Clinical Oral Investigations最新文献

Objectives: To determine the impact of alveolar socket surface area and number of root extractions for developing medication-related osteonecrosis of the jaw (MRONJ) in polypharmacy patients following multiple tooth extractions.

Materials and methods: A retrospective sample of 40 patients was recruited, including 20 polypharmacy patients (109 tooth extractions) who developed MRONJ in at least one of the extraction sites, matched with 20 controls (100 tooth extractions). Tooth-specific alveolar socket surface areas were assessed using CBCT scans from the control group to establish reference values for alveolar socket surface areas in polypharmacy patients with MRONJ. Correlations between the number of extracted tooth roots, alveolar socket surface area, and development of MRONJ were analysed within the polypharmacy group.

Results: 40% of tooth extractions in polypharmacy patients undergoing multiple extractions resulted in the development of MRONJ, with a higher prevalence observed in the mandible (44%). Among the extracted mandibular tooth roots, half were susceptible to MRONJ, and 45% of the exposed socket surface area was affected. Both jaws showed an increased risk (20%) of MRONJ following molar extraction. A strong positive correlation existed between extraction sites that developed MRONJ and both the number of mandibular tooth roots extracted (r = + 0.861; p < 0.001) and the total exposed alveolar socket surface area (r = + 0.757; p < 0.001). However, no significant correlations were observed in the upper jaw.

Conclusions: This study is the first to demonstrate that both mandibular alveolar socket surface area and number of extracted tooth roots are positively related to extraction sites developing MRONJ in polypharmacy patients undergoing multiple tooth extractions.

Clinical relevance: Identifying high-risk patients and implementing preventive strategies can reduce MRONJ incidence, underscoring the need for careful management of polypharmacy patients, especially those undergoing mandibular tooth extractions.

Objectives: To evaluate the impact of oral health problems on oral health-related quality of life (OHRQoL) among female patients received Radioactive iodine (¹³¹I) therapy.

Materials and methods: This unmatched case-control study was conducted on 40 female patients (20 cancer free controls and 20 patients treated with ¹³¹I therapy). Data were collected via clinical examination, self reported questionnaire including the Oral Health Impact Profile-14 (OHIP-14), salivary tests, socio-demographic and behavioural characteristics. Data were analyzed using descriptive, bivariate and multivariate statistics.

Results: There were significant differences in the total number of decayed, missing and filled surfaces, stimulated and unstimulated salivary flow rates, and periodontal indices between the study and control groups in the unadjusted analysis. Age adjusted analysis revealed significant differences in the stimulated and unstimulated salivary flow rates, periodontal indices, physical pain domain scores between groups. No significant differences were observed between groups in the xerostomia severity and OHRQoL. In study group, the score for the OHIP-14 psychological discomfort domain was negatively correlated with both stimulated and unstimulated salivary flow rates. The total OHIP-14 score and its domain scores of physical pain and psychological disability were correlated positively with the severity of xerostomia, but negatively correlated with number of the repeated ¹³¹I therapy.

Conclusions: Due to xerostomia, patients reported worse OHRQoL in the domains of physical pain, psychological discomfort and disability. They had worse periodontal status and tooth brushing habits than healthy controls.

Clinical relevance: The findings of this study may provide a valuable insight on the oral health problems and needs of target group when planning a a team-based care.

Objectives: To explore the level of peripheral blood immune cells in patients with different stages and grades of periodontitis.

Materials and methods: A total of 229 periodontitis patients and 36 periodontally healthy patients were included in this cross-sectional study. Individuals with systemic diseases were excluded. A periodontal examination and a complete blood cell examination were performed. The percentages of T and B cells and their subsets were analyzed via flow cytometry. Covariance and logistic regression analyses were conducted, and receiver operating characteristic curve analysis was used to assess the predictive ability of the indicators.

Results: The white blood cell (WBC) count, absolute neutrophil count (ANC), neutrophil percentage (NEU%) and neutrophil-to-lymphocyte ratio (NLR) were greater, but the lymphocyte percentage (LYM%) was lower in the periodontitis group than in the healthy control group. Patients with severe periodontitis (Stage III and IV) presented higher WBC, ANC, NEU% and NLR than those with mild and moderate periodontitis (Stage I and II) did. Area under curve (AUC) of the ANC, NEU% and NLR for the prediction of Stage III/IV periodontitis were 0.750, 0.771, and 0.774, respectively. Compared with Grade A or B periodontitis patients, Grade C periodontitis patients had a significantly lower absolute lymphocyte count (ALC) and LYM% but higher NEU% and NLR in Grade C periodontitis. The AUC of the NLR, LYM% and NEU% for predicting Grade C periodontitis were 0.797, 0.799, and 0.793, respectively. In lymphocytes, the proportions of T and B cells were lower in Grade C periodontitis patients than in Grade A or B group. Similarly, immune regulatory cells, including B10 and Treg cells, also decreased. Conversely, the Th17/Treg ratio was greater. Moreover, the Th17/Treg ratio was most strongly correlated with Grade C periodontitis (r = 0.87), followed by Treg cells(r = -0.70) and B10 cells(r = -0.38).

Conclusions: ANC, NEU%, NLR and LYM% are closely correlated with periodontitis. ANC, NEU%, and NLR may serve as potential markers for Stage III/IV periodontitis. LYM%, NEU%, and NLR may serve as potential markers for Grade C periodontitis. An increase in the Th17/Treg ratio is a high-risk factor for Grade C periodontitis.

Clinical relevance: Peripheral immune cell levels vary with the stage and grade of periodontitis and can be used to distinguish the grade and stage of periodontitis.

Objectives: This study investigated relationships between bone thickness at the insertion sites of orthodontic anchoring screws (OASs) and periodontal biotype (PB) using cephalograms and cone-beam computer tomography (CBCT).

Materials and methods: The PB at the maxillary central incisors was evaluated to differentiate into three categories. In total, 71 patients were examined to determine the relationship between PB and palatal bone thickness using cephalograms. Of these, 57 patients with CBCT were investigated further to explore the relationship between PB and bone thickness at the palatal and buccal regions. Mann-Whitney U-test and t-test were performed for comparisons in each PB group.

Results: The thickness of the palatal bone (p = 0.010) and cortex (p = 0.006) in patients with thick biotype in posteroanterior (PA) cephalograms was significantly greater than that those with thin biotype. CBCT evaluations showed that the paramedian bone thickness in the section between premolars in thick biotype (8.38 ± 2.61 mm) was significantly greater than that in thin biotype (6.41 ± 2.95 mm, p = 0.000). Regarding the buccal alveolar area, the cortical bone thickness in thick biotype was greater than those in medium and thin biotypes (p < 0.0167).

Conclusions: Thick biotype had thicker paramedian bones and palatal cortexes than with thin biotype in PA cephalograms. From CBCT images, the paramedian bone thickness in the section between premolars significantly differed according to PB. Cortical bone thickness in the buccal area from the first premolar to the second molar in the maxilla demonstrated statistically significant differences among PBs.

Clinical relevance: PB is a potentially useful preoperative screening test for OAS placement.

Objectives: This study aimed to compare the stress produced by three heat-treated flat-side prototype rotary instruments and a non-flat side instrument on the internal walls of simulated canals with three different curvature degrees using the photoelastic technique.

Materials and methods: Thirty-six resin blocks with simulated canals, comprising three curvature types (45°, 60°, and double curvature), were used in the study, with 12 blocks allocated to each curvature type. These blocks were further divided into four experimental groups (n = 9 per group) based on the heat treatment of the instruments: gold, silver, blue, and a control group with non-flat-side gold instruments. The blocks were analyzed using a circular polariscope setup, with real-time birefringence patterns captured by a digital camera. Stress on canal walls was evaluated using a semi-quantitative scale. Supplementary tests (stereomicroscope, SEM, energy-dispersive X-ray spectroscopy, and DSC) were performed to interpret the results further. Data were analyzed using the Kruskal-Wallis test (α = 5%).

Results: Inter- and intra-observer agreements were 0.91 and 1, respectively. All instruments exhibited high stress patterns on canal walls. The highest stress was observed in the 45° and 60° blocks (middle third) and the double curvature blocks (apical third). The flat-side gold instrument recorded the highest stress in the coronal third, and the flat-side blue in the apical third (p < 0.05). All instruments displayed some degree of distortion after use.

Conclusions: Instrument type and canal curvature significantly influenced stress distribution across root canal thirds. All flat-side instruments exhibited high stress patterns, warranting caution in curved canals due to potential distortion and performance impact.

Clinical relevance: This study recommended caution when using newly designed flat-side instruments in curved canals due to potential stress on canal walls and greater distortion, which may affect performance and durability.

Objectives: This study compared the effectiveness of adding autologous platelet concentrates (APCs(+)) and sole bone grafting procedures (APCs(-)) in maxillary sinus augmentation (MSA).

Materials and methods: A systematic search was performed to identify randomized controlled trials (RCTs) from electronic database and clinical registers published up to June 1, 2024. Six evaluation indices comprising percentage of new bone formation (NBF%), percentage of residual bone substitute (RBS%), percentage of fibrous tissue (FT%), implant stability quotient (ISQ), bone height (BH) and bone density (BD) were identified.

Results: We analyzed 14 studies involving 268 lifted sinuses and 119 implants. Compared with the APCs(-) group, the APCs(+) group demonstrated a significant advantage regarding NBF% (weight mean difference (MD)= 4.80, 95% confidence interval (CI) (1.82,8.32), p=0.007) and RBS% (MD=-4.48, 95% CI (-6.01,2.96), p<0.01), with no evident superiority in FT% (MD=-0.11, 95% CI (-0.56,0.35), p=0.64), ISQ (MD=-1.68, 95% CI (-6.77,3.40), p=0.52) and BH (standard mean difference (SMD) =-0.11, 95% CI (-3.04,2.83), p=0.94). While APCs(-) group showed a significant benefit in BD compared to the APCs(+) group (MD=-28.34, 95% CI (-48.98,-7.71), p=0.01).

Conclusion: Compared with APCs(-), APCs(+) could be a better option for promoting NBF% and reducing RBS%, whereas we found no evident influence in FT% and ISQ under MSA. Concerning BD and BH results, there were no additional effects with the addition of APCs, which needs to be treated with caution due to the limited number of studies.

Clinical relevance: APCs(+) procedures show promising results, with a higher NBF% and lower RBS%, making them a potential routine MSA strategy.

Introduction: There is currently no recommendation for retaining corrected bimaxillary proclination cases. This study aimed to compare retention protocols for maintaining stability of such cases.

Materials and methods: In this single-center, single-blinded parallel control trial, 27 participants were assigned to three groups using block randomization with a 1:1:1 allocation ratio; fixed bonded retention (FBR), vacuum-formed retention (VFR), and dual retention (DR) comprising both types. Data were collected every 3-months from debond (T0) for 12 months (T4). The primary outcomes measured changes in soft and dental tissue parameters on traced lateral cephalograms. Secondary outcomes included intra-arch changes and the oral health impact profile (OHIP-14[M]). This trial was registered with Clinicaltrial.gov (NCT04578704).

Results: At T4, the upper lip, lower lip, and upper incisors moved anteriorly (mean difference (MD) of 1.63 mm (SD 3.7), 0.48 mm (SD 1.1), and 0.54 mm (SD 0.97), respectively). The upper and lower incisors were proclined by 0.96 degrees (SD 2.1) and 1.11 degrees (SD 2.63), respectively. The interincisal angle was reduced by 0.56 degrees (SD 1.23). Only the upper incisor inclination (UII) change showed significant differences between groups (η² = 0.296; p = 0.015). Post-hoc comparisons revealed that the FBR and VFR groups exhibited greater proclination than the DR group (UII, MD = 3.33 degrees and 3.22 degrees, respectively). No differences were observed in OHIP-14[M] scores between the groups.

Conclusion: All three retention protocols showed statistically small but clinically insignificant changes.

Clinical relevance: Dual retention offers better control in preventing upper incisor proclination in bimaxillary proclination cases.

Trial registration: This trial was registered with Clinicaltrial.gov (NCT04578704).

Aims: To investigate systemic risk factors contributing to the formation of sialolithiasis.

Methods: A retrospective big-data cohort study was conducted using data from Clalit HMO in Israel. Sialolithiasis patients were identified based on ICD-10 codes and matched with controls. Univariate and multivariable logistic regression analyses were performed to assess the relationship between systemic conditions and sialolithiasis. P-value < 0.05 was considered significant.

Results: 5100 sialolithiasis cases were collected. The statistical analysis revealed that hypertension (OR = 1.14, 1.08-1.24, p < 0.001), dyslipidemia (OR = 1.33, 1.27-1.41, p < 0.001), nephrolithiasis (OR = 1.55, 1.42-1.63, p < 0.001) and cholelithiasis (OR = 1.22, 1.16-1.27, p < 0.001) were significantly correlated with sialolithiasis.

Conclusions: Systemic diseases, particularly dyslipidemia, play a role in the development of sialolithiasis. Further research is needed to explore the underlying mechanisms linking these conditions and to develop targeted strategies for the prevention of sialolithiasis.

Clinical relevance: This study highlights the potential interplay between systemic conditions and sialolithiasis. Recognizing these associations can inform clinical practice in understanding the pathogenesis of the disease, risk assessment, early diagnosis, and preventive measures.

Objective: The aim of this clinical trial was to evaluate the effectiveness of Piano level laser therapy using Nd-YAG laser and intramuscular EGF injection in pain alleviation, function, and quality of life improvement in patients suffering from myogenic TMD.

Materials and methods: A randomized clinical trial was performed on 29 patients suffering from chronic painful myogenic TMD based on diagnostic criteria for temporomandibular disorders. Group I (n = 13patients) was treated using 1064 nm Nd-YAG Laser (4 sessions once/week). Group II (n = 14 patients) was treated by intramuscular injection of EGF. Pain using numerical rating score, pain free opening and unassisted maximum opening were measured at baseline, 7,14,21 days, 1 and 3 months. Quality of life using OHIP-14 was assessed at baseline, 1 and 3 months.

Results: Results showed that there was a significant pain reduction (P < 0.000) and increase in pain free opening (P < 0.0001) in both test groups. However, only group I showed a significant increase in maximum opening (P = 0.007). Quality of life significantly improved in both groups (P = 0.0001). There was no significant difference between the two treatments in pain scores, pain free opening, maximum opening nor quality of life.

Conclusion: Both treatment modalities offered effective and cost-effective non- to minimally invasive treatment options for myogenic TMD with no side effects.

Clinical relevance: Myogenic TMD forms a public health issue and is a common musculoskeletal problem causing pain and disability. The proposal of effective, non-invasive, and affordable treatment options can help solve this issue.

Objectives: To compare the long-term remineralization of initial caries lesion (ICL) treated with different remineralizing agents during orthodontic retention using optical coherence tomography (OCT).

Materials and methods: This randomised clinical trial recruited 30 patients on fixed appliances with at least one ICL labially on any maxillary incisor. At debond (baseline), they were allocated to three groups, where twice daily fluoride toothpaste was given: (1) as control; (2) supplemented with daily casein phosphopeptide amorphous calcium phosphate with fluoride (CPP-ACPF); or (3) supplemented with three-monthly professional applied fluoride varnish (FV). Primary outcome was the OCT backscatter reflectance changes of the ICL, measured as integrated reflectivity (IR). Follow-ups were at three-month intervals up to 12 months. The trial was registered with Clinicaltrials.gov (NCT04788550).

Results: Analyses included 26 participants (nine control; nine CPP-ACPF; eight FV). There were significant reduction in integrated reflectivity over time. Post hoc comparisons showed reductions were significant up to 150-micron depth at 6-months, and up to 250-micron depth at both 9- and 12-months follow-up compared to baseline. At 12-months, FV had the lowest IR values, followed by CPP-ACPF and control, but the differences between groups were not significant.

Conclusions: After 12-months observation, use of fluoridated toothpaste alone or supplemented with either fluoride varnish or CPP-ACPF promotes enamel remineralization up to 250-micron depth.

Clinical relevance: Daily fluoridated toothpaste with regular 3-monthly recall visits from the start of orthodontic retention is recommended for effective control of initial caries lesions. FV and CPP-ACPF supplementation can be considered but their long-term benefits remain inconclusive.