Clinical Oral Investigations最新文献

Objectives: This pilot study aimed to compare the efficacy of 0.1% tacrolimus and 0.05% clobetasol propionate in orabase for treating symptomatic oral lichen planus (OLP).

Materials and methods: Pilot, randomized, and controlled study conducted on 21 patients with symptomatic OLP, selected according to the clinical and histopathological criteria of Cheng et al. 2016. Twelve patients received 0.1% tacrolimus, and nine received 0.05% clobetasol, both in orabase for 30 days with a two-month follow-up. The patients were examined for scores of signs (ODSS), symptoms (VAS), quality of life (OHIP-14), anxiety (Beck Anxiety Scale), and treatment satisfaction (Hedonic Scale).

Results: Both treatments were effective in reducing ODSS, VAS, and Beck Anxiety Scale scores and performed well on the hedonic scale, yet without statistical difference between them. However, at the 1-month follow-up, patients in group Clobetasol showed a greater percentage reduction in ODSS score compared to baseline by 50% (p = 0.02) and significantly lower average values (p = 0.03) than those in group Tacrolimus. Longitudinal intragroup analysis revealed significant improvements over time in both groups for ODSS, and only in the tacrolimus group for OHIP-14 and Beck scores.

Conclusions: Both tested protocols were effective over a three-month follow-up. However, due to the lower cost of clobetasol propionate it can be considered the first-choice option. Tacrolimus in orabase formulation may be a promising alternative for refractory lesions that do not respond to topical steroids.

Clinical relevance: Managing symptomatic OLP is challenging. Comparisons between tacrolimus and clobetasol propionate in orabase formulations have not yet been thoroughly explored.

Objectives: The aim was to identify radiographic characteristics of mandibular third molars in young adults without symptoms or clinical signs of pericoronal infection.

Materials and methods: An existing cross-sectional material, including records from clinical oral examination and panoramic radiographs (PANs) of university students, was submitted to retrospective analysis. The outcome variable was a symptomless and clinically pericoronitis-free mandibular third molar. Predictor variables for the third molar were clinical eruption level, pathological signs in the follicle, marginal bone level, radiographic depth in bone, inclination, stage of root development, and available space for eruption. Statistics included χ² and Mann-Whitney U tests.

Results: Analysis included 345 mandibular third molars in 189 participants (20% men, 80% women; mean age 20.7 years; SD ± 0.6). Symptomless and clinically pericoronitis-free mandibular third molars were characterized as follows: clinically unerupted in 78% of teeth, associated with reduced marginal bone level in 70%, located deeper in the bone in 87%, mesially inclined in 73%, and stage of root development incomplete in 68% (p ≤ 0.001 for all).

Conclusions: Radiographic characteristics of symptomless mandibular third molars without clinical pericoronitis in young adults can be assessed from a PAN with 68-87% certainty.

Clinical relevance: These findings may prove useful when trying to exclude non-pathological mandibular third molars from diseased teeth.

Objectives: To investigate dimensional accuracy of polyether (PE) and vinylpolysiloxane (VPS) impressions taken with manually fabricated and 3D-printed trays.

Materials and methods: To evaluate impression accuracy, highly precise digital data of a metallic lower jaw model with prepared teeth (regions 34 and 36), an implant (region 47) and three precision balls placed occlusally along the dental arch served as reference. PE (Impregum, 3M Oral Care) and VPS (Aquasil, Dentsply Sirona) impressions (n = 10/group) were taken with trays fabricated using different materials and manufacturing techniques (FDM: filament deposition modeling, material: Arfona Tray, Arfona; printer: Pro2, Raise3D; DLP: digital light processing, material: V-Print Tray, VOCO, printer: Max, Asiga; MPR: manual processing with light-curing plates, material: LC Tray, Müller-Omicron) including an open implant impression. Scans of resulting stone models were compared with the reference situation. Global distance and angular deviations as well as local trueness and precision for abutment teeth and scan abutment were computed. Possible statistical effects were analyzed using ANOVA.

Results: Clinically acceptable global accuracy was found (all mean absolute distance changes < 100 μm) and local accuracy for single abutments was excellent. All factors (abutment type, impression material, tray material) affected global accuracy (p < 0.05). In particular with PE impressions, MPR trays led to the best accuracies, both in horizontal and vertical direction.

Conclusions: Within the limitations of this in vitro study, impression accuracy was high in use of both polyether and vinylpolysiloxane combined with different 3D-printed and customized trays making them recommendable for at least impressions for smaller fixed dental prostheses. Manually fabricated trays were overall still the best choice if utmost precision is required.

Clinical relevance: Based on the results of this study, use of innovative CAD-CAM fabrication of individual impression trays fulfills the perquisites to be a viable option for impression making. In the sense of translational research, performance should be proved in a clinical setting.

Objective: This study aimed to determine the survival of class II composite restorations in premolars and molars with and without base bulk-fill composite in general dental practice.

Materials and methods: We collected data from the electronic patient files of the Public Dental Services in the City of Oulu, Finland. The timespan of data collection was from August 15th, 2002, to August 9th, 2018. The data consisted of class II composite restorations both with and without base bulk-fill composite. We compared the survival of these restorations using Kaplan-Meier survival curves, the log-rank test, survival rates, and the Wilcoxon signed ranks test.

Results: We observed 297 restorations in 96 patients. The five-year survival rates for restorations with and without base bulk-fill composite were comparable in premolars (77.5% and 77.4%, respectively) but different in molars (69.9% and 57.8%, respectively, p = 0.069). In molars, the restorations with base bulk-fill composite exhibited a higher survival rate in 14 patients, whereas in 11 patients the restorations without base bulk-fill composites exhibited a higher survival rate. In 24 patients the survival rates were similar for restorations with and without the base bulk-fill composite (p = 0.246).

Conclusions: The restorations with and without base bulk-fill composite had similar longevity.

Clinical relevance: Base bulk-fill composites are safe to use in general practice due to their similar survival rates compared to conventional composites.

Objectives: The primary aim is to assess differences in accuracy of orthodontic bracket positioning between fully digital indirect bracket bonding (IDB) and conventional direct bracket bonding (DBB). The secondary aims are to assess differences in bracket bonding failures, bracket repositioning need, clinician experience and patient satisfaction.

Materials and methods: This prospective study was designed as a split-mouth randomized clinical trial. In total, 35 patients were analyzed with a six month follow-up period. Translational and orientational deviations from the planned bracket position were determined. Clinician experience and patient satisfaction were evaluated by means of a survey.

Results: The difference in translation was 0.34 mm (95% CI: 0.238-0.352, p = 0.017), the difference in orientation was 4.80˚ (95% CI: 3.858-5.727, p < 0.001), both in favour of IDB. IDB showed significantly more immediate (IDB: 3.9%, DBB: 0%) and late (IDB: 5.4%, DBB: 2.5%, p = 0.008) bonding failures. Clinicians and patients experienced a shorter clinical chair time with indirect bonding over direct bonding.

Conclusions: IDB bracket positioning leads to significant smaller translation and orientation deviations from digital IDB planning, than DBB bracket positioning. However, IDB leads to more immediate bonding failures than DBB. The majority of patients preferred IDB over DBB, due to a shorter clinical chair time.

Clinical relevance: This study adds to the knowledge of IDB in orthodontics and contributes to evidence on this technique. This evidence is applicable in everyday orthodontics, with respect to patient satisfaction and technical limits of IDB. The trial was registered in the Dutch Trial Register and the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization (WHO), number NL9411.

Objectives: Previous finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA.

Materials and methods: A previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS^® Mandible Hexadrive cortical screws.

Results: The three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30% reduction in maximum von Mises stress for the top screw and a 46% reduction for the bottom screw.

Conclusions: Fracture treatment with three magnesium screws could be a valuable and sufficiently stable alternative to the established treatment with titanium screws. Further studies on screw geometry could help improve material stability under mechanical loading, enhancing the performance of magnesium screws in clinical applications.

Clinical relevance: The use of magnesium screws for osteosynthesis of mandibular condylar head fractures offers the benefit of reducing the need for second surgery for hardware removal. Clinical data is needed to determine whether the advantages of resorbable screw materials outweigh potential drawbacks in condylar head fracture treatment.

Objectives: This study aimed to estimate the prevalence of prostheses and investigate how demographic and socioeconomic characteristics influence choices of restoration types in the adult population of the United States over 20 years of age.

Materials and methods: The study utilized data from the National Health and Nutrition Examination Surveys (NHANES) conducted from 2017 to March 2020 Pre-Pandemic Data. We examined demographic and socioeconomic variables, dentition status, and restoration types among participants with partial edentulism. The percentage of categorical variables between restoration types was compared using chi-square tests. Multinomial logistic regression models were employed to explore the relationship between prosthetic choices and demographic and socioeconomic factors, both unadjusted and adjusted for all characteristics, including the number of missing teeth.

Results: Out of 15,560 participants, 7,805 eligible individuals with a mean age of 47.8 and a male percentage of 48.4% were included in the analysis. The results indicated that individuals who were younger, male, of Mexican American or non-Hispanic Black ethnicity, possessed lower educational attainment, were never married, had a low income-to-poverty ratio, held private insurance, or were unemployed were more inclined to choose no restoration. Further, males, non-Hispanic Black individuals, those with lower educational attainment, lower income-to-poverty ratios, and those who were unemployed or retired were more likely to choose RPDs over FPDs. Furthermore, never-married individuals and those with private insurance were likelier to choose FPDs in the maxilla (p < 0.01).

Conclusions: Significant differences were observed among restoration types, demographic and socioeconomic variables, and dentition status in both the upper and lower jaws.

Clinical relevance: This study underscores the significance of socioeconomic variables in the restoration of partial edentulism.

Objectives: To assess the effectiveness of ozone therapy in guided bone regeneration (GBR) for critical size calvarial defects in rats.

Materials and methods: 96 male Wistar rats were divided into four groups (n = 6 each). An 8 mm critical defect was created in the calvaria of each rat. The groups were: BIO (porcine collagen membrane, BioGide^®), BIO + OZ (membrane with systemic ozone therapy every 2 days), COA + OZ (blood clot with ozone therapy), and COA (blood clot only). Evaluations at 7, 15, 30, and 60 days included histological, histomorphometric, inflammatory profile, Micro-CT, and immunohistochemical analyses. Statistical analysis involved two-factor ANOVA with Tukey's post-hoc test for general data, and one-factor ANOVA with Holm-Sidak post-hoc test for Micro-CT data.

Results: The BIO + OZ group demonstrated superior bone regeneration with well-organized, mature bone tissue and significant bone formation at 30 and 60 days. The COA + OZ group showed early angiogenesis and reduced inflammation, resulting in complete defect closure by 30 days. The BIO group had good regeneration, but less mature tissue compared to BIO + OZ. The COA group exhibited limited bone formation and higher porosity.

Conclusion: Ozone therapy positively influences bone regeneration by enhancing cell proliferation and the healing response.

Clinical relevance: Improving regenerative processes with auxiliary therapies like ozone therapy can be significant for advancing dental reconstructions.

Objectives: The subepithelial connective tissue graft (SCTG) plus coronal advanced flap is commonly evaluated by clinical parameters, but potential sensory changes (patients' perception of painful or painless sensations) need to be further explored. This preliminary study aimed to qualitatively evaluate the somatosensory profile of recipient and palatal donor sites of SCTG.

Materials and methods: Sensory tests were applied at SCTG recipient and donor sites at baseline, after 3 and 6 months. A single calibrated examiner applied Douleur Neuropathique 4 questionnaire (DN4), qualitative sensory test (QualST), discriminating the areas as hypersensitive, hyposensitive or normosensitive, and two-point acuity test. Descriptive statistics, non-parametric Kruskal Wallis test for QualST evaluation and ANOVA for Two-point test (p < 0.05) were used.

Results: QualST revealed that recipient areas presented no significant differences in tactile, pressure and thermal tests. Brush test revealed hyposensitivity after 3 months (p = 0.03). In donor areas, only thermal evaluation showed a significant difference (p = 0.01), being hypersensitive after 3 months and hyposensitive after 6 months. At baseline, all evaluations in recipient and donor areas were normosensitive. According to DN4, no patient reported pain in recipient and donor sites. Non-painful sensory perception was reported as numbness in recipient (3.14% of patients) and donor (18.4%) areas. No significant differences were found for two-point acuity test values.

Conclusions: Somatosensory variations were observed in donor and recipient areas using qualitative tests, with no detection of painful sensations, only non-painful sensations of numbness and electric shock.

Clinical relevance: This preliminary study demonstrated that alterations of hypo- and hypersensitivity may occur in donor and recipient areas of gingival grafts. However, when present, these alterations were non-painful and did not impact oral functions.

Clinical registration: ReBEC #RBR-7zz3b6p.

Objectives: Persistent idiopathic dentoalveolar pain (PIDP) is a challenging clinical entity associated with both physical and emotional consequences. Currently, the management is symptom-based and includes both topical and/or systemic treatments. More recently, botulinum neurotoxin-A (BONT-A) has been suggested as a treatment option.

Materials and methods: We present a case series of 9 patients (5 female) with mean age 56 ± 15 diagnosed with PIDP. All patients reported prior experience with systemic drugs without a sufficient pain-relieving effect. BONT-A (BOTOX, Allergan) 100 U diluted with saline solution was used and the dose ranged from 20U to 50U distributed in 3 sites (intraoral and/or extraoral) per session. Patients underwent further injections (50U) monthly if pain severity measured using a Numerical Rating Scale (NRS 0-10) was still > 3 for 3 months. Pain severity and characteristics were recorded at baseline (T0), after 1 month (T1), 2 months (T2) and 3 months (T3).

Results: Mean pain intensity at baseline was NRS 6 (4-10). Latency before analgesic effect was at least 5-10 days after injection. Minor adverse effects were sickness and muscular hypotonia. Pain significantly reduced to NRS 4 (0-8) at T1, to NRS 2 (0-8) at T2 and to NRS 2 (NRS 0-8) at T3. Patients' functional variables (discomfort while chewing, talking, swallowing) were also recorded.

Conclusions: BONT-A is widely used and although the exact mechanism of action remains unclear, it can be used effectively in reducing pain for a variety of conditions including PIDP.

Clinical relevance: Our results suggest that BONT-A seems to be an alternative therapeutic approach for patients with PIDP.