Assessment of Tooth Shade Measurement Precision and Consistency with Digital Photography Calibration System.

Objectives: To ascertain the degree of precision and repeatability inherent in the "capture to edit" digital imaging system, namely the ColorChecker Passport Photo (X-Rite, MI, USA), and to juxtapose its performance against spectrophotometric assessments utilizing the Vita Easyshade® (Vita Zahnfabrik, H Rauter GmbH & Co. KG., Bad Sackingen, Germany) for the same set of teeth. Materials and methods: Eighty participants aged 19-25 were included in the study; all of them were Croatian students at the School of Dental Medicine, University of Zagreb. Color measurements of the maxillary right central incisors were performed in controlled, standardized laboratory conditions. The measurements were performed on calibrated digital photographs by an experienced clinician three times in a row, and L, a, and b of CIELAB color space values were recorded. The same procedure was performed using the Vita Easyshade 5.0 spectrophotometer (Vita Zahnfabrik, Bad Säckingen, Germany) in "Tooth single" mode. Results: The Cronbach's alpha was used as a repeatability measurement, thus revealing high consistency for both methods (α=0.94-1). Correlations were moderate (Pearson r=0.44-0.66 p<0.05). Testing confirmed that digital photography is inaccurate as spectrophotometry (p<0.05). An analysis of errors of means and their standard deviations revealed consistent discrepancies with minor deviations. Conclusion: The "capture to edit" method showed high consistency (Cronbach's α=0.94-0.96), and it exhibits comparability in terms of variability, reliability, and repeatability when compared to spectrophotometric measurement (VitaShade 5, VitaZahnfabrik). Disparities between the methods are evident and anticipated, yet they do not follow a consistently linear pattern. The combination of repeatability and consistency renders the "capture to edit" method a valuable tool for enhanced color mapping, thus facilitating comparisons between digital images.

The Asymmetry of the Mandible in Patients with Unilateral Temporomandibular Joint Disc Displacement Confirmed by Magnetic Resonance Imaging.

Objectives: The study aimed to determine the relationship between the mandibular asymmetry index according to Kjellberg between patients with painful unilateral anterior disc displacement (DD) and asymptomatic volunteers without disc displacement. Vertical measurements were performed on a panoramic single-image radiograph, and the disc status was confirmed by magnetic resonance imaging (MRI). Material and methods: Two groups of subjects were retrospectively selected, 40 patients (the overall mean age was 35.5 years; 75% female) with temporomandibular disorder symptoms confirmed by RDC/TMD axis I and manual functional analysis. Unilateral DD was determined by MRI. A comparative group of asymptomatic volunteers (20 dental students with a mean age of 23.4 years; 72% female) had the physiological position of the disc determined by MRI. The vertical asymmetry of the condyle was determined by the method of Kjellberg et al. The symmetry of the gonial angle of the mandible was also measured. Results: A comparison of the mean of the asymmetry index between patients (average 90.89±7.08%) and asymptomatic volunteers (mean 95.86±4.44%) showed a statistically significant difference (p=0.0029). There was no difference (p=0.088) in gonial angle symmetry between the patients (mean 96.48±2.96°) and the asymptomatic volunteers (mean 97.52±2.31°). The distribution of the presence of individual DD diagnoses (partial and total displacement with reduction, displacement without reduction) in patients diagnosed with asymmetry of the mandible was without statistical significance (p>0.05). Conclusion: This study actually points to the asymmetry of the mandible as a potential morphological risk of anterior DD.

Comparison of Three Prosthodontic Treatment Modalities for Patients with Periodontally Compromised Anterior Mandibular Teeth: A 2-year follow-up study.

OBJECTIVES: To prospectively assess self-perceived chewing function (CF) and oral health-related quality of life (OHRQoL) in geriatric patients after receiving three different treatment modalities in the mandible: removable partial denture (CD-RPD), complete denture (CDs), or complete overdenture supported by mini dental implants (CD-MDI). At baseline, all patients had mobile anterior teeth (1 mm or >) and missing posterior teeth in the mandible. Patients were completely edentulous in the maxilla. After treatment, patients were recalled at the 3-month and the 2-year post-treatment period. MATERIALS AND METHODS: A total of 176 patients participated (CD group, n=68; CD-RPD group, n=58; CD-MDI group, n=50). Self-reported CF was assessed using the Chewing Function questionnaire (CFQ), The OHRQoL was evaluated using the OHIP14 questionnaire, which the patients completed 1. before treatment, 2. three months after treatment, and 3. at the 2-year post-treatment stage. RESULTS: The OHRQoL and the self-perceived CF significantly improved in all groups after treatment (p<0.01). The highest improvement of a CF was recorded in the CD-MDI group. The OHRQoL was significantly higher in the CD-MDI group in comparison to the CDs group after treatment (p<0.01). At the 2-year post-treatment stage, self-perceived CF significantly further improved in the CD-MDI group, while it worsened in the CD and the CD-RPD groups (p<0.01). The same pattern was recorded for the OHIP14 summary scores. The highest amount of denture repairs and adjustments was recorded in the CD-RPD group, although maintenance was also demanding in the CD-MDI group. CONCLUSION: Within the limitations of this study, rehabilitation with mandibular MDI retained overdenture can be considered as preferred treatment with the constant improvement of OHRQoL and a chewing function in comparison to mandibular CD or mandibular RPD option in patients with mobile anterior mandibular teeth.

Prevalence of third molars and pathological changes related to them in dental medicine.

The purpose of this study was to determine the prevalence of third molars in terms of respondents' age. Furthermore it was desired to determine the extent of the manifestation of pathological changes, such as caries, apical lesions, and alveolar bone resorption. This study was based on 500 OPGs of patients from the Faculty of Dentistry, University of Zagreb. Patients were divided into seven age groups. The total number of molars, the number of cavities on remaining molars, the quality of endodontic treatment and the evaluation of their performance and presence of periapical lesions was analyzed. As apart of the periodontal status, the number of inadequate fillings, the number of damaged furcations and bone resorption was analyzed. The statistical analysis was performed by means of STATISTICA 7 statistical package (StatSoft, Tulsa, USA). The correlation between the total number of molars and the age of patients was analyzed by means of Spearman's correlation to the level of significance of 0.05. The number of first, second and third molars significantly decreased in higher age groups. The prevalence of caries in third molars as compared to first and second molars was generally lower, third molars were endodontic treated at least. Assessment of involved furcations showed that the lowest percentage of 8% was found in third molars. The majority of all remaining molars had bone resorption of 1-3 mm.

Craniofacial morphology of Croatian patients with obstructive sleep apnea.

Currently, there is no information available regarding craniofacial morphology of Croatian patients with obstructive sleep apnea (OSA). The aim of the study was to determine the craniofacial characteristics of patients with OSA and to assess the association of cephalometric and anthropometric variables related to craniofacial morphology with the apnea hypopnea index (AHI). Anthropometric measurements and upright lateral cephalometric radiographs were obtained from 20 male patients with OSA and 20 male controls. The 20 OSA patients were classified into two groups on the basis of body mass index (BMI) as obese and non-obese. Twenty three variables were identified and calculated for each cephalometric radiograph. OSA was defined as AHI > or = 5/hour. The OSA patients showed greater body mass index (BMI), neck circumference (NC) and cranial index (CI) and lower facial index (FI) compared to the controls (p < 0.01). The patients with OSA showed significant cephalometric features as opposed to the controls: smaller linear distance between gonion and menton and anterior cranial base, greater linear distance from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate. Furthermore, they showed reduced upper airway width at two levels: the nasopharynx, and the region of posterior airway space, smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx and greater upper airway length. They also displayed significantly increased craniocervical angulation, larger angle between supramentale, menton and hyoid bone and larger angle between posterior nasal spine, supramentale and hyoid bone. The obese OSA patients showed greater neck circumference (NC) compared with the non-obese OSA. The obese OSA patients showed significant cephalometric features compared with the non-obese OSA patients: larger craniocervical angles larger angle between the third cervical vertebra, the centre of sella turcica and the posterior nasal spine, furthermore, greater linear distance between the hyoid bone and the third cervical vertebra and smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx. In our study, AHI was significantly correlated with cephalometric measurements S-Go, S-H, H-C3 and S-PNS-C3.

Decreasing of residual alveolar ridge height in complete denture wearers. A five year follow up study.

The resorption of the residual alveolar ridges is a chronic and continuous process of bone remodeling. The aim of this study was to analyse the rate of residual ridge resorption at different sites in the both jaws in complete denture wearers, through a five-year period of denture wearing. Residual ridge changes were measured on successive lateral cephalograms at 5 measurement points of the maxilla and the mandible. The first lateral radiograph was obtained at the delivery of complete dentures. The second lateral cephalogram was obtained after five years of denture wearing. Measurements were performed using a calibrated grid. The results of this study showed the existence of a significant alveolar ridge resorption at all five measurement points of the maxilla and the mandible. The observed variables, such as body mass index and the night time denture wearing had no significant influence on the rate of residual alveolar ridge resorption (p > 0.05). The duration of edentulousness had a significant influence on the rate of residual ridge resorption with significantly higher amounts of alveolar bone height decrease in those patients who had lost the last remaining teeth more recently.

Depression, somatization and anxiety in female patients with temporomandibular disorders (TMD).

The aim of this research was to determine the possible differences in degrees of depression, somatization and anxiety between the acute and chronic female patients with temporomandibular disorders (TMD), and whether these differences exist in healthy female patients. Ninety female patients were involved in this research; 60 of them were TMD patients of the Dental Polyclinic, while other 30 females came for a routine recall visit and had no problem related to TMD. Patients were aged 22 to 67 years, the average age being 38.5 +/- 12 years. All patients were asked to fill in the RDC/TMD protocol and three psychological tests (Emotions Profile Index, Somatization Scale and life Events Scale). Following the analysis of the RDC/TMD protocol and psychological tests, it was determined that the chronic female patients had higher depression and somatization scores in comparison with the acute patients (p < 0.01); the acute patients self-perceive higher levels of anxiety in relation to the control group; furthermore, the patients reporting higher levels of depression were more inclined to somatization and had experienced a greater number of stress events in the past six months. It is beyond doubt that patients suffering from the TMD's exhibit higher levels of depression, somatization and anxiety compared to the healthy ones, which proves that physiological factors may play a predisposing role in combination with reduced level of body tolerance to pain, and a decreased tolerance to stress.

Dental status as a quality control health care parameter for children with disabilities.

The aim of this study was to determine the level of dental health condition in children with disabilities and to find out weather dental health status might be used as a quality control parameter regarding overall health care for disabled children. Disabled and healthy children from 3 to 17 years old were examined. There were 86 boys and 34 girls in each group. Dental health status was evaluated using the World Health Organization diagnostic criteria for decayed, missing and filled teeth. The relations between mean decayed, missing and filled teeth index for primary, mixed and permanent dentition showed no statistically significant differences among groups. Our results showed that disabled children have evenly level of dental caries as their healthy peers. One can conclude that organized health care for disabled children have positive influence on dental care, too. Furthermore, dental status as an indicator of dental care level might be used as a parameter for quality control regarding overall health care for disabled children.

Changes of alveolar bone density around the abutment teeth in patients wearing removable partial dentures depending on Kennedy classification.

The aim was to study the influence of Kennedy classification on alveolar bone density changes around the abutment teeth of removable partial denture (RPD) clasp and rests. A total of 50 examinees of both gender wearing RPDs were included in the study. Changes of bone density around the abutment teeth were determined by an intraoral microdensitometry method. Standard retroalveolar radiographs were obtained twice: the first one at the RPD delivery and the second one after a period of 3 month of denture wearing. The copper stepwedge consisting of 5 steps (0.1-0.1 mm) was attached to the radiograph prior to exposure in order to calibrate it. Seven regions of interest (ROI) in different position close to the root of the abutment tooth were selected on each radiograph, all 10 pixels in size. Grey levels of each ROI were measured and were converted into equivalents of the copper stepwedge thickness using the third degree polynomial in order to compare the difference of bone density between the two radiographs. The results indicated that Kennedy classification had no significant influence on the change of bone density in RPD patients during first 3 month of RPD wearing (ANOVA: p > 0.05).

Incidence of caries in children of rural and subrural areas in Croatia.

The aim of this paper was to determine certain regularities in caries incidence in children in primary and permanent dentition in respect of clinical and non-clinical variables that can be collected in everyday dental practice. This way it could be easier for the operator to adjust individual preventive therapy of patients. The study was conducted on 301 subjects, aged 3-6 (74 subjects) and 11-14 (227 subjects) inhabitants of Petrinja and Topusko, postwar rural and subrural areas in Central Croatia. Using an oral hygiene questionnaire, habits, diet and use of fluoride were assessed. The clinical finding comprised the dental status, amount of stimulated saliva, oral hygiene index and the presence of orthodontic anomaly. Children showed very high values of the dmf-t/DMF-T (decayed, missing, filled index) (7.7/6.7), dmf-s/DMF-S (16.5/11.8), and significant index of caries (SiC = 10.89). The study confirmed correlation between the OHI (oral hygiene index) and dmf-t/DMF-T and dmf-s/DMF-S index, and the influence of the regularity of dental check-ups and frequency of tooth brushing on OHI. Furthermore, the children that started practicing oral hygiene later, brush their teeth irregularly, and visit dentists only when having pain. It can be concluded that Croatia is still very far from achieving the goals set by WHO concerning oral health improvement.

Serum immunoglobulins IgG, IgA and IgM in patients with oral lichen ruber.

The aim of this study was to determine level of serum IgA, IgG and IgM in patients with OLR as indicators of humoral immunity which might reflect cell-mediated immunity. This study was conducted on 30 patients (age 60.17 +/- 11.75) with clinically and histopathologically confirmed diagnosis of OLR and 30 healthy controls (age 56.16 +/- 11.82) Determination of serum IgA, IgG and IgM was performed by use of standard laser nephelometry in both patients and controls. Statistical analysis was done using Mann-Whitney U test and the level of significance was determined as p values lower than 0.05. Serum IgA and IgM in patients with OLR were significantly increased in comparison to the control group, while serum IgG levels were higher in patients with OLR but they did not reach significance. We might conclude that elevated levels of serum IgA and IgM show that humoral immunity is implicated in the pathogenesis of OLR.

The influence of age on tooth root colour changes.

The purpose of this study was to examine the relationship between tooth root colour and age, and its possible application in age assessment. In this research altogether 100 tooth roots have been analysed. All teeth, that is their roots, were digitally recorded and the colorimetric treatment was made using Adobe Photoshop 7.0 computer program. Studies have shown no significant difference between RGB values analysed on the whole root surface or only on its central part, with certainty p >0.99. It is also established that there is no statistically significant difference in colouration on four anatomical surfaces (buccal, mesial, lingual, distal) of tooth roots with certaintyp>0.99 for red, p>0.99 for green and p>0.50 for blue colouration component. Statistical data interpretation showed that there is a linear correlation between obtained RGB values and age, with r=-0.994, p>0.99 for red component, r=-0.972, p>0.99 for green and r=-0.982, p>0.95 for blue colouration component. From the obtained results it is possible to conclude that analysing the above mentioned parameter we can easily establish dental age and this technique can be the basis of practical application in establishing chronological age of man.

Oral health status and temporomandibular disorders in multiple sclerosis patients.

Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Certain clinical manifestations affect the oro-facial region. Three in particular should be of interest to the dentist: trigeminal neuralgia, sensory neuropathy of the trigeminal nerve and facial palsy. The aim of this study was to determine the oral health status, the frequency of subjective symptoms and temporomandibular disorders (TMD) subtype according to Research diagnostic criteria for temporomandibular disorders (RDC/TMD) among MS patients. Examinees in this study were 50 patients suffering from MS, who were at least once treated during their disease in the Clinic Hospital Center, Rijeka, Clinic for Neurology. All examinees had to meet the diagnostic criteria for clinically and laboratory confirmed MS, according to Poser. The results show the difference in mean DMFT (decayed, missing, filled teeth) between MS and the control group. The number of decayed and missing teeth was higher, but the number of filled teeth was significantly lower in MS group. Eighty-two per cent of the subjects with MS had a least one symptom of dysfunction compared with 24% of the subjects in the healthy control group. In the present study, pain, the pain during mouth opening, the difficulty with mouth opening and temporomandibular joint (TMJ) sounds were more commonly reported in the MS group than in the control group. This study shows a statistically significant excess of dental caries and temporomandibular disorders among MS patients compared with the control group. These results suggest that MS is a possible etiological factor in temporomandibular disorders.

Caries and oral hygiene in children in postwar Novi Travnik (Bosnia and Herzegovina) and Zabok (Croatia).

The study was performed in 1997 and involved school children between the age of 6 and 12 in Novi Travnik, Bosnia and Herzegovina (n = 203) and Zabok, Croatia (n = 132). OHI-S (Simplified Oral Hygiene Index by Green-Vermillion) and DMF (Decayed, Missing, Filled) index were used as main outcome measures. Prewar data were taken from the respective literature. The value of the DMF/dmf (PERMANENT/deciduous teeth) for six-year-olds in Novi Travnik of the period before the war was: d = 5.6, m = 0.4, f= 0.6 and D = 0.3, F = 0.1 and the average DMF index of twelve-year-olds for the same period were 6.5. The DMF/dmf index in 1997 in Novi Travnik was: d = 9.4+/-4.4; m = 0.7 +/-1.1; D = 1.9+/-1.2 and average DMF index of twelve-year-olds was 9.0+/-4.16. The DMF index of twelve-year-olds in Zabok in 1990 was 3.4 and 4.1+/-2.1 in 1997. Total DMF index for all the examined ages in 1997 for Zabok was 6.1+/-3.7 and for the examinees in Novi Travnik 10.5+/-4.1 (p<0.001). Similarly, the OHI-S in 1997 for Zabok was 1.0+/-0.7 whereas 1.7+/-0.7 (p<0.001) in Novi Travnik. In comparison to prewar data, DMF index in 1997 was considerably higher. Increase of DMF index was higher in Novi Travnik than in Zabok, which can be attributed to the war and wartime conditions.

Tissue expression of proliferative antigens (PCNA and Ki-67) in oral lichen ruber related to clinical status.

The aim of this study was to determine the expression intensity of PCNA and Ki-67 tissue antigens related to pathologically modified oral mucosa in OLR lesions, and to determine the reaction intensity of these antigens in individual clinical forms, i.e. lichen ruber planus (LRP) and lichen ruber erosivus (LRE) comparing the reaction intensity with the inflammation grade and the degree of hyperkeratosis in lesions of 30 patients. Control group included patients (n = 15) with oral leukoplakia simplex. Tissue antigens were observed by immunohistochemical analysis using APAAP and LSAB methods. The reaction on tested tissue antigens was focal positive and of mosaic type. The reaction of the PCNA antigen was intensely high in OLR lesions regardless on the clinical form of the lesion. The reaction intensity positively correlated with the inflammation grade and the degree of hyperkeratosis in lesions. The reaction on Ki-67 tissue antigen ranged from low to moderately high intensity. Intensely high reaction was observed in lesions of lichen ruber erosivus. The reaction positively correlated with the inflammation grade and the degree of hyperkeratosis in lesions. Observed modified reaction of analyzed tissue antigens related with individual clinical forms of OLR might be the indicator of transformed nature of these lesions.

Changes in the tissue expression of the C-erbB-2 oncogen in the oral lichen ruber.

The aim of this study was to determine the expression intensity of c-erbB-2 antigen in oral lichen planus and erosive form of oral lichen in 30 patients, and to compare the obtained results with the inflammation intensity i.e. hyperkeratosis. The examination of expression intensity of c-erbB-2 antigen was conducted through immunohistochemical analysis by APAAP method. Obtained reaction of examined tissue antigen was positive in individual or in group cells of spinous epithelium layer and mosaically expressed. The reaction was negative in basal cell epithelium layer. Strong intensity reaction was observed in intercellular bridges of spinous cells layer. In control group, the reaction was of uniform strong intensity in all epithelium layers. The reaction was not dependent on the inflammation intensity in lesions but it was positively correlated with their degree of hyperkeratosis. Changed expression of c-erbB-2 antigen in OLR lesions reveals the possibility of potential malignant transformation of these lesions.

Influence of the partial denture on the articulation of dental and postalveolar sounds.

Dental prosthesis is a foreign body in oral cavity and thus necessarily interferes with speech articulation. The purpose of this study was to examine influence of partial denture on speech quality and to show eventual differences in pronunciation of dental sounds c[ts], z [z], s [s] and postalveolar sounds c [t], z [3] and s [integral of]. We have examined differences in pronunciation between subjects with removable partial dentures, the same group without partial dentures and a control group. The study was performed on 30 subjects with removable partial dentures and 30 subjects with complete dental arch. All subjects were recorded while reading six Croatian words containing the examined sounds. Recordings were analyzed with Multispeech Program (Kay Elemetrics Inc.). Acoustic analysis--LPC (linear prediction coding) provided formant peaks (Hz) for each examined sound, its intensity (dB) and formant bandwidths (Hz). Results showed that subjects with partial dentures had 50% less distorted variables and that prostheses did not completely restore articulation of postalveolar sounds. Groups with and without prostheses had lower formant peaks intensities and wider formant bandwidths in comparison to the control group. Partial dentures have not significantly interfered with resonance frequency. At the same time, pronunciation of the examined sounds was significantly improved. However, precision of the articulation movements has deteriorated.

SEM analysis of tooth enamel.

SEM analysis contains researches of tooth enamel surfaces of two populations. First group of samples is tooth enamel of prehistorically ancestor from Vucedol and the second group of samples is enamel of modern Croatian citizen. Even on small number of human teeth samples from cooperage site of Vucedol (3,000 BC) and today's Croatian people, we can conclude about chewing biometry of prehistorically ancestors and today's modern Croatian people, comparing interspecifically the morphology of enamel microdefects. With the interspecific comparison of morphology changes on tooth occlusal surfaces, we can connect the size and shape of abrasive particles and diet with microdefects of tooth enamel.