Clinical Oral Investigations最新文献

Objective: The objective was to develop a manually operatable, non-electric device to measure salivary spinnbarkeit for research, clinical and educational purposes.

Materials and methods: A newly developed device, named the Kamranmeter, was built and evaluated in a pilot study, comparing the spinnbarkeit of unstimulated and chew-stimulated saliva samples from healthy volunteers. The Neva Meter, which operates on electrical resistance, was used as a reference standard.

Results: The study found no statistically significant differences between the two devices when measuring the spinnbarkeit of both unstimulated and stimulated saliva samples from healthy volunteers.

Conclusions: We developed a hand-operated device to analyse salivary spinnbarkeit. The Kamranmeter performs comparably to the Neva Meter in measuring spinnbarkeit in saliva obtained from healthy volunteers.

Clinical relevance: The Kamranmeter has potential applications in diagnostic tests involving saliva, such as assessing spinnbarkeit to evaluate conditions like caries and dry mouth. Moreover, it holds promise for broader medical uses, including fertility assessments, where spinnbarkeit is a key indicator of cervical mucus quality. Its ease of handling is expected to make it well-suited for research, clinical, and educational applications.

Objectives: To evaluate the antibacterial efficacy of two fluoride-containing (1450 ppm F) toothpastes with or without zinc-citrate (ZCT), hydroxyapatite (HAP) and potassium-citrate (KCit); to assess and compare their clinical effects in terms of tooth sensitivity, plaque accumulation and gingivitis, as well as patients' satisfaction.

Materials and methods: Healthy, adult patients were selected and randomly assigned to two groups (n = 50): Experimental: ZCT-, HAP-, KCit- and fluoride-containing toothpaste; Control: fluoride-containing toothpaste. Salivary counts of Streptococcus mutans (S. mutans), plaque and gingival index, as well as clinically diagnosed sensitivity were recorded at baseline, and after 4 weeks. A custom-made questionnaire was used to assess patients' self-reported sensitivity (baseline and after 4 weeks) and overall satisfaction with the tested toothpastes. Data were statistically analyzed (α = 0.05).

Results: After 4 weeks, a statistically significant salivary reduction of S. mutans was observed in both groups (p = 0.001). Furthermore, the percentage of S. mutans decrease was significantly higher in Experimental group (p = 0.014). There were no statistically significant differences between the groups in terms of plaque and gingival index (p > 0.05). After 4 weeks, the self-reported tooth sensitivity was lower in Experimental group (p < 0.001).

Conclusions: Both toothpastes showed good antimicrobial effect after 4 weeks; however, the toothpaste containing ZCT, HAP, KCit and fluoride was found to be more effective in reducing the salivary counts of S. mutans than the product containing fluoride alone.

Clinical relevance: Toothpaste containing ZCT, HAP, KCit and fluoride can be recommended for patients at risk for developing caries and may also be beneficial for individuals experiencing dental sensitivity.

Objective: Comparatively assess the fluorescence and color adjustment potentials of paste-type and flowable resin composites performed in cervical restorations.

Materials and methods: Five paste-type resin composites and 5 highly-filled flowable composites were investigated (n=5 for each). Class V cavities on 50 extracted A2 shade human central incisors were restored. Cross-polarization (CP) and fluorescence illumination (FI) images were recorded for each restoration. L*a*b* values were analyzed using the Photoshop software and color adjustment (ΔE_CP) and fluorescence adjustment (ΔE_FI) levels were quantitatively assessed. Kruskal Wallis Test, Independent Samples t Test, One Way Anova-Welch test, and Pearson Correlation were used for the statistical analyses. The deemed significance was set at p<.050.

Results: Paste-type composites presented significantly lower ΔE_FI and ΔE_CP values than the flowable composites (p=.006 and p<.001 respectively). ΔE_FI and ΔE_CP values were positively correlated (r=0.584; p<.001). Paste-type Gaenial A'chord presented the lowest ΔE_FI value [7.67 (5.35 - 10.99)^b], while Estelite Asteria presented significantly the highest [19.94 (17.08 - 22.17)^c]. Charisma Diamond One Flow presented the highest ΔE_CP value [3.25 (3.13 - 3.39)^a] and Gaenial A'chord presented the lowest [0.79 (0.48 - 0.87)^e] which was the only imperceptible score (<0.8). The only clinically acceptable color adjustment was found for Geanial Universal Injectable [1.06 (0.73 - 1.62)^e] among the flowable composites. ΔE_FI and b* values were positively correlated (r=0.493; p<.001).

Conclusions: Color adjustment level and fluorescence adjustment level were considered coherent for particular composite brands. At the same time, both were better for the paste-type composites than the flowable composites on A2 base shade class V restorations. Fluorescence adjustment potential as well as the color adjustment potential varied among different composite brands regarding paste-type and flowable composites.

Clinical significance: Understanding both the color and fluorescence adjustment potentials of paste-type and flowable resin-based composite materials is clinically vital to achieve the high-end esthetics.

Objective: To develop and validate an artificial intelligence (AI)-driven tool for automated segmentation of the pulp cavity system of mandibular molars on cone-beam computed tomography (CBCT) images.

Materials and methods: After ethical approval, 66 CBCT scans were retrieved from a hospital database and divided into training (n = 26, 86 molars), validation (n = 7, 20 molars), and testing (n = 33, 60 molars) sets. After automated segmentation, an expert evaluated the quality of the AI-driven segmentations. The expert then refined any under- or over-segmentation to produce refined-AI (R-AI) segmentations. The AI and R-AI 3D models were compared to assess the accuracy. 30% of the testing sample was randomly selected to assess accuracy metrics and conduct time analysis.

Results: The AI-driven tool achieved high accuracy, with a Dice similarity coefficient (DSC) of 88% ± 7% for first molars and 90% ± 6% for second molars (p > .05). The 95% Hausdorff distance (HD) was lower for AI-driven segmentation (0.13 ± 0.07) compared to manual segmentation (0.21 ± 0.08) (p < .05). Regarding time efficiency, AI-driven (4.3 ± 2 s) and R-AI segmentation (139 ± 93 s) methods were the fastest, compared to manual segmentation (2349 ± 444 s) (p < .05).

Conclusion: The AI-driven segmentation proved to be accurate and time-efficient in segmenting the pulp cavity system in mandibular molars.

Clinical relevance: Automated segmentation of the pulp cavity system may result in a fast and accurate 3D model, facilitating minimal-invasive endodontics and leading to higher efficiency of the endodontic workflow, enabling anticipation of complications.

Objectives: During mandibular third molar (MTM) extraction surgery, preoperative analysis to quantify the proximity of the MTM to the surrounding inferior alveolar nerve (IAN) is essential to minimize the risk of IAN injury. This study aims to propose an automated tool to quantitatively measure the proximity of IAN and MTM in cone-beam computed tomography (CBCT) images.

Materials and methods: Using the dataset including 302 CBCT scans with 546 MTMs, a deep-learning-based network was developed to support the automatic detection of the IAN, MTM, and intersection region IR. To ensure accurate proximity detection, a distance detection algorithm and a volume measurement algorithm were also developed.

Results: The deep learning-based model showed encouraging segmentation accuracy of the target structures (Dice similarity coefficient: 0.9531 ± 0.0145, IAN; 0.9832 ± 0.0055, MTM; 0.8336 ± 0.0746, IR). In addition, with the application of the developed algorithms, the distance between the IAN and MTM and the volume of the IR could be equivalently detected (90% confidence interval (CI): - 0.0345-0.0014 mm, distance; - 0.0155-0.0759 mm³, volume). The total time for the IAN, MTM, and IR segmentation was 2.96 ± 0.11 s, while the accurate manual segmentation required 39.01 ± 5.89 min.

Conclusions: This study presented a novel, fast, and accurate model for the detection and proximity quantification of the IAN and MTM on CBCT.

Clinical relevance: This model illustrates that a deep learning network may assist surgeons in evaluating the risk of MTM extraction surgery by detecting the proximity of the IAN and MTM at a quantitative level that was previously unparalleled.

Objective: This randomised clinical study aimed to assess the influence of low-dose cone-beam computed tomography (CBCT) on the visibility of the mandibular canal (MC) and its proximity to mandibular third molars (M3Ms) as assessed by general dental practitioners (GPs) and oral-maxillofacial surgeons (OMFSs), as well as its impact on their clinical decisions, when compared to standard-dose CBCT.

Methods: 154 impacted M3Ms from 90 patients were randomly assigned to three groups for two CBCT exposures using one standard-dose (333 mGy×cm²) and one of the three investigated low-dose (78-131 mGy×cm²) protocols. Blinded assessments of the MC visibility, M3M-MC proximity, surgical approach, crown/root sectioning, and referral decisions, were made by GPs and OMFSs on the images separately. Pairwise comparisons for MC visibility between paired scans were evaluated using Wilcoxon signed rank test, followed by a non-inferiority test with non-inferiority margin of 0.5 on a four-point scale. Differences in other variables between paired scans were evaluated using Wilcoxon signed-rank or McNemar tests.

Results: The majority (78.5-99.3%) of MCs were clearly identified on standard-dose CBCT by all observers. Pairwise comparisons showed significant differences between paired scans only in MC visibility but not in the M3M-MC proximity or treatment decisions. The mean differences in MC visibility between paired scans ranged 0-0.22 with the upper bounds of the 95% confidence intervals (0.09-0.36) falling within the non-inferiority region.

Conclusions: The investigated low-dose CBCT protocols could provide acceptable image quality for the evaluation of impacted M3Ms in most cases. When compared to standard-dose CBCT, these low-dose CBCT images did not significantly affect the assessments of the M3M-MC proximity, treatment strategies, and patient management decisions made by GPs and OMFSs.

Clinical relevance: The low-dose protocols might be clinically acceptable for M3M management while greatly reducing radiation exposure.

Objectives: The C-shaped mandibular second molars (MSMs) may pose an endodontic challenge. The aim of this study was to develop a convolutional neural network (CNN)-based deep learning system for the diagnosis of C-shaped MSMs on panoramic radiographs.

Materials and methods: Panoramic radiographs and cone beam computed tomographic (CBCT) images were collected from a hospital in China and subsequently divided into two groups. In Group A, conventional panoramic images and CBCT images were derived from the same patients (n = 730 individuals), and the dataset consisted of conventional panoramic image patches of 1453 MSMs. In Group B (n = 610 individuals), the patients underwent CBCT examinations in the absence of available panoramic images; CBCT images were acquired and utilized to generate simulated panoramic images, and the dataset consisted of image patches of 1211 MSMs. Five pretrained CNN networks (ResNet-101 and - 50, DenseNet-121 and - 161, and Inception-V3) were utilized for the classification of C-shaped and non-C-shaped MSMs. Finally, the networks trained on the Group B dataset were tested on the Group A dataset. The diagnostic performance of each model was evaluated using receiver operating characteristic (ROC) curve analysis, and the CBCT images were taken as the gold standard. The results were compared with those achieved by three dental professionals.

Results: In Group A, all five networks exhibited satisfactory diagnostic performance, with AUC values ranging from 0.875 to 0.916 and accuracies ranging from 81.8 to 86.7%. No statistical differences were detected among the five CNNs. Notably, the models trained with Group B dataset (CBCT-generated panoramic images) achieved enhanced performance as tested on Group A dataset. The AUC values reached 0.984-0.996, and the accuracies ranged between 94.5% and 98.1%. CNNs outperformed dental professionals in classification performance, and the AUC values achieved by dental specialist, novice dentist, and dental graduate student were only 0.806, 0.767 and 0.730, respectively.

Conclusion: CNN-based deep learning system demonstrated higher accuracy in the detection of C-shaped MSMs on panoramic radiographs compared to dental professionals. CBCT-generated panoramic images can serve as a substitute for conventional panoramic images in the training of CNN models when the quantity and quality of conventional panoramic image dataset is insufficient.

Clinical relevance: CNN-based deep learning models have demonstrated significant potential in assisting dentists with the identification of C-shaped MSMs on panoramic radiographs, which facilitating more effective, efficient and safer dental treatment.

Objectives: The study was conducted to investigate the effect of Yoga-based exercise program on pain, range of motion (ROM), quality of sleep, depression and quality of life in female patients with myofacial pain of temporomandibular disorders (TMD).

Materials and methods: 39 Female patients with myofacial pain of TMD were included in the study. Yoga based exercise program was performed to the first group and second group was control group. Visual Analog Scale (VAS), Neck Pain and Disability Scale (NPDS), neck and jaw ROM, Pittsburg Sleep Quality Index (PUQI), Beck Depression Inventory (BDI) and Short Form 36 (SF36) were evaluated. Evaluations were repeated before treatment and 6 weeks later.

Results: From the measurements, a decrease in Temporomandibular Joint (TMJ) (p = 0.005) and neck pain (p = 0.031) was found to be significant in favor of Yoga Group. It was also observed that the increase in ROM in the neck right lateral flexion (p = 0.001) in favor of Yoga Group. The sleep quality did not change. In yoga group, a decrease in depression level (p = 0,023) and increase Quality of life in parameters of physical function (p = 0.023), vital capacity (p = 0.026), emotional health (p = 0.002), mental health (p = 0.080) were found as significant, statistically.

Conclusions: It was concluded that yoga-based exercise program can be used as an alternative program in patients with myofacial pain of TMD. Further study on myofascial pain of TMD is recommended.

Clinical relevance: Yoga-based exercise program can be used in patients with myofascial pain due to TMD.

Objective: The objective of this randomized controlled clinical trial (RCT) was to compare the frequency of early implant failure, postoperative infection, and pain/inflammation and the degree of implant stability between healthy non-penicillin-allergic individuals receiving a single prophylactic dose of 600 mg clindamycin versus 2 g amoxicillin at 1 h before implant surgery.

Materials and methods: A single-center double-blinded RCT study with parallel groups was undertaken. Eighty-two patients fulfilled study inclusion criteria and were randomly assigned to the amoxicillin (n = 41) or clindamycin (n = 41) group. The primary outcome variable was early implant failure. The presence of infection was evaluated immediately after surgery and on days 7, 14, 30, and 90, and postoperative pain/inflammation was assessed daily on days 1 to 7 post-surgery. Resonance frequency analysis was used to measure primary and secondary implant stability.

Results: One early implant failure was observed (1/81), in a patient from the amoxicillin group. No statistically significant between-group differences were observed in early implant failure rate, postoperative infection rate up to 90 days, pain/inflammation scores during the first week post-surgery, or primary or secondary stability values.

Conclusions: A single dose of 600 mg clindamycin before implant surgery does not increase the risk of early implant failure or infection.

Clinical relevance: These findings suggest that a single dose of 600 mg clindamycin at 1 h before implant surgery is a safe antibiotic prophylactic approach; however, when a more prolonged antibiotic therapy is required, it appears advisable to prescribe an alternative antibiotic to avoid adverse effects.

Objective: This study aimed to systematically review the effect of laser treatment on the bond strength of epoxy resin-based and calcium silicate-based endodontic sealers to root dentine.

Methods: The search encompassed four databases: PubMed/MEDLINE, EMBASE, Scopus, and ISI Web of Science. Inclusion criteria were limited to in vitro studies conducted on extracted human teeth evaluating bond strength in megapascals (MPa) of either epoxy resin-based or calcium silicate-based sealers, using the push-out test. Two independent reviewers appraised the methodological quality of the selected studies to assess the risk of bias. Meta-analysis was performed for different laser types, endodontic sealers, and control groups. Standard Mean Difference and 95% Confidence Interval values were calculated.

Results: 17 studies met the inclusion criteria for qualitative synthesis, and 15 for quantitative analysis. Meta-analyses revealed that certain lasers (Er,Cr:YSGG, Er:YAG) significantly increased bond strength for epoxy resin-based sealers when compared to negative controls (inert solutions), but did not show a significant advantage over EDTA agent. For calcium silicate-based sealers, laser treatment did not show significant enhancement in bond strength compared to either inert solutions or EDTA. The subgroup analysis suggested that erbium lasers, especially in the PIPS mode, potentially increase the bond strength of epoxy resin-based sealers.

Conclusion: Laser treatment enhances the bond strength of epoxy resin-based sealers compared to inert solutions, but not more than EDTA. For calcium silicate-based sealers, laser treatment does not significantly improve bond strength over inert solutions or EDTA.

Clinical relevance: Laser treatment increases the bond strength of epoxy resin-based sealers.