Objective Oxygen-glucose deprivation (OGD) is used to mimic ischemia in vitro to observe whether endoplasmic reticulum (ER) stress is involved in human dental pulp cells (hDPCs) after OGD and to better understand the regulatory mechanism of hDPCs in ischemia. Methods hDPCs were cultured in glucose-free DMEM and hypoxia (volume fraction 2% O₂) to establish an hDPCs OGD model in vitro, which mimics hDPCs ischemia in vitro. hDPCs were divided into a control group (normal culture) and an experimental group (OGD 0 h, 2 h, 4 h and 8 h groups). After pretreatment with OGD for 0, 2, 4 and 8 h, hDPC viability was measured by methylthiazol tetrazolium (MTT) assay. qRT-PCR was used to detect the mRNA expression of ER stress markers [splicing x-box binding protein1 (sXBP1), activating transcription Factor 4 (ATF4) and C/EBP homologous protein (chop)]. Western blot was used to detect the protein expression of ER stress markers [phosphorylated RNA-activated protein kinase-like ER-resident kinase (p-perk) and phosphorylated eukaryotic initiation factor-2α (p-eIF2α)]. Results Compared with OGD 0 h group, cell viability of hDPCs decreased when exposed to OGD treatment for 2 h, 4 h and 8 h. Compared with the control group, mRNA expressions of ER stress makers (sXBP1, ATF4 and chop) and the protein expressions of ER stress protein markers (p-perk andp-eIF2α) increased in OGD treatment cells after 4 h were higher in OGD cells. The differences were statistically significant (P<0.05). Conclusion The results indicate that ER stress response is involved in hDPCs in OGD treatment.

Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.

In recent years, artificial intelligence technology has developed rapidly and has been gradually applied to the fields of clinical image data processing, auxiliary diagnosis and prognosis evaluation. Research has shown that it can simplify doctors’ clinical tasks, quickly provide analysis and processing results, and has high accuracy. In terms of orthodontic diagnosis and treatment, artificial intelligence can assist in the rapid fixation of two-dimensional and three-dimensional cephalometric measurements. In addition, it is also widely used in the efficient processing and analysis of three-dimensional dental molds data, and shows considerable advantages in determining deciding whether orthodontic treatment needs tooth extraction, thus assisting in judging the stage of growth and development, orthodontic prognosis and aesthetic evaluation. Although the application of artificial intelligence technology is limited by the quantity and quality of training data, combining it with orthodontic clinical diagnosis and treatment can provide faster and more effective analysis and diagnosis and support more accurate diagnosis and treatment decisions. This paper reviews the current application of artificial intelligence technology in orthodontic diagnosis and treatment in the hope that orthodontists can rationally treat and use artificial intelligence technology in the clinic, and make artificial intelligence better serve orthodontic clinical diagnosis and treatment, so as to promote the further development of intelligent orthodontic diagnosis and treatment processes.

Temporomandibular joint (TMJ) ankylosis is a joint disorder which refers to bone or fibrous adhesion of the anatomic joint components and the ensuing loss of function. When it occurs in children, it can cause secondary dentofacial deformities with physical and psychological disability. Correction of TMJ ankylosis and secondary deformities remains a great challenge for oral and maxillofacial surgeons. Distraction osteogenesis (DO) has been used for the treatment of TMJ ankylosis and secondary deformities with satisfactory outcomes. An average of 50-60 patients with TMJ ankylosis is referred to our department annually.In this review, we summarized the characteristics of DO and discussed some factors involved in the treatment of TMJ ankylosis with dentofacial deformities.

Objective To summarize the clinical manifestations of IgG4-related diseases in the head and neck, explore treatment methods. Methods The clinical data of 21 patients diagnosed with IgG4-related diseases were retrospectively analyzed. The clinical data and the results of glucocorticoid and immunosuppressive therapy were studied retrospectively. Results All patients had swollen sclerotic masses, and CT showed irregular high-density masses with uniform enhancement in the enlarged glands. Some patients had mucosal thickening and mass-like changes in theoral cavity, nose, sinuses, throat and other tissues, and most of the patients had cervical lymphadenopathy and elevated serum IgG4 levels (≥ 1.35 g/L). Histopathological examination of affected exosine glands and affected mucosa and lymph nodes in all patients showed infiltration of lymphocytes, plasma cells and IgG4⁺ plasma cells. In 21 patients, the mass in the affected glands and mucosa (including head, neck and other tissues) disappeared, and the clinical symptoms were relieved after the application of glucocorticoids. However, with a reduction in glucocorticoids, the mass recurred or even worsened. Conclusion For patients with a single mass in the submandibular gland, parotid gland and other salivary glands, as well as lymph node enlargement, CT is the first choice to identify the nature of gland neoplasms. Combined with pathological examination, related auxiliary examination and peripheral blood examination are also needed to obtain a definitive diagnosis. Glucocorticoid therapy is used to achieve a good prognosis, and long-term follow-up and timely adjustment of medication regimens are required.

Objective To explore the value of an oral squamous cell carcinoma (OSCC) diagnostic model constructed by using principal component analysis (PCA) to analyze a database of differentially expressed genes in OSCC and to provide a reference for clinical diagnosis and treatment. Methods RNA-seq expression data of OSCC and normal control samples were obtained from The Cancer Genome Atlas (TCGA) database, and then, normalized and differentially expressed genes (DEGs) were identified by R software. DEGs were enriched by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to identify their main biological characteristics. 70% of DEGs expression data in RNA-seq were randomly selected as the training set and 30% were selected as the test set. Then, the PCA method was applied to analyze the training set data and extract the principal components (PCs) related to the diagnosis of OSCC in order to construct a PCA model. Then, the receiver operating characteristic (ROC) curves of PCA models in the training set and the test set were respectively drawn, and the area under curve (AUC) was calculated to evaluate the accuracy of the PCA model in the diagnosis of OSCC. Results RNA-seq expression data of OSCC and normal control samples obtained from TCGA database included 330 samples and 32 samples, respectively. Using false discovery rate (FDR) <0.001 and |log2 fold change| (|log2FC|) >4 as the thresholds, a total of 159 downregulated and 248 upregulated DEGs were identified, which were mainly enriched in cellular components such as intermediate fiber and melanosomal membrane, pigment and salivation-related biological processes and mainly involved in salivary secretion and tyrosine metabolism pathways (P.adjust<0.05 and Q<0.05). The DEGs were proposed as tumor markers for OSCC, and PCA analysis of the training set showed that the cumulative ratio of variance of PC1, PC2 and PC3: [including submaxillary gland androgen regulated protein 3B (SMR3B), proline rich 27 (PRR27), histatin 3 (HTN3), statherin (STATH), cystatin D (CST5), BPI fold containing family A member 2 (BPIFA2), proline rich protein Hae Ⅲ subfamily 2 (PRH2), keratin 35(KRT35), histatin 1 (HTN1), amylase alpha 1B (AMY1B)] were 0.873, 0.100 and 0.023, respectively, and the total weight of the three was 0.996. The PCA diagnostic model of OSCC was further constructed by combining the eigenvectors of the above three components. The ROC curves of the training set and test set showed that the AUC values of the PCA model were 0.852 and 0.844, respectively, which were higher than those of other single genes. Conclusion The OSCC diagnostic model based on the expression levels of SMR3B, PRR27, HTN3, STATH, CST5, BPIFA2, PRH2, KRT35, HTN1 and AMY1B constructed with the PCA method and DEGs has a high diagnostic advantage. This study provides a theoretical basis for the early genetic diagnosis of OSCC and the application of the PCA model in clinical diagnosis.

The reconstruction effect of peri-implantitis bone defects depends on their morphological characteristics. This paper reviews the morphological classification and treatment of peri-implantitis bone defects. A literature review shows that the morphological classification of bone defects in peri-implantitis includes morphology classification and clinical classification. At present, the Renvert classification is more commonly used in the clinic and is divided into four-wall bone pockets, three-wall bone pockets, two-wall bone pockets, one-wall bone pocket and dehiscence according to the number of bone walls. This has guiding significance in the treatment plan of peri-implantitis. The treatment of peri-implantitis depends on the severity of peri-implant bone defects. Peri-implantitis with mild bone defects is treated by nonsurgical treatment, peri-implantitis with severe bone defects is recommended to remove the implant, and peri-implantitis with moderate bone defects is further judged according to the shape of the bone defects. Four-wall bone pockets, three-wall bone pockets and dehiscence are mostly treated by bone regenerative surgery. For shallow two-wall bone pockets, one-wall bone pockets and horizontal bone resorption, bone resection is often used. However, most peri-implantitis has a variety of bone defect forms at the same time, which need to be treated with bone regenerative surgery and bone resection surgery.

Tooth loss is accompanied by alveolar bone absorption or defect, resulting in insufficient bone and soft tissue. In addition to restoring the masticatory function of missing teeth, implant treatment should also needs to restore the contour and shape of the dental arch. Guided bone regeneration is a common means of bone increase. Xenogeneic granular bone substitute materials are widely used in the field of clinical bone augmentation due to their advantages of long degradation time and low immunogenicity, but other problems, such as inconvenient operation and low osteogenic activity, remain. Plasmatrix can effectively improve the effect of oral tissue regeneration and reduce the occurrence of postoperative complications, and its application in oral tissue regeneration is gradually increasing. This article first introduces the main application forms of plasmatrix in horizontal bone augmentation (mainly solid plasmatrix membrane and plasmatrix bone block), and reclassifies horizontal bone defects according to commonly used decision-making schemes in clinical bone augmentation, in other words, whether the implant can be placed in the ideal position and whether there is bone dehiscence after implantation. Type Ⅰ defects refers to the situation where the bone at the implant site can allow the insertion of an implant with ideal size, and there is no bone dehiscence around the implant, but the alveolar bone contour is not ideal; type Ⅱ defects refers to the situation that when an ideal size implant is placed at the implant site determined by the future prosthesis position, there will be bones on three sides of the implant, but there is bone dehiscence in the buccal bone wall (the length of bone dehiscence is less than 50% of the implant length); type Ⅲ defects refers to the situation where the bone volume at the implant site is not enough to for the placement of the ideal size implant at the ideal position, and bone grafting is required to restore the bone volume before the implant placement. The application of plasmatrix in different types of bone defects is then described. In type Ⅰ bone defects, the solid plasmatrix membrane is used instead of the collagen membrane; in type Ⅱ bone defects, the bone defect around the implant is filled by plasmatrix bone block and then covered with collagen membrane and solid plasmatrix membrane; and in type Ⅲ bone defects, plasmatrix bone block is used to replace autogenous bone block to fill the defect area, and titanium screws are used for fixation. The defect is then covered with a collagen membrane and a solid plasmatrix membrane. This article aims to provide oral clinicians with a comprehensive understanding of plasmatrix and simplify the guidelines for bone regeneration operations.

Objective To investigate the effect of tension on donor site recovery of modified forearm flaps (closed forearm donor site skin flaps). Methods From October 2018 to April 2021, 12 patients with oral cancer underwent forearm flap repair at Xuzhou Central Hospital. Handgrip strength and wrist motion were recorded before surgery. During the surgical incision at the donor site of the forearm, the triangular full-thickness skin of the donor site was used to close part of the surgical incision, and the other part of the surgical incision was directly closed and sutured. Tension was measured with a tension meter during the surgical incision at the donor site. Patients were followed up after surgery to observe whether there were postoperative complications such as necrosis and poor healing of donor site wounds, as well as forearm grip strength, wrist range of motion and appearance satisfaction. Results Among the 12 patients, there was only one elderly patient with postoperative necrosis near the wrist in the donor site skin, and the average tension of the patient was 0.65 kg; the lesion healed after dressing changes. All of the other patients recovered well without postoperative complications. The mean tension of 12 patients was (0.51 ± 0.05) kg. The preoperative and postoperative grip strength of 12 patients was (23.7 ± 10.3) kg and (22.3 ± 10.7) kg, respectively, and the difference was not statistically significant (t=5.872, P<0.001). The mean range of motion of the wrist was (47.6 ± 8.3)°, (45.8 ± 5.8)°; dorsiflexion (54.6 ± 3.2)°, (53.9 ± 2.3)°; radial deviation (37.0 ± 2.3)°, (36.1 ± 2.2)°; ruler deviation (27.1 ± 1.9)°, (26.4 ± 1.3)°, respectively. The t values were 1.64, 1.636, 2.116 and 1.412, and the P values were 0.129, 0.130, 0.058 and 0.186, respectively. All 12 patients were satisfied with the appearance of the donor site of the forearm. Conclusion When the average tension during suturing is less than 0.5 kg, there is a lower risk of complications at the donor site of the forearm one month after surgery, a lower risk of impaired donor site function, and a greater possibility of patient satisfaction with the appearance of the donor site.

Condylar displacement can lead to temporomandibular joint (TMJ) symptoms and relapse after orthognathic surgery. To minimize condylar displacement, numerous condylar positioning techniques have been applied in clinical practice. To verify the effectiveness of condylar positioning techniques in preventing postoperative TMJ symptoms and relapse, we reviewed the literature related to all types of intraoperative condylar positioning techniques in the past 20 years. According to a literature review, positioning techniques aim to seat the condyles at a preoperative position during surgery and are divided into noncomputer-aided and computer-aided condyle positioning methods. At present, computer-aided design/computer-aided manufacturing condylar positioning devices (CAD/CAM CPDs) are the most superior positioning methods and are composed of teeth-supported and bone-supported guidance. The sequence of the remaining technology positioning effect from high to low is as follows: CAD/CAM titanium plate positioning > manual positioning > computer-aided navigation system > image positioning system. Different techniques reach considerable accuracy within 1-2 mm and 1°-2° in locating the preoperative condylar position and preventing TMJ symptoms or disorders and surgical relapse to provide a clinical reference for different levels of surgeons and cases. However, this study lacks randomized controlled trials with large samples and long-term follow-up. Future studies should upgrade the current methods, improve the clinical utility, and develop new positioning techniques.

Objective To evaluate the therapeutic effect of dental autotransplantation with the application of digital design combined with 3D printing of donor tooth models and recipient alveolar fossa model preoperatively. Methods Twelve cases that could not be retained due to tooth fracture or extensive absorption of alveolar bone were recruited in the study. Cone-beam computed tomography (CBCT) data were imported into Mimics software for digital design, and the best-matched third molar was selected as the donor tooth. Replicas of the donor teeth and the recipient socket were printed out with three-dimensional (3D) printing technologies as a simulation model for recipient tooth socket preparation. During tooth autotransplantation, preparation of the recipient tooth socket and the donor tooth were guided by the 3D-printed replicas sequentially. Then, the donor tooth was implanted into the recipient tooth pocket. Patients were followed up at 3, 6 and 12 months after the operation, with CBCT examination to evaluate the status of bone reconstruction and periodontal ligaments at each time point. Results Twelve patients were transplanted with an autogenous third molar with the apical foramen completely closed. Among them, 7 patients had alveolar fossa infection before the operation, of which 1 had extensive resorption of the alveolar bone due to the infection. All 12 patients recovered well after the operation and were followed up for at least 12 months. In total, 11 caseswere successful in tooth autotransplantation with normal mastication, and 1 case had root resorption 14 months postoperation. Conclusion Digital design combined with 3D printing technology can assistin the selection of thebest-matched donor tooth and preparation of the recipient socket before tooth transplantation proceduresand reduce the extra-alveolar exposure time of the donor tooth and number of trial placementsintothe alveolar fossa. Thus, this combined strategy can effectively improve the outcome of dental autotransplantation.

Root fracture is a kind of dental trauma involving dentin, cementum, pulp tissue, periodontal membrane ligament and even the surrounding alveolar bone. It occurs frequently between the ages of 10-20, mostly in the area of the maxillary anterior teeth with high aesthetic requirements. The treatment goal for root fracture in permanent teeth is to maintain the physiological and functional integrity of the tooth as much as possible and to reduce the incidence of complications. Clinicians usually classify the affected teeth according to the position of the root fracture, including the apical, mid-root, cervical-mid-root and cervical segments, since it determines the treatment plan and the prognosis of the affected teeth. CBCT examination can avoid misdiagnosis and missed diagnosis of root fracture to the greatest extent. The sequential treatment plan of root fracture after permanent anterior tooth trauma includes initial emergency treatment, pulp vitality monitoring and complication management during follow-up. Emergency treatment mainly includes local anesthesia and repositioning, if displaced, the coronal segment of the tooth as soon as possible. Then, after checking its position radiographically, adjustment occlusion and flexible splinting for 4 weeks (4 months for cervical root fracture). The process of root fracture repair includes many tissues and is affected by many clinical factors. Timely and standardized treatment and close follow-up according to the Dental Trauma Guideline guarantee a good prognosis of root fracture. The closer the root fracture line is to the apex, the higher the survival rate is. In addition to the location of the root fracture line, the prognosis is affected by many other clinical factors, such as the displacement of the coronal fragment of the root fracture, the pathological state of the dental pulp, patient age, developmental stage of the root, timely and good replacement of the root fracture, splinting method, and the presence of other dental trauma complications. Pulp vitality should be monitored regularly, and root canal therapy of the coronal segment should be carried out only when infection of the pulp is established. This article reviews the classification, diagnosis, emergency treatment, sequential follow-up treatment, and prognostic assessment of root fracture trauma to provide suggestions for clinicians to manage root fracture trauma in permanent teeth.

Objective To explore whether RhoA plays a role in the migration and invasion of the salivary adenoid cystic carcinoma cell lines SACC-LM and SACC-83. Methods Total RNA and total protein were extracted from 20 salivary adenoid cystic carcinoma (SACC) and normal adjacent tissues frozen in liquid nitrogen to detect RhoA expression. RhoA-siRNA was constructed to transfect two cell lines (SACC-LM and SACC-83) for cytological experiments. The research included an experimental group (RhoA-siRNA transfection), negative control group (siRNA-NC transfection) and blank group by transient transfection with liposomes. Expression of RhoA mRNA and protein as well as the protein expression of biomarkers of epithelial-mesenchymal transition (EMT) were analyzed, including E-cadherin, N-cadherin, and Vimentin. Furthermore, the changes in invasion and migration of cells in each group were analyzed by comparing the number of transmembrane cells in the Transwell assay and the results of the scratch test. Results Compared with normal adjacent tissues, RhoA protein and mRNA levels increased in SACC tissues. Compared with the control group, the relative expression levels of RhoA mRNA and protein decreased (P < 0.01), the relative expression levels of E-cadherin protein increased, and the relative expression levels of N-cadherin and vimentin protein increased in the experimental group (P < 0.01). Additionally, the trial results revealed that RhoA knockdown restrained cell migration and invasion (P < 0.01). Conclusion RhoA expression increased in SACC tissue. Silencing RhoA in vitro could effectively restrain cell migration and invasion in SACC-LM and SACC-83 cells through the regulation of EMT signaling pathways.

Salivary exosomes are extracellular vesicles with a diameter of 30-50 nm in saliva. With the development of technology in recent years, many studies have revealed that salivary exosomes play an important role in the occurrence and development of various oral diseases. For example, salivary exosomal CD9 and CD81 promote tumor cell metastasis by regulating the cell adhesion and movement, salivary exosomal miR-24-3p promotes the tumor cell proliferation by acting on PER1, and salivary exosomal programmed cell death-ligand 1 (PD-L1) mRNA inhibits the destruction of inflammatory tissue, which can be biomarkers for the diagnosis of oral cancer, periodontitis and other oral diseases. Therefore, salivary exosomes can be used as potential prognostic and diagnostic markers for oral diseases. In addition to oral diseases, such as oral cancer, periodontitis, oral lichen planus, Sjogren’s syndrome, etc., salivary exosomes are closely related to distant tumors, such as pancreatic cancer, lung cancer, and systemic diseases, such as Parkinson’s disease, inflammatory bowel disease, etc. It is of great significance to study the role of salivary exosomes in the diagnosis and treatment of oral and systemic diseases and to develop the potential of salivary exosomes as biomarkers for disease diagnosis.

Excellent mechanical properties and biocompatibility resulted in titanium and titanium alloys being widely used in the medical field. However, the biological activity of atitanium surface will gradually fade with increasing exposure time, which affects its final osseointegration. As an effective surface modification method, ultraviolet (UV) photofunctionalization does not change the surface morphology of implants and is a suitable surface treatment for many brands of implants. This article summarizes the research progress on the effect of UV photofunctionalization technology on the characteristics of titanium surfaces, biological activity and implant osseointegration, as well as its current clinical applications. Studies have shown that the superhydrophilicity of the titanium surface and improved biological activity endowed by UV photofunctionalization can accelerate and enhance bone formation, resulting in a higher success rate of implant surgery. Therefore, UV photofunctionalization has great potential for clinical chairside applications.

Objective To investigate the effect of elective neck dissection on the 5-year survival rate of patients with early oral squamous cell carcinoma. Methods The data of 100 patients with early oral squamous cell carcinoma (cT1-2N0M0) were retrospectively analyzed. In 61 cases, the primary tumor was subjected to elective neck dissection (END). Neck observation and follow-up (NOF) were performed in 39 cases with enlarged resection of primary lesions. Clinicopathological data such as pT staging, pathology classification,the rate of cervical lymph node metastasis and the 5-year survival rate of the patients were statistically analyzed. Results The 5-year survival rates of the END and NOF groups were 86.9% and 69.2%, respectively, and the difference was statistically significant (P=0.028). END treatment was significantly better than NOF in controlling cervical lymph node metastasis in early oral squamous cell carcinoma (P=0.009). After stratified analysis of histopathological features, the 5-year survival rate of patients with pathological T2 (pT2) stage OSCC in the END group was significantly higher than that in the NOF group (P=0.020). The 5-year survival rate of patients with moderate and poorly differentiated pathological grade OSCC in the END group was significantly higher than that in the NOF group (P=0.013). Conclusion END is effective for the management of the cervical lymph node metastasis rate in early OSCC patients. For patients with pT2 stage or low differentiation pathological grade, active END can significantly improve the 5-year survival rate.

Objective To analyze the adverse drug reaction（ADR） reports of hydroxychloroquine for clinical medication safety. Methods The ADR reports of hydroxychloroquine between May 2019 and May 2021 were analyzed. Age, reasons for drug use, time of ADR, combined drug use, and ADR outcomes were statistically analyzed. Results No severe ADR was reported. Patients over 60 years old accounted for 53.85% of the total cases, and the time of ADR appearance was significantly earlier among those under 60 years old. A total of 61.54% of ADRs were involved in multiple organs, and optic neurotoxicity was reported in 46.15% of cases. Conclusion In the treatment of oral lichen planus with hydroxychloroquine, adverse drug reactions should be monitored, and increased attention should be given to patients over 60 years old to ensure the safety of this medication.

Objective To investigate the clinical efficacy of Nd: YAG laser combined with 3% acyclovir cream in the treatment of herpes labialis. Methods A total of 72 patients with herpes labialis were enrolled. According to the random number table method, the patients were divided into an observation group and a control group with 36 patients in the observation group and 36 patients in the control group. The Nd: YAG laser combined with 3% acyclovir cream was administered to the observation group, while 3% acyclovir cream was administered to the control group. The total effective rate, scab, scab removal, analgesic time, and quality of life were compared between the two groups. Results 7 days after treatment, the total effective rate of clinical treatment in the control group was 27 patients (75%), and that in the observation group was 34 patients (94.4%); the contrast difference was statistically significant (P < 0.05). Compared with those in the control group, the crusting, prolapse and analgesic time of the observation group were shorter, and the differences were statistically significant (P < 0.05). Compared with the control group, the observation group had higher quality of life scores, and there was a statistical significance (P < 0.05). Conclusion For patients with herpes labialis, using Nd: YAG laser combined with 3% acyclovir cream treatment can significantly improve the quality of life of patients and accelerate the speed of patient rehabilitation.

Objective To explore the effects of red LEDs on the proliferation and osteogenic differentiation of human stem cells from apical papilla (hSCAPs). Methods hSCAPs were obtained by isolation, culture and flow cytometry in vitro and irradiated with 1, 3, 5, and 7 J/cm² red LEDs. The proliferation of hSCAPs was detected using a CCK-8 assay. The osteogenic differentiation of hSCAPs was evaluated using alkaline phosphatase (ALP) staining, ALP activity assay and Alizarin red quantitative detection. The effect of 5 J/cm² red LEDs on the expression levels of the ALP, Runx2, OCN, OPN and BSP genes and proteins was detected by RT-PCR and western blot, respectively. Results Red LEDs at 1, 3, 5, and 7 J/cm² promoted the proliferation of hSCAPs (P < 0.05). The effects of red LEDs with different light energies on the proliferation of hSCAPs were different at different time points (P < 0.05). On the 7th and 14th days after irradiation, red LEDs promoted the osteogenic differentiation of hSCAPs, and the effect of 5 J/cm² red LEDs was the most obvious under osteogenic induction culture conditions (P<0.05). Red LEDs (5 J/cm²) promoted the expression of the ALP, Runx2, OCN, OPN and BSP genes and proteins (P < 0.05). Conclusion Red LEDs promoted the proliferation and osteogenic differentiation of hSCAPs.

With the improvement of computer computing capability and the accumulation of a large amount of medical data, artificial intelligence is gradually being applied in the diagnosis of oral and maxillofacial tumors. Artificial intelligence technology can assist doctors in clinical diagnosis and improve the efficiency of clinical work and the accuracy of diagnosis. In recent years, researchers have focused primarily on the recognition of medical images. The commonly used method is to annotate a large number of images by experts for learning image features by machines. The available literature has been able to utilize artificial intelligence technology to diagnose tumors by analyzing medical images, pathological sections, and tumor photos. The main issues in the current research are uneven labeling data quality, small data size, limited research problems, and single data modalities. These problems need to be solved through the continuous improvement of algorithms and the accumulation of high-quality data. The future direction of artificial intelligence applications should be to integrate medical data from multiple sources, assist doctors in diagnosis, and explore a variety of noninvasive and easy-to-use new methods for the early diagnosis of tumors. This may completely change the existing diagnosis and treatment model of oral and maxillofacial tumors.

Objective To explore the influence of impacted maxillary central incisor on craniofacial structure and its orthodontic treatment. Methods A total of 63 subjects with impacted upper central incisors were selected and categorized into the mixed (n=32) and permanent dentition group (n=31). By using the lateral cephalograms of each subject, 15 angular and 6 linear measurements were made. The cephalometric data were analyzed and compared to data of its corresponding control group with normal occlusion. Results Among the etiological factors of all 63 cases with impacted upper incisors, supernumerary teeth, dentigerous cyst or odontoma, mechanical trauma and idiopathic factors comprise of 6.3%, 6.3%, 12.4% and 73% respectively. Cephalometric analysis demonstrated a more retruded position of "A" point with decreased SNA and ANB angle in incisor impaction group. Dental compensations followed the decreased ANB angle with more proclined upper incisor and more upright lower incisor. In early stage of root development (stage 7 and 8 of Nolla's method), 12 out of 13 incisors were tracted successfully, whereas in late stage( stage 9 and 10), 7 out of 15 incisors were extracted. Conlusions Upper central incisor impaction adversely influences maxillary development. Early orthodontic treatment can improve successful rate and gain a better root morphology.

TNM（tumor node metastasis）classification is a common way to evaluate the prognosis of patients with oral cancer; however, many years of application have proven this method to be confined merely in clinical and pathological data and it cannot be adapted to the development of modern medicine. Deep learning (DL) has been widely used in various aspects of human life, has advantages for conducting efficient and intelligent searches and can explore and analyze substantial medical information well. Additionally, the application of DL to medical practice is quickly increasing. In the field of oral cancer prognosis, DL can efficiently process and analyze the pathological, radiographic and molecular data of oral cancer patients represented by lymphocytes, gray level cooccurrence matrix (GLCM) and gene maps and make accurate prognostic judgments accordingly. By assisting physicians in optimizing treatment plans, DL can effectively improve patients’ survival. Although DL lacks sufficient data and practical clinical application in prognostic studies, it has shown good clinical application prospects.

Objective To evaluate the clinical effect of endoscopic-assisted subgingival scaling and root planning (SRP) in the treatment of periodontitis. Methods PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched for randomized controlled trials (RCTs) related to endoscopy-assisted SRP. The search time limit was from the establishment of the database to September 15, 2021. The outcome indicators included in the study included the plaque index (PLI), probing depth (PD), attachment loss (AL), and bleeding index (BI). Review Manager 5.4 and Stata 12.0 software were used for the meta-analysis. Results A total of 111 studies were retrieved, and 5 quantitative studies were included after screening. Meta-analysis showed that for sites with 4 mm ≤ PD < 6 mm, 3 and 6 months after treatment, there was no significant difference in the PD value between the endoscope assisted group and the simple SRP group (P > 0.05); for sites with PD ≥ 6 mm, the PD value of the endoscope assisted group was smaller than that of the simple SRP group 3 and 6 months after treatment. The difference between the two groups was statistically significant (P < 0.05), but there was no significant difference in PLI, Al or BI between the two groups (P > 0.05). Conclusion Compared with simple SRP, the auxiliary use of endoscopy has a better effect on reducing PD in deep periodontal pockets (PD ≥ 6 mm). However, for clinical indicators such as PLI, AL, and BI, there was no difference between the therapeutic effects of the two methods.

Tongue squamous cell carcinoma (TSCC) is the most common oral cancer, with early lymph node metastasis and poor prognosis. Surgery is the primary treatment based on sequential therapy for TSCC. The treatment of TSCC has evolved gradually in the past few years and has exhibited a trend of standardization and personalization. Several aspects of TSCC treatment are discussed in this article, such as surgery, radiotherapy, chemotherapy, biotherapy, functional rehabilitation, psychological rehabilitative treatment, prognosis and follow-up systems. This article comments on the types of treatments and research progress for TSCC in China and abroad with the aim of providing a better understanding and references for clinical treatment.

As a new type of antibacterial material, copper-containing titanium alloys have good biological and mechanical properties and are expected to be widely used in clinical orthopedics and dental implants. Macrophages are the main cells that mediate the immune response after the alloy is implanted into the human body, and they directly affect the stability of the alloy in long-term service. Due to the addition of copper, the copper-containing titanium alloy gives the alloy antibacterial properties. On the one hand, this promotes the phagocytosis of macrophages and kills bacteria. On the other hand, copper promotes the polarization activation of macrophages, which then express a variety of cytokines and trigger inflammation in the body. However, at present, there is no definitive conclusion about the type of copper-containing titanium alloys that regulate the polarization of macrophages, and the mechanism of copper ions regulating the polarization of macrophages is still not fully clear. This article summarizes the published studies on the regulation of macrophage polarization by copper-containing titanium alloys and reviews the relevant literature in terms of material types, surface treatments, processing methods, cell culture methods, and culture density. The application of medical copper-containing titanium alloys has prospects. It is hoped that by changing the properties of copper-containing titanium alloys, such as the processing methods or surface treatments, the polarization direction of macrophages can be adjusted, with a view to the design and clinical application of medical copper-containing titanium alloys.

Optical illusion refers to the phenomenon in which the scene observed by the human eye is not completely consistent with the objectively presented scene. Optical illusions in stomatology, as well as their clinical application, are demonstrated in this paper in terms of shade, shape and aesthetic design. Shade is not only affected by the optical illusions with which it is associated, such as color metamerism, color constancy and the Chevreul illusion, but also influenced by the surroundings. It is suggested that the surrounding lighting during veneering should be the same as that during color matching in the clinic. As indicated by the Poggendorf illusion and the Leaning Tower illusion, the practice should be conducted and checked from multiple perspectives to compensate for the limitation of human eyes, such as intraoral scanning. Other digital technologies, including digital facial scanning and cephalometric measurement, could be used to reduce the subjective influence of observation. In terms of esthetic design, the interaction of the part and the whole, suggested by Ebbinghaus illusion, should be considered: an individual harmony smile should be designed considering the characteristics of the personality and the features of the face, lips, teeth and gingiva of the patient. Furthermore, personal information, such as gender and age, should be taken into consideration in beautification presentation. Further research should be focused on the influence of optical illusions in stomatology in more details. More communication among doctors, technicians and patients is needed. Clinicians should be aware of the impact of optical illusions to reduce subjective bias in clinical standardized operations and further take advantage of optical illusions to create beautification presentations of dental restorations and smiles.

Objective To investigate the mechanisms by which D-methionine (D-Met) eradicates Porphyromonas gingivalis biofilms by suppressing cyclic dimeric GMP (c-di-GMP) levels. Methods Cell viability, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured to determine the effective concentrations of D-Met, which were subsequently used in the following experiments. During the P. gingivalis biofilm formation inhibition experiment and the mature biofilm disassembly experiment, biofilm biomass, exopolysaccharide (EPS), biofilm morphology, integrity of the cell membrane, and the level of c-di-GMP were determined. Results D-Met < 40 mmol/L was biocompatible. During the biofilm formation inhibition and mature biofilm disassembly experiments, D-Met ≥ 20 mmol/L decreased the biofilm biomass and the production of EPS. SEM analysis showed that the extracellular matrix and bacterial density were drastically reduced by D-Met ≥ 20 mmol/L. TEM detection showed that 35 mmol/L D-Met ruptured the cell membrane during biofilm formation and increased the permeability of the cell membrane in the disassembly phase of mature biofilms. C-di-GMP levels decreased with increasing concentrations of D-Met in a concentration-dependent manner. Conclusion D-Met ≥ 20 mmol/L could eradicate P. gingivalis biofilms by suppressing c-di-GMP levels.

Objective To evaluate the caries preventive effect and economic outcome of an oral health promotion model in rural primary schools in Guangxi Zhuang Autonomous Region. Methods In November 2015, a baseline survey was conducted on the caries prevalence of rural first graders in program areas, and then a program intervention was carried out on the first graders of target primary schools. The intervention methods included the distribution of oral health care products, oral health education, teacher training, etc. In 2020, the method of cluster random sampling was adopted to include the sixth graders who received the program intervention as first graders and were still available in 2020 as the intervention group. During this period, the sixth graders transferred from foreign schools who failed to receive the program intervention as first graders were included in the non-intervention group. The caries preventive effect was evaluated by analyzing the caries epidemiological data of 2 652 children aged 11-13 years, comparing the intervention and non-intervention group. The cost of the program was estimated by the structural analysis method. A decision tree model was established by TreeAge pro2019 and incorporated into the effect parameters and cost parameters for cost-effectiveness analysis and sensitivity analysis. Results The prevalence of caries in the intervention group was 54.8%, and the mean DMFT was 1.36 ± 1.64, both of which were lower than those in the non-intervention group. The difference in prevalence and mean DMFT between the two groups was statistically significant (P < 0.05). It costs CNY 319.83 per child to reduce suffering from caries. The number of patients with caries in the intervention group was the most sensitive indicator of an economic effect. The probability of a cost-effectiveness advantage for the program was 92.2%. Conclusion This oral health promotion model used in rural schools demonstrated a caries preventive effect that was very likely economically advantageous. It is of practical significance to improve and promote this model in the Guangxi Zhuang Autonomous Region.

Objective To determine the clinical problems and outcome indicators that need to be included in the expert consensus of 5-aminolevulinic acid (ALA) photodynamic therapy in the treatment of oral potential malignant diseases. Methods Based on the relevant literature, the clinical problems and outcome indicators were drafted during the meeting. The Delphi method was used for expert consultation and expert opinion collection. The average and standard deviation of the voting results were calculated to determine the importance of the indicators, and the positive coefficient, variation coefficient and coordination coefficient were calculated for quality control. Results In the first round of the Delphi method, 12 outcome indicators (the main reference elements include photon integral flux, power density, illumination time, and spot diameter were identified; the specific parameters are photon integral flux of 100 J/cm² and power density of 100-600 mW/cm². A diode laser of (630 ± 5) nm wavelength should be chosen. The analgesic regimen is local anesthesia supplemented by hypothermia and intermittent laser irradiation before treatment. Lesions with hyperkeratotic require pretreatment. The concentration of ALA administered was set at 20%. Eight clinical problems (main reference elements of photodynamic irradiation dose, specific parameters, choice of light source, evaluation criteria of efficacy, prevention of adverse effects, dosing concentration, whether oral potentially malignant diseases with hyperkeratosis should be pretreated, administration of photosensitizers) were included according to the literature and expert discussion. In the second round, 89 experts completed the questionnaire and gave very important evaluations of 9 outcome indicators (the main reference elements included photon integral flux, power density and illumination time; the specific parameters were a photon integral flux of 100 J/cm ² and a power density of 100-600 mW/cm²). A diode laser of (630 ± 5)nm wavelength should be chosen. The concentration of ALA administered was set at 20%. Six clinical problems (main reference elements of photodynamic irradiation dose, specific parameters, choice of light source, evaluation criteria of efficacy, dosing concentration, administration of photosensitizers), and the remaining 3 were given important evaluations, with good consistency. Conclusion In this study, the irradiation dose, mode of administration and concentration, evaluation criteria of efficacy, prevention of adverse effects and pretreatment regimen of ALA photodynamic therapy for oral potentially malignant diseases determined by the Delphi method had good agreement among experts.

Plaque pH detection technology can detect the risk of caries and assist in the prevention of caries, with a mature theory and a relatively simple operation. With the increasing demand for clinical caries risk detection technology and the rapid development of microelectrode techniques, there is an increasing variety of types of microelectrodes that can detect the pH of dental plaque, including glass microelectrodes, metal oxide microelectrodes and ion-sensitive field effect transistors. The glass microelectrode was the first microelectrode to be applied in this field, but its structure is weak. Among the various options, the iridium oxide microelectrode has become the most promising caries risk detection electrode in recent years because of its high strength and excellent response. Metal oxide microelectrodes can also effectively compensate for the insufficient strength of glass microelectrodes. With advances in electrode technology, miniaturized, sensitive ion-sensitive field effect transistors have attracted the attention of researchers. Scientists have also recently developed a way to detect the pH of dental plaque with an optical no-contact technique. Optical contactless detection technology will not damage the dental plaque structure, so it has great research and clinical prospects. Future research will further improve the strength and performance of these electrodes on the premise of ensuring miniaturization and achieving noncontact detection.

All-ceramic restorations are widely used in oral restoration because of their beauty and high strength. Glass ceramics and zirconia all-ceramic materials are the two most widely used all-ceramic materials in the clinic. However, when all-ceramic restorations need to be removed due to marginal microleakage and secondary caries, its high strength and high bonding strength greatly increase the difficulty of removal. In recent years, clinicians have tried to use Er: YAG lasers to remove all-ceramic restorations. The Er: YAG laser can be safely and efficiently applied to the removal of glass restorations, and it can also play a role in thinner zirconia restorations. Various factors, such as the material and thickness of the all-ceramic restoration, the type of cement, and the laser power, can affect the speed of removal of the Er: YAG laser. However, the current research is limited to case reports and in vitro studies, lacking systematic clinical research. The specific mechanism of Er: YAG laser removal of all-ceramic restorations and the influence of laser frequency, adhesive type, and abutment on the removal speed need to be further demonstrated by follow-up research.

The endocrown, a modified overlay or crown, is considered to have the advantages of adhesive retention and mechanical retention. Marginal adaptation and mechanical strength are common criteria for evaluating endocrowns. This review studied these aspects of endocrowns to guide further clinical application. Results from previous academic studies indicate that endocrowns made of different materials, such as glass-based ceramics, zirconia-based ceramics and resin-based ceramics, exhibit clinically acceptable marginal adaptation. Zirconia is a common dental material, but when used in endocrowns, it tends to present a risk of irreparable tooth root fractures. Compared with products manufactured with zirconia, endocrowns manufactured with resin-based ceramics and glass-based ceramics, such as lithium disilicate ceramics, do not tend to cause irreparable results, such as tooth root fracture, but their mechanical strengths are not as good as those of zirconia. At the same time, the tooth prepration design such as the types of endocrowns, the pulp chamber extension depth and angles, the endocrown thickness can influence the mechanical strength of endocrowns as well. Compared with traditional zirconia, self-glazed zirconia, a new type of material used to restore defective teeth, has the similar elasticity modulus（210 GPa）and better aesthetic advantages, and is suitable for short crown patients with insufficient occlusal space. Further study is warranted to improve the performance of endocrowns made from ceramic materials to prevent root fracture.

Objective To explore the application effect of a four-dimensional smile design as the leading and facial streamline as the reference system in the aesthetic restoration of anterior teeth. Methods A case of scattered space in anterior teeth was treated with a four-dimensional smile design and digital aesthetic restoration with ultrathin porcelain veneer. The digital information of the patients was obtained through oral and facial scanning, and a four-dimensional smile design and prediction were carried out. After the treatment plan was jointly determined by doctors and patients, minimally invasive abutment preparation was carried out, and ultrathin porcelain veneer was made and bonded in place. After the operation, the esthetic degree and marginal fit were observed and reexamined one year after the repair. Results The edges of the ultrathin ceramic veneers were naturally tight, and the color was coordinated, with satisfying pink and white esthetics. The face was more harmonious and natural when smiling. One year after the restoration, the facial aesthetics were wonderful, the abutment teeth and periodontal tissues were healthy, and the patients were satisfied. The results of the literature review showed that the fitting of temporal facial scanning and intraoral scanning data can accurately predict four-dimensional smile aesthetics, simulate the real state of the dynamic smile and pronunciation process, and combine it with facial streamlines to design a natural and coordinated personalized smile for patients with asymmetric faces. However, for patients with occlusal changes, unstable occlusion or temporomandibular joint disorder, it is necessary to add data fitting, such as electronic facial arch and cone beam CT, to more accurately simulate postoperative mandibular movement. Conclusion With a four-dimensional smile design as the leading and facial streamline as the reference system, the whole process digital design assisted the restoration of asymmetric anterior teeth with ultrathin porcelain veneer and had a good effect. The postoperative smiling of patients is harmonious and beautiful, which is in line with the expected effect. Patient participation and satisfaction are high; thus, this method is worthy of clinical promotion.

Objective To observe the clinical effect of Er:YAG laser for pulpotomy in young permanent incisors.Methods 40 young permanent incisors with xeposed pulp were divided into 2 groups respectively. Teeth in laser group were treated with mineral trioxide aggregate combined with Er:YAG laser for pulpotomy with teeth in control group were treated with mineral trioxide aggregate (MTA) pulpotomy only. Patients were scheduled for follow-up after 1, 3, 6, 12 months to undergo clinical and radiographic examination.Results 18 of the treated teeth in control group and 19 of the treated teeth in laser group showed no clinical or radiographic signs of failure during the follow-up period. There was no significant difference between the two groups.Conclusion Pulpotomy with Er:YAG laser and direct capping with MTA was a successful and effective treatment for pulp exposure in young permanent incisors.

Objective To explore the design and manufacture of anatomical healing abutment for mandibular first molar implant in order to provide more choices for clinical healing abutment.Methods The buccal lingual diameter and mesial distal diameter of the tooth neck, as well as the slope data of the four axial surfaces of the natural isolated teeth, were obtained by scanning the isolated mandibular first molar with a shining scanner. After statistical analysis of the data, the anatomical healing abutment of the mandibular first molar was designed and constructed using computer aided design/computer aided manufacturing (CAD/CAM).Results The mean buccal and lingual diameters of the mesial and distal diameters of the isolated mandibular first molars were (8.54 ± 0.78) mm and (7.87 ± 0.86) mm, and the tooth neck slopes of each axial surface of the isolated mandibular first molars were 17.53 °(buccal), 14.41 °(lingal), 13.40 °(mesial) and 13.43 °(distal), respectively. Three anatomical healing abutments with different peripheral diameters and heights of 5 mm were obtained according to a certain proportion of reduction of the natural teeth of the mandibular first molars.Conclusion The anatomical healing abutment of the mandibular first molar can be quickly obtained by Shining scanning and CAD/CAM technology.

Corona Virus Disease 2019 (COVID-19) has broke out in 29 countries and regions in the world in a short period since December 2019. Various measures of prevention and control have been taken all over China. At present, the epidemic situation shows a positive trend, however, there are still a few new comfirmed cases in some area of China. So the job and thinking of epidemic prevention still cannot be relaxed. As an important specialty of stomatology, the risk of cross infection is high in oral medicine. Establishing an effective system of pre-inspection and triage and adopting strict measures of prevention and control are essential. According to the prevention and control situation of COVID-19, the characteristics of hospital infection, pre examination, protective measures, the home management strategies of oral mucosal diseases during the epidemic period and the differential diagnosis between COVID-19 and common oral mucosal diseases with fever were summarized and recommended in this paper.

Objective To compare the clinical effect of the tunnel technique (TUN) and vestibular incision subperiosteal tunnel access (VISTA) combining connective tissue grafts (CTGs) on recovering the exposed root surface in a case of gingival recession over the upper anterior teeth and then to provide clinical evidence for gingival recession treatment. Methods A case of gingival recession (Miller I type) over teeth 13-14 and 22-23 was treated using different techniques bilaterally. 22-23 were treated by a TUN combined CTG transplantation,while teeth 13-14 were treated by a VISTA technique combined with CTG transplantation. The gingival retraction height (GRH), gingival retraction width (GRW), keratinized gingival width (KW), root coverage aesthetic score (RES) and visual analog scale (VAS) were measured after operation. Results The effect of post-operation were ideal and complete ginglval recovering were achieved, the postoperative effects of the two methods were stable, GRH and GRW decreased, and KW increased. RES was 10. The VAS score of VISTA combined with CTG transplantation was 6, which was higher than that of TUN+CTG. Conclusion Gingival recession can be treated by TUN+CTG or VISTA+CTG with ideal prognosis. VISTA with an additional incision facilitates the operative procedure but leads to less comfort.

Skeletal angle class Ⅲ malocclusion with mandibular deviation involves the rotation and translation of the cranial base, maxilla, mandible, and soft tissue. It compromises the patients’ appearance and stomatognathic function. The treatment outcome is not satisfactory, and correct evaluation is of great significance. The causal relationship between skeletal Class Ⅲ with mandibular deviation and TMD remains controversial. This review focuses on the structural alterations of hard and soft tissue, the etiology, the choice of treatment methods, and the association with TMD in patients with skeletal class Ⅲ malocclusion with mandibular deviation. The results show that mandibular deviation is a complex disease with unclear etiology. It involves morphological changes, rotation and displacement of the cranial base, maxilla and mandible, morphological changes of the soft tissue, and occlusal changes, which also compromise the temporomandibular joint and mandibular function. Skeletal Class Ⅲ malocclusion is common in patients with mandibular deviation. Early treatment is needed; however, the treatment methods vary. The correct evaluation of the morphological changes of soft and hard tissues leading to facial asymmetry is the premise of treatment. Orthodontic and orthognathic treatment (combined with soft tissue repair when necessary) is an effective method for the treatment of skeletal class Ⅲ malocclusion with mandibular deviation. In addition, there is a close relationship between mandibular deviation and TMD, which needs to be fully considered in the design of treatment.

Universal adhesives have been widely used in dentistry due to their easy application process and wide range of applications. In the literature, the etching modes of universal adhesives, coating methods of universal adhesives, pretreatment of adhesive, and other factors were reported to have an impact on the bonding performance of universal adhesives. This review focused on the factors affecting the bonding performance of universal adhesives and aimed to provide evidence-based recommendations for clinical practice. Current research suggests that the etch-and-rinse mode can achieve a better adhesive strength of enamel and that the etch-and-rinse mode and the self-etch mode exhibit a similar adhesive performance in bonding dentin. The bond strength would be improved by prolonging the application time, applying a double layer of adhesives, and wetting enamel and dentin with water or ethanol before adhesive procedures. Chlorohexidine (0.2%) and metal nanoparticles can inhibit matrix metalloproteinases (MMPs) and improve the long-term bond strength of dentin. Finally, universal adhesives have excellent stability and saliva pollution resistance, although they lack blood pollution resistance. In the clinic, dentists should pay attention to the etching modes of universal adhesives, coating methods of universal adhesives, pretreatment of adhesive, and other factors that may affect the effect strength. universal adhesives will be improved in bonding strength of enamel in self-etch mode and bonding performance in demineralized dentals around caries.