Dentistry Journal最新文献

Background: Immediate post-extraction dental implants are increasingly popular, but ensuring primary stability and managing peri-implant tissues remain challenging. Implant macro-design significantly impacts stability and osseointegration. This study used Cone-beam Computed Tomography (CBCT) to evaluate changes in alveolar bone following immediate placement of two implant designs, System 2P and Dura-Vit 3P, which feature semi-conical microgeometry and apical self-tapping portions for improved stability and bone regeneration. Methods: With a 1:1 allocation ratio, the current investigation was a two-arm parallel group randomized clinical trial. Patients qualified if they required immediate dental replacements with adequate buccal bone support. Two types of implants were placed: System 2P (cylindrical shape) and Dura-Vit 3P (more conical shape, with a particular architecture of threads). Following the intervention, CBCT was performed both immediately (T1) and six months later (T2). Measurements of CBCT horizontal bone level at apical, medial, and bevel height on the palatal/lingual and vestibular sides as well as the buccal vertical gap were the primary results. Complications, implant stability quotient (ISQ), and torque insertion were evaluated. The Mann-Whitney test was used to determine time-based differences within each group, while the Wilcoxon test was used to estimate differences between groups. The impact of baseline marginal gap dimension and gingival biotype was estimated using multiple regressions. Results: Thirty patients were recruited and randomized to treatments, with two lost to follow-up. One System 2P implant failed and two patients of the Dura-Vit 3P group dropped out. At T1, the Dura-Vit 3P group exhibited a lower mean insertion torque and a higher ISQ than the System 2P group. Furthermore, the Dura-Vit 3P group showed lower bone reduction compared to System 2P at horizontal and vertical measurements with significant differences for the vestibular and palatal base and medial level (p-values < 0.05). Regression models indicated a positive effect of thick biotypes on gap filling and dimensional bone reduction. No complications were observed in both groups. Conclusions: The Dura-Vit 3P implant exhibits high primary stability when inserted in post-extraction sites. Furthermore, this kind of implant stimulates higher bone stability on both the palatal and buccal side when compared to the System 2P implant. The present findings support the evidence that the macro-design of the Dura-Vit 3P implant promotes increased primary stability and reduces bone loss.

Background: Several therapies involving the use of oxygen have been developed; however, the literature to date has poorly addressed the effects of Topical Oxygen Therapy (TOT) on oral tissues. The aim of the present pilot study was to histologically evaluate the response to TOT in epithelial-connective samples harvested from the palate. Methods: In eight patients selected for a free gingival graft (FGG) procedure, the lateral portions of the graft were randomly assigned to receive TOT (test) or no treatment (control). Both the portions were stained with hematoxylin-eosin for the evaluation of histomorphological changes and with Picrosirius for the study of collagen. Immunohistochemical staining was performed with antibodies for the characterization of the inflammatory infiltrate and neoangiogenesis. Results: The analysis failed to show morphological variations in both groups, demonstrating that there was no tissue damage due to TOT. The prevalence of type I collagen in both samples supported this finding. Immune cells were present in low levels and mainly consisted of CD3+ T lymphocytes. The histomorphometric analysis showed an increased average vessel area (7607.95 μm² ± 3983.24 vs. 4038.42 μm² ± 1823.52), an increased number and caliber of vessels (49.82 ± 20.55 vs. 32.35 ± 16.64), and a higher microvessel density (7.89 ± 3.25 vessels/0.26 mm² vs. 5.13 ± 2.63 vessels/0.26 mm²) in the test group. Conclusions: Although further investigations are needed, TOT could improve and speed up oral wound healing through the local condition of hyperoxia.

Background/Objectives: Many commercial light-emitting diode (LED) devices are available for consumer home usage. The performance characteristics in respect to the dosimetry of many of the devices, currently on direct sale to the public, have not been subject to formal appraisal. In order to 'bridge the gap' between the evidence-based photobiomodulation therapy (PBMT) community and other interested parties, an evaluation is made of a selection of torch type hand-held LED PBMT products currently available for home use. Methods: Five randomly chosen intra-oral and hand-held LED PBMT devices were selected. The optical delivery parameters of the devices were measured, including the beam divergence angle, surface area exposure as well as the output power at the level of the LEDs. The surface and sub-surface temperature changes in porcine tissue samples were assessed under standardised conditions. The manufacturer's patient instructions were correlated to the measured optical parameters. Calculations were made of irradiance and surface radiant exposure. Consumer satisfaction ratings and feedback data were collated, and a relevant statistical analysis conducted. Results: The results were heterogeneous with a wide range of applied wavelengths, output power and irradiance. Power output stability was variable, and, together with a wide beam divergence angle of 74°, the manufacturer's directions for dosimetry were found to be inconsistent with an accurate dose delivery. Conclusions: The manufacturer's proposed dosimetry fails to consider the relevance of the beam divergence angle and optical attenuation in view of the scatter and absorption. Appropriate instructions on how best to gain and optimise an acceptable clinical outcome were inconsistent with an evidence-based approach. Subject to validation by well-planned clinical trials, the concept of home PBMT may open interesting new therapeutic approaches.

Surgical guides are integral tools in orthodontics, enhancing the precision and predictability of mini-implant placement. These guides facilitate accurate positioning, reduce risks to surrounding anatomical structures, and ensure proper angulation and depth during procedures. The aim of the present paper is to present a detailed review of the surgical guides used in orthodontics, focusing on their classification, mechanical properties, biocompatibility, and future developments. The advantages, disadvantages, clinical steps, and implications are also described based on the data in recent scientific literature. Future developments may incorporate artificial intelligence and augmented reality, further optimizing treatment planning and patient outcomes, thus solidifying the role of surgical guides in efficient orthodontic care.

Background: Clinical teaching is crucial to dental education as it shapes the identity and professional development of students. However, there is a lack of research regarding the responsibilities of clinical teachers, their professional behavior, pedagogical approaches, and their influence on students' clinical learning outcomes. This study aims to identify factors that students perceive in clinical teachers and how these factors influence the effectiveness of their clinical education. Methods: This cross-sectional study involved predoctoral and graduate dental students (N = 354). Data were collected using a questionnaire adapted from the Stanford Faculty Development Program (SFDP) scale and open-ended questions. Simple and multiple linear regression analyses were conducted to examine associations and predictive capabilities of the SFDP constructs for clinical teaching effectiveness. Data were analyzed using SPSS version 29. Results: A total of 332 responses were received, with a 94% response rate. Significant positive correlations were found between SFDP constructs and clinical teaching effectiveness. The evaluation construct had the strongest correlation (r = 0.480, p < 0.001), explaining 23.1% of the variance. The communication of clinical goals had the second strongest correlation (r = 0.415, p < 0.001), explaining 17.3%. The lowest correlation was for promotion of understanding and retention (r = 0.332, p < 0.001), explaining 11%. Cronbach's alpha ranged from 0.607 to 0.783. Conclusions: This study highlighted key factors influencing the effectiveness of clinical teaching, including evaluation quality, clear communication of clinical goals, supportive learning environments, and effective feedback. Clinical teachers' respect for students also facilitates successful education. More studies are required to explore additional factors across different contexts.

Background: Replacing a maxillary central incisor and immediately placing an implant represents a clinical challenge. Methods: This case report demonstrates a full digital workflow to achieve a predictable implant placement and esthetically pleasing restoration for a 35-year-old male patient who suffered a horizontal root fracture after a sports accident. The patient's treatment included digital implant planning, minimally traumatic tooth extraction, computer-guided implant placement, soft tissue augmentation, and a provisional restoration to contour the augmented gingival tissues. The process began with cone beam computed tomography (CBCT) evaluation and patient consultation on treatment options, with the patient opting for implant therapy. Using a 3D-printed surgical guide, the implant was placed precisely, and a soft tissue graft was used to enhance the gingival architecture and volume. A provisional restoration was designed to support the emergence profile and condition the peri implant soft tissues. A final digital impression was made, and a screw-retained all-ceramic crown was fabricated uneventfully after healing. Results: This digital approach allowed accurate planning and allowed the efficient execution of a technique-sensitive procedure such as immediate implant placement, thus providing an esthetic and functional solution while minimizing treatment time. Conclusions: The case highlights that immediate implant therapy in the esthetic zone requires meticulous planning and execution, and that incorporating advanced digital tools and techniques is required to achieve favorable clinical outcomes.

Objective: This study aims to investigate the mechanical behavior of titanium (Ti6Al4V) mini-implants (MIs) under varying orthodontic forces using finite element analysis (FEA) and to evaluate their performance and durability under realistic clinical conditions. Optimal orthodontic forces significantly influence the structural integrity and functional longevity of MIs while minimizing adverse effects on surrounding bone tissues. Materials and Methods: A commercially available MI (diameter: 2.0 mm, length: 12 mm) was modeled using FEA. The mandible geometry was obtained using computed tomography (CT) scanning, reconstructed in 3D using SpaceClaim software 2023.1, and discretized into 10-node tetrahedral elements in ANSYS Workbench. Material properties were assigned based on the existing literature, and the implant-bone interaction was simulated using a nonlinear frictional contact model. Orthodontic forces of 2 N and 10 N, inclined at 30°, were applied to simulate clinical loading conditions. Total displacement, von Mises stresses, equivalent strains, fatigue life, and safety factors were analyzed to assess the implant's mechanical performance. Results: At 2 N, the MI demonstrated minimal displacement (0.0328 mm) and sustained approximately 445,000 cycles under safe fatigue loading conditions, with a safety factor of 4.8369. At 10 N, the implant's lifespan was drastically reduced to 1546 cycles, with significantly elevated stress (6.468 × 10⁵ MPa) and strain concentrations, indicating heightened risks of mechanical failure and bone damage. The findings revealed the critical threshold beyond which orthodontic forces compromise implant stability and peri-implant bone health. Conclusions: This study confirms that maintaining orthodontic forces within an optimal range, approximately 2 N, is essential to prolong MI lifespan and preserve bone integrity. Excessive forces, such as 10 N, lead to a rapid decline in durability and increased risks of failure, emphasizing the need for calibrated force application in clinical practice. These insights provide valuable guidance for enhancing MI performance and optimizing orthodontic treatment outcomes.

Background/Objectives: The objective of this study was to investigate the internal morphology and root canal configurations (RCCs) of maxillary central incisors (MxCIs) in a Swiss-German population by means of micro-computed tomography (µCT). Methods: RCCs, main foramina, and accessory canals of MxCIs were examined using µCT and 3D imaging software. The root canal anatomy was classified according to three classification systems by Vertucci (Ve, 1984), Weine et al. (We, 1969), and Briseño-Marroquín et al. (Br, 2015). Results: The most common RCC observed among a total of 112 investigated single-rooted maxillary central incisors was Br 1-1-1/1 (97.3%, Ve I, We I), with a small percentage showing Br 1-1-1/2 (2.7%). One main foramen existed in 87.5% of the specimens, 8% had one accessory foramen, 3.5% had two, and a rare case had four accessory foramina (0.9%). Accessory root canals were mainly located in the middle and apical regions of the roots. Conclusions: Detailed insights into the root canal morphology of MxCIs in a Swiss-German population are provided. The predominant RCC was a simple root canal (Ve I, Br 1-1-1/1). However, accessory canals were detected in the middle and apical third in over 40% of the teeth examined. These anatomical features should be considered during endodontic treatment planning and execution.

Objective: This study aimed to compare the effects of orthodontic treatment on the same patients using aligners (upper arch) versus traditional fixed appliances (lower arch) on oral hygiene and periodontal health. Materials and Methods: A total of 90 patients, all treated by the same orthodontist and with an average age of 26 years, were included in the study. The research focused on factors predisposing patients to periodontitis, as well as plaque and tartar accumulation. Statistical analysis was performed using the paired-samples Student's t-test, with values of p < 0.05 deemed statistically significant. Results: Patients treated with fixed orthodontic appliances generally showed increased plaque accumulation (+10% PI) and a decline in periodontal health compared to those treated with aligners (40% presented a high level of S.Mutans and Lactobacilli). In patients who did not maintain proper oral hygiene, the initial conditions of the upper arch remained stable, while the lower arch exhibited significant deterioration, with increased plaque buildup and greater tissue inflammation. Conclusions: The findings emphasize the critical role of individual oral hygiene practices during orthodontic treatment in preserving periodontal health. Aligners appear to be more favorable in protecting periodontal tissues, improving plaque control, and reducing gingival inflammation. Various supplementary approaches for plaque management and microbial colonization in saliva should be implemented based on the type of orthodontic appliance used.

Background: Untreated impacted wisdom teeth can lead to complications, including delayed healing and inferior alveolar nerve damage. Delayed management is further complicated by age-related comorbidities. Aim: This study aimed to evaluate the management of impacted wisdom teeth in a teaching dental hospital and identify challenges faced by dental care providers. Materials and Methods: A retrospective radiographic study was conducted using data from electronic medical records and panoramic radiographs of patients. Independent variables included demographics and clinical details of wisdom teeth, such as type and presence of impaction, associated pathology, nerve proximity, second molar resorption, and extraction difficulty. The study assessed the evaluation of dental care provider practices in managing impacted wisdom teeth. Chi-square tests analyzed relationships between management type, provider level, and extraction difficulty. Results: Data from 270 panoramic radiographs and dental records were analyzed. Most cases were not managed (n = 216, 80%), irrespective of extraction difficulty or care provider level (undergraduate vs. graduate). There was no significant association between care provider levels and the type of management or between impaction difficulty and management type (p > 0.05). Conclusions: The findings highlight a lack of proper evaluation and management of impacted wisdom teeth, regardless of the provider's experience. In hospital settings, all care providers should ensure the timely evaluation and management of impacted wisdom teeth to prevent complications.