Acta Stomatologica Croatica最新文献

Background: Evaluation of maxillary width holds significant clinical importance in identifying developmental abnormalities, aiding in orthodontic diagnosis and treatment planning, providing ethnicity-specific data, and supporting forensic applications. Still, research on maxillary growth in transverse dimension is limited due to a lack of standardized diagnostic criteria and methods for defining normalcy. Addressing these gaps, this study aimed to establish a standard transverse maxillary dimension using the intermolar (IMW)-to-intercanine (ICW) width ratio determined on a large, homogeneous sample of dental Class I well-aligned arches with Little's irregularity index 1 or 2 across India.

Methods: A pan-India, cross-sectional, model-based study of 1575 maxillary arch models with normal occlusion was conducted to define the transverse dimension of the maxillary arch. The IMW and the ICW linear dimensions and their ratio were measured and statistically analyzed. These parameters were also compared for sex-based differences.

Results: The results revealed a mean IMW and ICW of 36.87mm and 35.44 mm, respectively. The mean ratio of IMW to ICW was 1.04. Sexual differentiation revealed a significantly higher mean values of IMW (37.54) and ICW (36.10) in males compared to females for IMW (35.84) and ICW (34.92), respectively, at p=0.000.

Conclusion: In normal and well-aligned dentition, the ratio between IMW and ICW in the transverse dimension is 1.04:1. It provides a clinically easy visual evaluation chairside method to identify normal arches, even without radiographs. This norm can be further explored in diverse ethnic populations and explored for applications in orthodontic diagnosis and treatment planning, forensic odontology, and anthropological studies.

Objective: Prescription opioid abuse, associated with numerous opioids, is a well-established public health problem in developed countries such as the UK, US and Australia. Opioids have a limited role in general dental practice; hence the aim of this study was to assess prescribing rates of opioids in dentistry from 2013 to 2023 in Croatia.

Materials and methods: Data on opioid prescribing practices for this study were provided by the Croatian Health Insurance Fund. The analysis included the number of prescriptions, cost, and the number of packages prescribed.

Results: Over the 11 years, dentists in Croatia have prescribed a total of 9132 opioid prescriptions, representing annually on average 1,1% of all analgesic prescriptions, and 0,2% of all dental prescriptions. The number of opioid prescriptions per 1,000 dental patients was on average 0, 19. Tramadol/paracetamol and tramadol were the most prescribed opioids, with average annual number of prescriptions amounting to 622, 7 (64% of opioids prescriptions) and 114, 5 (1, 1% of analgesic prescriptions), respectively. Trends in opioid prescription varied, especially during pandemic years (2020-2022), when tramadol rates decreased while fixed combination medications tramadol/paracetamol and tramadol/dexketoprofen increased. But an overall increasing trend was observed during that period.

Conclusion: Dentists in Croatia are restrictive and conservative in prescribing opioids, and there is no need for intervention, but because of increasing trends, observing the prescribing pattern in the future is highly recommended.

Objective: To investigate whether factors associated with surgical trauma influence postoperative pain in the first postoperative week.

Study design: The study included 30 healthy, non-smoker adults of both genders, with an indication for periapical surgery on a single tooth in the upper anterior region, no history of prior surgery, no allergies to lidocaine with adrenaline or ibuprofen, no acute inflammation or pain, and a PAI of 3, 4, or 5. A single surgical team treated all patients by following the same surgical protocol. In the first postoperative week, each patient received the same postoperative instructions and a pain questionnaire to record pain intensity and analgesic consumption.

Results: The highest pain intensity was recorded on the day after surgery, while the highest analgesics consumption was recorded on the day of surgery. Participants with a BMI correlated positively with the amount of analgesics taken in the postoperative period (P<0.05). The duration of the operation correlated negatively with the intensity of pain and the consumption of analgesics after the operation (P<0.05). The volume, height and width of the alveolar bone defect after the operation did not significantly influence the intensity of pain and the consumption of analgesics in the postoperative period (P>0.05). The presence of a fistula correlated negatively with analgesic consumption after surgery (P<0.05), while preoperative fenestration correlated negatively with the intensity of postoperative pain (P<0.05).

Conclusion: Patients with a preoperative fistula and fenestration reported less pain and lower analgesic consumption in the postoperative period. These results indicate a potential relationship between the severity of postoperative pain and the degree of surgical trauma.

Objective: Medical emergencies (MEs) pose immediate threats to patients' lives and health and can occur in dental clinics. This study aimed to evaluate how well dentists in Croatia feel prepared to manage MEs and how well their clinics are equipped with necessary drugs and equipment.

Materials and methods: The study involved 319 active dentists who completed an online questionnaire covering demographic data, education on MEs, self-assessment of their ability to manage MEs, clinic equipment for MEs, knowledge and ability to use drugs for MEs, and opinions on further education needs. The normality of the distribution was tested using the Shapiro-Wilk test. Percentages were used for nominal variables, and mean ± standard deviation was applied for continuous variables. A t-test and χ2 test were used to analyze group differences.

Results: Most of the respondents (77%) were general dentists. Adrenaline was the most available drug (98.7%), while other drugs were less common. The respondents in secondary and tertiary healthcare clinics showed greater readiness and better education for managing MEs and attended ME training significantly more often than those working in primary healthcare clinics (p=0.009). Additionally, the respondents with specialization and experience in secondary and tertiary clinics had more drugs and equipment and attended ME training more frequently (p < 0.0001 and p=0.001).

Conclusions: Training on managing MEs should be held more frequently, on an annual basis, and should be mandatory for all dentists, regardless of their workplace.

Accurate age estimation is an integral part of the identification process. Although used infrequently when compared to more established methods, the Haavikko method can be used in cases where other dental age estimation methods have proven ineffective.The aim of this study was to adapt the Haavikko method as a means of improving age estimation on a representative sample of Croatian children and to establish an applicable standard for the Haavikko developmental stages. To achieve this objective, digital, standardized orthopantomograms of children aged 5 to 16 were collected in four Croatian cities in 1997. Drawing upon a previously published study of the Croatian population, a simple adaptation named 'shift' was introduced to the Haavikko method by adding the average difference between chronological and dental age to the estimated dental age. Square deviations were used to compare the results of the original Haavikko method with the 'shift' adaptation. Accuracy of age estimation was presented as the percentage of correct estimations within intervals of ±0.5 years, ±1 year, ±1.5 years and ±2 years. The 'shift' adaptation was tested through simulation to assure population applicability. The average age for every stage of each permanent tooth was then calculated to provide Croatian specific tables for the Haavikko method. The 'shift' adaptation significantly improved age estimation accuracy among boys and girls in all age groups. Simulation confirmed the representativity of the sample and its population applicability. The Croatian specific tables comprise a standard when estimating age using the Haavikko method among Croatian children.

Objective: The aim of this in vitro study was to evaluate the bond strength of a resin composite fissure sealant to enamel which was pre-treated with different laser pulse modes and additional acid etching.

Materials and methods: Forty-two healthy molars and premolars were collected for this study and randomly divided into 6 groups (n=7). Group 1: Quantum Square Pulse (QSP); Group 2: Medium-Short Pulse (MSP) mode; Group 3: Super Short Pulse (SSP) mode; Group 4: QSP + acid etching; Group 5: MSP + acid etching; Group 6: SSP + acid etching. The occlusal surfaces of the teeth were pre-treated according to the defined group. Laser conditioning of the enamel was performed using an Er:YAG laser Fotona Light Walker AT-S (Fotona, Ljubljana, Slovenia) with a wavelength of 2940 nm + acid etching (EN etch Ivoclar Vivadent AG, Schaan, Liechtenstein). Occlusal surfaces were sealed with a resin-based composite fissure sealant (Helioseal F, Ivoclar Vivadent AG, Schaan, Liechtenstein). Micro-tensile bond strength (μTBS) test and stereomicroscope evaluations of the failure mode were performed. The μTBS was tested using the Games-Howell method. The failure mode between groups was tested using the chi-square test. The significance level for all tests was set at p <0.05.

Results: The highest bond strength was measured using laser etching in MSP mode combined with acid etching (36.09 MPa). This combination showed a significantly higher bond strength than the other combinations (SSP + ETCH, p<0.001; QSP + ETCH, p<0.001).

Conclusion: The SP laser followed by acid etching of enamel yielded the highest bond strength. Thus, the MSP with a 140 µs pulse mode might be the preferred choice as a pre-treatment procedure for fissure sealing.

Objectives: The aim of this study was to evaluate the change in self-efficacy in endodontics among dental students during their studies and to make a comparison between the generations affected and not affected by the COVID-19 lockdown.

Materials and methods: The Endodontic General Self-Efficacy Scale was used. Data for this longitudinal study were obtained from two generations of students who have completed the same three self-efficacy questionnaires at the end of each academic year over a three-year period.

Results: Repeated measurements of each participant revealed a statistically significant difference in self-efficacy level among the three repeated measures over a three-year period (F(1, 580) = 80.226; p < 0.05). The effect size between groups showed a statistically significant difference in self-efficacy in performing endodontic treatments across all three repeated measures (F(1) = 13.958 p < 0.05). The post hoc analysis confirmed the between-group difference (2.838; p < 0.05) in the arithmetic mean between the lockdown-affected and non-lockdown-affected groups. Active participation and length of time in a dental office (between several days and one year of experience) were associated with an increase in self-efficacy.

Conclusions: Self-efficacy increased as students progressed in their studies. The self-efficacy of students who were not affected by the lockdown tended to increase; however, in the final year of study, the level of self-efficacy was similar for students affected and not affected by the lockdown. The social persuasion component could explain the alignment in self-efficacy levels. It means that individuals who receive verbal encouragement affirming their abilities to succeed in specific tasks are more likely to exert increased efforts and maintain persistence.

Objective: The aim of this study was to examine whether the method of surface treatment of the acrylic teeth and reinforcement of the denture base (carbon fibers) affect the reduction of stress concentration for gap initiation at the interface of acrylic teeth and denture base as a measure of bond strength.

Materials and methods: Samples of cross-sections of acrylic teeth and denture base were isolated from four pairs of complete acrylic dentures (with and without reinforcement of the denture base) and were subsequently subjected to compressive loading in a universal testing machine simulating two different occlusions. Selected groups of acrylic teeth (central incisors, first premolars, and first molars) from complete dentures were treated in various ways (untreated, mechanical, chemical, and mechanical-chemical). The gap size at the interface of acrylic tooth and denture base was measured using a light inverted microscope on selected acrylic teeth of individual quadrants. The one-way analysis of variance was used to investigate the influence of denture base reinforcement and different methods of surface treatment of the acrylic tooth on bond strength at the level of statistical significance of p ≤ 0.001.

Results: Microscopic analysis of gap size measured at five selected points at the interface between the acrylic teeth and the base of the complete denture ranged from 40 to 144 micrometers. The one-way analysis of variance showed a statistically significant difference between the arithmetic means of the measured gap sizes concerning different methods of surface treatment of the acrylic teeth.

Conclusion: The fracture strength, or load-bearing capacity, of complete dentures reinforced with carbon fibers was increased compared to complete dentures with non-reinforced bases. Reduction in gap size at the interface between the acrylic teeth and the base of complete dentures was influenced by the mechanical-chemical treatment of the lower surface of acrylic teeth, while reinforcement of the complete denture base with carbon fibers had no effect on the bond strength.

Objective: The aim was to test the Belgrade age formula based on the calculation of open apices of two permanent mandibular teeth on a Bosnian children population and compare its accuracy with European formula.

Material and methods: We included 412 panoramic images of children (204 female and 208 male) 7 to 13 years of age. We assessed the performance of both methods (the European formula and the BAF) and compared their results in both sexes.

Results: The results showed a high point of average understanding between the age estimated by chronological age and the European formula (ICC=0.927, 95% CI 0.904-0.944, p<0.001)., BAF also confirmed a high point of agreement with chronological age in boys (ICC=0.941, 95% CI 0.922-0.955, p<0.001) and girls (ICC=0.913, 95% CI 0.886-0.934, p<0.001). BAF was better than the European formula in estimating age in males (0.4448±0.9135 vs. 0.9807±0.9422).

Conclusion: The Belgrade Age Formula (BAF) demonstrates comparable accuracy to the European formula for age determination in Bosnian children, while offering the advantage of being easier and faster to use. This makes the BAF a practical alternative in clinical and research settings where efficiency and reliability are essential.

Objective: The objective of the study was to investigate the influence of different irrigation protocols on the shear bond strength (SBS) of self-adhesive resin cement (SARC) on primed radicular dentin.

Methods: Radicular dentin slabs (N=58) were embedded in acrylic. Subsequently, they were polished and randomly assigned to five experimental groups (N=8-12) and one control group, CG (N=8). Irrigation solutions used were 2.5% sodium hypochlorite (H), 17% ethylenediamine tetraacetic acid (EDTA), 9% etidronic acid with hypochlorite (HEDP), 0.9% saline solution (SS), and 2% chlorhexidine (CHX). Each experimental group underwent a different irrigation protocol for two minutes: 1) H/EDTA/H, 2) HEDP, 3) H/EDTA/CHX, 4) H/EDTA/SS and 5) HEDP/SS. The CG samples were not treated with any irrigation solution. After drying, the adhesive-enhancing primer (AEP) and dual-curing SARC were applied to the radicular dentin using molds corresponding to the Ultra Tester (Ultradent Products, South Jordan, USA). The specimens were stored at 37 °C in distilled water and broken after 10 days in shear mode. The results were analyzed using ANOVA and post-hoc Games-Howell test, α=0.05.

Results: CG exhibited the highest SBS. With the exception of HEDP and HEDP/SS, all experimental groups showed significantly lower SBS compared to CG (p<0.05).

Conclusions: HEDP appears to be an adequate solution for cleaning the root canal prior to dentin priming and fiber post cementation with SARC.