Background: s/Aims: The critical view of safety (CVS) prevents bile duct injury, but severe inflammation hinders its achievement.This study evaluated the parkland grading scale (PGS) as a real-time intraoperative predictor of CVS attainment in a Southeast Asian population, establishing standardized clinical data for future artificial intelligence applications. Methods: This prospective observational study (January–June 2025) included 88 consecutive patients undergoing laparoscopic cholecystectomy by a single surgeon. PGS was assessed upon initial laparoscopic inspection. We analyzed correlations between PGS, CVS attainment (Strasberg’s criteria), operative time, and bail-out procedures using Spearman’s correlation and multivariate logistic regression. Results: Severe inflammation (PGS grade 4–5) was observed in 31.8% of patients. PGS exhibited a strong negative correlation with CVS score (p = −0.652; p < 0.001) and strong positive correlations with operative time and blood loss. A PGS threshold of 4 accurately predicted CVS failure (area under the curve = 0.863). Bail-out procedures were necessary in 11 cases (12.5%), all occurring in the PGS ≥ 4 group. Advanced age and diabetes mellitus were independent risk factors for CVS failure. Conclusions The PGS serves as a precise intraoperative early warning system. A score ≥ 4 indicates a significant risk of CVS failure, prompting safer bail-out strategies. Additionally, this study provides a standardized dataset vital for training future autonomous surgical risk assessment models.

Human breast milk (HBM) is an ideal nutritional source for the growth and development of infants. In addition, HBM contains hormones, growth factors, microRNAs and exosomes that perform various physiological functions. This study investigates the immunomodulatory effects of HBM-derived exosomes on myeloid cells and chondrocytes, and implications for juvenile idiopathic arthritis. HBM-derived exosomes were isolated and characterized using nanoparticle track analyzer and Western blotting. The HBM-derived exosomes treatment decreased the expression of inflammatory mediators and proinflammatory cytokines in mouse peritoneal macrophages upon lipopolysaccharide stimulation. Flow cytometry analysis of bone marrow-derived macrophages indicated that exosomes promoted M2 polarization, as evidenced by a decrease in cells expressing CD80 (M1 marker) and a concurrent increase in cells expressing M2 marker CD206. In addition, exosome treatment attenuated the mitogen-activated protein kinase signaling pathway by reducing the phosphorylation of extracellular signal-regulated kinase, c-Jun N-terminal kinase, p38 mitogen-activated protein kinase, and IκB-α, thereby reducing the expression of inducible nitric oxide synthase, cyclooxygenase-2, metalloprotease (MMP)-1, MMP-3, and MMP-13 in SW1353 chondrocytes following IL-1β stimulation. These findings suggest that HBM-derived exosomes promote macrophage polarization toward an anti-inflammatory M2 phenotype and exert significant immunomodulatory effects.

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Purpose: The Korean Oral Biobank Network (KOBN) collects, stores, and provides oral samples for research. Quality control (QC) of biospecimens is necessary to ensure that they meet the basic prerequisites before being sent to researchers. This study presents the standard operating procedures (SOPs) for the QC of biospecimens. Methods: QC methods using molecular genetic techniques according to sample types, including teeth, blood, oral soft tissue, oral tissue-derived cells, saliva, mouth rinse solution, dental plaque, and gingival crevicular fluid, are described in detail. Results: The KOBN established SOP for oral biospecimen QC and assessment methods. Conclusions To ensure a stable supply of high-quality biospecimens for researchers, regular QC checks should be carried out according to the SOP following the specifications of the Korea Biobank Network under the Korea Disease Control and Prevention Agency.

Purpose: Root coverage (RC) procedures require long-term evaluation. This study assessed the clinical validity and long-term stability of a modified tunneling technique for lower anterior gingival recession (GR) using a subepithelial connective tissue graft (SCTG) and a volume-stable collagen matrix. Methods: Across 39 patients, 66 mandibular incisors with ≥1.0 mm of GR were examined before and after RC surgery. Clinical photographs documenting the results of RC were taken at baseline (T0 ) and the most recent follow-up visit (T l ). Impressions were obtained either at baseline (T0 ) or 3 weeks later (T 3 ). The recession depth, Miller classification, and rates of RC and complete root coverage (CRC) were assessed. Results: This study analyzed 66 GR sites across 39 patients, with an average follow-up period of 41.3 months. Overall, the mean RC achieved was 86.2%±15.7%. Among single recessions, the RC was 85.2%±25.6% for Miller class I, 91.5%±10.4% for class II, and 79.2%±18.3% for class III. Regarding multiple recessions, the RC was 85.1%±16.2% for Miller class I, 87.0%±12.5% for class II, and 89.8%±16.0% for class III. By Miller classification, the RC was 85.1%±16.8% for class I, 88.7%±11.6% for class II, and 85.8%±17.3% for class III.Furthermore, the RC varied by follow-up duration: 72.5%±15.1% at 12 months, 90.1%±12.6% at 25–36 months, 89.0%±16.7% at 37–48 months, 91.10%±9.88% at 49–60 months, and 97.6±4.79% for longer than 61 months, with 77.8% of the last group achieving CRC. RC also differed based on the initial recession depth, at 88.0%±16.8% for 1–3 mm, 83.1%±14.1% for 3–6 mm, and 80.2%±5.04% for depths exceeding 6 mm. Conclusions A modified tunneling technique, utilizing SCTG and a volume-stable collagen matrix, appears to represent a reliable option for the long-term management of GR in the lower anterior region, even in cases involving multiple Miller class III GRs.

Purpose: A small magnetic peg, named “BracketPeg,” has been developed as an attachment magnet for implant prostheses. This study aimed to determine the feasibility of measuring implant stability at the prosthesis level, evaluate the reliability and accuracy of BracketPeg, and examine the consistency of measurements obtained using other devices for damping capacity assessment (DCA) and resonance frequency analysis (RFA). Methods: Forty implants were installed into artificial bone blocks, with each block representing 1 of 4 different diameters (3.5, 4.0, 4.5, and 5.5 mm; 10 implants per diameter).Each implant was paired with a customized zirconia prosthesis that matched the implant diameter. Implant stability was measured at both the fixture and prosthesis levels using Anycheck™ (Neobiotech) for DCA and Osstell™ Beacon (W&H) and ChecQ™ (Dentis) for RFA. To obtain prosthesis-level measurements using RFA devices, BracketPeg was attached to the coronal, middle, and apical thirds of the prosthesis to evaluate implant stability. Results: The implant stability quotient (ISQ) was significantly lower at the prosthesis level than at the fixture level (P<0.001), reflecting the impact of the increased mass and size of the prosthesis. RFA values varied depending on the position of BracketPeg, with lower stability values observed at the coronal position than at the apical position. The 2 RFA devices demonstrated reasonable agreement between ISQ measurements, with a mean difference of −0.58 (95% confidence interval: ±0.31). Conclusions BracketPeg provides reliable and consistent implant stability measurements at the prosthesis level compared to other devices, making it a practical and feasible tool for the clinical evaluation of implants.

Purpose: Gingival fibroblasts are a major cellular component of the connective tissue and play a crucial role in wound healing and tissue regeneration through collagen synthesis.This study aimed to assess the effect of polynucleotide (PN) combined with cross-linked hyaluronic acid (HA) on the proliferation, differentiation, and anti-inflammatory responses of human gingival fibroblasts-1 (HGF-1). Methods: In this in vitro experimental study, HGF-1 cells were cultured with PN/HA, PN, HA, and enamel matrix derivative (EMD). Cell proliferation and migration were assessed at 24 hours and 48 hours, respectively. Long-term cultures were evaluated for collagen and proteoglycan deposition using sirius red and alcian blue staining. Levels of phospho-nuclear factor-κB (NF-κB) p65, collagen type I (Col 1), and interleukin-6 (IL-6) were measured using Western blot analysis or enzyme-linked immunosorbent assay. Results: All experimental groups exhibited increased cellular proliferation and migration compared to the control group. Similar to EMD, PN/HA promoted the synthesis of Col 1 and proteoglycans. At concentrations of 2.5 mg/mL for PN and HA, and 1.0 mg/mL for PN/HA, significant anti-inflammatory effects were observed. These effects included reductions in phospho-NF-κB p65 levels and IL-6 production when exposed to lipopolysaccharides from Porphyromonas gingivalis. EMD, however, did not demonstrate these anti-inflammatory effects. Conclusions Within the limitations of this study, we concluded that PN/HA improves gingival tissue healing by promoting cell proliferation and migration, facilitating rapid collagen deposition, and exerting anti-inflammatory effects.

Purpose: This retrospective study aimed to evaluate the long-term survival rate and marginal bone loss (MBL) of tapered-straight-tapered dental implants, considering various associated factors, over an observational period of ≥5 years. Methods: This study included 186 patients who underwent tapered-straight-tapered dental implant placement at Seoul National University Dental Hospital from 2014 to 2019. Digital panoramic radiographic images and dental records were examined. We evaluated multiple variables, such as sex, age, diabetes mellitus (DM), smoking status, placement region, jaw type (maxilla and mandible), implant diameter, implant length, staged surgery, immediate placement, splinted prosthesis, and implant placement depth (IPD). We first determined the implant survival rate using Kaplan–Meier analysis and analyzed potential risk factors for implant survival using mixed-effects Cox proportional hazards regression. Next, the Mann– Whitney and Kruskal–Wallis tests were used to examine differences in MBL across variables.Linear mixed-effects models with backward stepwise selection were used to identify associations between risk factors and MBL. Results: This study included 316 implants in 186 patients, monitored over a follow-up period of 7.0±1.36 years. The cumulative survival rate of the implants was 98.1%. The average mesial and distal MBLs were 0.59±1.36 mm and 0.68±1.36 mm, respectively. Linear mixed-effects models indicated that MBL exhibited statistically significant positive correlations with DM (Coeff.=0.614, P=0.026) and staged surgery (Coeff.=0.410, P=0.002). Additionally, greater mesial IPD was associated with reduced MBL (Coeff.=−0.143, P=0.046), and a similar trend was observed for distal IPD (Coeff.=−0.316, P=0.068). Conclusions This study demonstrated a high cumulative survival rate for tapered-straighttapered dental implants over a 5-year period. DM, staged surgery, and IPD showed strong associations with increased MBL. The results suggest that tapered-straight-tapered implants offer advantages in terms of peri-implant MBL and consistent clinical outcomes. These findings underscore the importance of considering these variables in clinical decisionmaking to optimize implant outcomes.

Purpose: Immediate implant placement (IIP) offers several advantages, including minimizing hard and soft tissue deformation, reducing implant time and cost, and rapidly restoring tooth function. However, IIP is technically challenging due to the need to secure initial stability and limit functional loading during healing. Therefore, this study aimed to evaluate the clinical outcomes of a bone-level implant featuring a dual thread design—an upper U-shaped thread and a lower V-shaped thread—with an 11° internal hexagonal connection in IIP within the maxillary esthetic zone. Methods: This study included 20 patients. Implants were inserted immediately after tooth extraction. Soft tissue changes were evaluated before tooth extraction (V0), after IIP (V1), at prosthesis delivery (V5), at a 3-month follow-up after prosthesis delivery (V6), and at a 1-year follow-up (V8). Bone dimensional changes were assessed at V1 and V8 using cone beam computed tomography, and the marginal bone level (MBL) was evaluated at V6 and V8 using 2-dimensional. Results: Of the 20 patients, 3 dropped out due to osseointegration failure during the followup period. Although the horizontal dimensions of the soft and hard tissues decreased slightly, the gingival margin and MBL remained well maintained throughout the follow-up. Conclusions Within this limited dataset, the lower V-shaped thread enabled favorable initial stability in IIP, and the esthetic outcomes were positive—with minimal gingival recession and marginal bone loss. Long-term follow-up is required to fully assess the impact of thread design and connection on esthetics.

Following tooth extraction, inevitable hard and soft tissue remodeling leads to buccal contour loss, and complete prevention remains challenging despite strategies including ridge preservation, immediate implant placement and bone grafting. To rehabilitate the contour loss, soft tissue augmentation with a collagen matrix is widely performed to increase crestal mucosal thickness. In addition, the use of customized healing abutment (HA) contributes to establishing harmonious buccal transmucosal margin with an adjacent natural tooth. This case report presents two cases in which ridge contour loss following extraction and implant placement that were reconstructed to the pre-extraction contour synergistically via soft tissue augmentation and customized HA. Horizontal soft tissue thickness changes were quantitatively assessed by superimposing stereolithographic files obtained from sequential intraoral scans, and the rehabilitation rate was calculated. At 3 months postoperatively, the rehabilitation rate at the 5-mm measurement point was 52.9% in Case 1 treated with a bilayer collagen matrix, and 102.9% in Case 2 treated with a volume-stable collagen matrix for soft tissue augmentation. With combined use of customized HA, the present cases established harmonious peri-implant mucosal architecture and emergence profiles of implant restoration.