Clinical Analysis of the Diagnostic Accuracy and Time of Execution of a Transillumination Caries Detection Method Compared to Bitewing Radiographs.

PURPOSES: this clinical study evaluated the accuracy and execution time of a digital imaging fiber-optic transillumination (DIFOTI) technique for the detection of approximal caries in posterior teeth compared to intra-oral examination associated with bitewing radiographs. METHODS: one hundred patients were selected and submitted to clinical inspection and bitewing radiographs. The outcomes of this process were converted into scores, according to the International Caries Detection and Assessment System (ICDAS): 0-sound tooth; 1, 2, and 3-carious lesion confined within enamel; 4, 5, and 6-dentin carious lesion. Subsequently, an independent investigator acquired digital images of the same teeth using a DIFOTI device (DIAGNOcam, Kavo Dental), which were also converted into ICDAS scores. The time required for executing diagnostic procedures was measured. The clinical sensitivity and specificity of DIFOTI were analyzed by receiver operating characteristic (ROC) curves. The time necessary to perform the diagnostic methods was evaluated by Mann-Whitney U (alfa = 0.05). RESULTS: the overall test accuracy for the DIFOTI-based device ranged from 0.717 to 0.815 (area under the ROC curve) with p < 0.0001 for all ICDAS scores. Bitewing radiographs took almost twice the time required by DIFOTI (p < 0.001). CONCLUSIONS: the DIFOTI-based device DIAGNOcam provided accurate detection of approximal caries in posterior teeth, even at early stages. The technique employed for transillumination caries diagnosis by the same device took less time than conventional bitewing radiographs. CLINICAL RELEVANCE: transillumination devices, such as DIAGNOcam, can be accurately used for caries diagnosis in approximal surfaces of posterior teeth, demanding less clinical time and without radiation-related risks.

Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: protocol of a randomised controlled trial.

INTRODUCTION: Temporomandibular disorders (TMDs) are considered a collection of musculoskeletal conditions involving the masticatory muscles, the temporomandibular joint and associated structures. The myogenous group appears to represent the most frequently diagnosed category. In the context of a multimodal approach, splint therapy and musculoskeletal physiotherapy are often considered as a preferred therapy. The purpose of this study will be to investigate the effects of musculoskeletal physiotherapy combined with occlusal splint and education versus occlusal splint and education alone in the treatment of chronic myogenous TMD on pain and mandibular range of motion. METHODS AND ANALYSIS: All consecutive adults complaining of TMDs presented to the Department of Biomedical and Neuromotor Sciences of the University of Bologna will be considered eligible. Inclusion criteria shall be based on the presence of myogenous TMDs, as diagnosed through clinical examination in reference to the international diagnostic criteria of TMDs. Randomisation, concealed allocation, blinded assessment and intention-to-treat analysis will be employed. The splint therapy will consist of the use of the splint every night and concurrent delivery of an educational programme; the protocol shall have a duration of three consecutive months. The combined musculoskeletal physiotherapy, splint therapy and education will additionally consist of manual therapy techniques and exercise; such protocol shall consist of a duration of three consecutive months, inclusive of 10 sessions for the enhanced elements. All outcome measures will be collected at baseline, after treatment and at a 6 months follow-up. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Independent Ethic Committee in Clinical Research of AUSL Bologna-Italy (47/2018/SPER/AUSLBO). Pursuant to applicable rules,we will obtain informed consent from each participant and collect data anonymously to maintain privacy. Results will be disseminated to clinicians and researchers through peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER: NCT03726060.

Coronectomy: A Surgical Option for Impacted Third Molars in Close Proximity to the Inferior Alveolar Nerve-A 5-Year Follow-Up Study.

PURPOSE: The extraction of third molars is the most common surgical procedure performed in the oral cavity. Coronectomy is a surgical protocol to reduce the risk of neurologic lesions to the inferior alveolar nerve (IAN). We evaluated early (up to 1 month) and late (from 2 to 60 months) postoperative complications. MATERIALS AND METHODS: This prospective cohort study enrolled patients treated at the Unit of Oral and Maxillofacial Surgery, University of Bologna. The predictor variable was the time after coronectomy with up to 5 years' follow-up. To assess the rate of postoperative complications, the outcome variables were neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success rate, need for a second surgical procedure, probing pocket depth, and bleeding on probing also were investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards modeling were performed to evaluate the variables. RESULTS: We performed 116 coronectomies in 94 healthy patients (37 men and 57 women; mean age, 28.99 ± 8.9 years). At 5 years' follow-up, we re-evaluated 63 patients with 76 coronectomies. In total, 30 complications were verified. No cases of neurologic lesions to the IAN or lingual nerve were observed after surgery. In the first 3 years, the surgeons extracted migrated roots in 5 cases (6%) without any neurologic lesions to the IAN. No complications were observed from the third to fifth year. CONCLUSIONS: This prospective study on coronectomy of third molars in a close relationship with the mandibular canal found no cases of neurologic lesions, no cases of late infection of the retained roots at 5 years, and a low rate of immediate postoperative complications. Further investigations should include a follow-up study at 10 years and more research about the mechanism of pulp healing.

Periodontal Healing Distally to Second Mandibular Molar After Third Molar Coronectomy.

PURPOSE: Coronectomy of mandibular third molars is a procedure that still raises a number of questions. The aim of the present study was to answer one unsolved question: the periodontal healing distal to the mandibular second molar after third molar coronectomy. MATERIALS AND METHODS: A prospective cohort study was performed of 30 patients treated at the Unit of Oral and Maxillofacial Surgery of the Department of Biomedical and Neuromotor Science of the University of Bologna. The predictor variables were the probing pocket depth (PPD), the distance between the marginal crest (MC) and the bottom of the osseous defect (BOD), and the distance between the cementum enamel junction (CEJ) and the BOD. These clinical indexes were recorded on 3 points of the distal surface of second molar: the distobuccal (DB), distomedial (DM), and distolingual (DL) sites. The other variables evaluated included root migration and postoperative complications. The Wilcoxon test for paired data and Kendall's tau-b correlation coefficient was used to evaluate all variables. The significance level was set at P = .05. RESULTS: The cohort was composed of 30 patients with 34 high-risk mandibular third molars (9 men and 21 women), with a mean age of 28 ± 7 years. At 9 months, a statistically significant reduction in the PPD of 2 ± 3, 1 ± 2, and 2 ± 2 mm and a statistically significant reduction in the MC-BOD distance of 4 ± 4, 4 ± 4, and 4 ± 5 mm for the DB, DM, and DL sites, respectively, was observed (P = .001). Also, the intraoperative CEJ-BOD distance showed a statistically significant reduction for the DB, DM, and DL sites. CONCLUSIONS: After coronectomy, restoration of a clinical healthy periodontium distal to the second molar was observed. However, further studies are necessary to confirm these preliminary clinical results and to compare periodontal healing between coronectomy and complete extraction.

Maxillary first premolar inclination in 8- to 11-year-old children: An observational cross-sectional study on panoramic radiographs.

INTRODUCTION: In this study, we examined first premolar inclination in a large sample. METHODS: First premolar inclination, canine inclination, and mesiodistal location were measured on 797 panoramic radiographs of orthodontically untreated children (ages, 8-11 years; 381 boys, 416 girls). The sample comprised 1496 premolars and 1496 canines. A linear mixed-effects model was used to determine the contribution of age, sex, canine inclination, canine sector location, second molar maturational stage (D-G), and dental arch side on premolar inclination. RESULTS: First premolar inclination values (medians and interquartile ranges) were 12.76° (8.12°-19.05°) at 8 years, 11.82° (7.87°-16.04°) at 9 years, 10.40° (6.38°-15.46°) at 10 years, and 9.03° (5.42°-12.81°) at 11 years; 13.86° (8.60°-18.78°) at stage D, 10.56° (7.39°-14.77°) at stage E, 10.43° (6.08°-15.09°) at stage F, and 8.00° (4.62°-10.74°) at stage G. The following equation was selected (Akaike information criteria = 424.99): first premolar inclination (°) = -2.211 + 2.240 (8 years) + 1.363 (9 years) + 0.955 (10 years) + 0.387 (canine inclination) + 0.902 (right side) + 2.320 (stage D) + 6.320 (sector 1) + 5.446 (sector 2) + 3.803 (sector 3). There was no difference between percentiles constructed by age and maturational stage. CONCLUSIONS: First premolar inclination decreases during the mixed dentition and is moderately correlated with canine inclination.

What Are the Types and Frequencies of Complications Associated With Mandibular Third Molar Coronectomy? A Follow-Up Study.

PURPOSE: Coronectomy has been proposed for impacted third molars in close proximity to the inferior alveolar nerve (IAN) to avoid neurologic injury. Immediate (up to 1 month) and late (2 to 36 months) postoperative complications were investigated. MATERIALS AND METHODS: A prospective cohort study was performed on healthy patients treated in the dental clinic of the Department of Oral Surgery, University of Bologna. The predictor variables examined were experience of the surgeon (<10 vs ≥10 yr), length of surgery, type of mandibular third molar inclusion, and patient age. To assess the rate of postoperative complications, outcome variables were neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success rate and need for a second surgery also were investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards modeling were performed to evaluate the variables. RESULTS: The study involved 94 healthy patients (mean age, 28.99 ± 8.9 yr; range, 17 to 56 yr; 37 men and 57 women) who had 116 third mandibular molars treated with coronectomy. During the 3-year follow-up period, 28 patients (29 coronectomy procedures) dropped out of the study. There was no case of neurologic injury to the inferior alveolar nerve (IAN) or to the lingual nerve (LN). In total, 30 complications were observed (25 within 1 month; 5 at 2 to 12 months). Surgeons with less than 10 years of training exposed patients to a greater risk of complications (hazard ratio = 2.069; 95% confidence interval, 1.004-4.263). An overall success rate of 74% at 6 months was estimated, and a second surgery was needed in 6% of cases. Of the retained roots analyzed, 80% showed postoperative root migration. CONCLUSIONS: In this study, coronectomy of mandibular third molars did not result in temporary or permanent injury to the IAN or LN. Coronectomy showed a low rate of postoperative complications. However, within the first year, a second surgery was needed in 6% of coronectomy procedures to remove migrated root fragments. Additional studies with larger patient samples are recommended to further investigate differences in postoperative complications in relation to patient age.

Accuracy of fibular sectioning and insertion into a rapid-prototyped bone plate, for mandibular reconstruction using CAD-CAM technology.

Modern techniques of mandibular reconstruction, such as CAD-CAM technology and rapid prototyping, offer new means by which reconstructive surgery can be planned to optimise aesthetic outcomes and prosthetic rehabilitation. The high degree of accuracy afforded by these approaches is principally attributable to high-precision fibular sectioning and insertion of the bone into a customised bone plate. CAD-CAM mandibular reconstruction procedures using vascularised bone free-flap transfers were performed on 10 patients with benign or malignant neoplasms. Five were not treated with the aid of CAD-CAM technology, and served as the control group. Five were scheduled for maxillofacial surgery using surgical cutting guides and customised bone plates. A generalised linear model for linear measures was used to compare the accuracy of reconstruction between the two groups. A difference, even though not significant, in the lateral shift of the mesial and distal positions of the fibular units was evident between groups. CAD-CAM-generated fibular surgical guides afford improved accuracy when used to restore native anatomy, especially in the context of mandibular arch restoration, and both operating room time and related costs are reduced during fibular sectioning.

Pressure pain threshold of the cervico-facial muscles in healthy elderly people: the role of gender, age and dominance.

OBJECTIVE: The aim of this study was to assess the impact of age on pressure pain threshold (PPT) of cervico-facial muscles in healthy geriatric subjects and to investigate the role of gender and dominance on nociception. BACKGROUND: Musculo-skeletal pain is common in the elderly, but being subjective, it risks to be underdiagnosed and undertreated. A useful method for assessment of local pain is determining PPT through pressure algometry. Ageing process seems to increase PPTs, but reference values for the assessment of pain in geriatric subjects are lacking. METHODS: In this study, PPTs in temporal muscle, masseter, sternocleidomastoid, occipital and splenius capitis of 97 healthy elderly subjects were measured using Fischer algometer. Participants were divided by age in four classes (years 65-69; 70-74; 75-79; ≥80). RESULTS: Women had lower PPTs in all muscles compared with men. Comparing PPTs obtained from the right and the left side, no significant differences were recorded neither in men nor in women. When dividing subjects by age class and education, in both genders no significant differences were observed in PPTs among the groups, neither in the right nor in the left sides. CONCLUSION: In conclusion, the present study reports reference PPT values for the cervico-facial muscles that can be applied to a population of healthy elderly subjects. After 65 years of age, further ageing does not influence PPTs in cervico-facial muscles whereas female gender has lower PPTs.

Wear and metallographic analysis of WaveOne and reciproc NiTi instruments before and after three uses in root canals.

Reciprocating instruments made from M-wire alloy have been proposed to reduce the risk of fracture. No information is available on the surface alteration after single and multiple uses in root canals. Two reciprocating NiTi instruments were used on extracted teeth up to three times. ESEM/EDS analysis was conducted to determine defects, alterations, and wear features of the apical third of instruments and metallographic analysis was performed on the cross-section of new and used instruments to compare alloy properties. Topography of apical portion was evaluated by AFM before and after uses. Extracted single-rooted teeth were divided into two groups and instrumented according to the manufacturer's recommendations with: (A) WaveOne Primary and (B) Reciproc R25. Each group was divided into three subgroups according to the number of canals instrumented: 1, 2, and 3, respectively. Chi square test was performed to verify homogeneity of defects distribution and GLM to evaluate the differences of RMS at baseline and after use for both groups (α level 0.05). No instrument fractured and no spiral distortions were observed under optical microscope even when the number of uses increased. Not significant differences were found for WaveOne and Reciproc. Blades presented a wrapped portion in WaveOne group and a more symmetrical feature in Reciproc group. Metallographic analysis revealed in both groups the presence of twinned martensitic grains with isolated flat austenitic areas. Both instruments demonstrated limited alteration, such as tip deformation and wear. This study confirmed the safe clinical use of both instruments for shaping multi-rooted teeth.

Coronectomy: a surgical option for impacted third molars in close proximity to the inferior alveolar nerve.

BACKGROUND: Damage to the inferior alveolar nerve (IAN) during the extraction of impacted mandibular third molars in close proximity to the mandibular canal is a postoperative complication that most frequently occurs in patients 40 years and older. METHODS: The authors evaluated the postoperative complications of 43 coronectomies of impacted mandibular third molars in 37 patients (17 men and 20 women, mean age [standard deviation] 31 [2] years). The authors used cone-beam computed tomographic images to determine that all of the teeth that underwent a coronectomy were in close proximity to the IAN. RESULTS: The authors did not observe neurological injuries to the IAN or to the lingual nerve. One patient complained of intermittent pain and, 10 months after undergoing the coronectomy, underwent a second operation for extraction of the root fragments. The root extraction did not result in any neurological deficits, because the root fragments had migrated from the mandibular canal. One case of alveolitis was reported that manifested 15 days after the coronectomy. CONCLUSIONS: Coronectomies are safer to perform than complete extractions in situations in which the third molar is in close proximity to the mandibular canal. Root migration generally is asymptomatic, but in a case in which the patient underwent a second operation, the risk of the patient's experiencing neurological injuries was reduced. CLINICAL IMPLICATIONS: Coronectomy appears to be a valid surgical alternative in patients 40 years and older who are at a higher risk of experiencing neurological deficits than are younger patients.

Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars.

BACKGROUND: The authors conducted a study to evaluate the predictive value of five radiographic markers on the panoramic radiograph, or PR, to point out the relationship between the mandibular canal and the impacted third molar. METHODS: The authors evaluated the accuracy of the radiographic markers by comparing the PR with an axial computed tomographic, or CT, scan. They identified a sample of 73 third molars that showed a close relationship between the tooth roots and the mandibular canal on the PR, and then classified them on the basis of five radiographic markers. They also detected contact between the third molar and the mandibular canal on the CT scan. RESULTS: The distribution of the five radiographic markers was as follows: 37 teeth exhibited increased radiolucency, 13 exhibited superimposition, 14 exhibited interruption of the radiopaque border, 14 exhibited narrowing of the canal and seven exhibited diversion of the canal. In 11 cases, two or more markers were recognizable. The predictive values of a positive test result were as follows: increased radiolucency, 73 percent; superimposition, 38.5 percent; interruption of the radiopaque border, 71.4 percent; narrowing, 78.6 percent; and diversion, 100 percent. The authors detected contact in all of the cases that exhibited two or more markers. CONCLUSION: Increased radiolucency, narrowing and interruption of the radiopaque border, as well as the concomitant presence of two or more radiographic markers, on the PR were highly predictive of contact between the third molar and the mandibular canal. An axial CT scan probably is indicated in such cases. CLINICAL IMPLICATIONS: The results of this study may lead to some guidelines for oral surgeons evaluating whether to obtain an axial CT scan for further investigation after examining an impacted mandibular third molar via PR.

Retrospective study of tooth loss in 92 treated periodontal patients.

BACKGROUND/AIMS: In this retrospective study, the efficacy of periodontal therapy and maintenance in preventing tooth loss was evaluated. METHODS: The study included 92 patients with 2310 teeth diagnosed with chronic adult periodontitis and observed over a mean period of 6.7 years, with each patient receiving surgical therapy in two or more quadrants. The group was divided into two subgroups: those who complied with the recommended maintenance schedule and those whose compliance was erratic. Individual tooth prognosis was assigned according to radiographic parameters. RESULTS: At the completion of active periodontal therapy, 2184 teeth were present. During the maintenance period, 44 teeth were lost due to periodontal reasons. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.07/year. Molars were the teeth most frequently lost; canines the least. The number of teeth lost in the three prognostic categories was: one (0.07%) for teeth with good prognoses, 21 (3.63%) for questionable prognoses and 22 (11.34%) for hopeless prognoses. Patients complying erratically with supportive periodontal therapy were at a 5.6 times greater risk for tooth loss following active therapy than regularly compliant patients. CONCLUSIONS: The results demonstrated a low tooth mortality rate in periodontal patients following active treatment combined with a strict maintenance program.