Dental and Medical Problems最新文献

Background: The Montreal Cognitive Assessment (MoCA) is the most accurate cognitive screening tool for early diagnoses of mild cognitive impairment (MCI). However, the majority of research on the correlation between MCI and periodontitis has been conducted using the Mini-Mental State Examination (MMSE).

Objectives: The study aimed to determine a possible correlation between the gingival index (GI), periodontitis staging and MCI as evaluated by the MoCA in adults aged ≥55 years.

Material and methods: A total of 120 Mexican patients with or without periodontal disease who met the selection criteria were included in this cross-sectional study. A comprehensive clinical and radiographic evaluation was conducted to determine the periodontal status of all patients. The MoCA was applied to assess cognitive impairment. Descriptive statistics and logistic model-based multivariate statistical analyses were performed to identify variables associated with MCI.

Results: The cognitive status of subjects aged ≥55 years with and without periodontitis was mildly impaired in more than half of the studied sample. Thirty-four patients were diagnosed as periodontally healthy (group 1), 48 were diagnosed with mild to moderate periodontitis (group 2; stages I and II), and 38 had severe periodontitis (group 3; stages III and IV); 54% of the subjects exhibited MCI, mostly in groups 2 and 3. A negative correlation was observed between GI and MCI (p = 0.025). Other prognostic variables associated with MCI were loss of clinical attachment level (CAL) (odds ratio (OR) = 1.68 (95% confidence interval (CI): 1.06-2.68)), sex and education level.

Conclusions: These findings highlight the potential clinical relevance of gingival and periodontal parameters, such as GI and CAL, and their association with MCI in patients of advanced age.

Background: Cleaning overdentures is challenging due to their complex metallic structures, which often create small and irregular areas that are difficult to clean. Thus, it is necessary to find an effective and safe method for their maintenance.

Objectives: The aim of the study was to evaluate the effects of hygiene methods on the dimensional changes and retention force of the O-ring system over a simulated two-year period.

Material and methods: A total of 54 specimens with 2 O-rings each were distributed into 9 groups: control - no cleaning; brushing - blue®m toothpaste (BM); brushing - Trihydral toothpaste (TR); immersion - NitrAdine® (Ni); immersion - 5 mg/mL chitosan solution (Ch); and combined methods: BM+Ni, BM+Ch, TR+Ni, TR+Ch. The deformation and retention force were evaluated every 6 months for 2 years. The statistical analysis was performed using two-way analysis of variance (ANOVA) and Pearson's correlation test (α = 0.05).

Results: The BM+Ch group exhibited smaller changes in diameter after 6 months (Δ(T1-T0)) than the control and BM+Ni groups, both internally and externally (p < 0.001). In addition, the BM+Ch group demonstrated greater retention forces at 6 months (p = 0.024) and 18 months (p = 0.028) in comparison to the TR+Ch group. The TR+Ch group exhibited a negative correlation with changes in the external diameter (r = -0.334, p = 0.021), while BM+Ch showed a negative correlation with changes in the internal diameter (r = -0.334, p = 0.021). The Ni group demonstrated a negative relationship with changes in both the internal (r = -0.296, p = 0.041) and external diameters (r = -0.405, p = 0.004).

Conclusions: A combination of brushing with blue®m toothpaste and immersion in the chitosan solution demonstrated satisfactory results in maintaining the retention force of the O-ring system.

Background: Following selective caries removal, the efficacy of bonding to the dentin substrate is questionable due to alterations in mineral content and the quality of remaining dentin, especially in deep proximal cavities.

Objectives: The aim of the study was to evaluate the microtensile bond strength of resin composite to artificially demineralized dentin and sound dentin compared to demineralized dentin that underwent different remineralization protocols. Additionally, the study sought to evaluate the effect of the 2 bonding modes (total-etch/self-etch) on the applied remineralizing agent, and to analyze the failure mode.

Material and methods: The study utilized 30 sound proximal molar surfaces. They were randomly divided into 5 groups based on the remineralization protocols, as follows: sound dentin as positive control (G1); artificially demineralized dentin but without surface treatment as negative control (G2); and artificially demineralized dentin surface groups with surface treatments (sodium fluoride (NaF) solution (G3), nano-hydroxyapatite (nHAp) (G4), and a combination of remineralizing agents (G5)). Different modes of application of the bonding agent (total-etch (B1) and self-etch (B2)) were implemented. Then, a nanohybrid composite was applied and light cured. The microtensile bond strength test was performed, and the failure mode was evaluated.

Results: The application of the total-etch mode resulted in a statistically significant difference between microtensile bond strength values of remineralization protocols. The NaF and nHAp groups (G3 and G4) exhibited the highest values. A statistically significant difference was observed between the microtensile bond strength values of remineralization protocols in the self-etch mode. The positive control, NaF, nHAp, and combined groups (G1, G3, G4, and G5) showed the highest values. The negative control group (G2) in both bonding modes demonstrated the lowest microtensile bond strength.

Conclusions: All remineralization protocols applied to demineralized dentin demonstrated an improvement in bond strength that was equivalent to sound dentin. All remineralized dentin surfaces exhibited a favorable failure mode in comparison to the negative control group.

Background: The immediate placement of the implant into a fresh extraction socket site with immediate provisionalisation is considered to be a predictable and acceptable procedure. However, there are mixed results regarding the advantages of the immediate provisionalization of dental implants, using a biomaterial in the jump space (JS).

Objectives: This randomized controlled trial (RCT) aimed to evaluate the use of a concentrated growth factor (CGF)-enriched bone graft in the JS of immediate implant placement with provisionalization (IIPP) in the maxillary esthetic zone.

Material and methods: Forty immediate dental implants were placed with and without a CGF-enriched bone graft in the test and control groups, respectively, along with provisional restorations. The clinical evaluation of the modified plaque index (mPI), the modified sulcular bleeding index (mSBI), the probing depth (PD), the gingival thickness (GT), and the Testori implant esthetic score (TS) was done at baseline, and at 6 and 12 months postoperatively. The assessment of the crestal bone height (CBH), the buccal bone thickness (BBT), the ridge width (RW), the vertical distance (VD), JS, and the radiolucent area (RA) was carried out using cone-beam computed tomography (CBCT) at baseline and 12 months postoperatively. The visual analog scale (VAS) was used to assess pain and patient satisfaction.

Results: Highly significant differences were observed with regard to the change in RW at 4 mm from the crest (9.80 ±0.89 mm), VD-distal (1.35 ±0.43 mm), JS-mesial (0.38 ±0.34 mm), JS-distal (0.25 ±0.34 mm), JS-buccal (0.42 ±0.39 mm), RA-mesial (0.63 ±0.48 mm2), and RA-buccal (0.19 ±0.47 mm2) in the test group as compared to the control group at 12 months. The intergroup comparison for TS showed a statistically significant difference (p < 0.05).

Conclusions: It is recommended to use CGF-enriched bone grafting in JS, along with provisionalization, in the anterior esthetic zone.

The aim of the present systematic review was to critically evaluate the recommendations from evidencebased clinical practice guidelines (CPG) and scientific statements (SS), as well as expert consensus, related to the management of oral complications in intensive care unit (ICU) patients.A search was made in the PubMed, Scopus, Ovid/Cochrane, and LILACS databases, following the CPG identification filters from the Canadian Agency for Drugs and Technologies in Health (CADTH). Both scientific repositories and document references were incorporated as well. The critical assessment was performed by means of the AGREE-II instrument (an ideal scenario) for CPG and SS, and using the AGREEREX instrument for recommendations (ideal and local scenarios).A total of 13 related recommendations from 4 SS were included. The mean score in AGREE-II was 58.25. The mean AGREE-REX scores were 45.82 and 39.07 for the ideal and local scenarios, respectively. The included recommendations focused on the oral care assessment, and the development of prevention and execution tools with regard to respiratory infections.There is a lack of CPG following a rigorous methodology that would incorporate recommendations for oral care in ICU. Dentists are responsible for the development and improvement of recommendations from CPG and/or SS to mitigate oral complications in ICU patients.

Background: Periodontitis is a chronic inflammatory condition caused by the bacterial infection of the gums that leads to tissue destruction, bone loss and tooth loss. Various risk factors, including smoking, age, diabetes, and obesity, contribute to its development and progression. Recent studies have revealed systemic effects of periodontitis, linking it to diabetes, atherosclerosis, stroke, and dementia.

Objectives: The study aimed to assess the relationship between periodontitis and cerebral atrophy, an indirect marker of brain health.

Material and methods: A cross-sectional study was conducted to examine the association between cerebral atrophy and periodontitis. A total of 166 participants were included in the study. All individuals underwent computed tomography (CT) of the head and a full-mouth periodontal assessment to verify if they met the diagnostic criteria for periodontitis. They also underwent a complete neurological examination to rule out dementia.

Results: Sixty-four patients (38.6%) had periodontitis, 85 individuals (51.2%) had cerebral atrophy, and 43 patients presented with both conditions. The study sample included 89 females (53.6%), and the median age of the participants was 67 ±10 years. Patients diagnosed with periodontitis showed a higher grade of cerebral atrophy, as measured using the global cortical atrophy (GCA) scale. An independent association was identified between periodontitis and cerebral atrophy (odds ratio (OR): 2.56; 95% confidence interval (CI): 1.29-5.07).

Conclusions: Cerebral atrophy, even in the absence of cognitive decline, is significantly associated with periodontitis.

Background: The effect of the macrogeometry of dental implants with double trapezoidal threads on the probability of survival and the long-term success of oral rehabilitation is unclear.

Objectives: The purpose of this in vitro study was to evaluate the effect of dental implant macrogeometry on the probability of survival, failure mode and strain distribution of an implant-abutment set.

Material and methods: Dental implants were divided into 2 groups according to their macrogeometry (n = 21 per group): trapezoidal thread (control group); and double trapezoidal thread (test group). The macrogeometry analysis was performed with the use of computed microtomography (n = 1). The specimens were subjected to single load to failure (SLF) (n = 3), which permitted the step-stress profiles for design-based step-stress accelerated life testing (SSALT) (n = 18). The probability of survival and reliability for a mission of 50,000 cycles were calculated at 100 N and 150 N. The scanning electron microscope (SEM) was used to analyze the failure mode of the implant-abutment set. The digital image correlation (DIC) (n = 3) was performed using the implant-abutment set embedded in a polyurethane resin subjected to a static load of 250 N in axial and non-axial positions.

Results: No statistically significant differences were observed between the groups with respect to the probability of survival. All groups showed a reliability level higher than 95% at 100 N, while a decrease in reliability was observed at 150 N. The Weibull modulus and characteristic resistance exhibited no significant differences between the groups. The β mean values (control = 0.66, test = 0.33) indicated that failures were dictated by material strength. The SEM revealed an abutment and implant body fracture, characterized by fracture initiation on the lingual surface that subsequently propagated to the opposing buccal side. In the context of non-axial loading, the test group exhibited a higher concentration of tensile strain in the cervical region (152.05 μs), while the control group exhibited a predominance of compression strain (-800.00 μs).

Conclusions: The macrogeometry of dental implants did not influence the failure mode and probability of survival, but modified the strain distribution of the implant-abutment set.

Background: Host response to periodontal pathogens present in microbial plaque is characterized by the expression of various inflammatory and immune mediators known as biomarkers. There is a paucity of literature addressing the impact of non-surgical periodontal therapy (NSPT) on serum biomarkers, such as mannose-binding lectin (MBL), sirtuin 1 (SIRT-1) and C-reactive protein (CRP), in non-smokers and smokers with stage III periodontitis.

Objectives: The study aimed to evaluate and compare the effect of NSPT on serum levels of MBL, SIRT-1 and CRP in non-smokers and smokers with stage III periodontitis.

Material and methods: A total of 105 patients were equally divided into 3 groups, as follows: group I - periodontally healthy individuals; group II - non-smokers with stage III periodontitis; group III - smokers with stage III periodontitis. Probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were recorded, and serum MBL, SIRT-1 and CRP levels were analyzed using enzyme-linked immunosorbent assay (ELISA). The patients underwent NSPT, and all parameters were re-evaluated 6 weeks after the procedure.

Results: The mean change in MBL levels across the 3 groups from baseline to recall was significant. Conversely, SIRT-1 and CRP levels exhibited non-significant differences from baseline to recall, with p-values of 0.172 and 0.548, respectively. The mean differences in MBL and SIRT-1 levels between groups I and III at baseline (p < 0.0001 and p = 0.041 for MBL and SIRT-1, respectively) as well as in MBL between groups II and III at recall (p < 0.0001) were statistically significant.

Conclusions: A positive association of serum MBL levels and CRP levels as well as a negative association of SIRT-1 with the severity of periodontal disease may serve as a valuable, precise and feasible method of identifying individuals at risk of developing periodontal disease.

Background: Since impacted canines are a frequent eruptive anomaly, it is imperative to study their etiological aspects. A possible cause of impaction is the presence of odontogenic lesions close to the impacted canine.

Objectives: The aim of this study was to evaluate the frequency of odontogenic lesions in patients with impacted canines and their association with the characteristics of impaction.

Material and methods: This cross-sectional study was carried out with the scans of 93 impacted maxillary canines obtained from cone-beam computed tomography (CBCT) studies performed in 3 radiological centers. The selection criteria regarded male and female patients older than 12 years, and were based on the CBCT scans of impacted canines, showing unilateral or bilateral maxillary impaction, with or without odontogenic lesions. The position of the impacted canines, the sector of impaction, the presence or absence of a dentigerous cyst, an odontoma or follicular enlargement, as well as the total diameter of the lesion, were evaluated. The χ2 test and logistic regression analysis were performed, and the level of statistical significance was set at p < 0.05.

Results: The frequency of odontogenic lesions near the canine impaction area was generally low (7.5% for a dentigerous cyst, 6.5% for follicular enlargement and 3.2% for a mesiodens). However, there was a significant association between the presence of a dentigerous cyst and buccal or mid-alveolar impacted canines (p = 0.032). The alpha and beta angles influenced the possibility of the occurrence of dentigerous cysts, with the alpha angle increasing the risk (B = 1.22; p = 0.041) and the beta angle decreasing the chance of developing a dentigerous cyst (18%) (p = 0.024).

Conclusions: The presence of odontogenic lesions in impacted maxillary canine cases is low, and involves mainly dentigerous cysts and follicular enlargement in buccal or mid-alveolar impacted canines. The alpha and beta angles may influence the development of dentigerous cysts.

Background: Root resorption (RR) is usually a consequence of dental trauma, pulpal infection, primary occlusal pressure, or orthodontic tooth movement, leading to the loss of anatomical root formation. As a result of apical RR, the apical constriction is destroyed, and the determination of the working length (WL) may become difficult.

Objectives: The purpose of the present study was to evaluate the accuracy of 4 different electronic apex locators (EALs) - ProPex® II, Propex Pixi®, DentaPort ZX, and DTE DPEX V - in the determination of WL in teeth with natural apical RR in the presence of different irrigation solutions (ISs).

Material and methods: A total of 36 teeth with natural apical RR were included in the study. The actual length (AL) was determined under a stereomicroscope at ×15 magnification. Afterward, the electronic length (EL) was established by using 4 different EALs in the presence of different ISs. The ISs used in the measurements were freshly prepared, and 6 groups were organized based on the solution used. The control group was marked as group 1. For groups 2-6, 1% sodium hypochlorite (NaOCl), 2.5% NaOCl, saline, 2% chlorhexidine (CHX), and 17% ethylenediaminetetraacetic acid (EDTA) were used, respectively. After each measurement, the roots were washed with 5 mL of distilled water and dried with paper points before the same teeth were used in the subsequent group. The absolute length was subtracted from EL for each tooth to calculate the difference. The data was analyzed statistically.

Results: For each device, there were no significant differences in the success rates between the ISs used. In group 1, there were no significant differences among the 4 EALs. In group 2, DentaPort ZX was significantly more successful than DTE DPEX V (p = 0.037). There were no significant differences among EALs in groups 3-6.

Conclusions: The difference between DentaPort ZX and DTE DPEX V was statistically significant in group 2 (1% NaOCl).