Journal of oral rehabilitation最新文献

Background: Mandibular advancement devices (MADs) are an effective treatment for obstructive sleep apnoea (OSA), though individual responses to therapy can vary.

Objectives: This study aims to: (1) examine how craniofacial characteristics are associated with MAD effectiveness to refine patient selection and improve outcomes; and (2) assess the association of skeletal facial patterns with treatment efficacy and mandibular advancement.

Methods: This retrospective study used data from a previous quasi-experimental study. Analysis was conducted with two-piece adjustable devices, following a standardised protocol. K-means clustering analysis categorised the sample into subtypes using clinical, polysomnographic, and anatomical data to evaluate MAD treatment response. Patients were also classified by growth pattern, and treatment response and mandibular advancement were compared across facial patterns.

Results: The study included 112 patients. Of these, 41 patients (36.61%) were assigned to Cluster 1 and 71 patients (63.39%) to Cluster 2. Cluster 1 patients had more severe OSA, with higher ESS, BMI, T90%, and AHI, along with a vertical facial pattern and narrower airways. Treatment response rates were significantly lower in Cluster 1 compared to Cluster 2. Among facial pattern groups, 32 patients were hyperdivergent, 46 were neutral, and 34 were hypodivergent. The responder rate was significantly lower in the hyperdivergent group, indicating reduced treatment effectiveness.

Conclusions: This study suggests that the efficacy of OSA treatment with MADs may be associated with anatomical subtypes. Cluster 1 patients showed a lower response rate compared to Cluster 2. Additionally, patients with hyperdivergent patterns may have a less favourable response to MAD treatment.

Background/objectives: The aim of this study was to examine if a person's preferred chewing side (PCS) corresponds to his/her hemispheric body laterality (HBL) or is dominated by the dental state.

Methods: After ethical approval, 82 volunteers were recruited. Asymmetry of bite force (ABF) was tested using an occlusal force-meter (GM-10) on both sides separately. The occlusal contact area (OCA) was observed using a pressure-indicating film (GC Fujifilm Prescale). The PCS was evaluated using an asymmetry index (ASI) or a visual analogue scale (VAS). Both tests were repeated. For the HBL, participants underwent four different tests to assess handedness, footedness, earedness and eyedness, respectively. Statistical analysis comprised kappa agreement for HBL tests and their repetition, as well as paired Wilcoxon tests for intraoral parameters.

Results: Hand, eye and ear showed a substantial reproducibility, while foot produced moderate agreement (kappa = 0.58, p < 0.001). No correlation was found between a participant's PCS and HBL, with the exception of EAR with VAS (kappa = 0.29, p = 0.001). There was a significant correlation between ABF and the number of residual teeth (NNT) both for PCS (p < 0.01; r² = 0.29) and NPCS (p < 0.01; r² = 0.18). There was no significant difference between PCS and NPCS for OCA (p = 0.13). The results revealed a significantly higher number of residual posterior teeth on the participant's PCS (for VAS p < 0.0001; ASI p < 0.03).

Conclusion: Masticatory laterality does not correspond to body hemispheric laterality. Rather than HBL, the number of residual teeth seems to determine on which side a person prefers to chew.

Background: Body pain widespreadness may be related to biopsychosocial impact in TMD (temporomandibular disorders) pain patients.

Objectives: The aim was to assess, by using pain drawings (PDs), the whole-body pain locations/widespreadness and their association with pain-related intensity/interference and clinical Axis I diagnoses among Finnish tertiary care TMD pain patients using the DC/TMD-FIN (Diagnostic Criteria for TMD-FIN).

Methods: Based on PDs, 197 TMD pain patients were divided into PD profile subgroups: PD-1 (local head/face pain), PD-2 (regional head and neck/shoulder pain) and PD-3 (widespread pain). Using the Graded Chronic Pain Scale 2.0 (GCPS 2.0) assessing pain-related intensity/interference, the patients were classified into TMD subtypes (1 = uncompromised, 2 = moderately, 3 = severely compromised). Based on quantitative analysis of PDs, PD score was calculated, considering the pain widespreadness. Differences between PD profile subgroups in TMD subtypes, PD scores and Axis I diagnoses were evaluated with Independent Samples Kruskal-Wallis and chi-squared tests and pairwise comparisons with Mann-Whitney U test with Bonferroni correction. PD score sum was explored by linear regression with age, sex, Axis I diagnoses and TMD subtype as independent variables.

Results: Patients were evenly distributed by PD profiles. Patients with widespread PD-3 profiles were significantly more often classified into TMD subtype 3, had higher PD scores and more pain-related Axis I diagnoses as compared to local PD-1 and regional PD-2.

Conclusion: Among TMD pain patients widespread pain associates with biopsychosocial impact. PD is an important adjunct tool in biopsychosocial Axis II assessment of TMD pain patients for treatment planning and personalised care.

Background: Masticatory function is a major indicator for oral health status. At the time being, only few studies have investigated orofacial functional conditions with different methods.

Objective: To assess the masticatory performance (MP) of individuals aged ≥ 45 residing in Swiss communities by means of a a two-colour chewing gum.

Methods: Subjects aged ≥ 45 years and residing in Swiss communities (Bern-Canton) were recruited for this cross-sectional study. After a comprehensive clinical examination and subjects' data collection thorough dedicated questionnaires, a two-colour mixing-ability test was carried out. The photographed specimens were analysed with a subjective (SA) and an Opto-Electronic assessment (SD_Hue). Descriptive, bivariate analysis and multinomial logistic regression were performed between the outcome variable (SA) and subjects' variables.

Results: From the whole analysed sample (275 patients; male n = 154, women n = 121, mean age = 69.7 years), MP was assessed on 207 chewing samples. The SA revealed 118 (57%) categorised as SA 4-SA 5 (very good), 76 (36.7%) as SA 3 (good) and 13 (6.3%) as SA 1 and SA 2 (poor), respectively. MP was higher in the younger (age 45-64, SD_Hue: 0.09 SD 0.89) than in older group (age ≥ 75 years, SD_Hue: 0.19 SD 0.18). A significant association between MP and age (p < 0.01), time to the last visit at the dentist, visit to the dental hygienist (p = 0.03; p = 0.01) as well as the use of dental floss (p < 0.01) were detected.

Conclusion: MP of individuals aged ≥ 45 residing in Swiss communities was overall good. High plaque and bleeding scores were increasing with subjects' age.

Background: Oral torus assessment is recommended as a part of routine craniofacial examination in patients with obstructive sleep apnoea (OSA). However, there are conflicting studies on whether oral torus is associated with OSA and whether it affects OSA therapy.

Objective: This study aimed to systematically review the effects of mandibular torus on OSA and its treatment.

Methods: The PubMed, Embase and Cochrane Library databases were searched up to 15 July 2024. Studies that included patients with oral torus and examined the diagnosis and severity of OSA (Apnoea-Hypopnea Index [AHI], oxygen saturation, blood pressure and patient-reported outcomes), and studies that examined the effectiveness of OSA treatment in patients with oral torus were included. PRISMA guidelines were followed for data extraction.

Results: Eleven studies with 1372 patients were included in the study. Patients with mandibular torus were found to have a relative risk of 1.9 (95% CI = 0.9; 4.1) for OSA. The pooled mean difference in AHI between patients with and without mandibular torus was 1.6 (95% CI = -5.3; 8.6). Large mandibular torus was found to be associated with mild and moderate OSA but not with severe OSA. A greater reduction in AHI after mandibular advancement device or soft-tissue OSA surgery can be achieved in patients with torus. However, the difference was not significant when compared to patients without it.

Conclusion: Patients with mandibular torus are more likely to have OSA. Larger mandibular torus may be associated with mild or moderate OSA but not severe OSA. Mandibular torus does not impede OSA treatment.

Background: Artificial Intelligence (AI) has been widely used in health research, but the effectiveness of large language models (LLMs) in providing accurate information on bruxism has not yet been evaluated.

Objectives: To assess the readability, accuracy and consistency of three LLMs in responding to frequently asked questions about bruxism.

Methods: This cross-sectional observational study utilised the Google Trends tool to identify the 10 most frequent topics about bruxism. Thirty frequently asked questions were selected, which were submitted to ChatGPT-3.5, ChatGPT-4 and Gemini at two different times (T1 and T2). The readability was measured using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKG) metrics. The responses were evaluated for accuracy using a three-point scale, and consistency was verified by comparing responses between T1 and T2. Statistical analysis included ANOVA, chi-squared tests and Cohen's kappa coefficient considering a p value of 0.5.

Results: In terms of readability, there was no difference in FRE. The Gemini model showed lower FKG scores than the Generative Pretrained Transformer (GPT)-3.5 and GPT-4 models. The average accuracy of the responses was 68.33% for GPT-3.5, 65% for GPT-4 and 55% for Gemini, with no significant differences between the models (p = 0.290). Consistency was substantial for all models, with the highest being in GPT-3.5 (95%). The three LLMs demonstrated substantial agreement between T1 and T2.

Conclusion: Gemini's responses were potentially more accessible to a broader patient population. LLMs demonstrated substantial consistency and moderate accuracy, indicating that these tools should not replace professional dental guidance.