Clinical Oral Investigations最新文献

Objectives: This study was aimed to investigate the efficacy of comprehensive conservative treatments in patients with temporomandibular joint (TMJ) retrodiscal layer rupture and/or disc perforation.

Materials and methods: This was a retrospective study of thirty-one consecutive patients with findings of TMJ retrodiscal layer rupture and/or disc perforation using magnetic resonance imaging. Comprehensive stomatognathic system assessments were performed. Comprehensive treatment modalities were applied to each patient and treatment outcomes were analyzed. The changes in patient-reported symptoms and comfortable mouth opening (CMO) and maximum mouth opening (MMO) distances were analyzed between the baseline and after treatment.

Results: Twenty-eight females and three males were included in this study. Four patients (12.9%) reported a history of facial injury and another four (12.9%) reported having rheumatoid arthritis. Unilateral chewing was the most frequently reported parafunctional habit, followed by clenching. The mean treatment duration was 24.3 ± 11.1 months. Most of the patients received more than one type of treatment. Both CMO and MMO distances increased significantly (P < 0.001) after treatment. Approximately three-quarters of patients reported partial improvement in symptoms, and one-fourth reported complete improvement.

Conclusions: Comprehensive conservative treatments were effective and should be applied first in patients with TMJ retrodiscal layer rupture and/or disc perforation.

Clinical relevance: Conservative treatments are recommended for patients with severe damage to the TMJ structures, such as retrodiscal layer rupture and/or disc perforation, before applying surgical approach.

Objectives: To evaluate recent advances in the automatic multimodal registration of cone-beam computed tomography (CBCT) and intraoral scans (IOS) and their clinical significance in dentistry.

Methods: A comprehensive literature search was conducted in October 2024 across the PubMed, Web of Science, and IEEE Xplore databases, including studies that were published in the past decade. The inclusion criteria were as follows: English-language studies, randomized and nonrandomized controlled trials, cohort studies, case-control studies, cross-sectional studies, and retrospective studies.

Results: Of the 493 articles identified, 22 met the inclusion criteria. Among these, 14 studies used geometry-based methods, 7 used artificial intelligence (AI) techniques, and 1 compared the accuracy of both approaches. Geometry-based methods primarily utilize two-stage coarse-to-fine registration algorithms, which require relatively fewer computational resources. In contrast, AI methods leverage advanced deep learning models, achieving significant improvements in automation and robustness.

Conclusions: Recent advances in CBCT and IOS registration technologies have considerably increased the efficiency and accuracy of 3D dental modelling, and these technologies show promise for application in orthodontics, implantology, and oral surgery. Geometry-based algorithms deliver reliable performance with low computational demand, whereas AI-driven approaches demonstrate significant potential for achieving fully automated and highly accurate registration. Future research should focus on challenges such as unstable registration landmarks or limited dataset diversity, to ensure their stability in complex clinical scenarios.

Objectives: In advanced stages of osteoradionecrosis, medication-related osteonecrosis of the jaw, and osteomyelitis, a resection of sections of the mandible may be unavoidable. The determination of adequate bony resection margins is a fundamental problem because bony resection margins cannot be secured intraoperatively. Single-photon emission computed tomography (SPECT-CT) is more accurate than conventional imaging techniques in detecting inflammatory jaw pathologies. The clinical benefit for virtual planning of mandibular resection and primary reconstruction with vascularized bone flaps has not yet been investigated. This study aimed to evaluate the determination of adequate bony resection margins using SPECT computed tomography (SPECT-CT) for primary microvascular reconstruction of the mandible in inflammatory jaw pathologies.

Materials and methods: The cases of 20 patients with inflammatory jaw pathologies who underwent primary microvascular mandibular reconstruction after the bony resection margins were determined with SPECT-CT were retrospectively analyzed. The bony resection margins determined by SPECT-CT were histologically validated. The sensitivity was calculated as the detection rate and the positive predictive value as the diagnostic precision. Radiological ossification of the vascularized bone flaps with the mandibular stumps was assessed at least 6 months after reconstruction. The clinical course was followed for 12 months.

Results: The determination of adequate bony resection margins with SPECT-CT yielded a sensitivity of 100% and a positive predictive value of 94.7%. Of all the bony resection margins, 97.4% were radiologically sufficiently ossified with the vascularized bone flap and showed no complications in the clinical course.

Conclusions: SPECT-CT could increase the probability of determining adequate bony resection margins.

Clinical relevance: SPECT-CT could have a beneficial clinical impact in the context of primary microvascular bony reconstruction in inflammatory jaw pathologies.

Objective: To evaluate short, mid and long-term clinical outcomes and patients' satisfaction of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear. Furthermore, materials were analyzed to identify their influences on clinical results.

Materials and methods: Search was conducted in PubMed, Cochrane Central Register of Controlled Trial, Embase, Web of science and Scopus until December 19, 2024. Randomized clinical trials (RCT), cohort studies and case series with at least mean period of 3 years were included. The revised Cochrane risk of bias tool, Newcastle-Ottawa scale and Joanna Briggs Institute Critical Appraisal were used to evaluate the quality of RCT, cohort studies and case series. Meta-analysis and Poisson regression were conducted.

Results: Ten studies in this review included three case series, six cohort studies and one RCT with three low, six moderate risks and one some concerns. Annual failure rates (AFRs) and annual complication rates (ACRs) of direct composite restorations were 0-6.2% and 1.0%-4.2%, respectively. AFRs of indirect restorations were 0%-0.5%. Overall ACRs of indirect restorations fabricated by traditional indirect resin composites, polymer-infiltrated ceramic-network, resin nanoceramics and ceramics were at 1.6%-15.1%, 0.7%-4.8%, 0.5%-5.0% and 0.2%-1.1%, respectively. The estimated AFRs of direct composites, resin nanoceramics and ceramics were 0.64%, 0.13% and 0.04% respectively. Significantly lowest AFRs of ceramic was found after mid-term follow-up with incidence rate ratios of direct composites, resin nanoceramics and ceramics being 1: 0.68 (P = 0.60): 0.001 (P < 0.05). The estimated ACRs of the three materials were 2.16%, 2.14% and 0.62%. Overall AFRs of restorations using different techniques were 0%-0.5%. Overall ACRs of direct and indirect techniques were 1.1%-2.2% and 0.2%-4.8%, respectively. Overall ACRs of hybrid technique were 0.5% to 15.1%. Restoration fracture was the most predominant complication regardless of materials. High appreciation was expressed by patient reported outcomes measures.

Conclusions: Minimally invasive full-mouth rehabilitation for patients with moderate to severe tooth wear presented good clinical performance apart from traditional indirect resin composite used in posterior teeth.

Clinical relevance: Minimally invasive full-mouth rehabilitation should be strongly advocated for the patients with moderately and severely worn dentition.

Objectives: The main symptom of diabetes mellitus (DM) is hyperglycaemia, and patients with DM often have microvascular complications, such as retinopathy, neuropathy, and nephropathy; macrovascular complications, such as coronary heart disease, peripheral arterial disease and cerebrovascular disease; and oral complications, such as xerostomia, hyposalivation and periodontal disease. The main aim of this study was to evaluate the submandibular and parotid glands in type 2 DM patients and healthy individuals and to determine the changes in the salivary glands caused by diabetes.

Materials and methods: In this study, the salivary glands of 100 patients (50 individuals with type 2 DM and 50 healthy individuals) were evaluated by ultrasonography (US). Echogenicity, parenchymal homogeneity, hypoechogenic and hyperechogenic areas, margin characteristics, and vascularity of the glands were analysed. The anteroposterior, superoinferior, and mediolateral lengths and volumes of the submandibular glands were measured.

Results: Statistically significant differences in submandibular gland echogenicity, parotid gland vascularity, and hyperechogenic reflections of the parotid glands were observed between the groups (p < 0.05). In addition, the volume and dimensions of the submandibular glands were significantly greater in the type 2 DM group.

Conclusions: DM leads to changes in the salivary glands. US, which has many advantages for salivary gland imaging, is a highly effective method for investigating these changes in individuals with diabetes.

Clinical relevance: US, which is well tolerated by patients and does not involve ionizing radiation, can be used for long-term monitoring of the effects of diabetes mellitus on the salivary glands.

Introduction: Cymbopogon martini, Syzygium aromaticum, and Cupressus sempervirens are used for antimicrobial purposes in the worldwide. Both their extracts and essential oil contents are rich in active ingredients.

Objective: The aim of this study was to investigate the inhibitory effect of Cymbopogon martini essential oil (CMEO), Syzygium aromaticum essential oil (SAEO) and Cupressus sempervirens essential oil (CSEO) on Candida albicans biofilm formation on heat-polymerized polymethyl methacrylate (PMMA) samples in vitro and in silico.

Materials and methods: Essential oil contents with anticandidal potential were determined by Gas Chromatography-Mass Spectrometry. Following C. albicans adhesion, PMMA samples were treated independently with Corega^® and each essential oil. The anticandidal activity of the essential oils was determined by spectrophotometric absorbance measurement at 600 nm, taking into account the cultures of each sample. The cytotoxicity evaluation of essential oils was performed by MTT Colorimetric assay. The software package AutoDockTools (1.5.6) was used for the in silico studies. The effect of essential oil content on the inhibition of Secreted aspartic proteinase (SAP2) was evaluated considering the Ligand@SAP2 complex formation.

Results: 2% of CMEO and 5% of SAEO exhibited higher anticandidal activity than Corega^® (p < 0.05), whereas Corega^® had higher anticandidal activity than 2% and 5% of CSEO (p < 0.05). The cytotoxicity of essential oils on NIH/3T3 cells after 24 h was found to be 2.41 for CSEO, 2.84 for CMEO, and 2.85 µg/mL for SAEO. The results of the in silico study showed that citronellol from CMEO, chavibetol (m-eugenol) from SAEO and β-pinene from CSEO each had the highest effect on the inhibition of SAP2. The highest binding affinity value was found for citronellol at -5.3 kcal/mol.

Conclusions: The biofilm formation of C. albicans onto acrylic resin was inhibited by CMEO, SAEO and CSEO at a concentration of 2% through in vitro assay. The most effective inhibition was determined to be due to citronellol in CMEO through in silico analysis.

Objective: Evaluation of the accuracy of direct digitization of maxillary scans depending on the scanning strategy.

Materials and methods: A maxillary model with a metal bar as a reference structure fixed between the second molars was digitized using the CEREC Primescan AC scanner (N = 225 scans). Nine scanning strategies were selected (n = 25 scans per strategy), differing in scan area segmentation (F = full jaw, H = half jaw, S = sextant) and scan movement pattern (L = linear, Z = zig-zag, C = combined). Trueness was assessed by evaluating linear differences in the X, Y, and Z axes and angular deviations (α axial, α coronal, α total) compared to a reference dataset. Statistical differences were analyzed using Kruskal-Wallis and Mann-Whitney U tests (p<0.017). Precision was analyzed by the standard deviation of linear and angular aberrations (ISO 5725-1) (p < 0.05).

Results: Strategy F_L showed significantly higher trueness and precision than F_Z for VE (p = 0.009), V_E(y) (p = 0.010), α_overall (p = 0.004), and α_axial (p = 0.002). Strategy F_C demonstrated significantly better trueness than F_Z for VE (p = 0.007), α_overall (p = 0.010), and α_coronal (p = 0.013). For scan segmentation, F_L showed better trueness for V_E(y) (p = 0.001) and α_axial (p < 0.001) than H_L. Strategy H_L showed better trueness for V_E(z) than for F_L and S_L (p = 0.001, p = 0.002). The scanning patterns F_L, F_C, and H_L exhibited the best performance for trueness and precision.

Conclusions: Scanning motion and segmentation have a significant impact on the trueness and precision of full-arch scans.

Clinical relevance: The scanning strategy is decisive in enhancing the clinical workflow and the accuracy of full-arch scans.

Objectives: To develop a platform including a deep convolutional neural network (DCNN) for automatic segmentation of the maxillary sinus (MS) and adjacent structures, and automatic algorithms for measuring 3-dimensional (3D) clinical parameters.

Materials and methods: 175 CBCTs containing 242 MS were used as the training, validating and testing datasets at the ratio of 7:1:2. The datasets contained healthy MS and MS with mild (2-4 mm), moderate (4-10 mm) and severe (10- mm) mucosal thickening. A DCNN algorithm adopting 2.5D structure was trained for automatic segmentation. Automatic measuring algorithms were further developed to evaluate the clinical reliability of the DCNN.

Results: The median Dice Similarity Coefficient (DSC) for the air cavity, mucosa, teeth and maxillary bone segmentation were 0.990, 0.850, 0.961 and 0.953, respectively. The Intra-class Correlation Coefficien (ICC) of all automatic measuring algorithms exceeded 0.975. The 95% confidence interval (95%CI) of all volumetric metric bias were within ± 0.5 cm³, of all 2D metric bias were within ± 1 mm. The DCNN also produced satisfying outcome for notably incomplete MS and edentulous alveolar crest.

Conclusions: The DCNN provided clinically reliable results. The automatic measuring algorithms could reveal 3D information embedded in CBCT 2D planes on the basis of automatic segmentation.

Clinical relevance: This platform helps dentists to conduct instant 3D reconstruction and automatic measuring of 3D clinical parameters of MS and adjacent structures.

Objectives: This study aimed to accurately assess the gingival phenotype by comparing the mean gingival thickness (GT) measured at various levels with a single-point GT measurement.

Materials and methods: Fifty participants were divided into thin and thick gingival phenotype groups according to two different classifications. The first classification was based on the GT measured at the base of the gingival sulcus (GT1), whereas the second classification was based on the mean of the GT (GTm) measured at the base of the gingival sulcus (GT1 point) and 1 mm apical (GT2 point) and 2 mm apical to the base of the gingival sulcus (GT3 point). The GT was measured using the transgingival method from the buccal region of 1195 teeth, including the incisors, canines, premolars, and first molars, and was statistically analyzed.

Results: The mean GT was 0.95 ± 0.25 mm for GT1, 0.97 ± 0.3 mm for GT2, 0.81 ± 0.22 mm for GT3, and 0.91 ± 0.22 mm for the overall GTm. Good agreement was found between the GTm and GT1 and GT2 (k = 0.712; k = 0.758, p < 0.001for both), and moderate agreement was found between the GTm and GT3 (k = 0.534, p < 0.001). In both classifications, the effect of the dental arch location on the GT was found to be statistically significant.

Conclusion: Standardized methods are required to minimize the differences in measurements from different vertical levels, which can influence gingival phenotype classification.

Clinical trial registration: ClinicalTrials.gov identifier: NCT06369506.

Clinical relevance: Multiple gingival thickness measurements showed that gingival phenotype varied depending on the vertical level of the gingiva measurement point. Gingival phenotype assessment based on the mean of multiple gingival thickness measurements provided precise results, emphasizing the clinical importance of multiple measurements.

Objectives: Successful implant therapy must also ensure the integration of the soft tissues around the crown/abutment emergence profile. The existing literature does not consistently agree on the necessity of a minimal amount of keratinized tissue (KT), though it appears advantageous for the long-term stability and aesthetics of implants. The purpose of this clinical retrospective study is to compare the effectiveness of amnion/chorion membrane and autogenous subepithelial connective tissue in increasing the keratinized mucosa and maintaining it over a 5-year follow-up.

Methods: Twenty patients who had previously undergone implant surgery were included in the study. Ten patients had received the allograft (Group 1) and ten had received autogenous connective tissue (Group 2).An independent examiner retrospectively analyzed the patient records at 7, 15, and 60 days, and five years post-procedure. Data from these observations were collected and analyzed using SPSS Statistics, version 25. Descriptive statistical analysis was conducted.

Results: All patients exhibited an increase in KT. For Group 1, the mean KT width measurements were 1.27 ± 0.46 mm at the initial evaluation, increasing to 2.00 ± 0.38 mm, 2.80 ± 0.78 mm, 3.27 ± 0.80 mm, and 3.01 ± 0.68 mm at 7, 15, and 60 days post-surgery (with prosthesis delivery on day 60), and five years after prosthetic rehabilitation, respectively.

Conclusions: Within the limitations of this retrospective clinical study, both amnion/chorion and connective tissue show significant potential for KT expansion when used in conjunction with implant surgery.

Clinical relevance: The use of allografts, due their low morbidity, and acceptable results should be considered as a viable option for soft tissues augmentations.