Medicine in Evolution is a recognized, peer-reviewed, open access publication dedicated to the dissemination of original theoretical research across the interdisciplinary spectrum of medicine and healthcare, encompassing a wide array of topics within the realms of human life science, medical community, dental medicine and pharmacology. Original research papers, communications, letters, short notes, case reports, and reviews are all warmly welcomed for submission. Its commitment lies in conducting thorough peer reviews, facilitating swift publication of groundbreaking research. We strongly encourage authors to present their experimental and theoretical findings with meticulous detail. The submission of theoretical papers should include comprehensive proofs to facilitate verification, while experimental papers should provide thorough experimental procedures to ensure reproducibility. Authors are also encouraged to deposit supplementary materials such as electronic files or software containing detailed calculations and experimental procedures alongside their publications. The objectives of the journal are aligned with the vision of the World Health Organization, the International Dental Federation, fitting seamlessly into the research strategy of Victor Babes University of Medicine and Pharmacy Timisoara and the Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health. Topics of interest include, without being limited to, the following areas: medicine, dentistry, pharmaceutics. Detailed information about each topic can be found here. Indexing The journal is indexed by several organizations like Index Copernicus and Romanian UEFISCDI (B+).
Impact of Skeletal Class II Malocclusions with Different Vertical Growth Patterns on the Upper Airway
1.Background/Objectives: Considering the clinical relevance of malocclusion in dentistry, the main objective of this study is to assess the changes in the upper airway dimensions in patients with skeletal Class II and a normodivergent growth pattern compared with those with skeletal Class II and a hyperdivergent growth pattern.2.Methods: This observational comparative study was conducted on lateral cephalograms and cephalometric analyses of 52 subjects obtained at the Dentavis imaging center in Timișoara. The sample was divided into two groups of n=25 and n=27 subjects, respectively: Group 1 included subjects with skeletal Class II malocclusion and a normodivergent growth pattern, whereas Group 2 comprised subjects with skeletal Class II malocclusion and a hyperdivergent growth pattern. 3.Results: In Group 2, the mean length of the upper pharyngeal airway was 3.68 mm smaller than the corresponding mean value in Group 1 (p<0.001), indicating that subjects with skeletal Class II and a hyperdivergent vertical growth pattern present a significantly more constricted upper pharyngeal airway compared with those with skeletal Class II and a normodivergent pattern. 4.Conclusion: Initiating orthodontic treatment would modify the cephalometric measurements and mandibular rotation, leading to an increase in upper airway dimensions and an improvement in respiratory function.
Upper pharyngeal airways, class II malocclusions, vertical growth pattern
Copyright (c) 2025 Mălina Popa, Ștefania Dinu, Cristina-Fulga Lazăr, Andreea Igna, Robert-Paul Avrămuț, Roxana-Maria Talpoș-Niculescu (Author) https://creativecommons.org/licenses/by/4.0
Comparative Evaluation of Icon Resin Infiltration and Clinpro XT Varnish on the Remineralization of Enamel White Spot Lesions: An in Vitro Study
1.Background: The aim of this research is to investigate microscopically the behavior of two materials, Clinpro XT Varnish and Icon Vestibular, on the surfaces of teeth with chalky white lesions induced by 37% phosphoric acid. Microscopic evaluation is performed based on different degrees of penetration and infiltration. 2.Methods: The materials tested in this study were Icon – Vestibular DMG (LOT 281473) and 3M ESPE Clinpro XT – Varnish (LOT 9703392).3.Results: Phosphoric acid demineralizes the superficial enamel layer, exposing prisms and hydroxyapatite crystals, and generating a rough surface with uniform etching patterns visible at different magnifications, which favor the adhesion of restorative materials. The use of the infiltrant resin Icon fills microcracks and interprismatic spaces, integrating the enamel prisms into a compact, smooth mass that stabilizes the enamel structure and prevents the progression of demineralization. SEM images show that the varnish forms a thin, relatively uniform film on the enamel, but with small discontinuities and uncovered areas, indicating a less effective seal and protection compared with Icon. 4.Conclusion: The integration of materials such as Icon and fluoride varnishes makes it possible to postpone invasive restorative treatments and is particularly useful in the management of white spots, while maintaining the structural integrity of the teeth.
Copyright (c) 2025 Sorana Nicoleta Rosu, Ioan Alexandru Simerea, Malina Popa, Anamaria Matichescu, Vlad Tiberiu Alexa (Author) https://creativecommons.org/licenses/by/4.0
Internal Fit of Cobalt–Chromium Metal–Ceramic Crowns Fabricated by Conventional Casting and Selective Laser Sintering: An In Vitro Comparison of Three Measurement Techniques
1.Background/Objectives: The purpose of this study was to compare the internal fit of cobalt-chromium metal-ceramic single crowns fabricated through conventional casting versus selective laser sintering (SLS), and to determinate the relative accuracy of three internal space measurement techniques. 2.Methods: A standardized CAD design of a maxillary first molar was used to create two metal frameworks, one produced by was-pattern milling followed by casting and the other by SLS. Internal fit was assessed before and after ceramic firing using methods: differential micrometer measurements on frameworks with and without impression material, direct micrometer readings of detached silicons replicas, and digital microscopy of sectioned silicone specimens. 3.Results: All methods revealed measurable differences in internal adaptation between the cast and SLS crown. Digital microscopy offered the highest precision and consistency, while micrometer-based techniques showed greater operator- dependent variability and were influenced by the elastic behaviour of the silicone impression material. Ceramic firing did not introduce clinically relevant changes in internal space. 4. Conclusions: Within the limitation of the study, conventionally cast frameworks demonstrated a more favourable internal fit than SLS frameworks, and digital microscopy proved to be the most reliable method for evaluating internal adaptation in metal-ceramic crowns.
metal-ceramic crowns; internal fit; CAD/CAM, prosthodontics; selective laser sintering
Copyright (c) 2025 Daniela-Maria Pop, Lucian Floare, Delia Abrudan-Luca, Vlad Tiberiu Alexa, Tareq Hajaj, Boris Dusan Caplar, Lavinia Simona Florea, Cristian Zaharia, Doina Chioran (Author) https://creativecommons.org/licenses/by/4.0
Redefining Digital Precision: How Scanning Technique Shapes the Quality of Intraoral Impressions
Abstract Background/Objectives: Digital dentistry increasingly relies on intraoral scanners to capture full-arch impressions, yet the influence of scanning technique on the accuracy and efficiency of digital models remains insufficiently clarified. This study compared several scanning strategies—varying in segmentation and scanner motion patterns—to determine which protocols yield the highest precision and operational efficiency. Methods: Ten participants underwent full-arch intraoral scanning using seven techniques that combined different segment divisions (one, two, or three segments) with motion types (linear, zig-zag, or combined). Accuracy was assessed by superimposing STL files of each scan onto a reference model using CloudCompare and calculating point-to-point 3D deviations. Efficiency was evaluated based on the number of digital images generated and the total scanning time measured by software and a stopwatch. Results: For the maxillary arch, the most accurate technique was a single-segment zig-zag scan; for mandibular arch accuracy, it was a two-segment linear approach. The motion that produced the shortest scanning time was zig-zag, while that which required the least number of digital records was the two-segment linear scan. Combined-motion and three-segment strategies had the lowest accuracy as well as efficiency. Conclusions: Scanning techniques employing single uniform motion with minimum segmentation provide the best balance between accuracy and efficiency. Over-segmentation along with combined motions reduces the quality of the scan and increases the duration for scanning, thereby emphasizing a simple yet consistent path in clinical practice.
accuracy; CloudCompare; digital dentistry; efficiency; full-arch scan; intraoral scanner; scanning strategy; 3D analysis
Copyright (c) 2025 Camelia-Alexandrina Szuhanek, Iana Grigoreac, Andra-Alexandra Stăncioiu, Vlad Tiberiu Alexa, Sorana Rosu (Author) https://creativecommons.org/licenses/by/4.0
3D Facial Scanning Technologies - Comparative Analysis of Three Modern Three-Dimensional Acquisition Systems
1.Background: Three-dimensional (3D) facial scanning technologies have advanced rapidly, offering new possibilities for clinical, engineering, and educational applications. However, performance varies substantially across mobile, portable, and professional systems, and a direct comparison using standardized acquisition protocols is essential for determining their suitability in medical practice. 2.Methods: Eight healthy adults (20–25 years old) were scanned using three technologies representing different levels of complexity: the iPhone LiDAR sensor with Qlone, the CR-Scan Ferret structured-light scanner, and the professional ProMax 3D Mid ProFace system. All participants were scanned under controlled conditions, maintaining identical positioning and acquisition procedures. Raw data were processed using each system’s dedicated software and analyzed comparatively with respect to geometric accuracy, texture quality, model completeness, artifacts, processing workflow, and cost–performance ratio. 3.Results: The iPhone LiDAR system produced the least accurate models, characterized by surface discontinuities, loss of fine anatomical detail, and low-resolution texture. The CR-Scan Ferret achieved higher geometric fidelity and more coherent color mapping but remained sensitive to lighting conditions and operator stability. The ProMax 3D Mid ProFace system generated the most complete, consistent, and photorealistic models, with minimal artifacts and fully automated processing. These differences reflect the technological capabilities of each device category. 4.Conclusions: The findings confirm that no single scanning technology is universally optimal. Mobile systems are suitable for rapid, non-clinical, or educational applications; portable structured-light scanners offer a balance between accuracy and accessibility; and professional systems remain the gold standard for advanced clinical environments requiring high precision.
3D facial scanning; LiDAR; structured light scanning; ProMax 3D Mid ProFace; CR-Scan Ferret; photogrammetry; 3D reconstruction; medical imaging.
Copyright (c) 2025 Raluca Todor, Tareq Hajaj, Cristian Zaharia, Doina Chioran, Cristina Modiga Modiga, Emanuela Lidia Petrescu, Meda-Lavinia Negrutiu, Cosmin Sinescu, Andreea-Codruta Novac Novac (Author) https://creativecommons.org/licenses/by/4.0
In Vitro Evaluation of Antimicrobial Mouthwashes on Biofilm Formed on Polyethylene Terephthalate Glycol–Based Orthodontic Template Aligner Materials
Orthodontic template aligners used for attachment bonding are thermoformed polymeric materials that may act as vectors for microbial contamination despite their short intraoral use. This study evaluated the antimicrobial efficacy of seven mouthwash solutions on biofilms formed by Streptococcus mutans, Streptococcus oralis, and Candida albicans on a polyethylene terephthalate glycol–based template aligner material. After 24 h biofilm formation, samples were exposed to the tested mouthwashes for 1 min and microbial viability was assessed by optical density measurements. The solution containing fluoride and cetylpyridinium chloride showed the highest antibacterial activity, while the essential oil–based formulation exhibited the strongest antifungal effect. In contrast, fluoride-only solutions showed reduced efficacy, and one plant-based formulation demonstrated a slight stimulatory effect on Candida albicans. These findings indicate that the antimicrobial performance of mouthwashes on template aligner materials depends primarily on their chemical composition rather than fluoride content alone.
Copyright (c) 2025 Vlad-Tiberiu Alexa, Stefania Dinu, Berivan Laura Rebeca Buzatu, Victor Emil Alexa, Ramona Dumitrescu, Ruxandra Sava-Rosianu, Atena Galuscan, Sorana Nicoleta Roșu (Author) https://creativecommons.org/licenses/by/4.0
Accuracy of CEREC Shade Analysis and Lightroom-Based Photographic Evaluation Compared with a Spectrophotometer: A Pilot In Vivo Study
Accurate shade determination remains a key factor in the esthetic success of fixed restorations. This pilot in vivo study evaluated the accuracy of dental color assessment performed by two digital methods—CEREC Shade Analysis and Lightroom-based analysis of calibrated intraoral photographs—compared with a spectrophotometric reference (Vita Easyshade Compact). Four healthy volunteers (80 teeth) were evaluated at the cervical, middle, and incisal thirds, and measured using Vita Classical, Vita 3D-Master, and CIELAB systems. The Wilcoxon Signed-Rank Test was used for spectrophotometer–CEREC comparison, and an unequal variance t-test was used for spectrophotometer–Lightroom comparison (α = 0.05). Statistically significant differences were observed between CEREC and Vita Easyshade in all regions except the middle third of the Vita Classical system (p = 0.76). Lightroom-based analysis showed clinically relevant deviations for L* and a* (p < 0.001), while b* values were comparable (p = 0.24). Within the limitations of this pilot study, both CEREC and Lightroom analysis demonstrated lower accuracy than spectrophotometry. These findings suggest that digital shade detection methods may be useful as adjunctive tools but currently require spectrophotometric verification for definitive color selection in restorative dentistry.
Copyright (c) 2025 Cezar Lăzărescu, Smaranda Buduru, Marius Negucioiu, Andreea Kui, Roxana Buzatu, Mihnea Ioan Nicolescu (Author) https://creativecommons.org/licenses/by/4.0
Comparative Histological Analysis of Normal and Supernumerary Teeth: Clinical and Morphological Implications
This study aims to highlight the histological differences between normal (temporary and permanent) teeth and supernumerary teeth by analyzing enamel, the pulpo-dentin complex, and cementum. Through comparative microscopy of prepared histological slides, the research identifies microstructural peculiarities that may support a better understanding of the development, diagnosis, and management of dental number anomalies. This study involved histological analysis of 12 permanent preparations obtained from supernumerary, temporary, and permanent teeth, aiming to highlight the microstructural differences between normal and supernumerary dentition. Clinical cases and laboratory protocols, including decalcification, paraffin embedding, microtomy, and hematoxylin-eosin staining, allowed detailed observation of enamel prism organization, dentin tubule arrangement, and cementum characteristics. Histological comparison revealed that supernumerary teeth exhibit significant structural deviations, including atypical enamel prism orientation, reduced dentinal tubule density with frequent interglobular spaces, and a poorly differentiated cementum. These anomalies suggest incomplete mineralization and altered tissue development, potentially linked to the frequent impaction and limited functional integration of supernumerary teeth. Supernumerary teeth, although not pathological entities per se, can disrupt the harmony of the dento-maxillary system, affecting eruption, bone development, and dental aesthetics. Histologically, they exhibit morpho-structural hypodifferentiation, with disorganized enamel, reduced dentinal tubules, and imprecise cementum stratification, indicating a lower functional potential. These findings support the importance of histological evaluation in treatment planning and justify a conservative, individualized therapeutic approach based on both structural integrity and functional prognosis.
Supernumerary teeth;Histological analysis;Mineralization defects;Dento-maxillary anomalies
Copyright (c) 2025 Dinu Ștefania , Laura-Cristina Rusu, Iulia Muntean, Șerban Talpoș Niculescu , Dorin Cristian Dinu, Diana- Nicoleta Gheața, Diana Florina Nica, Cristina Fulga Lazăr, Mălina Popa (Author) https://creativecommons.org/licenses/by/4.0
Association of Oral Hygiene Products and Their Impact on Oral Health
1.Background/Objectives: Oral hygiene plays a crucial role in maintaining ecological balance within the oral cavity. Salivary pH is a key functional marker, closely linked to enamel demineralization–remineralization dynamics and microbial homeostasis. The study aimed to compare the influence of two oral hygiene regimens-using Elmex Anti-Caries Professional toothpaste alone versus its combination with alcohol-free Listerine Coolmint mouthwash-on salivary pH values in young adults. 2.Methods: A controlled crossover design was applied to 30 participants aged 20–30 years. Saliva samples were collected under standardized conditions at 30 minutes and 2 hours after toothbrushing with Elmex toothpaste (Day 1) and after toothbrushing followed by mouthrinse with Listerine Coolmint (Day 2). Salivary pH was assessed using the Saliva Check Buffer kit, which provides semi-quantitative values in 0.5-unit intervals. Data were analyzed with descriptive statistics and the Wilcoxon signed-rank test.3.Results: Toothbrushing alone maintained salivary pH mostly in the physiological range of 6.5–7.0, while the combined regimen produced a significant alkalinizing effect, with values shifting towards 7.0–7.5 at both time points. Statistical analysis confirmed significant differences between the two protocols (p < 0.001).4.Conclusion: The combined use of fluoridated toothpaste and alcohol-free antiseptic mouthwash enhances salivary pH stability compared with toothbrushing alone, supporting remineralization and reducing acidogenic bacterial activity. These findings provide evidence-based support for integrating complementary oral hygiene products into daily preventive protocols, especially in young adults at increased risk for caries.
Salivary pH, Oral hygiene, Fluoride toothpaste, Mouthwash
Copyright (c) 2025 Iulia Muntean, Laura-Cristina Rusu, Alexandra Roi, Ștefania Dinu, Șerban Talpoș Niculescu, Daniela Trotea (Author) https://creativecommons.org/licenses/by/4.0
The Influence of Oral Health on Quality of Life in Young Adults: A Public Health Perspective
1.Background/Objectives: Oral health plays an increasingly vital role in overall health and well-being. 2.Methods: This cross-sectional design evaluated the impact of oral health on quality of life in adolescents and young adults. The study was conducted using a validated psychometric tool — the Oral Impact on Daily Performance (OIDP) questionnaire — which captures the self-perceived effect of oral conditions on various daily functions. Participants were recruited from a general adolescent and young adult population via online distribution channels. The target demographic included individuals aged approximately 14–25 years, either attending secondary school or university. The survey was administered using Google Forms platform, ensuring accessibility across various devices. Participants were informed about the purpose of the study and anonymity was guaranteed. Submission of the completed form was considered an expression of informed consent, in accordance with ethical research standards. Collected data were processed using Microsoft Excel. Descriptive statistics determined central tendency (mean, median), dispersion (standard deviation, range), and item-specific frequency distributions. 3.Results: The study included a total of 76 participants, aged between 14 and 25 years. All participants completed the Oral Impact on Daily Performance (OIDP) questionnaire. Each respondent rated the frequency of 15 oral health-related impacts on a 0–4 scale. The mean OIDP Score among the group was 11.37, with scores ranging from 1 to 30, indicating a moderate burden of oral health on daily life activities across the sample. The difference between the psychosocial and appearance domains was the only one reaching statistical significance, suggesting that aesthetic and emotional concerns may affect participants differently and deserve further study in a larger sample. 4.Conclusion: the findings from this study emphasize the importance of viewing oral health through a biopsychosocial lens, especially in adolescent and young adult populations.
Copyright (c) 2025 Ruxandra Sava-Rosianu, Vlad Alexa, Vanessa Bolchis, Delia Abrudan Luca, Lucian Floare, Malina Popa (Author) https://creativecommons.org/licenses/by/4.0
Beyond The White Smile: In Vitro Insights into Carbamide Peroxide Bleaching by Confocal Microscopy
1.Background/Objectives: Tooth bleaching with carbamide peroxide (CP) is one of the most common aesthetic procedures in modern dentistry, yet its effects on enamel ultrastructure remain a matter of concern. This in vitro study aimed to qualitatively assess microstructural changes in human enamel following in-office bleaching with two professional CP formulations—Opalescence Quick 45% and Pola Office+ 37.5%—in accordance with ISO 28399:2021 guidelines. 2.Methods: Forty extracted human molars and premolars were sectioned to obtain paired specimens, with one half treated and the other serving as control. Bleaching protocols were performed under standardized conditions, and samples were analyzed using laser scanning confocal microscopy (CLSM) with three-dimensional reconstruction to evaluate enamel prism organization, porosity, and dentinal tubule exposure. 3.Results: Both agents induced morphological alterations, including partial prism disorganization, increased porosity, and widening of interprismatic spaces. Opalescence Quick, with its higher CP concentration, produced more pronounced structural effects compared with Pola Office+, which exhibited a more moderate impact. Despite these changes, enamel integrity was not severely compromised. 4.Conclusion: These findings suggest that carbamide peroxide bleaching can be considered safe when performed under professional supervision, particularly when complemented with remineralizing strategies. Future studies should investigate long-term effects and interactions with restorative materials under clinical conditions.
Copyright (c) 2025 Vlad Tiberiu Alexa, Ramona Dumitrescu, Berivan Laura Rebeca Buzatu, Octavia Balean, Atena Galuscan, Malina Popa (Author) https://creativecommons.org/licenses/by/4.0
Salivary Detection of High-Risk Human Papillomavirus (HPV) in Dental Patients: A Pilot Study on Clinical and Behavioral Risk Correlates
Background/Objective: Oral infection with high-risk human papillomavirus (HPV) is a growing etiological factor in oropharyngeal cancer, often affecting individuals without traditional risk factors. Dentists may contribute to early detection through salivary screening and behavioral risk assessment. This pilot study aimed to investigate the prevalence of oral HPV infection and its association with clinical and lifestyle variables in dental patients. Methods: Thirty adult patients attending routine dental visits were enrolled in a cross-sectional study. Each underwent clinical oral examination, behavioral risk assessment (including smoking, alcohol use, and sexual history), and provided an unstimulated saliva sample. HPV DNA detection was performed using PCR, with genotyping for HPV16 and HPV18. Associations between HPV positivity and variables were analyzed using univariate tests and logistic regression. Results: HPV DNA was identified in 6 patients (20%), with high-risk genotypes detected in most cases. HPV positivity was associated with current smoking, poor oral hygiene, oral sexual practices, and presence of suspicious mucosal lesions. Logistic regression revealed oral lesions (OR = 19.17) and poor hygiene (OR = 7.00) as independent predictors. ROC analysis showed high model discrimination (AUC = 1.00). Conclusion: Salivary testing is feasible in dental settings and may assist in identifying patients at elevated risk for HPV-related oropharyngeal cancer. Integrating behavioral screening and salivary diagnostics in dentistry could improve early referral and prevention strategies. Larger studies are needed to refine predictive algorithms for routine use.
oral human papillomavirus (HPV); salivary diagnostics; oropharyngeal cancer; dental screening;
Copyright (c) 2025 Adela Hiller, George Andrei Drăghici , Cosmin Sinescu (Author) https://creativecommons.org/licenses/by/4.0
Comparative Evaluation of Mechanical Properties in Contemporary Prosthetic Dental Materials: Zirconia, Lithium Disilicate, and Hybrid Composites
Background/Objective: The choice of dental prosthesis material necessitates consideration of the compromise between strength, esthetics and long-term durability. Speakers claim that monolithic zirconia, lithium disilicate, and hybrid composites are the most popular materials with different mechanical and clinical properties. The present study was conducted to compare the mechanical properties of these three materials in vitro by standardised procedures in relation to seven factors important for prosthodontic use. Methods: Ninety rectangular specimens (n = 30 per group) were prepared from monolithic zirconia, lithium disilicate, and a CAD/CAM hybrid composite. The samples were tested for flexural strength, fracture toughness, Vickers microhardness, wear, surface roughness, fatigue survival (1.5 million cycles) and marginal adaptation. ​). For reliability of zirconia, the Weibull modulus (m = 14.2) was shown to be higher than the hybrid group. Conclusion: All three materials provide specific clinical benefits. Zirconia is best suited for rear and high-stool restorations, lithium dislikes for anterior and asthetic operated cases, and hybrid composite for temporary or minimal invasive applications. Understanding the mechanical behavior of each material is necessary for evidence-based artificial decision making and improvement in long-term clinical results.
zirconia, lithium disilicate, hybrid composite
Copyright (c) 2025 Sorin Gheorghe Mihali, Adela Hiller (Author) https://creativecommons.org/licenses/by/4.0
The Internal Thoracic Artery: An Anatomical Narrative Review
The internal thoracic artery (ITA) is a paired vessel originating from the first part of the subclavian artery, descending along the inner thoracic wall in close relation to the sternum. Owing to its reliable caliber, predictable course, and favorable long-term patency, the ITA plays a critical role in both clinical anatomy and surgical practice, particularly in coronary artery bypass grafting. This review synthesizes current anatomical knowledge of the ITA, emphasizing its origin, course, branching patterns, and collateral circulation. Variations in its trajectory, branching morphology, and termination are examined in detail, along with rare anomalies such as duplication and complete absence. Surgical relevance is addressed, with a focus on harvesting techniques, the impact of competitive flow, and strategies to manage side branches. Nomenclature is briefly discussed, noting the adoption of “internal thoracic artery” as the primary term. By integrating findings from cadaveric, radiological, and surgical studies, this review highlights the anatomical variability of the ITA and its implications for thoracic, cardiovascular, and reconstructive procedures. Understanding these variations is essential for optimizing surgical outcomes and reducing perioperative complications.
Copyright (c) 2025 Răzvan-Costin Tudose, Andreea Treteanu, Mugurel Constantin Rusu (Author) https://creativecommons.org/licenses/by/4.0
The Implications of Combined Hormonal Contraceptives in Cancer
1.Background/Objectives: Combined hormonal contraceptives (CHCs) are widely used by women during their fertile years. Often, these pills are taken without medical advice, which can lead to certain unwanted effects. This class of medication has been studied over the years for its impact on various types of cancer. Since cancer is becoming an increasingly common condition, understanding the factors that contribute to its development is important for prevention. 2. Methods: This paper reviews recent literature from reputable sources such as PubMed, Google Scholar, ScienceDirect, and Scopus. 3. Results: The review of the medical literature reported evidence about the risk of CHCs in developing breast and cervical cancer, and more, about the protective effect on ovarian, endometrial, and colorectal cancer. 4. Conclusion: This paper presents the risk/benefit balance of CHCs in terms of their impact on some cancerous pathologies. According to the analysis, we can state that CHCs are effective and even safe if administered appropriately and according to the recommendations of specialists, depending on the particularities of each patient.
Copyright (c) 2025 Florina Borozan, Alexandra Semenescu, Larisa Tomescu, Ioan Sas (Author) https://creativecommons.org/licenses/by/4.0
Evaluating the Use of Dietary Supplements to Improve Physical and Sports Performance - Survey Study
Dietary supplements (DS) use among athletes to enhance endurance, strength and muscle recovery is a complex issue influenced by factors such as sport type, individual goals, access to nutritional information, and nutrition trends, with higher prevalence among elite performers. Despite their growing popularity and benign perception, scientific evidence regarding the safety, quality, and efficacy of DS remains insufficient. Therefore, the current study employed a questionnaire-based survey to assess Romanian athletes’ awareness and consumption behaviours, as well as potential adverse effects associated with DS use. Statistical analysis (chi-square test and Pearson test) was used to reveal relevant correlations among the examined variables, providing insight into usage patterns. The results highlight a high prevalence of DS consumption among young people and frequent reports of adverse reactions. Thus, educational interventions become essential to reduce potentially risky self-medication. The study revealed also the effectiveness of questionnaires as data collection tool among both amateur and competitive athletes, facilitating data-driven insights for enhancing athletic performance, promoting balanced lifestyles, and informing evidence-based guidance regarding the consumption of DS for both athletes and regulators.
Copyright (c) 2025 Oana Ramona Cătălina Gheorghiu , Daniela Mădălina Anghel, Anne-Marie Ciobanu, Claudia Maria Guțu , Ștefan Rohnean, Daniela Luiza Baconi (Author) https://creativecommons.org/licenses/by/4.0
Phytochemical Characterization and Biological Evaluation of Ribes nigrum Leaf Extracts: A Study of Aqueous and Butanolic Fractions
Background: Ribes nigrum (black currants) are recognized for their outstanding biological properties, including antioxidant, anti-inflammatory, and anticancer activities. Colorectal cancer (CRC) is a type of cancer with a high mortality, for which various natural products have been investigated as alternatives that have emerged as potential candidates in the oncological domain. Methods: The present work involved the development of two types of Ribes nigrum leaves extracts (in aqueous and butanolic fractions), which were evaluated by the HPLC method and subsequently assessed for the antioxidant capacity, the antimicrobial activity, and in vitro cytotoxicity on the DLD-1 cell line. Results: The results indicated that both types of extracts contain amounts of polyphenols, the antioxidant activity of the extracts supports their potential as natural sources of free radical scavengers, antimicrobial evaluation showed that the extract in aqueous fraction produced a selective antimicrobial effect on gram-positive bacteria, and the MTT assay suggested that the extracts produced a dose-dependent cytotoxicity, with a superior effect noted for the extract in the butanolic fraction. Conclusion: These findings emphasized the biological potential of Ribes nigrum extracts due to their versatile composition and opened new research directions regarding their anticancer potential in CRC.
blackcurrants, Ribes nigrum, colorectal cancer, natural alternative, antimicrobial activity, antioxidant activity
Copyright (c) 2025 Oana-Adla Coman, Andreea Smeu, Alina Moacă, Delia Muntean, Ana-Maria Vlase, Laurian Vlase, Szilvia Toth, Andreea Vădan, Anca Stoica, Sergio Liga, Diana-Simona Tchiakpe-Antal (Author) https://creativecommons.org/licenses/by/4.0
Understanding Halitosis: A Survey on the Knowledge and Perceptions of Dental Students
1.Background/Objectives: Currently, there is a lack of definitive data regarding the prevalence of halitosis. This study was conducted to assess the knowledge and awareness of dental medicine students regarding halitosis, as well as to examine their approach to the diagnosis and management of patients presenting with this condition. 2.Methods: A total of 95 dental students were invited to participate in this cross-sectional study, conducted between February and June 2024. The data collection instrument consisted of a self-administered, structured questionnaire comprised of 14 questions. All items were mandatory, ensuring that every submission represented a complete data set for analysis. The study was conducted in accordance with ethical principles related to human subjects research, particularly concerning participant privacy, confidentiality, and data protection. Descriptive statistics were employed to analyze the data, with a focus on calculating frequency distributions and percentages. 3.Results: Among fourth-year respondents, only 58.1% reported familiarity with the term. In comparison, a significantly higher proportion of fifth-year students—86.2%—indicated awareness of the condition. This trend continued in the sixth year, with 89.3% of students reporting familiarity with halitosis, suggesting a gradual increase in awareness as students advance through their academic training. When asked whether they had access to instruments or tools for diagnosing or managing halitosis. Among fourth-year respondents, 64.5% reported lacking such instruments, while 35.5% stated they had access. Fifth-year students reported a slightly more favorable ratio, with 41.4% indicating access to instruments and 58.6% reporting the opposite. Similarly, among sixth-year students, 42.9% had access to instruments, while 57.1% did not. 4. Conclusion: In conclusion, while the current study highlights encouraging improvements in dental students’ awareness and clinical exposure to halitosis over time, it also reveals critical gaps in theoretical knowledge and confidence in management.
Copyright (c) 2025 Vlad Tiberiu Alexa, Ramona Dumitrescu, Octavia Balean Balean, Berivan Laura Rebeca Buzatu, Ioan Alexandru Simerea, Ruxandra Sava-Rosianu (Author) https://creativecommons.org/licenses/by/4.0
Examining the Commercial Determinants of Oral Health: A Comprehensive Review
The commercial determinants of oral health refer to the ways in which corporate activities, market forces, and economic policies influence oral health outcomes. Key industries, including the food and beverage, tobacco, alcohol, and pharmaceutical sectors, play a significant role in shaping oral health behaviors and disease patterns. The widespread availability and marketing of sugar-rich foods and beverages contribute to high rates of dental caries, while tobacco and alcohol consumption are major risk factors for periodontal disease and oral cancers. Additionally, corporate lobbying and regulatory policies impact access to preventive dental care and the affordability of oral health products. Socioeconomic disparities further exacerbate these issues, with lower-income populations facing greater exposure to unhealthy commercial influences and limited access to professional dental care. Addressing these determinants requires multi-sectoral collaboration, including stronger regulations on harmful product marketing, policies that promote affordable and accessible dental services, and increased public health education. By recognizing and mitigating the negative impact of commercial interests, policymakers and healthcare professionals can work towards reducing oral health inequities and improving population-wide dental health outcomes. A shift towards sustainable and health-promoting commercial practices is essential for fostering long-term improvements in global oral health.
Copyright (c) 2025 Ruxandra Sava Rosianu, Delia Abrudan-Luca, Vlad Tiberiu Alexa, Antonia Ilin, Vanessa Bolchis (Author) https://creativecommons.org/licenses/by/4.0
The Impact of Smoking on the Progression and Management of Periodontal Disease
Periodontal disease is a chronic inflammatory condition that affects the supporting structures of the teeth and is significantly influenced by modifiable risk factors, among which smoking plays a prominent role. Although the detrimental effects of smoking on periodontal health are well-documented, the specific impact of smoking intensity—measured as the number of cigarettes smoked per day—remains less clearly defined. Objective: This study aimed to investigate the influence of smoking intensity on the progression and clinical management of periodontal disease by comparing periodontal health parameters among three groups: heavy smokers (>10 cigarettes/day), light smokers (<10 cigarettes/day), and non-smokers. Methods: A cross-sectional observational study was conducted on a sample of 226 adult patients from Timișoara, Romania. Each participant underwent a comprehensive full-mouth periodontal examination assessing key parameters, including probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP). Additionally, participants completed a standardized questionnaire documenting demographic data, smoking habits, and general health status. Statistical analysis involved one-way ANOVA and Hochberg GT2 post hoc tests to identify significant differences across groups. Results: The findings revealed a clear dose-dependent relationship between smoking intensity and periodontal disease severity. Heavy smokers exhibited the most severe periodontal deterioration, with significantly greater mean PPD and CAL compared to both light smokers and non-smokers (p < 0.001). Light smokers also presented significantly worse clinical outcomes than non-smokers (p < 0.01). Interestingly, non-smokers displayed a higher incidence of bleeding on probing, likely due to smoking’s vasoconstrictive effects masking inflammatory signs. Conclusions: This study demonstrates a strong, dose-dependent negative impact of smoking on periodontal health. Even light smoking is associated with clinically significant periodontal damage, reinforcing the notion that there is no safe level of tobacco exposure for periodontal tissues. These results highlight the critical need for integrating smoking cessation programs into periodontal disease prevention and management strategies.
Copyright (c) 2025 Alexandru Simerea, Delia Abrudan Luca, Lucian Floare, Octavia Balean, Ramona Dumitrescu, Vanessa Bolchis, Antonia Ilin, Atena Galuscan (Author) https://creativecommons.org/licenses/by/4.0
Complementary Autofluorescence Imaging in the Diagnostic Evaluation of Oral Potentially Malignant Lesions: A Comparative Clinical Study
Background/Objectives: Oral cancer remains a significant global health concern, with early detection being essential for improving patient outcomes. This study aimed to evaluate the clinical utility of autofluorescence imaging as a complementary tool to conventional examination for identifying potentially malignant oral lesions. Methods: Thirty patients with clinically suspicious oral mucosal lesions were randomly assigned to two groups: one examined under conventional white light (control group), and the other using both white light and autofluorescence (experimental group). All cases were subsequently biopsied, and histopathological analysis was used as the diagnostic reference standard. Results: The autofluorescence-assisted group demonstrated a higher proportion of histologically confirmed malignancies (93.3%) compared to the control group (75.0%), suggesting greater diagnostic alignment with biopsy outcomes. Autofluorescence facilitated enhanced visualization of lesion borders and subtle mucosal changes, supporting its role in improving clinical assessment. Conclusion: Autofluorescence imaging appears to be a useful adjunct in the evaluation of suspicious oral lesions, offering better lesion detection compared to conventional examination alone. While not a substitute for biopsy, it may improve early identification and biopsy site selection. Further studies are needed to confirm these findings in larger populations.
Oral cancer, autofluorescence imaging, adjunctive diagnosis, early detection, non-invasive diagnostic methods
Copyright (c) 2025 Doina Chioran, Octavia Balean, Ramona Dumitrescu, Vlad Tiberiu Alexa, Adrian Moldoveanu, Antonis Perdiou, Tareq Hajaj (Author) https://creativecommons.org/licenses/by/4.0
In Vitro Assessment of Eugenol’s Impact on Human Keratinocyte (Hacat) Cell Line
Background: Oral health is one of the most concerning health problems, as it affects almost half of the worldwide population. Eugenol is an excellent natural compound when it comes to prophylactic and curative treatments for several oral problems. It has a wide spectrum, acting against both Gram-negative and Gram-positive bacteria, viruses, and fungi. For this reason, it can be used in treating various dental problems, such as dental caries and periodontitis, and can be used to alleviate pain after surgical extractions. Eugenol has been tested over the years, and it has been proven to induce cytotoxic effects depending on the dosage. Methods: HaCaT cells were used to evaluate eugenol’s safety. Cell confluence, cell morphology assessment, LDH release, and average cell area measurement were analyzed at concentrations of 20, 40, and 80 µg/mL after 72 hours. Results: Eugenol exhibited a mild, dose-dependent antiproliferative effect without inducing cytotoxicity. LDH release remained below 30% even at the highest concentration, and only slight reductions in average cell area and confluence were observed, with no major morphological changes. Conclusion: These findings indicate that eugenol is safe for use on healthy keratinocytes at concentrations up to 80 µg/mL. This study supports future research aimed at optimizing its therapeutic potential while minimizing adverse effects.
Keywords: dentistry, eugenol, human keratinocytes, safety.
Copyright (c) 2025 Ștefania Dinu, Stefania-Irina Dumitrel, Adrian Moldoveanu, Doina Chioran, Mălina Popa, Raluca Milutinovici (Author) https://creativecommons.org/licenses/by/4.0
Use of Electronic Imaging Programs in Dental Practice
1.Background/Objectives: Digital radiography has continuously evolved as an innovative technology in dental imaging for nearly two decades. Digital radiography sensors are divided into: storage phosphor plates (SPPs) called photostimulable phosphor plates (PSPs), silicon devices such as charge-coupled devices (CCDs) or complementary metal oxide semiconductors (CMOS). Digital imaging programs facilitate precise treatment planning by providing detailed images that can be easily manipulated and analyzed 2.Methods: The study period February to March 2025 with a study area of urban and peri-urban areaApproach method: 125 questionnaires were distributed to dentists practicing in urban and peri-urban area, 98 completed questionnaires were returned only 78 questionnaires remained in the study and 20 questionnaires were discarded due to incomplete completion or non-use of electronic medical imaging programs in current medical practice 3.Results: 46% of the doctors work in large private dental clinics, 40% in small private dental clinics and 14% in individual practices, Approximately 55% of respondents reported using electronic imaging programs frequently (more than 50% of the time) in the dental office on a daily basis, while 22% reported using them moderately (between 25% and 50% of the time), 12% use them always and 11% use them only occasionally (less than 25% of the time). 4.Conclusion: Electronic imaging programs offer numerous benefits, including enhanced diagnostic accuracy, more effective treatment planning, improved communication with patients, and streamlined image storage and retrieval.
Copyright (c) 2025 Dragos Bucur, Ramona Amina Popovici, Malina Popa, Stefania Dinu, Andreea Mihaela Kis, Corneliu Zeicu, Mohamed Joma, Adrian Moldoveanu, Serban Talpoș (Author) https://creativecommons.org/licenses/by/4.0
Lifestyle Risk Factors That Increase Chances of Developing Oral Cancer: Up to Date Review
Oral cancer is on the 6th most common cause of malignancies of the world. With higher prevention strategies, the 5‑year survival rate of oral cancer is lower than 50% in some countries. Several risk factors that are linked with lifestyle behaviors have been identified in the occurrence of oral cancers. 2.Methods: Multiple database from 2014 to mid 2024. Applying filters were used to identify systematic reviews and meta-analyses, which investigated oral cancer incidence and risk factors. All published articles related to ″behavior risk factors in oral cancer″ were included in this review. 3.Results: The utilization of tobacco has reached the proportions of a global epidemic; alcohol association even raises the risk of developing oral cancer. In recent studies, there has been an association between smoking and a higher HPV infection. In addition, Candida albicans disrupt the metabolism of epithelial cells, so they can evolve from leukoplakia to dysplasia or even carcinoma leading to association of chronic inflammation. Also a persisting chronic inflammation with the association of one more risk factors from above can lead to an increase chance of developing oral cancer. 4.Conclusion: Most oral cancer are due to behavior habits, the main risk factors in oral cancer are smoking, alcohol consumption and the presence of HPV. ). Improving lifestyle changes should be one of the goals in every patient’s life. In addition, different strategy of public health information should be promoted in order to consider giving up smoking and excessive drinking of alcohol. A change in diet is also necessary. Therefore, public health campaigns are essential in determining a prevention of behavior lifestyle habits especially in younger adults because they represent the future adults.
Copyright (c) 2025 Adela Ramona Boroghina, Ramona Amina Popovici, Stefania Dinu, Malina Popa, Andreea Mihaela Kis, Matin Asad Salehi , Alsayed Ahmad Mhd Kher , Diana Sarbu , Serban Talpoș (Author) https://creativecommons.org/licenses/by/4.0
Assessing Knowledge and Intentions Related to HPV Vaccination in Romanian Dental Students
Background: Human papillomavirus (HPV) is a leading etiological agent of various malignancies, including cervical and oropharyngeal cancers. Despite the availability of safe and effective prophylactic vaccines, vaccination uptake remains suboptimal in several regions, including Romania. Dental students, as future oral healthcare providers, are uniquely positioned to contribute to HPV-related cancer prevention. Objective: This study aimed to evaluate HPV vaccination status, awareness, and behavioral intentions among dental students enrolled at the “Victor Babeș” University of Medicine and Pharmacy in Timișoara, Romania. It also sought to identify factors associated with actual vaccine uptake and intention to vaccinate. Methods: A cross-sectional analytical study was conducted in April–May 2025 using a structured questionnaire administered to second-, fifth-, and sixth-year dental students. Variables analyzed included demographic data, HPV vaccination status, awareness of vaccine safety and efficacy, understanding of community-level protection, and declared intent to vaccinate. Descriptive statistics, correlation analysis, and logistic regression were employed for data interpretation. Results: Out of 199 participants, only 25% reported being vaccinated against HPV, despite high levels of awareness—over 85% acknowledged vaccine safety and effectiveness, and 78% recognized its role in reducing community transmission. Among the unvaccinated students, more than 60% expressed an intention to receive the vaccine. However, the logistic regression model did not yield significant predictors due to limited variability in awareness-related responses, indicating a well-informed but behaviorally inconsistent cohort. Conclusions: Romanian dental students exhibit strong theoretical knowledge of HPV-related health risks and vaccination benefits, yet vaccination uptake remains low. The high intention to vaccinate among unvaccinated individuals suggests a readiness that could be harnessed through targeted behavioral interventions. These findings highlight the importance of integrating both educational and motivational strategies into dental curricula to transform knowledge into preventive action.
HPV, vaccination, dental students, Romania, awareness, public health, behavioral intention
Copyright (c) 2025 Octavia Balean, Ramona Dumitrescu, Atena Galuscan, Vanessa Bolchis, Vlad Tiberiu Alexa, Delia Abrudan Luca, Lucian Floare, Doina Chioran (Author) https://creativecommons.org/licenses/by/4.0
The Impact of Injectable Biostimulatory Substances on Current Trends in Aesthetic Medicine: Focus on Poly-L-lactic Acid, Polycaprolactone, and Calcium Hydroxyapatite
In recent years, aesthetic medicine has witnessed a paradigm shift from conventional volumizing fillers toward regenerative, biostimulatory approaches that promote long-term skin health and natural rejuvenation. This analysis compares the most commonly used injectable biostimulators—poly-L-lactic acid (PLLA), polycaprolactone (PCL), and calcium hydroxyapatite (CaHA)—focusing on their mechanisms of action, clinical efficacy, safety profiles, and aesthetic indications. These agents stimulate neocollagenesis through controlled inflammatory responses, resulting in enhanced dermal structure and prolonged aesthetic outcomes. PLLA acts mainly via the TGF-β/SMAD pathway to promote type I collagen synthesis and fibroblast activation. PCL combines immediate volumization with long-lasting collagen stimulation and neovascularization, while CaHA induces fibroblast proliferation, angiogenesis, and extracellular matrix remodeling. The review underscores the growing preference for minimally invasive yet regenerative treatments, highlighting the importance of tailored therapeutic strategies to optimize clinical outcomes while ensuring patient safety.
Injectable biostimulators, Poly-L-lactic acid, Polycaprolactone, Calcium hydroxyapatite, Aesthetic medicine
Copyright (c) 2025 Mihaela Boța, Andreea Maria Cristea, Lavinia Lia Vlaia, Vicențiu Vlaia (Author) https://creativecommons.org/licenses/by/4.0
Plant-Derived Essential Oils −An Alternative Option for Oral Health Management
Oral health is one of the most pressing aspects of human well-being, complemented by the health of the digestive or respiratory system. As oral hygiene and dental care are essential health missions, products of natural origin are becoming increasingly recognized for their multifaceted benefits (reduced side effects, multiple therapeutic effects). The essential oils (lavender, eucalyptus, oregano, basil, and others) have proven their implications in the field of dentistry through effects observed in several studies, having antimicrobial, pain-reducing, anxiolytic, and many other actions that can be valuable alternatives. This overview presents the applicability and effects of different essential oils in oral health as potential candidates for oral treatments.
dentistry, oral health, essential oils, natural products
Copyright (c) 2025 Stefania Dinu, Serban Talpos-Niculescu, Andreea Smeu, Daniela Sasco, Andreea Alexandrescu-Bauer4, Mălina Popa (Author) https://creativecommons.org/licenses/by/4.0
National Conference of Infectious Diseases 14-16 May 2025, Timișoara, România
We are pleased to present this Supplement to Volume XXXI, No. 1/2025 of the journal Medicine in Evolution, a special collection of scientific contributions dedicated to current challenges and advances in the field of infectious diseases, immunization, and antimicrobial therapies. This supplement brings together high-impact topics at the forefront of medical research and clinical practice. The thematic focus includes the persistent global challenge of HIV/AIDS, centered around a critical question: Can we stop the pandemic? Other articles explore the real-world difficulties encountered in the treatment of acute and chronic viral hepatitis, addressing both therapeutic barriers and innovative solutions. Vaccination is also prominently featured, with perspectives combining long-term experience and cutting-edge innovation. Furthermore, this supplement covers modern strategies in antibiotic, antiviral, and antifungal therapy, reflecting the ongoing need to combat resistance and improve therapeutic efficacy. A dedicated Varia section provides additional original contributions spanning a wide range of medical disciplines and interests. We gratefully acknowledge the leadership of Prof. Univ. Dr. Voichița Lăzureanu, President of the Conference, whose commitment and expertise have been essential in curating this scientific endeavor. Our sincere appreciation also goes to Prof. Univ. Dr. Adrian Streinu-Cercel, Honorary President, whose remarkable contributions to infectious disease research and public health continue to inspire generations of medical professionals. We hope that this supplement will serve as a valuable resource for researchers, clinicians, and public health specialists, fostering dialogue and advancing knowledge in the pursuit of better health outcomes worldwide
Copyright (c) 2025 Elena - Voichița Lăzureanu (Author) https://creativecommons.org/licenses/by/4.0
Mechanical Evaluations of Devitalized Teeth Reconstructed Using Direct and Indirect Techniques
This study evaluates the efficiency of direct and indirect techniques in the corono-radicular reconstruction of devitalized teeth, focusing on mechanical resistance, aesthethic outcomes, and cost effectiveness. Two experimental groups were created using extracted human teeth with prior endodontic tratament. The first group received direct restorations with fibergalss posts and composite resin, commonly used due to to its simplicity and reduced clinical time. The second group underwent indirect reconstruction with zirconia based restorations, produced throught digital workflow involving scanning, milling and sintering. Zirconia restorations showed greater compessive strenght, while fiberglass-based ones exhibited more elasticity, potentially reducing fracture risk. Aesthethic evaluations confirmed satisfactory initial results for both materials, althuoght slight discoloration occurred in composite over time due to staining and material aging. Cost analysis showed that direct techniques are more affordable and time-efficient, while indirect methods, throught more expensive, offer superior long term durability. CBCT imaging was used to evaluate the internal adaptation and fit of materials, confirming accurate placement in both groups. The study concludes that direct techniques are effective and accessible for moderate-load cases, while indirect zirconia restorations provide better resistance for high stress areas. Further research is recommended to enhance material properties and esure long-lasting functional and aesthethic performance.
Keywords: corono-radicular reconstruction, devitalized teeth, direct technique, indirect technique, zirconia, fiberglass, mechanical resistance, aesthetic performance, cost analysis
Copyright (c) 2025 Răzvan Lăcătușu, Pop Daniela-Maria, Negru Radu Marcel, Caplar Borislav -Dusan, Olari Alexandru Ionut, Ilincar Nadina, Dumitrescu Ramona, Oancea Roxana (Author) https://creativecommons.org/licenses/by/4.0
Anxiety as a Determining Factor in Medical Specialty Choice: A Literature Review
Choosing a medical specialty is a crucial moment for future doctors, with a significant impact on their careers. Anxiety is a significant determinant in choosing a medical specialty, having a substantial impact on how students select their medical field. Students who experience high levels of uncertainty and stress are more likely to hesitate in choosing a specialty perceived as demanding and fast-paced. The decision-making process is influenced by numerous internal factors, such as individual skills and competencies, as well as external factors, including socio-economic conditions and the pressure of the academic environment. The purpose of this paper is to analize the anxiety level related to the choice of medical specialty. The highest levels of anxiety and stress are found in emergency medicine, surgery and intensive care units. Medium stress levels are found in doctors working in cardiology, psychiatry and neurology departments. The lowest anxiety level is related with specialties such as dermatology and laboratory medicine. In conclusion, stress and anxiety levels vary greatly between medical specialties, influencing the decisions of future doctors.
ANXIETY, STRESS LEVEL, MEDICAL SPECIALTY, FUTURE DOCTORS
Copyright (c) 2025 Vanesa Cristina Baciu, Dora Mihaela Cimpian, Andreea Salcudean (Author) https://creativecommons.org/licenses/by/4.0