Clinical Oral Investigations最新文献

Objectives: The aim of this study was to evaluate the fracture resistance of endocrowns made of experimental short fiber-reinforced CAD/CAM block (SFRC CAD) in comparison with different commercial CAD/CAM materials.

Materials and methods: In this study, 60 sound mandibular molar teeth with similar occlusal sizes (± 1 mm) were used. Standard preparations simulating an endocrown cavity were prepared and the teeth were divided into four groups randomly. After the digital photoimpression of the prepared cavities using a dental intraoral scanner (CEREC), the restorations were designed (4 mm high) and milled using IPS e.max, Cerasmart 270, Katana Avencia and SFRC CAD blocks (n = 15/per group). Restorations were cemented with self-adhesive dual-cure resin cement (G-Cem One). The specimens were immersed in a 37 °C water bath within the chewing simulator. Following cyclic fatigue aging for 1.000.000 cycles (F_max=150 N), a quasi-static load was applied using a universal testing machine at a speed of 1 mm/min. Fractography analysis was conducted using optical microscopy.

Results: According to the data obtained, there are statistically significant differences in fracture resistance values between different CAD/CAM materials (p < 0.05). The highest values were observed in the experimental SFRC CAD group (3025 N), while the lowest values were observed in the IPS e.max group (2295 N).

Conclusions: The type of CAD/CAM restorative material influences the fracture resistance of endocrowns. SFRC CAD blocks could potentially serve as an alternative material for endocrown restorations in the future.

Clinical relevance: Endocrowns fabricated from SFRC CAD blocks have demonstrated promising fracture behavior, suggesting their suitability for clinical testing.

Objective: To assess the upper central incisor's (U1) external apical root resorption (EARR) and incisive canal (IC) changes and their influencing factors under clear aligners and passive self-ligating fixed braces in first premolar extraction cases using CBCT.

Materials and methods: This retrospective study included 60 participants (120 teeth) with similar baseline characteristics based on the American Board of Orthodontics discrepancy index scores. Participants were divided into clear aligner (CA) and passive self-ligating fixed appliance (FA) groups, with 30 participants per group. Pre- and post-treatment EARR, IC dimensional changes, U1-IC proximity, and orthodontic movements were analyzed through CBCT using Invivo 6.0.3 software. Descriptive and analytical statistics are performed, and a P-value < 0.05 is considered statistically significant.

Results: The CA group exhibited statistically significantly lower U1-EARR compared to FA group. However, there were no significant differences in overall IC dimensions (P < 0.05). In FA, contact or invasion of U1 with IC are associated with a significant increase in EARR, but not in CA. The invasion also reveals significant reductions in IC dimensions in FA, whereas CA exhibited more limited changes (P < 0.05). Retraction and intrusion were significantly positively correlated with U1-EARR in FA, whereas intrusion only was correlated positively with U1-EARR in CA (P < 0.05). In both FA and CA, there was no significant correlation between the torque and U1 EARR (P > 0.05). Retraction, intrusion, and torque movements had differential impacts on IC dimensions in FA and CA treatments.

Conclusion: In this study, our findings indicate that in cases involving the extraction of first premolars, Invisalign® clear aligners may have less U1-EARR than passive self-ligating fixed braces but no significant differences in the overall IC dimensions between both appliances. Clear aligners may reveal better outcomes in U1 EARR/IC changes concerning U1-IC proximity and different orthodontic movements. These findings may be necessary for orthodontists to consider during treatment planning.

Clinical relevance: Clear aligners may be an appropriate choice in first premolar extraction cases, especially when the U1 is closer to IC or when there is a need for more retraction, intrusion, and torque. Their potential to reduce root resorption while preserving IC dimensions may make them more advantageous over passive self-ligating fixed braces in these scenarios.

Objectives: To evaluate a tissue autofluorescence (AF) system as an aid for Dental Hygienist (DH) to screening oral mucosa alterations during supportive periodontal care (SPC).

Materials and methods: Two hundred patients in regular SPC with no previous oral mucosa lesions were enrolled. The oral cavity of each patient was examined by a DH without and with the AF system. Afterward, the patient was examined by a General Dentist (GD) by means of conventional visual inspection alone. The primary outcome was the sensitivity of AF system used by a DH. Furthermore, the specificity, predictive values and likelihood ratios were also evaluated. Receiver operating characteristic (ROC) curves were generated and area under ROC (AUROC) was estimated to overall evaluate the ability of DH to detect oral mucosa lesions with and without an AF system.

Results: After completion of intraoral screening, 111 and 66 oral mucosa alterations were detected by DH without and with the AF system. A total of 83 lesions were instead recorded by GD with conventional inspection. The sensitivity and specificity of AF system used by a DH were 61.5% and 90.6% while the conventional visual inspection showed a sensitivity of 81.3% and specificity of 97.6%. AUROC values of 0.760 and 0.894 were found for AF system and for conventional visual inspection respectively.

Conclusions: Whitin the limitations of present study, the results showed for DH an increase of specificity and a loss of sensitivity in detection of oral mucosa alterations using the AF system.

Clinical relevance: The use of AF system may be considered an aid for DH to improve screening of oral mucosal alterations during SPC.

Introduction: This longitudinal study assessed the salivary metabolic profile in patients with head and neck cancer (HNC) treated with radiotherapy (RT). This study aims to investigate salivary metabolites and biological oral pathways induced by RT.

Methods: Clinical data and unstimulated whole-mouth saliva (USWMS) were obtained from 45 HNC patients before, during, and one week after the RT. Data was also collected from 30 healthy controls. NMR spectroscopy identified and quantified 24 metabolites. Spearman's rank correlation analysis and pathway enrichment analysis (MetaboAnalyst 6.0) was performed to check the effect of cancer therapy on the correlation and pathways of different salivary metabolites.

Results: Of 24 metabolites identified, 17 salivary metabolites showed a consistent decrease in the concentration during and after treatment of HNC patients. The metabolite proline decreased, whereas fucose and 1,2-Propanediol were increased in the saliva causing altered redox balance and abnormal fucosylation in HNC patients compared to controls. Spearman correlation analysis indicated changes between pyruvate and some other metabolites, including alanine, trimethylamine, choline, taurine, and succinate, during RT. Five pathways (Pyruvate metabolism; Glycolysis / Gluconeogenesis; Glycine, serine, and threonine metabolism; Glyoxylate and dicarboxylate metabolism; and Alanine, aspartate and glutamate metabolism) are affected, demonstrating the metabolic dysregulation due to RT. The pyruvate metabolism was overpresented with the high Pathway Impact score.

Conclusion: Salivary metabolomics analysis revealed significant alterations in the metabolic profile of HNC patients undergoing RT, providing valuable insights into treatment-induced oral pathobiological changes. Alterations in salivary pathways during RT suggest disturbances in redox homeostasis, oxidative stress, and inflammation. The ability to monitor salivary metabolites and pathways non-invasively holds promise to personalized medicine in HNC treatment by enabling early detection of treatment-related toxicities, monitoring treatment response, and tailoring interventions to patient needs.

Objectives: This systematic review and meta-analysis aimed to compare the anesthetic efficacy of 4% articaine buccal infiltration (BI) with 2% lidocaine inferior alveolar nerve block (IANB) for mandibular first molars with symptomatic irreversible pulpitis.

Methods: Randomized clinical trials (RCTs) comparing the anesthetic efficiency of one cartridge of 4% articaine BI (as the primary injection) with one cartridge of 2% lidocaine IANB in permanent first mandibular molars with symptomatic irreversible pulpitis were searched in five databases. The risk of bias (RoB) was evaluated using the RoB2 (Cochrane Risk of Bias Tool). A fixed-effects meta-analysis was performed using STATA software. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results: Out of 780 records, five RCTs were included. The meta-analysis revealed no significant difference in the success rates of articaine BI and lidocaine IANB [Risk ratio (RR) = 1.06, 95% confidence interval (CI) = (0.93, 1.20), I² = 24.51%)]. The certainty of the evidence was graded as "moderate".

Conclusions: The moderate certainty of evidence suggests that the anesthetic efficacy of 4% articaine BI is comparable to 2% lidocaine IANB for mandibular first molars with symptomatic irreversible pulpitis. However, more clinical trials are needed.

Clinical relevance: BI with 4% articaine for mandibular first molars with symptomatic irreversible pulpitis can be an alternative for clinicians compared with 2% lidocaine IANB.

Objectives: To evaluate the efficacy of non-surgical debridement with repeated diode laser application in comparison to surgical treatment for management of peri-implantitis.

Materials and methods: Forty patients diagnosed with peri-implantitis were randomised into two groups. The test group received mechanical debridement and repeated diode laser therapy at Days 0, 7 and 14. The control group received mechanical debridement at Day 0 followed by surgical treatment at Day 14. Clinical evaluations were performed at baseline, 3 and 12 months.

Results: Thirty-six participants (test n = 17, control n = 19) completed the 12-month observation period. Laser treatment failed in 4 cases (23.5%); of which 3 implants lost osseointegration and one necessitated surgical treatment due to progressively increasing probing depths (PD) and bone loss. In comparison, the control group showed a 100% survival rate with a statistically significant difference between the two groups (p = 0.04). Therefore, thirty-two participants were examined at the final evaluation (test n = 13, control n = 19). Twenty-two implants (57.9%) showed complete disease resolution without significant differences between the groups. The test group reported significantly lower post-operative discomfort on the visual analogue scale (VAS). At 3 months, both groups showed clinical signs of healing with reduction in probing depths (PD) and bleeding upon probing. Surgical treatment resulted in significantly lower PDs (control 3.7 mm [3.2, 4.0], test 4.5 mm [3.8, 4.8]), but recession was significantly higher (control 0.5 mm [0.3, 1.2], test 0 mm [0.0, 0.3]). At the final reevaluation, PD values remained significantly lower in the control group; 3.3 mm [3.1, 3.9] compared to 4.3 mm [3.7, 4.8] for the test group, but the difference in mucosal recession fell below the level of significance. Marginal bone levels improved after one year without significant differences between the two groups (Test = 3.5 mm [2.8, 4.6] at baseline and 1.5 mm [1.0, 4.4] at one year, Control = 2.8 mm [2.5, 3.1] at baseline and 1.4 mm [1.0, 2.6] at one year).

Conclusion: Surgical approaches for management of peri-implantitis demonstrated significant benefits over laser therapy in terms of treatment success and PD reduction. Nevertheless, diode laser therapy, as described in this study, could represent a minimally invasive alternative for treatment of non-advanced peri-implantitis defects.

Objectives: This study aimed to investigate the impact of Twin Block appliances on intracranial pressure (ICP) in adolescents by measuring the optic nerve sheath diameter (ONSD) using ultrasonography.

Methods: We conducted a prospective study involving 20 adolescents (8 girls and 12 boys) with skeletal mandibular retrognathia undergoing treatment with Twin Block appliances. ONSD measurements were taken at six different time points: before appliance placement (T0), 1 min after placement (T1), 10 min after placement (T2), one month after the start of treatment with twin block (T3), immediately after appliance removal (T4), and 10 min after removal (T5). Mean arterial pressure (MAP), heart rate, and peripheral oxygen saturation (SpO2) were also monitored. Statistical analyses were performed using Friedman and Wilcoxon Signed-Rank tests with Bonferroni correction, considering p < 0.05 as statistically significant.

Results: Significant increases in ONSD were observed at T1 and T2 compared to T0 (p < 0.05), with the highest ONSD recorded at T1. No significant changes in ONSD were noted at T3 or T5, indicating that the initial increase in ONSD was temporary. MAP showed a significant decrease at T2, but no significant changes were observed in SpO2 or heart rate across the time points.

Conclusion: This study is the first to report a significant increase in ICP, as indicated by ONSD, in adolescents using Twin Block appliances. The observed rise in ONSD shortly after appliance placement suggests a temporary increase in ICP. These findings highlight the importance of monitoring intracranial pressure during orthodontic treatment, particularly in adolescents.

Objectives: Artificial Intelligence (AI), particularly deep learning, has significantly impacted healthcare, including dentistry, by improving diagnostics, treatment planning, and prognosis prediction. This systematic mapping review explores the current applications of deep learning in dentistry, offering a comprehensive overview of trends, models, and their clinical significance.

Materials and methods: Following a structured methodology, relevant studies published from January 2012 to September 2023 were identified through database searches in PubMed, Scopus, and Embase. Key data, including clinical purpose, deep learning tasks, model architectures, and data modalities, were extracted for qualitative synthesis.

Results: From 21,242 screened studies, 1,007 were included. Of these, 63.5% targeted diagnostic tasks, primarily with convolutional neural networks (CNNs). Classification (43.7%) and segmentation (22.9%) were the main methods, and imaging data-such as cone-beam computed tomography and orthopantomograms-were used in 84.4% of cases. Most studies (95.2%) applied fully supervised learning, emphasizing the need for annotated data. Pathology (21.5%), radiology (17.5%), and orthodontics (10.2%) were prominent fields, with 24.9% of studies relating to more than one specialty.

Conclusion: This review explores the advancements in deep learning in dentistry, particulary for diagnostics, and identifies areas for further improvement. While CNNs have been used successfully, it is essential to explore emerging model architectures, learning approaches, and ways to obtain diverse and reliable data. Furthermore, fostering trust among all stakeholders by advancing explainable AI and addressing ethical considerations is crucial for transitioning AI from research to clinical practice.

Clinical relevance: This review offers a comprehensive overview of a decade of deep learning in dentistry, showcasing its significant growth in recent years. By mapping its key applications and identifying research trends, it provides a valuable guide for future studies and highlights emerging opportunities for advancing AI-driven dental care.

Objectives: To develop a highly sensitive and reliable method for detecting Monobond Etch & Prime (MEP) residues on lithium disilicate glass ceramic (LDGC) surfaces treated with different cleaning procedures after MEP treating.

Materials and methods: A sensitive and reliable high performance liquid chromatography-tandem triple quadrupole mass spectrometry (HPLC-TTQ/MS) method was developed for the accurate quantitative determination of tetrabutylammonium dihydrogen trifluoride (TDTF) in MEP. 100 rectangular LDGC specimens (8.0 × 5.0 × 2.0 mm) were fabricated using CAD/CAM and then treating with MEP. The residual amount of TDTF in the LDGC specimens surface was tested after different cleaning procedures with different experience dentists (Junior Dentist, Experienced Dentist), different rinsing times (3 s, 6 s, 9 s) and with or without ultrasonic cleaning (UC) (n = 10).

Results: The developed method showed good linearity (r² > 0.999) over a wide concentration range. The limit of quantification of TDTF for MEP residue was less than 5 ng/mL. The method was then applied to a comparative study of MEP residues after various cleaning procedures of LDGC specimens. Residual TDTF was detected in all experimental groups with masses ranging from 62.42 ng to 74,611.74 ng. In the absence of UC, the Experienced Dentist group had lower TDTF residual levels (5,930.74 ng) than the Junior Dentist group (30,802.05 ng) (P < 0.001). The TDTF residue level was significantly lower in the rinsing 9 s group (3,102.89 ng) compared to the rinsing 3 s group (25,348.57 ng) (P < 0.05). After UC, for the same rinsing time there was no significant difference in TDTF residue between groups (P ≥ 0.062). Notably, TDTF residue levels were substantially lower after UC with the same cleaning dentist and rinsing time (P ≤ 0.012).

Conclusions: No cleaning procedure can completely remove MEP residues, the dentist's clinical experience affects the degree of MEP cleaning, extended rinsing time improves cleaning efficiency, and ultrasonic cleaning is an effective method of removing MEP residues.

Clinical relevance: No cleaning procedure can completely remove MEP, and dentists can increase the efficiency of cleaning by extending the rinsing time and using ultrasonic cleaning.