The occurrence and progression of oral infectious diseases are, in essence, a process in which oral microecological imbalance leads to the formation of an oral infectious microecosystem, which subsequently drives tissue destruction. The oral infectious microecosystem is a pathological ecosystem with self-maintaining capacity, formed within infectious lesions through steady-state drift and structural remodeling of the healthy oral microecosystem under continuous perturbations from both intrinsic and extrinsic factors. It constitutes the common microecological foundation for diseases such as dental caries, periodontal disease, and pulpal and periapical diseases. From the perspective of systems ecology, this article deconstructs the oral infectious microecosystem into three dimensions: Living organisms, space, and environmental media. The living organism dimension encompasses microbial components including bacteria, fungi, viruses, and archaea, as well as the host cellular network. The spatial dimension includes the surface chemical characteristics of heterogeneous colonization interfaces, the habitat spectrum ranging from open, semi-closed to closed systems, and the physiological and pathological dynamic changes. The environmental media dimension covers the physiological-pathological shifts in parameters such as pH, oxygen partial pressure and redox potential, temperature and fluid flow, nutrient substrates, and mechanical environment. On this basis, this article systematically analyzes the bidirectional interactions and feedback coupling mechanisms among the three dimensions, elucidates the ecological essence underlying the establishment and maintenance of pathological steady states, and provides perspectives for future research directions, aiming to offer a theoretical reference for understanding the pathogenesis of oral infectious diseases from an ecological standpoint.

To address the growing pathogenicity and biofilm-mediated drug resistance of Pseudomonas putida (P. putida) in root canal therapy failure and refractory apical periodontitis, and to overcome the bottleneck of "extremely low sample quantity" that hinders the systemic activity evaluation of natural products. This study aims to establish a micro-scale, visual, and high-throughput drug screening platform based on microfluidic chips.

P. putida KT2440 was selected as the model strain, and a green fluorescent protein (GFP) -labeled strain was constructed to establish a microfluidic biofilm model. To accommodate rare natural products, a "qualitative rapid screening" strategy with a fixed threshold of 200 μg/mL was established. Using the length of the fluorescent line segment as a quantitative metric, 40 natural products derived from myxobacteria and plants were blindly screened for anti-biofilm activity. Calcium hydroxide and Ciprofloxacin served as the lower and upper limits of efficacy, respectively, to define the effective screening range. A t-test was used to compare results with the traditional 96-well plate micro-broth dilution method; consistency between the two methods was verified, and sample consumption was compared.

The microfluidic screening platform successfully categorized the 40 compounds into three tiers: Strong, moderate, and ineffective. Ultimately, 6 lead compounds with significant anti-P. putida biofilm activity were identified (positive detection rate of 15%), including novel macrocyclic peptides and certain monoterpenoids. Methodological validation showed high qualitative consistency between the microfluidic chip screening and traditional methods. regarding sample consumption, the platform required only nanoliter (nL) -level volumes per test, with a single compound consumption as low as 8 ng. This represented a sample saving of approximately 15 000-fold compared to the traditional 96-well plate method, significantly reducing the demand for fermentation products.

The microfluidic high-throughput screening platform constructed in this study effectively overcame the technical challenge of sample scarcity in natural product mining through a fixed-concentration qualitative screening strategy. The platform featured extremely low sample consumption, high analytical throughput, and accurate results, providing strong technical support for rapidly locking onto active lead compounds against drug-resistant bacterial biofilms.

To evaluate the in vitro antibacterial effect of freshly-prepared slightly acidic electrolyzed water (SAEW) against Enterococcus faecalis (E. faecalis), a common and persistent pathogen in root-canal therapy, and to preliminarily explore its underlying mechanism.

Freshly-prepared SAEW was produced by on-site electrolysis. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of SAEW against planktonic E. faecalis were determined. An ex-vivo infected single-rooted tooth model was established. Infected teeth were assigned into four groups by simple randomization, and root canals were irrigated with 0.9% sodium chloride solution, low-concentration SAEW (MIC), high-concentration SAEW (2×MIC), and 5.25% sodium hypochlorite solution, respectively. Immediate antibacterial efficacy was assessed by bacterial sampling and colony counting before and after irrigation. Root-canal irrigants were collected. Scanning electron microscopy (SEM) was used to observe bacterial ultrastructural alterations. Confocal laser scanning microscopy combined with SYTO 9/PI fluorescent staining was performed to quantitatively analyze the effect of SAEW on bacterial membrane integrity. The cytotoxicity of SAEW toward human gingival fibroblast cells (HGFCs) was detected using the CCK-8 assay. Statistical analyses were conducted with SPSS 26.0. Normality and homogeneity-of-variance tests were performed for quantitative data. Normally distributed data with homogeneous variances were presented as mean ± standard deviation (SD). One-way analysis of variance (ANOVA) followed by the least-significant-difference (LSD) post-hoc test was applied for multi-group comparisons. A two-sided P<0.05 was considered statistically significant.

Freshly-prepared SAEW exhibited distinct concentration-dependent antibacterial activity against both planktonic and intracanal E. faecalis. The MIC and MBC values of SAEW for planktonic E. faecalis were 6.25 and 12.50 mg/L, respectively. The overall difference in the colony reduction rates of Enterococcus faecalis among the four groups was statistically significant (F = 306.46, P<0.001). The colony reduction rates of groups A, B, C, and D were (25.69 ± 7.41) %, (73.38 ± 1.69) %, (85.89 ± 2.09) %, and (96.60 ± 1.33) %, respectively. Compared with group A, groups B, C, and D exhibited significantly higher colony reduction rates. Moreover, group C showed a significantly higher antibacterial effect than group B but a lower bactericidal efficacy than group D (all P<0.001). These results indicated that SAEW exerts a concentration-dependent antibacterial effect, while its immediate bactericidal potency is inferior to 5.25% sodium hypochlorite. Scanning electron microscopy revealed varying degrees of bacterial ultrastructural damage in each group. Quantitative confocal laser scanning microscopy with SYTO 9/PI staining showed bacterial membrane-damage rates of 0.84% for the 0.9% sodium-chloride group, 74.39% for the low-concentration-SAEW group, 87.38% for the high-concentration-SAEW group, and 92.62% for the 5.25% sodium-hypochlorite group, with significant inter-group differences (F = 2 056.72, P<0.001). These findings indicated that SAEW exerted antibacterial effects by disrupting bacterial membrane integrity in a concentration-dependent manner. At effective antibacterial concentrations, the viability of HGFCs remained above 90% in SAEW-treated groups, whereas cell viability was below 10% in the sodium-hypochlorite-treated group.

This study demonstrated that SAEW could effectively inhibit and kill E. faecalis. Although its immediate in vitro bactericidal potency may be lower than that of high-concentration sodium hypochlorite, SAEW showed promising potential as a supplementary or alternative root-canal irrigant owing to its favorable antibacterial performance and biocompatibility. Further validation using complex biofilm and in vivo models is required.

Dental caries is a highly prevalent chronic infectious disease worldwide. However, traditional preventive agents, such as antimicrobials and fluorides, face limitations including the induction of bacterial resistance and disruption of oral microecological balance. Emerging as a novel strategy, microecological regulation using probiotics to "combat bacteria with bacteria" offers a promising alternative for caries prevention. Nevertheless, current clinical probiotic products generally suffer from short retention times in the oral cavity, susceptibility to saliva rinsing, and difficulty in achieving effective colonization on dental surfaces. As an innovative delivery system, hydrogels can efficiently encapsulate probiotics, achieve lesion-targeted colonization, and significantly prolong retention time. These hydrogel systems exert anti-caries effects through competitive exclusion of cariogenic bacteria, pH regulation, secretion of antimicrobial substances, and immune modulation. This article reviews recent research progress on probiotic-loaded anti-caries hydrogels, with a particular focus on the anti-caries mechanisms, principles of strain selection, hydrogel design mechanisms, and the regulatory roles of degradation kinetics in probiotic delivery and therapy. Overall, this review aims to provide a theoretical reference for the microecological prevention and clinical translation of dental caries.

Pulp and periapical diseases are prevalent conditions in dentistry, yet current clinical treatment approaches all exhibit certain limitations. Functional regeneration of dental pulp has progressively become a focal point and hot topic in oral medicine research, with stem cell transplantation technology being particularly significant. Compared to single-cell transplantation, stem cell spheroids can enhance post-transplantation cell survival rates; simultaneously, compared to two-dimensional culture, spheroids more accurately mimic the in vivo microenvironment, maintaining superior biological properties of stem cells and demonstrating significant potential in tissue regeneration. This article systematically reviews the structure, formation mechanism, and influencing factors of stem cell spheroids, with a particular emphasis on summarizing research progress in the field of pulp regeneration. It analyses existing challenges and future directions, providing a reference for subsequent basic research and clinical translation.

Self-etch resin cements are dental restorative materials that combine aesthetic appeal with outstanding performance. In recent years, they have gained significant attention in the field of prosthodontics owing to their unique advantages, such as simplified procedures, low technique sensitivity, and a reduced incidence of postoperative sensitivity. Consequently, they have been widely adopted for the cementation of indirect restorations clinically. This review systematically analyzes the chemical composition and bonding mechanisms of self-etch resin cements, summarizes clinical considerations across various situations, and discusses future development trends. Dental clinicians should thoroughly understand the material properties, master the operational essentials for different applications, and stay informed about relevant research to ensure precise and standardized clinical practice. With the increasing demand for clinical efficiency and the iteration and updating of bonding technology, balancing simplified procedures with the maintenance of optimal bonding performance remains a key direction for future advancement.

To explore the factors influencing the failure of root canal treatment in apical periodontitis, and to construct and validate a nomogram prediction model for the efficacy of root canal treatment in apical periodontitis based on these factors.

A prospective study was conducted involving 150 patients with apical periodontitis treated at Huizhou First People's Hospital from April 2024 to June 2025. All patients underwent root canal treatment and were followed up for 6 months. They were divided into the treatment failure group and the treatment success group according to the efficacy criteria of root canal treatment. Clinical data of the patients were collected. Logistic regression analysis was used to identify the factors influencing the failure of root canal treatment in apical periodontitis. A nomogram prediction model for the failure of root canal treatment in apical periodontitis was constructed, and the performance of this risk prediction model was validated.

The follow-up results showed that among the 150 patients with apical periodontitis, 35 (23.33%) had treatment failure and 115 (76.67%) had treatment success. Logistic regression analysis revealed that tooth position (posterior teeth), the number of root canal treatments (≥2 times), crown sealing effect (crown leakage), root canal filling length (underfilling/overfilling), and instrument fracture (present) were independent risk factors for the failure of root canal treatment in apical periodontitis, with odds ratios (ORs) of 2.002, 2.079, 2.255, 2.063, and 1.950, respectively. The corresponding 95% confidence intervals (CIs) were 1.080-3.711, 1.159-3.729, 1.111-4.575, 1.076-3.954, and 1.113-3.416, with P-values of 0.028, 0.014, 0.025, 0.030, and 0.020, respectively. The nomogram model developed using these five risk factors demonstrated an area under the ROC curve (AUC) of 0.836 (95% CI: 0.781-0.892), indicating good discrimination. The slope of the calibration curve was close to 1, and the Hosmer and Lemeshow test showed that the model had good fit (χ² = 7.568, P = 0.268) .

Tooth position, the number of root canal treatments, crown sealing effect, root canal filling length, and instrument fracture are risk factors affecting root canal treatment in apical periodontitis. The nomogram model constructed based on these factors has good accuracy and clinical application value, and may serve as a reference for clinical treatment of apical periodontitis.

This article presents a precise and efficient clinical strategy for managing complex defects in the anterior esthetic zone by integrating robotic arm-assisted implant placement with customized titanium mesh fixation. The patient presented with missing maxillary right lateral incisor and canine (teeth 12 and 13), accompanied by insufficient bone volume at the implant site and compromised anterior esthetics. A fully digital workflow was adopted for preoperative design, implant position planning, customized titanium mesh design, robotic arm-assisted implant site preparation, and titanium mesh fixation, followed by staged provisional and definitive restorations. This approach enabled reconstruction of the peri-implant hard and soft tissues, while avoiding a second course of long-term orthodontic treatment, shortening the overall treatment duration, improving anterior esthetic outcomes, and enhancing patient satisfaction. This case suggests that, in carefully selected complex defects of the anterior esthetic zone, robotic arm-assisted digital implant therapy combined with customized titanium mesh-guided bone regeneration may represent a clinically feasible and predictable treatment option.

Complex crown-root fracture is a type of dental trauma caused primarily by external forces, characterized by damage to dental hard tissues accompanied by pulp exposure, and often involving the subgingival region. This article reports a case of a 30-year-old male patient with fractured left upper anterior teeth. The patient had had fractured left upper anterior teeth for one week. The fractured crown was removed at another dental institution. Although the pain and swelling were relieved with medication, the tooth defect and discomforts persisted, affecting mastication and aesthetics. Intraoral examination revealed cervical fractures of the incisors (teeth 21 and 22). The fracture surface of incisor tooth 21 was irregular, with the labial fracture line level with the gingival margin and the palatal fracture line located approximately 2 mm below the gingival margin. The labial and palatal fracture lines of tooth 22 were level with the gingival margin. The gingiva surrounding the residual roots of teeth 21 and 22 exhibited mild redness and swelling, with tenderness on probing of the root canal orifices (+) and tenderness on percussion (±), and no tooth mobility. Based on the medical history, clinical examination, and radiographic findings, a diagnosis of complex crown-root fracture of teeth 21 and 22 was established. After root canal therapy, orthodontic extrusion was performed on teeth 21 and 22. Following completion of extrusion and assessment of the soft tissue morphology, gingivectomy was carried out, followed by fiber post-core placement and all-ceramic splinted crown restoration of teeth 21 and 22. A 1-year follow-up after restoration revealed stable gingival conditions, good retention of the restorations, and normal proximal contacts, demonstrating that post-core splinted crown restoration following orthodontic extrusion can effectively preserve residual roots fractured to the subgingival region and achieve both functional and aesthetic recovery.

Based on a review of relevant literature published between 2004 and 2025 in PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure, together with current guidelines, expert consensus statements, and representative clinical studies, this article proposes a four-domain integrated framework for oral and maxillofacial multispace infection (OMSI) centered on the physiology-inflammation axis. The framework is intended to support risk stratification and pathway-oriented management of severe OMSI by integrating evidence across four domains: Physiological decompensation, infection extent and anatomical involvement, inflammatory response, and host reserve. Risk assessment of severe OMSI should not depend on any single indicator. The proposed physiology-inflammation axis-based framework applies weighted integration of clinical information, in which physiological decompensation and infection extent with anatomical involvement directly determine the urgency of early intervention, whereas inflammatory response and host reserve are used to assess infection activity, treatment response, and the patient's tolerance of infection, anesthesia, surgery, and other interventions. Pathway-oriented management is organized around key time windows: Airway assessment and initial resuscitation at 0 h<t≤1 h, incision and drainage with source control at 1 h<t≤6 h, intensified multisystem monitoring at 6 h<t≤24 h, the first systematic reassessment at 24 h<t≤48 h, and de-escalation, rehabilitation, and follow-up at t>48 h according to the patient's clinical condition. By incorporating risk-factor identification, bedside assessment, risk stratification, and multidisciplinary collaboration into a unified decision-making pathway, the framework may facilitate the early identification of high-risk patients and the organization of structured clinical management. At present, the framework remains exploratory, and the weighting of individual indicators, threshold settings, and boundaries of clinical applicability require further validation and refinement through multicenter prospective studies.