Clinical Oral Investigations最新文献

Background: Bone denudation after conventional relaxing incisions could be a critical factor in inhibiting maxillofacial growth. To address this, alternative relaxing incisions were designed. Thus, this study aimed to compare the effectiveness of palatal relaxing incisions versus nasopharyngeal relaxing incisions in enhancing postoperative outcomes.

Materials and methods: A retrospective cohort study was conducted, involving a total of 120 patients divided into three groups: 40 patients have received modified Furlow palatoplasty with nasopharyngeal relaxing incisions (M.F + N.P.I palatoplasty), and 40 patients who received modified Furlow palatoplasty with palatal relaxing incisions (M.F + P.R.I palatoplasty). The other 40 patients received original Furlow palatoplasty without relaxing incisions (F palatoplasty). Data collected included gender, cleft type, cleft width, age at repair, velopharyngeal function, presence of palatal fistula, and follow-up. The chi-square test compared frequencies of sex, cleft type, postoperative fistula, and velopharyngeal outcomes across groups. The Mann-Whitney and independent t-tests compared mean values, with statistical significance set at p < 0.05.

Results: The mean age at repair was similar across groups, with follow-up periods ranging from 5 to 11 years. No significant differences were found among the M.F + N.P.I and M.F + P.L.I groups regarding gender, cleft type, cleft width, and age at repair. However, the F group had a significantly narrowest cleft width compared to the other groups. Postoperative outcomes showed no significant differences in velopharyngeal function among the three groups, but the F group had a significantly higher rate of palatal fistula (32.5%) compared to the M.F + P.L.I (10%) and M.F + N.P.I (7.5%) groups. A comparison of the two modified Furlow techniques revealed no significant differences in velopharyngeal closure rates or the incidence of velopharyngeal insufficiency and persistent palatal fistula across different Veau classifications.

Conclusions: While both incisions showed similar impacts on palatoplasty outcomes, palatal relaxing incisions may expose more bone and pose a higher risk of secondary healing issues. Therefore, nasopharyngeal relaxing incisions are recommended as an effective and potentially preferable technique in palatoplasty whenever feasible.

Clinical relevance: The current study suggests that, whenever feasible, nasopharyngeal relaxing incisions are advised as an effective and potentially superior technique in palatoplasty.

Objectives: To examine and compare the stability of buccal shelf mini-screws using self-drilling and pre-drilling implant placement techniques.

Methodology: It was a split-mouth, randomized controlled trial comprising of 7 patients, each receiving two buccal shelf bone screws. The screws were placed using a self-drilling protocol in one quadrant and a pre-drilling protocol in the opposing quadrant decided via coin toss randomization. Stability was examined at the time of placement and 1,2, 3 and 4 months thereafter, using the Resonance Frequency Analysis method with the Osstell Beacon ^TM device. The Implant Stability Quotient (ISQ) obtained was then compared and assessed between both quadrants. Friedman's Two-Way Analysis of Variance and the Wilcoxon signed rank test were utilized for the intergroup comparison. A statistically significant result was defined as one with a p-value of less than 0.05.

Results: A statistically significant difference between the mean ISQ reading in the pre-drilling and self-drilling group was observed, indicating higher stability of bone screws placed with the pre-drilling protocol. The primary stability of the buccal shelf screws decreased after placement, but the secondary stability remained stable.

Conclusion: Buccal shelf bone screws placed with a pre-drilling protocol depicted greater primary and secondary stability as compared to the self-drilling protocol, as depicted by the ISQ readings obtained. Resonance Frequency Analysis can be used as a valuable tool to assess the stability of buccal shelf bone screws.

Clinical relevance: The use of buccal shelf screws has increased tremendously over the past few years due to their myriad applications and have now become an essential part of an orthodontist's armamentarium. It is therefore essential for clinicians to be well-informed about all aspects of their use including insertion techniques. The results of this trial indicate that the pre-drilling protocol provides better stability and therefore treatment outcomes.

Objective: This study compares the efficacy of oral exercise alone to oral exercise with frenectomy in improving obstructive sleep apnea (OSA) symptoms and quality of life (QOL) in patients with ankyloglossia.

Materials and methods: A prospective, controlled, double-blind clinical study enrolled fifteen adults (20-60 years) newly diagnosed with mild to moderate OSA and ankyloglossia. Participants were randomly assigned to either oral exercise alone (control group; n = 8) or oral exercise with frenectomy (intervention group; n = 7). Outcomes were assessed after a 3-month therapy period using polysomnography, the Epworth Sleepiness Scale (ESS), tongue strength (measured in kPa), and QOL questionnaires.

Results: Both control (-2.88 ± 1.73; p = 0.02) and intervention (-4.00 ± 3.65; p = 0.03) groups showed a significant reduction in ESS scores, indicating both improved sleepiness. Although the apnea-hypopnea index (AHI) increased in both groups after treatment, these changes were not statistically significant (control 4.73 ± 15.55; p = 0.48, intervention 10.42 ± 14.66; p = 0.12). Tongue strength significantly increased in both groups: control group (p = 0.04) and intervention group (p = 0.03). Satisfaction rates with the overall treatment process were 100% in the control group and 57.1% in the intervention group. Furthermore, 75.0% and 57.1% of participants in the respective groups reported an improvement in QOL.

Conclusion: Frenectomy improved tongue mobility and the ability to perform oral exercises in individuals with OSA and ankyloglossia. However, these exercises did not significantly improve OSA-related symptoms or QOL.

Clinical relevance: While frenectomy enhances tongue mobility, thereby enabling better engagement in oral exercises. These exercises alone did not significantly improve OSA-related symptoms or QOL. This suggests that oral exercises focusing solely on tongue mobility may not be sufficient for managing OSA.

Trial registration: The Thai Clinical Trials Registry was TCTR20220429002.

Objectives: This study aimed to evaluate possible cytotoxic effects of thermoplastic materials commonly used for occlusal splints and orthodontic appliances.

Methods: Seven thermoplastics were included: three variants of the Essix sheets (C+, Plus, and Tray Rite; Dentsply Sirona), three thermoplastics (Bleach Heavy, Splint, and X-Heavy; Cavex Holland) and Invisalign (Align Technology). Cylindrical specimens (n = 24; 10 mm diameter) were incubated in cell culture medium for 24 h and 14 days. After incubation, the medium was collected, serially diluted, and dosed to primary human gingival fibroblasts in triplicate. Medium processed like the samples was used as negative control. Cell viability was evaluated by XTT and LDH assay to assess metabolic activity and membrane integrity, respectively. Next, cell cycle was assessed with flow cytometry after exposing HGFs to undiluted extracts.

Results: The 24-hour and 14-day extracts did not evoke cytotoxicity after 24-hour incubation. No significant differences in cell viability (one-way ANOVA, p > 0.05 ) in the XTT and LDH assays or in cell cycle distribution between the different materials (two-way ANOVA, p > 0.05 ).

Conclusion: The thermoplastics tested in the study showed no evident in-vitro cytotoxic effects. Further investigation should focus on determining which compounds are released from thermoplastic materials and assessing potential toxicity related to exposure to these compounds.

Clinical significance: Our study adds to the growing body of evidence on the biocompatibility of dental thermoplastics. This can aid clinical decision-making, as thermoplastics are expected to be safe to use in terms of cytotoxicity.

Objectives: Single midline implants in the edentulous mandible can be used to support existing complete dentures to improve patients' satisfaction and masticatory efficiency. The impact on patients' dietary habits and the influence of the loading protocol of the implants was the subject of this study.

Materials and methods: In this prospective randomized clinical trial, edentulous patients with existing complete dentures in both jaws were treated with a single midline implant in the mandible. In group A, the implants were loaded immediately, in group B the loading was delayed after three months. Patients were asked to report on their nutritional intake before implant placement and 12, 24 and 60 months after loading using a standardized two-part questionnaire.

Results: Nutritional intake regarding the frequency of consumption of the requested food items did not change significantly during the 60-months study period, regardless of the loading protocol. In contrast, the second part of the questionnaire revealed that after 60 months, there was a significant decrease in avoidance of food, that had a coarse and hard texture in both groups. This significant decrease was observable in the group A in the first 12 and 24 months and in the group B after 60 months.

Conclusion: A change in the patients' dietary habits due to the insertion of a single midline implant in the mandible to support the existing complete denture cannot be observed, independently to the loading protocol.

Clinical relevance: Improving the chewing efficiency by single midline implants in the edentulous mandible does not lead to a change in dietary habits.

Objectives: This study aimed to compare treatment efficacy and cephalometric outcomes between extraction and non-extraction MEAW therapies in non-growing open-bite patients.

Materials and methods: 22 Multiloop Edgewise Archwire MEAW patients (11 males, 11 females) and 15 bicuspid extraction patients (3 males, 12 females) were selected according to a strict inclusion criterion. Comprehensive data collection related to age, sex, Cervical Vertebral Maturation CVM staging, and severity of the Anterior Open Bite AOB (1 = 0-1 mm; 2 = 1-2 mm; 3 = > 2.1 mm) was performed independently and in duplicate by 2 examiners. Each included patient's pre and post-treatment lateral cephalograms were traced and compared. The primary outcomes assessed were related to the efficacy of treatment: treatment duration and time needed to achieve a positive overbite. The secondary outcomes assessed were related to the post-treatment changes in cephalometric measurements between the groups. Descriptive statistics, Mann-Whitney U test, unpaired student's t-test, and Chi-squared were used for data analysis.

Results: The mean change in open bite closure was 3.07 ± 2.07 mm in the MEAW group and 3.03 ± 2.28 mm in the extraction group (P > 0.05). MEAW therapy was 31% faster (118 weeks) than extraction therapy (171 weeks, P = 0.004). MEAW appliance showed a significantly shorter duration for open bite closure (71.82 ± 29.57 weeks) compared to the extraction group (127.25 ± 51.97 weeks, P = 0.002). A greater decrease in the U1-SN was seen in the extraction group (-8.70 ± 6.49°), compared to the MEAW group (-2.56 ± 7.36°, P = 0.047). The IMPA angle showed a greater decrease in the extraction group (-8.30 ± 8.85°) compared to the MEAW group (-0.90 ± 6.50°, P = 0.032). The (L6-MP perp) increased in the extraction group by (1.98 ± 3.43 mm), while decreased in the MEAW group (-0.43 ± 1.38 mm, P = 0.023).

Conclusion: In anterior open bite cases with bicuspid extraction, achieving a positive overbite typically involves retroclining and uprighting the upper and lower incisors (drawbridge effect). In contrast, the MEAW appliance focuses on uprighting the entire dentition and intruding the posterior teeth, often leading to shorter treatment durations.

Clinical relevance: The MEAW appliance's biomechanical advantage in uprighting posterior teeth in open bite cases may shorten treatment duration for correcting open bite malocclusion.

Objective: This study aimed to characterize the inflammatory profile of systemically healthy children's saliva and its association with clinical diagnoses of caries and gingival inflammation.

Materials and methods: Unstimulated saliva was collected from 100 children before clinical dental examinations. The saliva samples were analyzed for total protein and specific inflammatory cytokines (IL-10, IL-8, IL-6, and TNFα) with Bradford and ELISA assays, respectively. Salivary bacteria were quantified using a quantitative real-time polymerase chain assay. The salivary values were then correlated with age, DMFT index, plaque index (PI), and gingival index (GI).

Results: The mean age of the cohort was 8.08 ± 0.23 years with 49% females, the mean DMF of the cohort was 2.64 ± 0.31, the mean GI was 0.51 ± 0.06, and the mean PI was 1.33 ± 0.07. Significant correlations were found between PI with DMFT and GI. Children with DMFT > 2 had significantly higher levels of IL-8 compared with children with DMFT ≤ 2. IL-6 and TNFα were significantly higher among children with PI > 1 than among children with PI ≤ 1.

Conclusions: Salivary cytokine were found to be associate with clinical parameters as DMFT and PI, thus may be a potential tool that reflects dental health status.

Clinical relevance: The presence of salivary cytokines in children may reflect evaluation of dental caries and oral inflammation.

Objectives: To evaluate the efficacy of topically applied hyaluronic acid on wound healing (patient-reported outcomes and clinical healing) after a palatal autogenous gingival graft is harvested.

Materials and methods: A systematic search was performed in April 2024 in eleven electronic databases. Two investigators independently screened the references for inclusion. Outcomes of interest included postoperative pain, analgesic consumption, complete epithelialization, and color match, which were synthesized using narrative synthesis.

Results: A total of 535 results were identified and eight articles were included in the systematic review. Hyaluronic acid use on the palatal donor site had a better response to healing and wound size compared to the control sites with no agent applied. Hyaluronic acid demonstrated a positive effect in the form of complete epithelialization, and color match, with improved patient-reported outcomes such as post-operative pain.

Conclusion: Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions.

Clinical relevance: Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions.

Objectives: Space, an extreme environment, poses significant challenges to human physiology, including adverse effects on oral health (e.g., increase of periodontitis prevalence, caries, tooth sensitivity). This study investigates the differences in oral health routines and oral manifestations among analog astronauts during their daily routines and simulated space missions conducted on Earth.

Materials and methods: This research focused on scientist-astronaut candidates of the International Institute for Astronautical Sciences (IIAS) and analog astronauts from other institutions. The study used a cross-sectional methodology with a descriptive component. A total of 16 participants, comprising individuals aged between 21 and 55 years, were invited to complete an online questionnaire. A comparison was made between the subjects' oral hygiene practices in everyday life (designated as Earth in this research) and their oral hygiene routines during their space analog missions.

Results: (i) Toothbrushing duration was mostly "1-3 minutes" (n = 13; 81.30% on Earth; n = 11; 68.80% on a mission); (ii) "time spent" was the greatest difficulty in maintaining oral hygiene routine on a mission (n = 9; 53,6%); (iii) There were more experienced oral symptoms on Earth (n = 12; 75%) than on mission (n = 7; 43.80%); (iv) The most frequent frequency of oral check-ups was "> 12 months" (n = 6; 37,5%); (v) Oral health materials were scarce on the mission (n = 9; 56.30%); (vi) For the majority, personal oral hygiene was classified as "good" (n = 9; 56.30% on Earth; n = 7; 43.80% on the mission).

Conclusion and clinical relevance: This research contributes to increasing knowledge of oral hygiene measures in extreme environments, but further research is needed as this topic remains relatively understudied. This study represents an initial contribution to oral health in analog space missions, aiming to propose guidelines for future missions, including deep space missions and expeditions to extreme environments.

Objective: To evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD).

Methods: One-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey's HSD, and chi-square tests (alpha = 0.05).

Results: At T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05).

Conclusions: The short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month.

Clinical relevance: Earplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians.