyond xerostomia?","authors":"Sruti Murali, Mugundan Rn","doi":"10.1038/s41432-026-01268-2","DOIUrl":"https://doi.org/10.1038/s41432-026-01268-2","url":null,"abstract":"<p><strong>A commentary on: </strong>Lee AYS, Zembrzuska H, Franke KB, Gordon R, Franke EF, Kumble L, Boderman B, Pelkas C, Hitchcock ME, Cornec D, Rischmueller M, Bowman SJ, Seror R, McCoy SS, DiRenzo D. Patients' perspectives of living with Sjögren disease: A systematic review of qualitative studies from the OMERACT Sjögren disease working group. Semin Arthritis Rheum. 2026;77:152929 https://doi.org/10.1016/j.semarthrit.2026.152929 DESIGN: Systematic review with thematic synthesis of qualitative studies conducted in accordance with PRISMA guidelines to synthesise the lived experiences of adults with Sjögren disease.</p><p><strong>Case selection: </strong>MEDLINE (via PubMed), Embase and the Cochrane Library were searched for English-language studies published between July 2002 and July 2024. Eligible studies included adults (≥18 years) diagnosed with Sjögren disease according to the 2002 American-European Consensus Group or the 2016 ACR/EULAR classification criteria and explored patients' lived experiences using qualitative interviews or focus groups. Quantitative (survey) studies, case reports and conference abstracts were excluded.</p><p><strong>Data analysis: </strong>Two reviewers independently screened studies and extracted data. Methodological quality of the included studies was independently assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist and the Walsh-Downe criteria. Primary qualitative data underwent line-by-line coding followed by thematic synthesis using the Thomas and Harden approach to generate descriptive categories and overarching analytical themes.</p><p><strong>Results: </strong>Nine qualitative studies involving 162 participants from ten countries met the inclusion criteria. Five overarching themes characterised patients' experiences: the invisible and unpredictable nature of symptoms; coping and adaptation strategies; impaired social, occupational and interpersonal functioning; challenges navigating healthcare systems; and varying perceptions of disease and treatment. Persistent oral and ocular dryness, fatigue and pain were consistently associated with reduced quality of life, while delayed diagnosis, inadequate disease awareness and feelings of dismissal by healthcare professionals emerged as recurrent concerns.</p><p><strong>Conclusions: </strong>The lived experience of Sjögren disease extends well beyond sicca symptoms and encompasses substantial physical, emotional and social burdens. Integrating patients' perspectives into clinical care and outcome assessment may facilitate more patient-centred management and improve the relevance of future clinical research.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does preoperative ibuprofen reduce pain during treatment of deep caries in children?","authors":"Marcin Baranowski, Greig D Taylor","doi":"10.1038/s41432-026-01248-6","DOIUrl":"https://doi.org/10.1038/s41432-026-01248-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;A commentary on: &lt;/strong&gt;Bilmez Selen M, Kuru B. Effect of preoperative ibuprofen on pain perception and pulse rate in paediatric patients with deep caries: a randomised controlled trial. Eur J Paediatr Dent. 2026:1. https://doi.org/10.23804/ejpd.2026.2598 .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A prospective, parallel single-blinded randomised controlled trial aimed to evaluate the effect of pre-operative ibuprofen administration on pain control during vital pulp therapy (VPT) procedures for a mandibular molar diagnosed with reversible pulpitis. Participants were randomised through a computer-generated random sequence that was concealed in sealed envelopes. Participants received either oral ibuprofen (10 mg/kg) 40 minutes before treatment (intervention group) or no pre-operative analgesia (control group).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case selection: &lt;/strong&gt;A total of 46 participants, aged 7-13 years, were recruited from the Department of Paediatric Dentistry at the Faculty of Dentistry in Malatya, Türkiye. The sample size was based on a power calculation, determining the estimated effect size from a prior study restoring teeth in children with MIH. One participant from each group was excluded (suspected irreversible pulpitis) prior to randomising. Inclusion criteria included no history of systemic disease, cooperative behaviour, a clinical and radiographic diagnosis of reversible pulpitis (positive cold test response and no swelling, abscess or periapical pathology), in a mandibular molar, due to dental caries (ICDAS 5-6). A standardised treatment protocol was provided and undertaken by a single paediatric dentist. The type of VPT included protective liner, direct pulp capping, partial pulpotomy, or coronal pulpotomy, and was determined by the operator and based on cavity depth and presence, or not, of a pulp exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data analysis: &lt;/strong&gt;The primary outcome measured was intraoperative pain intensity, assessed using the visual analogue scale (VAS; 0-10) at the point of &lt;1 mm pulpal proximity during the vital pulp therapy component of the treatment. Secondary outcomes measured include patients' intraoperative pulse rate (bpm), at baseline and at the same point as the primary outcome, and post-operative pain, using VAS, post-operatively at days 1, 3, and 7. Data were collected by an independent investigator, who was blinded to the randomisation. Data were tested for normality, and statistically analysed, using appropriate non-parametric tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 44 patients (30 girls, 14 boys) diagnosed with hyperaemic pulp were included in the study, with a mean age of 9.45 ± 1.76 years. The mean intraoperative VAS score was significantly lower in the intervention group (0.64 ± 1.14) compared to the control group (5.05 ± 3.51) [mean difference = -4.41; 95% confidence interval (CI): -5.78 to -3.04], p &lt; 0.001. There was no statistically significant difference in postoperative VAS scores between the groups on days ","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building the evidence for environmentally sustainable dentistry","authors":"Mona Nasser","doi":"10.1038/s41432-026-01265-5","DOIUrl":"10.1038/s41432-026-01265-5","url":null,"abstract":"","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"27 3","pages":"45-45"},"PeriodicalIF":2.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-026-01265-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of overhanging proximal restorations on periodontal parameters: a systematic review and meta analysis.","authors":"Laura Daniela Caicedo-Jaramillo, Manuela Parra-Arango, Carolina Rodríguez-Medina, Javier Enrique Botero","doi":"10.1038/s41432-026-01246-8","DOIUrl":"https://doi.org/10.1038/s41432-026-01246-8","url":null,"abstract":"<p><strong>Objective: </strong>Overhanging proximal restorations are considered a risk indicator for adverse periodontal parameters and could affect the progression of periodontitis. The objective of this systematic review was to determine the association between overhanging proximal restorations in posterior teeth and periodontal parameters.</p><p><strong>Data sources: </strong>Electronic databases were systematically searched from inception to April 2025; Clarivate Analytics Web of Science, MEDLINE (via PubMed), Embase and Scopus.</p><p><strong>Data selection and extraction: </strong>Potential studies (case-control, cohort, cross-sectional, randomized clinical trials, non-randomized clinical trials) examining proximal restorations in posterior teeth and periodontal parameters were considered for inclusion by two independent reviewers in duplicate. The certainty of evidence was graded using the GRADE approach. Data were pooled using a random-effects model and an Analytic Hierarchy Process (AHP) framework was applied to rank the association of proximal restorations on periodontal health. After removing duplicate results and non-related studies, 54 studies were screened for full-text. Of these, 30 were excluded for different reasons leaving a total of 24 included studies.</p><p><strong>Data synthesis: </strong>24 studies (n = 5955 participants) from multiple countries were included, most with cross-sectional designs. Meta-analysis of eight studies (17,300 teeth/surfaces) showed overhanging proximal restorations were associated with greater radiographic bone loss (mean difference = 0.58 mm; 95% CI: 0.12-1.04 mm), reduced to 0.35 mm after sensitivity analysis. Compared to non-overhanging restorations, overhangs showed significantly greater bone loss (0.82 mm; 95% CI: 0.21-1.43 mm). Three studies (27,679 teeth/surfaces) found increased probing depth (0.28 mm; 95% CI: 0.26-0.30 mm). Risk of bias was high in 42% of studies; the certainty of evidence for bone loss and probing depth was graded low.</p><p><strong>Conclusions: </strong>Low certainty evidence indicates that overhanging proximal restorations in posterior teeth are associated with increased radiographic bone loss and slight increases in probing depth.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of vitamin D supplementation on periodontal health: a systematic review and meta-analysis.","authors":"Aafreen Gillani Haji, Benedetta Ghezzi, Sara Tagliaferri, Nagihan Bostanci, Elena Calciolari","doi":"10.1038/s41432-026-01244-w","DOIUrl":"https://doi.org/10.1038/s41432-026-01244-w","url":null,"abstract":"<p><strong>Aims/objectives: </strong>This systematic review aimed to assess whether supplementation with vitamin D compared to no supplementation or placebo might provide a significant benefit for periodontal and peri-implant health in terms of changes in probing pocket depth (PPD), clinical attachment level (CAL), tooth loss and implant loss.</p><p><strong>Methods: </strong>Three databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) looking at the effect of vitamin supplementation on periodontal and peri-implant health with a minimum follow-up of 1 month. Meta-analysis of the weighted mean differences (MD), with 95% confidence intervals (CI) was performed when ≥3 studies with the same characteristics and follow-up were identified.</p><p><strong>Results: </strong>Fourteen articles (13 RCTs and 1 CCT) were included for qualitative assessment, but none assessed the impact of vitamin D on peri-implant health. Three studies assessing the impact of vitamin D supplementation to non-surgical periodontal therapy with a total of four subset of subjects were included in the meta-analysis on changes in PPD with an estimated mean difference of 0.0023 mm (95% CI: -0.0378 mm to 0.0424 mm), which was not statistically significant (p = 0.9110).</p><p><strong>Discussion: </strong>Vitamin D supplementation does not confer a statistically significant additional benefit to non-surgical periodontal therapy in reducing probing pocket depth. Although vitamin D may exert anti-inflammatory effects on gingival tissues, current evidence is limited, heterogeneous, and insufficient to support a clear clinical recommendation. No studies addressing peri-implant health outcomes were identified, underscoring a gap in the literature. Well-designed, long-term randomized controlled trials that control for confounding variables are needed to determine the role of vitamin D supplementation in periodontal health.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148790224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemically modified curcumin in periodontal therapy: a scoping review.","authors":"Vishala Bhargavi Chilukuri, Rupali Agnihotri, Deepa G Kamath","doi":"10.1038/s41432-026-01237-9","DOIUrl":"https://doi.org/10.1038/s41432-026-01237-9","url":null,"abstract":"<p><strong>Aims/objectives: </strong>Periodontitis, a multifactorial chronic inflammatory disease that destroys the supporting structures of the teeth, is conventionally managed with treatments focusing on biofilm removal; however, these therapies do not fully address the dysregulated host response central to disease progression. To address this, chemically modified curcumin (CMC) analogues have been developed by modifying curcumin, a derivative of Curcuma longa, a host-modulating agent with potent anti-inflammatory and antioxidant properties. Recently, CMCs have been used to manage periodontitis. This scoping review systematically maps the available evidence on the therapeutic potential of CMCs and their analogues in managing periodontal disease.</p><p><strong>Methods: </strong>A comprehensive literature search in online databases (PubMed, EMBASE, Scopus and Web of Science) using the keywords \"chemically modified curcumin\" AND \"periodontitis\" yielded 76 results. Among them, 15 original research studies that evaluated the effects of CMC analogues on periodontitis were reviewed according to the PRISMA-ScR guidelines.</p><p><strong>Results: </strong>CMC2.24 was the most common analogue studied, followed by CMC 2.5, the mono-carbonyl analogue of curcumin (e.g., 1A) and iron-curcumin nanoparticles. They produced consistent anti-inflammatory and bone-protective effects across multiple in vitro, ex vivo and animal models. They suppressed the pathologically elevated MMP-9 and pro-inflammatory cytokines, including IL-1β, TNF-α and IL-6. Furthermore, they enhanced pro-resolving mediators, such as Resolvin D1. CMCs were superior to traditional curcumin, owing to their improved stability and bioavailability.</p><p><strong>Discussion: </strong>Analysis of the extracted data from the included studies revealed that the CMC analogues effectively reduced excessive inflammation, tissue degradation and dysregulated immune response in periodontitis.</p><p><strong>Conclusion: </strong>CMC2.24 was a promising host-modulating agent in periodontal therapy. However, the results are mainly derived from preclinical studies and further human clinical trials are required to apply CMCs into everyday practice.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can artificial intelligence accurately assess systematic review quality? Benchmarking large language models for AMSTAR 2 appraisal in dental evidence synthesis.","authors":"Nirmal Kurian, Joe Mathew Cherian, Ricku Mathew Reji, Kevin George Varghese","doi":"10.1038/s41432-026-01238-8","DOIUrl":"https://doi.org/10.1038/s41432-026-01238-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the accuracy and reliability of three AI platforms ChatGPT, Perplexity, and Google Gemini in assessing the methodological quality of systematic reviews using the AMSTAR 2 checklist, compared with expert manual evaluation in dental research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional comparative study was conducted to assess the performance of three AI platforms ChatGPT, Perplexity, and Google Gemini in evaluating the methodological quality of 35 systematic reviews using the AMSTAR 2 checklist. Manual assessments by a domain expert served as the reference standard. Each AI system was prompted with a standardized AMSTAR 2 query, and item-level outputs were collected for direct comparison. Key metrics included percentage agreement, error proportions, and inter-rater reliability measured by Cohen's kappa. Error proportions represent the proportion of discordant assessments out of total valid pairwise comparisons across 16 AMSTAR-2 items. Differences between LLM-generated and reference AMSTAR-2 ratings were summarized using effect estimates with corresponding 95% confidence intervals. Comparative performance across platforms was assessed based on confidence-interval overlap rather than hypothesis testing. Results are presented as effect estimates with corresponding 95% confidence intervals, without hypothesis testing or statistical dichotomization. This approach provided a robust and reproducible framework to benchmark AI-assisted quality appraisal in dental evidence synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 35 systematic reviews assessed, Perplexity demonstrated the highest agreement with expert AMSTAR-2 ratings (error proportion: 19.0%; weighted κ_w: 0.78, 95% CI 0.71-0.85), followed by ChatGPT (error proportion: 22.9%; weighted κ_w: 0.62, 95% CI 0.54-0.70) and Google Gemini (error proportion: 43.9%; weighted κ_w: 0.41, 95% CI 0.33-0.49). Perplexity also achieved the best sensitivity (81.3%, 95% CI 76.5-85.4%) and specificity (82.7%, 95% CI 78.1-86.5%) for correctly identifying high-quality reviews. Non-overlapping 95% confidence intervals suggest meaningful differences in performances among platforms, with Perplexity showing superior agreement across all metrics. Across all platforms, agreement was generally higher for non-critical AMSTAR-2 domains involving clear and structured reporting, whereas performance was weaker for critical domains requiring interpretation of complex methodological details, risk-of-bias considerations, and evidence synthesis procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Perplexity demonstrated the highest accuracy and agreement with expert assessments of the methodological quality of systematic reviews, suggesting its potential as a supportive AI tool for AMSTAR-2-based appraisal in dental evidence synthesis. In contrast, systematic biases observed in ChatGPT and Google Gemini underscore the continued need for human oversight to ensure the validity of methodologica","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ozonated water as a preventive oral hygiene aid: a systematic review and meta-analysis of its role in reducing dental plaque","authors":"Rahul Mohandas,&nbsp;Subhashree Mohapatra,&nbsp;Reshma Poothakulath Krishnan","doi":"10.1038/s41432-026-01245-9","DOIUrl":"10.1038/s41432-026-01245-9","url":null,"abstract":"Ozonated water is increasingly being explored as a gentler alternative to chlorhexidine for chemical plaque control because of its antimicrobial and anti-inflammatory properties and the absence of common side effects such as staining or altered taste. However, the evidence on its effectiveness—especially in healthy individuals—remains unclear. This systematic review and meta-analysis aimed to determine whether ozonated water is more effective than placebo or chlorhexidine mouthwash in reducing dental plaque. An extensive literature search was carried out across PubMed, Cochrane Library, Scopus, Web of Science, LILACS, ScienceDirect, EBSCOhost, and Google Scholar up to August 5, 2025. Randomized controlled trials involving healthy participants and comparing ozonated water with placebo or chlorhexidine were included. In total, five studies were selected for qualitative synthesis, of which four were included in the meta-analysis. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. A random-effects model was applied to calculate standardized mean differences (SMDs) with 95% confidence intervals. The meta-analysis suggested that ozonated water may provide slightly better short-term plaque reduction than placebo or chlorhexidine (SMD = −1.35; 95% CI: −2.77 to 0.06). However, as the confidence interval crossed the line of no effect, this difference was not statistically significant. Risk of bias was high in one study, unclear in three studies, and low in one study. The overall certainty for plaque reduction was rated as “low”. While ozonated water appears to be a promising short-term option for plaque control—especially for individuals unable to tolerate chlorhexidine—the current evidence is not strong enough to confirm that it works better than standard rinses or even plain water. Well-designed, longer-term clinical trials are needed before ozonated water can be recommended for routine daily use.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"27 3","pages":"84-85"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}