Journal of Clinical and Experimental Dentistry最新文献

Background: Attachments improve retention and facilitate complex tooth movement during clear aligner therapy. However, enamel demineralization and white spot lesions remain concerns, particularly in patients with poor oral hygiene. Fluoride-releasing materials help prevent white spot lesions, and bioactive composites, which release fluoride ions, show promise in preventing demineralization while maintaining strong mechanical properties. However, their application in clear aligner therapy remains underexplored. Therefore, this study investigated the shear bond strength (SBS) of three materials-Filtek Z350 XT Flowable (resin composite), Beautifil Injectable X (giomer), and Cention N (bioactive composite) used as attachments in clear aligner therapy under non-thermocycling (T0) and thermocycling (T1) conditions.

Material and methods: A total of 120 intact maxillary first premolars were randomly divided into three groups according to the material, with each further subdivided into T0 and T1 subgroups. The thermocycling protocol involved 1,000 cycles between 5°C and 55°C to simulate intraoral aging. SBS was tested using a universal testing machine, and failure modes were analyzed with the adhesive remnant index (ARI).

Results: Cention N exhibited the highest SBS (29.783 ± 4.741 MPa), followed by Filtek Z350XT Flowable (23.834 ± 4.708 MPa), while Beautifil Injectable X had the lowest (15.332 ± 4.087 MPa). The SBS was slightly higher in the T0 subgroup than in the T1 subgroup, but the difference was not significant. ARI analysis showed that Cention N was more likely to cause cohesive enamel failure during attachment detachment.

Conclusions: All three materials demonstrated adequate SBS for use as attachments in clear aligner therapy. However, material selection should consider both SBS and potential risks to enamel integrity. These findings provide valuable data for optimizing material choices in clear aligner therapy and highlight the need for further research to assess long-term performance.

Background: Dentin hypersensitivity (DH) is a transient pain triggered by thermal, tactile, or osmotic stimuli, commonly linked to exposed dentinal tubules. Its relationship with untreated periodontal disease, however, remains underexplored.

Material and methods: A retrospective epidemiological study was conducted at a specialized periodontics clinic and included 930 patients diagnosed with periodontal disease. Patients with a history of periodontal treatment, or other potential causes of DH, were excluded. Participants completed a questionnaire assessing habits and symptoms related to DH. Bivariate analyses and statistical tests were used to evaluate the associations between DH and clinical variables such as periodontitis stage, gingival recession, age, gender, toothbrush type, parafunctional habits, and smoking.

Results: DH prevalence was 84.8%, with cold being the most frequently reported stimulus (64.8%). DH increased with the severity of periodontitis, with an odds ratio (OR) of 2.23 for stage IV, grade B periodontitis. Gingival recession was strongly associated with a higher prevalence of DH (88.9% in patients with recession). Women and individuals under 35 reported greater DH. Bruxism and smoking were also contributing factors, particularly in response to sweet or pressure stimuli. The use of soft-bristled toothbrushes increased sensitivity, although not significantly.

Conclusions: DH is highly prevalent in patients with untreated periodontitis and increases with the stage and grade of the disease. Gingival recession, bruxism, and smoking are major contributing factors. Women and younger patients are more susceptible to DH. These findings highlight the need for preventive strategies to manage DH in patients with advanced periodontitis.

Background: Chronic orofacial pain (OFP) and sleep disorders are highly prevalent conditions that significantly impact quality of life. Increasing evidence suggests a bidirectional relationship between these disorders, whereby sleep disturbances may exacerbate OFP and vice versa. This systematic review synthesizes current evidence on the influence of sleep disorders on chronic OFP and explores additional factors that may contribute to this interaction.

Material and methods: A systematic review was conducted following PRISMA 2020 guidelines and registered the study with PROSPERO (CRD4202525111587). PubMed, Scopus, and Web of Science were searched for relevant literature published between 2004 and March 2024. Randomized controlled trials, cross-sectional studies, case-control studies, and cohort studies examining the association between sleep disorders and OFP were included. Ten studies met the eligibility criteria.

Results: A consistent association was identified between chronic OFP and sleep disorders, particularly insomnia and obstructive sleep apnea (OSA), with stronger correlations observed in women. Limited evidence also suggests that OFP severity may increase with age and that greater sleep disturbance correlates with more intense pain. Limitations: The paucity of high-quality studies specifically addressing the relationship between sleep disorders and chronic orofacial pain was a notable issue. Additionally, there was significant methodological heterogeneity among the included studies, especially regarding study design, diagnostic criteria, and assessment tools. The decision to include only studies focused on orofacial pain and to exclude other categories of pain-related diseases, such as temporomandibular joint disorders (TMD), introduced an additional challenge and resulted in a reduction of the number of selected studies.

Conclusions: There is a strong connection between chronic orofacial pain (OFP) and sleep disorders, particularly insomnia and obstructive sleep apnea (OSA). Addressing sleep-related issues could be an effective complementary approach in managing OFP, especially in female patients. More research is necessary to clarify the underlying mechanisms and to develop targeted, interdisciplinary interventions.

Background: To assess the accuracy of the London Atlas and RP Atlas methods estimating age and diagnosing adulthood in a Southern Brazilian population.

Material and methods: A total of 1,099 panoramic radiographs from individuals aged 15.00-22.99 years were analyzed. The London Atlas and RP Atlas tools were used to estimate age based on the developmental stages of the upper and lower left third molars (teeth 28 and 38). Statistical analysis included Spearman's rank test, Bland-Altman plots, Lin's concordance coefficient, and ROC curves, with adulthood (>18 years) as the cutoff (p<0.05).

Results: Both methods showed high accuracy, with the London Atlas exhibiting lower mean errors. Errors increased with age and were higher in females. The best adulthood cutoff for the London Atlas was 18.5 years for tooth 28 (78.5% accuracy) and 19.5 years for tooth 38 (80.0% accuracy). For the RP Atlas, the cutoff was 17 years for both teeth (80.8% and 80.0% accuracy, respectively). Both methods were suitable for age estimation and adulthood diagnosis, with the London Atlas tending to overestimate age - an advantage in legal contexts requiring caution.

Conclusions: Validating age estimation methods in specific populations enhance accuracy, preventing errors when applying methods developed for other populations and ensuring suitability for the local context. Research that applies these methods can provide a foundation for adjustments to the Atlases and their application in diverse subpopulations, and even serve as the basis for the establishment of an international data repository.

Background: This study investigates the association between upper arch dimensions and vertical facial height in individuals with Class I skeletal occlusion. The aim was to identify correlations that may inform orthodontic treatment planning.

Material and methods: A retrospective analysis was performed on 85 participants (43 females, 42 males) aged 18-25 years with Class I skeletal occlusion (ANB angle: 1-4°). Upper arch dimensions-intercanine width (ICW), interpremolar width (IPW), intermolar width (IMW), and arch length (AL)-were measured using digital dental models. Vertical facial height was assessed via digital cephalometric radiographs, including anterior facial height (AFH), posterior facial height (PFH), lower anterior facial height (LAFH), and the facial height ratio (FHR). Statistical analysis involved Pearson correlation coefficients and multiple regression.

Results: Significant positive correlations emerged between upper arch dimensions and vertical facial height. ICW correlated moderately with AFH (r = 0.61, p < 0.001) and LAFH (r = 0.57, p < 0.001). IPW showed a significant association with PFH (r = 0.70, p < 0.001), while IMW showed the strongest association with AFH (r = 0.73, p < 0.001). The connection between AL and FHR was moderate (r = 0.54, p<0.01). Males showed consistently higher correlations than females.

Conclusions: There is a strong relationship between vertical face height and upper arch dimensions in Class I skeletal occlusion. These results highlight the clinical significance of evaluating vertical facial structure when planning an arch expansion or contraction treatment. Its potential as a predictor of vertical face growth pattern is shown by its substantial association with IMW, which may help with clinical decision-making.

Background: Bone and soft tissue remodeling after tooth loss is an inevitable physiological process. By placing immediate dental implants and performing a custom healing abutment (CHA), we can help achieve a stable emergence profile and reduce tissue volume loss. Purpose: The purpose of this work is to present a series of two clinical cases to show the Spider Web Technique for the creation of custom healing abutments (CHAs) chair-side in immediate implants.

Material and methods: We present two cases of lower molars with CHAs performed chair-side in the clinic using titanium abutments and flowable composite with the Spider Web Technique as an alternative to prefabricated titanium or polyetheretherketone (PEEK) ones. A brief discussion was held providing other techniques for carrying out CHAs.

Results: The creation of CHAs was simple and fast and the postoperative period was very good. After the osseointegration period, the appearance of the peri-implant tissues, as well as the bone level, were optimal for making the definitive crown.

Conclusions: The Spider Web Technique provides an effective way to create a CHA around a provisional titanium abutment immediately intraoperatively chair-side with low cost and predictable results. Comparative protocolized studies with others are necessary to obtain clear conclusions and protocols.

Background: The objective was to evaluate the surface hardness of white spot lesions (WSL) treated with different caries prevention methods.

Material and methods: The Knoop microhardness (µKH) of 50 bovine dental enamel fragments was evaluated. WSL were induced (pH cycling) in those fragments and, after µKH analysis, the specimens received the following treatments (n=10): G1- fluoride gel (NaF 2%), G2- fluoride varnish (NaF 5%), G3-brushing with CPP-ACP based dentifrice, G4- infiltrant resin (Icon-DMG) and G5-Er,Cr:YSGG laser (8.92 J/cm2, 0.5 W). A second cariogenic challenge was done after treatments, and surface microhardness was measured before and after treatments. The Knoop hardness (KHN) values obtained were analyzed by one-way ANOVA followed by Tukey´s test (=5%).

Results: After treatments, the KHN was similar to the baseline in all groups. After the second cariogenic challenge, it was observed that G1, G4 and G5 presented KHN similar to their baseline numbers, and in G2 and G3 the KHN was similar to the post-treatment numbers. In general, the recovery of enamel hardness after treatment was above 86%, whith fluoride gel, varnish and Icon achieving slightly better results than the CPP-ACP and Er,Cr:YSGG laser. The analysis of the acid resistance of WSL showed that in groups 1, 3 and 5 the loss of hardness was lower than that observed in G2 and G4.

Conclusions: It was concluded that the treatments recovered the hardness of the demineralized enamel and that, despite the methods tested did not prevent demineralization of WSL, their effectiveness was greater than 85%.

Background: Cervical lymph node metastasis is the key prognostic factor in head and neck squamous cell carcinoma (HNSCC), particularly in oral cavity squamous cell carcinoma (OCSCC). Detecting occult metastases in clinically node-negative (cN0) necks remains challenging, as CT and PET-CT exhibit limited sensitivity and specificity. This study aimed to assess the incidence of occult cervical metastases in OCSCC patients, evaluate imaging accuracy, and identify associated histopathological factors.

Material and methods: We retrospectively analyzed 43 OCSCC patients undergoing elective neck dissection (END) from 2017 - 2024 at a tertiary hospital. Data on clinical staging, imaging findings, histopathological characteristics (depth of invasion [DOI], lymphovascular invasion [LVI]) and tumor location, were collected. Statistical tests (t-tests, chi-square) were performed using R v3.6.1.

Results: Occult cervical metastases occurred in 23.26% of patients (10/43). CT sensitivity was 70.27%, specificity 82.86%; PET-CT showed 81.25% sensitivity and 71.43% specificity. Patients with occult metastases had a higher mean DOI (13.13 ± 10.39 mm) compared to those without (8.1 ± 5.85 mm), though this difference was not statistically significant (p=0.172). LVI was absent in the metastatic group but present in 9.09% of non-metastatic cases. Tumor location did not significantly correlate with occult metastases (p=0.801).

Conclusions: Our findings confirm DOI as a crucial predictor of occult metastases in OCSCC, reinforcing the importance of END in high-risk patients. While PET-CT showed higher sensitivity than CT, both imaging modalities had limitations in detecting micrometastases. Further studies with larger sample sizes are needed to validate these findings and explore additional predictive factors, potentially integrating machine learning models for improved risk stratification.

Background: The present systematic review aimed to identify and summarize the radiographic and histological outcomes of alveolar ridge preservation (ARP) using autogenous particulate dentin (APD) compared with spontaneous healing (SH) or other materials in alveolus post-extraction.

Material and methods: The protocol of this PRISMA systematic review was registered in PROSPERO (CRD42021245740). Clinical trials (CT) fulfilling specific eligibility criteria were included. Screening, data extraction and quality assessment were conducted by two reviewers. Study results were summarized using random effect metanalyses to synthesize the findings of the trials.

Results: Fourteen articles concerning ten Randomized CT were included, involving a total of 304 participants, reporting data from 458 sockets. Most of the studies were considered as "unclear" risk of bias. Metanalyses indicated less horizontal at coronal third (difference in weighted means (WMD) = 2.04 mm; p<0.001) and middle third (WMD = 1.52 mm; p=0.002) bone resorption in ARP with APD compared to spontaneous healing assessed radiographically. However, no statistical significance was reached in the apical third (WMD = 0.33 mm; p=0.435) or in the vertical dimensional changes (at buccal aspect, WMD = 0.19 mm; p=0.789; and at lingual aspect, WMD = 0.44 mm; p=0.271). It was not possible to perform a meta-analysis for histomorphometric.

Conclusions: ARP with APD is an effective therapy to attenuate post-extraction bone resorption and ridge changes, especially in the coronal width of the socket.

Background: Head and neck cancer is a public health problem, and its treatment involves surgery and/or radio/chemotherapy. These procedures reduce the quality of life. To analyze survival in patients with head and neck cancer and survivors, the quality of life over 10 years.

Material and methods: An observational, cross-sectional, retrospective study was carried out on 460 medical records of patients diagnosed with head and neck cancer and treated at a referral hospital. Clinical pathological data were expressed in absolute and percentage frequencies, and the median survival time was calculated with their 95% confidence intervals using Kaplan-Meier curves. The curves were compared using the Log-Rank Mantel-Cox test and Cox regression. In survivors, we applied a quality of life (QoL) questionnaire where means and standard deviations of quality of life domains were calculated and compared using the Friedman/Dunn test and correlated with time after discharge using Spearman's correlation. Quality of life, classified as low or high with an average of 80 points, was associated with other clinical-pathological characteristics during the period of diagnosis using Pearson's chi-square test. All analyses performed adopted a 95% CI in the SPSS software. v20.0 for Windows.

Results: The medical records were analyzed; most of them were male, with a mean age of 61 years and a history of smoking and alcoholism. The most frequent staging was stage IV (T4, N2, M0). The most frequent location was the oropharynx, followed by the mouth. The median overall survival was 26.7 months (95% CI = 19.8-33.7). Of the 173 living patients, 41 (23.7%) responded to the questionnaire. Of the main problems related to QoL, swallowing (n = 10; 25.6%) was the most important, followed by chewing (n = 9; 28.1%) and saliva (n = 12; 42.9%). When QoL was associated with variables, it was observed that smoking (p = 0.014), alcoholism (p = 0.029), and time since discharge (p = 0.044) were associated with worse quality of life.

Conclusions: Cancer treatment has numerous consequences for the quality of life of patients who have survived head and neck cancer. Further studies and differentiated plans are needed for the rehabilitation of these patients.