Dental and Medical Problems最新文献

Nickel-titanium (NiTi) file separation during endodontic treatment is an undesirable event. This phenomenon needs to be understood by knowing the factors influencing fracture in endodontic files. There is a large amount of literature where these factors and their influence have been studied, increasing the knowledge about the mechanisms involved, mainly related to wire technology, file shapes and geometry, operator manipulation, the anatomy of the root canal, and the irrigation and sterilization processes. As many factors are involved, the complexity of the fracture phenomena increases and the isolated correlation of one factor with the file fracture becomes a small part of comprehending the separation phenomena. This thematic review aims to compile important reports from 2014 to 2022 on the factors influencing NiTi file separation. The information obtained was classified into wire technology, file geometry, operational aspects, irrigation and sterilization, and anatomy. For this purpose, the Scopus, Web of Science and ScienceDirect databases were consulted using a search string. Filters were applied to consolidate the final set of relevant papers covering the subject of factors influencing endodontic file separation. It was found that the fracture of NiTi files incorporates different mechanisms that operate simultaneously during the endodontic procedure and strongly affect the instrument performance. The collected information promotes good practices to prevent file separation.

Background: Sleep quality has a significant impact on a child's health and is linked to oral and systemic diseases. It affects the circadian rhythm, which plays a crucial role in regulating the balance of the endocrine and hormonal systems. Current research has focused on exploring its role in the development of caries, which is influenced by inherent oral factors such as the composition of the oral microbiome and pH levels.

Objectives: This study aimed to investigate the relationship between bacterial population, pH, and buffering properties of saliva and sleep patterns in 8- to 12-year-old children.

Material and methods: This cross-sectional study was conducted on 85 elementary school children aged 8-12 years. After obtaining written consent, non-stimulating saliva samples were collected using the spitting method. The participants' sleep pattern information was obtained with the use of the Persian version of the Children's Sleep Habits Questionnaire (CSHQ). Based on the results of the CSHQ, the participants were divided into 2 groups: those with appropriate sleep patterns; and those with inappropriate sleep patterns. The study compared the bacterial population of Streptococcus mutans, Lactobacillus spp. and Candida albicans, as well as the buffering capacity and pH of the saliva between the 2 groups. The statistical analysis employed the χ2 test, the independent samples t-test and Spearman's correlation.

Results: The group with inappropriate sleep patterns had significantly lower pH and buffering capacity (p < 0.001) and significantly higher colony counts of Lactobacillus and S. mutans (p < 0.001 and p = 0.012, respectively). There was no association between C. albicans and sleep patterns (p = 0.121).

Conclusions: Inappropriate sleep patterns increase the population of caries-causing bacteria and reduce salivary pH and buffering capacity. This can be a significant factor in the development of dental caries in children aged 8-12 years.

Background: Overweight and obesity are defined as abnormal or excessive fat accumulation that impairs health. The global prevalence of obesity has been increasing significantly among all age groups. Furthermore, obesity is a comorbid factor for numerous diseases, including cardiovascular and periodontal pathologies.

Objectives: The present study aimed to investigate the influence of overweight and obesity on the periodontium of young adults in relation to the functional state of the cardiovascular system.

Material and methods: The oral health status of 132 males and females aged 18-22 years was examined. They were divided into 4 groups according to their body mass index (BMI): normal weight; overweight; class I obesity; and class II obesity. A periodontal chart, the records on oral hygiene and caries, and periodontal indices were provided for each participant. The main functional parameters of the cardiovascular system were measured before and after the dental examination.

Results: Overweight or obesity did not affect the intensity of caries in young adults. The prevalence and severity of gingivitis were significantly higher in obese individuals. A moderate correlation was found between gingivitis and BMI in patients with class I and II obesity. Disturbances in the cardiovascular system function and in the autonomic nervous system tone were also diagnosed in obese patients. An impaired vascular response and significant functional changes in the cardiovascular system developed against the background of obesity. These changes show the development of subcompensation in young adults with obesity.

Conclusions: In obese individuals, significantly worse oral hygiene was observed as compared to normalBMI patients. Moreover, the clinical manifestation and intensity of gingivitis in obese individuals were high even in those with satisfactory oral hygiene. In young obese individuals, the periodontal disease manifested as gingivitis is due to significant adaptive and compensatory mechanisms.

Background: Nano-silver fluoride (NSF) has been introduced to improve enamel lesions. The effective use of varnishes is important in the prevention of dental caries.

Objectives: The study aimed to compare the effect of conventional sodium fluoride varnish with the same varnish containing 1% and 2% silver nanoparticles (AgNP) on the surface microhardness of enamel.

Material and methods: The baseline surface microhardness of 40 premolar teeth was measured using a Vickers microhardness tester. After immersing the samples in a demineralizing agent for 24 h, the microhardness was measured again. In group B, a layer of conventional fluoride varnish was applied to the tooth surfaces using a microbrush with soft bristles, following the manufacturer's instructions. Groups C and D were treated with 1% and 2% NSF varnishes, respectively, while group A received no varnish. Surface microhardness tests were conducted on all specimens, including those previously tested.

Results: The microhardness of the enamel surface increased significantly in all 3 test groups compared to the microhardness after demineralization (p < 0.05).

Conclusions: Conventional fluoride varnish and fluoride varnishes containing 1% and 2% AgNP are equally effective in remineralizing initial caries.

The systematic review aimed to compare and evaluate the effect of resin-based sealers and bioceramic sealers on postoperative pain after endodontic treatment. Two reviewers independently conducted electronic search in PubMed, the Web of Science, ScienceDirect, the Wiley Online Library, SpringerLink, Google Scholar, and the Cochrane Library, employing a complete dual-review process to ensure the inclusion of all relevant studies in the review. The search was carried out until November 2021. After selecting eligible studies, the risk of bias assessment was carried out using the revised Cochrane risk-ofbias tool for randomized trials (RoB 2). A total of 1,931 studies were identified from the electronic search, and finally 10 studies were included after full-text assessment. In all our included studies, the visual analog scale (VAS) was used for recording pain scores. Most of the studies recorded pain intensity starting from 6 h to 7 days. The results showed that there was no significant difference between resin-based sealers and bioceramic sealers in terms of incidence or intensity of postoperative pain at any point in time.

Actinomycotic osteomyelitis is a rare chronic suppurative, granulomatous, fibrosing saprophytic infection. It is an endogenous infection caused by the Actinomyces species, which are part of the normal oral microflora. There is a male predilection for this type of infection, with the male to female ratio of 4:1. Though the etiopathogenesis of the infection is unclear, it is mostly attributed to the disruption of the normal oral microflora and the invasion of the microorganism into deeper tissues through a break in the mucosal barrier due to damage from trauma, extraction or previous injury. The portal of entry can be through the pulpal, periodontal or mucosal route, causing the purulent and necrotic infection of soft tissue, bone, or both. The diagnosis is usually considered when there is a persistent infection without the presence of regional lymphadenopathy and is usually confirmed through the histopathological depiction of the bacterial colonies - 'ray fungus' - as obtaining the positive culture of the causative microorganisms is difficult and is reported to be effective in less than 50%. Patients with such infections are managed with surgical debridement, followed by antibiotic therapy for a longer time period. Recent advances have been emphasized for an early diagnosis and a better prognosis of the therapy. Therefore, this paper aimed to present a rare case of actinomycotic osteomyelitis of the maxilla in a 45-year-old female patient, and also to review the literature on this rare infection.

Background: Conscious sedation has gained more popularity these days, with different routes of drug administration having various advantages and disadvantages. Among all, ketamine is one of the most commonly used drugs in children.

Objectives: The aim of the present study was to compare 2 different routes of ketamine administration - intranasal (IN) vs. intramuscular (IM) - in 2-6-year-old uncooperative children needing dental treatment.

Material and methods: This single-blind, crossover clinical trial was conducted on a group of 26 uncooperative children aged 2-6 years, who required at least 2 similar dental treatment visits. The patients were randomly assigned into 2 groups: group I - IN ketamine at their 1st session and IM ketamine at the 2nd session; and group II - exactly the opposite sequence. The sedative efficacy of the 2 techniques was assessed by 2 independent pediatric dentists based on the Houpt sedation rating scale. The data was analyzed using the Wilcoxon test, the repeated measures analysis of variance (ANOVA) and the least significant difference (LSD) test.

Results: The participants showed reduced crying and movement with improved sleepiness at the 3 time points examined when IM administration was performed as compared to IN sedation (p < 0.05). The overall behavior scores were higher for the IM route as compared to the IN route at all tested time points (p < 0.05). The operating dentist and the parents believed that the IM route was significantly more effective (p < 0.05). The children in the IN session reached equilibrium faster than those in the IM session (p < 0.05). No significant statistical differences were noted between the groups with regard to various physiological parameters investigated at different time intervals.

Conclusions: Intramuscular ketamine was more satisfactory and effective than the IN route when sedating uncooperative children for dentistry.

Background: Immediate implant placement in the maxillary esthetic zone is a challenging and demanding task. To achieve favorable results, proper case selection and treatment planning are necessary. Variables like the sagittal root position (SRP) and the labial bone thickness (LBT) of maxillary anterior teeth are of paramount importance for predictable outcomes.

Objectives: The aim of the present study was to evaluate the SRP and LBT of maxillary anterior teeth in the context of immediate implant placement by using cone-beam computed tomography (CBCT) in a sample of the Pakistani population.

Material and methods: A cross-sectional study was conducted using the CBCT scans of patients. The SRP of each tooth (maxillary canine to canine) was evaluated in the sagittal section of a CBCT scan according to the classification by Kan et al. The LBT of each tooth was measured perpendicularly to the long axis of tooth at 3 sites: at the alveolar crest (P1); 2 mm from the alveolar crest (P2); and 4 mm from the alveolar crest (P3). Descriptive statistics were reported for SRP and LBT. The χ2 test was employed to assess any association between the variables.

Results: Class I SRP was the most prevalent (n = 196, 81.7%), while Class III was the least frequent (n = 1, 0.4%). The association between the tooth type and SRP was statistically non-significant (p = 0.510).

Conclusions: In the evaluated sample of the Pakistani population, the most frequent type of the SRP of maxillary anterior teeth was Class I, which is most favorable for immediate implant placement. Furthermore, the labial bone in the maxillary esthetic zone was found to be mostly thin - LBT was within the range of 0.5-0.9 mm - which makes immediate implant placement in the anterior maxilla a challenge. The results of the present study could serve as a guide for clinicians in terms of appropriate patient selection for immediate implant placement in the maxillary esthetic zone.

Background: Platelet-rich fibrin (PRF) is widely used in periodontics for its wound healing potential. Two major variations of PRF are the original leukocyteand platelet-rich fibrin (L-PRF) and the modified lowspeed advanced PRF (A-PRF).

Objectives: The aim of the present study was to evaluate and compare the conventional L-PRF protocol and the low-speed A-PRF protocol in terms of angiogenic potential of PRF, using an in vivo chorioallantoic membrane (CAM) assay.

Material and methods: Fifteen fertile Giriraja eggs were procured and after a 3-day incubation period, randomly allotted into 3 groups: control; L-PRF; and A-PRF. A total of 20 mL of blood was collected from systemically healthy male volunteers aged 18-24 years, using a standard protocol. The PRF samples were inoculated on the CAM of the eggs. On the 10th day, the eggs were reopened and photographed. The parameters assessed were the number, length, size, and density of blood vessels, as well as the number of junctions formed. The photographs were analyzed using the ImageJ and ProgRes® CapturePro software.

Results: Seven days after inoculation, both the A-PRF and L-PRF groups exhibited significantly better results than the control group in terms of the number (59.20 ±6.61 vs. 48.80 ±5.07 vs. 19.20 ±6.98), length (25,000 ±1,813.10 μm vs. 17,000 ±282.90 μm vs. 8,000 ±184.49 μm), size (230,000 ±15,054.00 μm2 vs. 200,000 ±8,295.27 μm2 vs. 150,000 ±4,105.16 μm2), and density (central: 9,100 ±296.78 vs. 5,370 ±272.42 vs. 1,420 ±564.36; peripheral: 9,094 ±400.14 vs. 3,370 ±479.39 vs. 5,420 ±746.73) of blood vessels, as well as the number of junctions formed (52 ±3.81 vs. 41 ±1.58 vs. 33 ±4.64), respectively.

Conclusions: The angiogenic potential was increased by the exposure to both L-PRF and A-PRF. However, A-PRF demonstrated statistically significant benefits in terms of the number, length, size, and density of blood vessels, as well as the number of junctions formed in comparison with the control and L-PRF groups.

The available literature indicates that smoking causes quantitative and qualitative changes in saliva. However, there is a lack of studies summarizing the knowledge in this area, and there are no clear guidelines on the use of salivary biomarkers for assessing exposure to cigarette smoke (CS). The present work aimed to provide a systematic review of the literature regarding the influence of smoking traditional and electronic cigarettes, as well as heat-not-burn products, on salivary homeostasis. An electronic search of the literature from 1982 to 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Based on the inclusion criteria, 65 studies were used for the final review. Smoking traditional as well as electronic cigarettes negatively affects salivary biomarkers, including the salivary flow rate, pH, antibody titer, electrolyte concentration, microflora composition, redox balance, and inflammation, in terms of both quantity and quality. However, to date, only single salivary biomarkers have been compared in traditional and electronic cigarette smokers. It can be concluded that the salivary production rate, pH, microbiome, and cytokines can be used to assess exposure to CS smoke. There is a lack of convincing evidence to compare the toxic influence of traditional and electronic cigarettes on salivary homeostasis. Future experiments should include long-term randomized clinical trials on larger populations of smokers.