Assessing the morphological characteristics of teeth and dental arches as potential predictors of dental crowding.

Background and aims: The early detection of dental crowding and its potential for aggravation is important during the clinical examination of mixed dentition patients, and these desiderates can be addressed by including among the clinically assessed items a series of accessible morphological characteristics of teeth and dental arches. The present study investigates possible correlations between morphological features of permanent teeth, widths of dental arches, and the onset of dental crowding during mixed dentition. Methods: A selected group of 100 class I dental casts on mixed dentition was analyzed. The dental arches were grouped as spaced, normally aligned, and crowded. The dental parameters consisted of mesiodistal dimensions of permanent teeth and specific morphological features of permanent incisors and first molars. The anterior and posterior arch widths according to Pont indices were measured. Results: Statistical analysis of data showed that mesiodistal dimensions of the permanent upper central incisors and lower incisors are significantly larger on severely crowded arches than on normally aligned arches; increased differences between mesiodistal dimensions of central and lateral permanent upper incisors and the presence of semi-shavel incisors and Carabelli cusps are associated with a greater extent of anterior crowding. The severely crowded arches presented significantly narrower anterior and posterior arch widths. Conclusions: Increased mesiodistal dimensions of permanent incisors, the presence of incisors shoveling, the Carabelli cusps on upper first permanent molars, and narrowing of dental arches during the early mixed dentition period were associated with severe dental crowding in class I cases.

Perceptions and Expectations of Academic Staff in Bucharest towards the COVID-19 Pandemic Impact on Dental Education.

Dental education was severely challenged by the COVID-19 pandemic worldwide. The evaluation of the viewpoint of the dental teachers of the Faculty of Dentistry at "Carol Davila" University of Medicine and Pharmacy in Bucharest, Romania, on these exceptional circumstances' consequences was the objective of this paper. A cross-sectional study was conducted in April 2022, on the academic staff who reported their perceptions of the emotional and educational impact of the pandemic by completing a Google Forms questionnaire. Although a significant emotional impact of the pandemic was reported by over a third of the participants (31.2%), most of them being teachers of fifth-year dental students (p = 0.019), the perceived stress had an impact on the teaching performance in few of them (14%), the quality of sleep remaining unaffected in most of them (53.7%), whereas the level of anxiety was low (57%). An educational impact regarding the techno difficulties during the online transition was mentioned by few respondents (16.1%), with male teaching staff facing the fewest problems (p = 0.024), as well as low levels of difficulties in transmitting academic information (11.9), with men also being the most unaffected (p = 0.006). More than half of the participants (59.1%) rather see digital and/or virtual education during the pandemic as having adverse effects on the educational system, the most sceptical being teachers of the fifth (p = 0.001) and sixth years (p = 0.001). The COVID-19 pandemic affected the academic staff of the Faculty of Dentistry at "Carol Davila" University of Medicine and Pharmacy in Bucharest, Romania, not only at a personal level but also at a professional, pedagogical one, due to the introduction of the online teaching system followed by the hybrid one. Age group, gender, and teaching year differentiated the degree of emotional and educational impairment.

Reducing Friction in Orthodontic Brackets: A Matter of Material or Type of Ligation Selection? In-Vitro Comparative Study.

(1) Background: Orthodontic appliances have changed and improved with the increasing demand for orthodontic treatment of the general population. Patients desire for shorter orthodontic treatments and for the wearing of more aesthetic devices has led to the technological development of orthodontic brackets; these were manufactured from aesthetic materials (ceramics, composite polymers) and presented different designs regarding the way archwires are ligated to the bracket. The aim of this study was to determine whether there were any differences between the static frictional forces generated by stainless steel (metallic) and polycrystalline alumina (ceramics) conventional and self-ligating brackets. (2) Methods: Static friction assessment was carried out in vitro with a universal testing machine, HV-500N-S (Schmidt Control Instruments, Hans Schmidt & Co. GmbH), intended for measuring compression and traction forces. (3) Results: The study revealed significant differences in static frictional forces at the bracket-archwire interface between the tested brackets. Stainless steel brackets produced lower static friction forces than polycrystalline alumina and self-ligating brackets generally produced lower static frictional forces than conventional brackets. The reduction of frictional forces was noticeable in the first stages of treatment, when thin, flexible orthodontic archwires (0.016" NiTi) are used. Engaged with large rectangular stainless steel archwires, (0.019 × 0.025" SS), the frictional forces produced by conventional and self-ligating metal brackets were similar, no significant differences being observed between the two types of metallic design. However, in the case of tested ceramic brackets, the results showed that the self-ligating type allows a reduction in frictional forces even in advanced stages of treatment compared to conventionally ligation. (4) Conclusions: From the perspective of an orthodontic system with low frictional forces, metal brackets are preferable to aesthetic ones, and self-ligating ceramic brackets are preferable to conventional ceramic brackets.

Vertical Cephalometric Characteristics in Class III Malocclusions.

The phenotypic variety of Angle Class III malocclusion requires in-depth investigation of the skeletal changes from a diagnostic, prognostic and therapeutic perspective alike. The aim of our study was to evaluate the particularities of vertical cephalometric parameters of patients with Class III malocclusions, according to gender and age group. Eight parameters were analyzed on lateral cephalograms of patients with Class III malocclusions and, comparatively, on lateral cephalograms of a group with Class I malocclusions. The results, grouped by gender and age, suggest that values of the gonial angle, values of the angles formed between the mandibular plane and the anterior cranial base, respectively the Frankfurt Horizontal plane were higher for patients with Class III malocclusions, differences being statistically significant especially after the pubertal growth period. Class III patients had lower values for the upper gonial angle and higher ones for the lower gonial angle. Furthermore, for patients with Class III malocclusions the Jaraback ratio decreased, based on the significantly higher values of the anterior facial height. No sexual dimorphism was associated with variation of the investigated parameters.

Hopeless tooth? Prognosis and comprehensive treatment. A case report.

A hopeless tooth from a periodontal point of view, with severe bone resorption, mobility and abnormal tooth migration, is often extracted. In advanced cases, function and esthetics are impaired, and an interdisciplinary treatment is requested. Retaining or not these teeth is based on clinician judgment. A growing body of evidence claims that prognosis has great potential to be improved in a motivated patient with good oral hygiene and regular maintenance. This case report aims to present a periodontal regenerative technique combining enamel matrix protein derivatives and a particulated xenograft to treat intraosseous defects caused by periodontitis. The patient healed uneventfully, and no complications were recorded after the surgical procedure. To correct abnormal tooth migration and improve function and esthetics, orthodontic treatment was instituted. Tooth prognosis improved from hopeless to questionable. This approach extended the life span of a compromised tooth, improving periodontal support and decreasing tooth mobility. This could be an alternative to extraction and implant.

Performance Evaluation on Rotary Preparation of Root Canal by Beginner Operators.

This study aims to analyze the performance of rotary root canal preparation, conducted by beginner operators (students). After acquiring the necessary skills involved in applying endodontic preparation techniques on extracted teeth, all students from a cohort learned to use ProTaper Universal files (Dentsply Maillefer). The preclinical training had several stages. Experience 1: instrumentation on extracted single-root teeth; Experience 2: instrumentation on EndoTraining blocks (Dentsply Maillefer); Experience 3: instrumentation on EndoTraining blocks (Dia Dent Group International); Experience 4: Instrumentation on extracted multiradicular teeth. Preparation was done according to the manufacturer's instructions, the initial file is Sx, followed by S1, S2, F1, F2 and the last file is F3. A batch of 50 teeth (E1, E2, E3, E4) was randomly selected to evaluate the onset of the rotary preparation of young operators. Two independent evaluators analyzed the array radiologically by stereomicroscope evaluation (E1, E4) and photo-analysis of the resulting Endo Training blocks (E2, E3). The success rate was 80% for E1, 72% for E2, 64% for E3 and 76% for E4 (p<0.05). The following were considered a failure: ledge formation and apical transportation in 10.66%, over instrumentation in 6.66%, zipping in 3.33%, and instrument fracture in 4% of cases. Endodontic instrumentation techniques require training to acquire the necessary skills. Rotary root canal instrumentation techniques used almost exclusively in modern endodontics require adequate preclinical training.

Autophagy, One of the Main Steps in Periodontitis Pathogenesis and Evolution.

Periodontitis represents a complex inflammatory disease that compromises the integrity of the tooth-supporting tissue through the interaction of specific periodontal pathogens and the host's immune system. Experimental data help to outline the idea that the molecular way towards periodontitis initiation and progression presents four key steps: bacterial infection, inflammation, oxidative stress, and autophagy. The aim of this review is to outline the autophagy involvement in the pathogenesis and evolution of periodontitis from at least three points of view: periodontal pathogen invasion control, innate immune signaling pathways regulation and apoptosis inhibition in periodontal cells. The exact roles played by reactive oxygen species (ROS) inside the molecular mechanisms for autophagy initiation in periodontitis still require further investigation. However, clarifying the role and the mechanism of redox regulation of autophagy in the periodontitis context may be particularly beneficial for the elaboration of new therapeutic strategies.

A Review on the Biocompatibility of PMMA-Based Dental Materials for Interim Prosthetic Restorations with a Glimpse into their Modern Manufacturing Techniques.

This paper's primary aim is to outline relevant aspects regarding the biocompatibility of PMMA (poly(methyl methacrylate))-based materials used for obtaining interim prosthetic restorations, such as the interaction with oral epithelial cells, fibroblasts or dental pulp cells, the salivary oxidative stress response, and monomer release. Additionally, the oral environment's biochemical response to modern interim dental materials containing PMMA (obtained via subtractive or additive methods) is highlighted in this review. The studies included in this paper confirmed that PMMA-based materials interact in a complex way with the oral environment, and therefore, different concerns about the possible adverse oral effects caused by these materials were analyzed. Adjacent to these aspects, the present work describes several advantages of PMMA-based dental materials. Moreover, the paper underlines that recent scientific studies ascertain that the modern techniques used for obtaining interim prosthetic materials, milled PMMA, and 3D (three-dimensional) printed resins, have distinctive advantages compared to the conventional ones. However, considering the limited number of studies focusing on the chemical composition and biocompatibility of these modern interim prosthetic materials, especially for the 3D printed ones, more aspects regarding their interaction with the oral environment need to be further investigated.

Elderly Patients' Perception of Previewing the Prosthetic Treatment Outcome.

The demographic statistics indicate that, with the industrial development and the advances in the medical field, the average life of the population has started to increase significantly; consequently, the needs of treatments in geriatric dentistry are becoming more and more significant. The purpose of this study was to evaluate patients' perception of diverse techniques used to obtain previews for final fixed prosthetic restorations: digital smile design (DSD), wax-up, indirect mock-up, temporary restorations, Computer-Aided Design (CAD). A focus group that included 11 participants, all of them geriatric patients, was formed; patients were invited to respond to a set of seven questions before and after various previsualization methods were applied. The focus-group report indicated that the indirect mock-up and the temporary restorations were considered by the geriatric patients as the best methods for obtaining good prosthetic previews. Comparing to the other tested methods, the use of indirect mock-up increased the acceptance of the prosthetic treatment plan and offered the most influential visual impact for 72.7% of participants. In addition, all tested previews allowed excellent communication with patients, the best results being obtained with the temporary prosthetic restorations (for 54.5% of participants). This approach represented a tool for better decisions regarding final dental restoration and has had a positive influence on patients' acceptance of the treatment plan as well, making the final restoration more predictable.

Alveolar blood clots and platelet-rich fibrin induce in vitro fibroblast proliferation and migration.

Wound healing process comprises a complex network of cells and molecules that are regulated in order to pursue tissue regeneration. Our study focused on the capacity of alveolar blood clots (ABCs), platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF) to induce in vitro fibroblasts proliferation and migration as a measure of alveolar regeneration. Using cellular impedance with xCELLigence technology we quantified the proliferation and the migration capacity of L929 fibroblast standard cell line in the presence of 4 different ABCs and 3 different PRFs harvested from healthy individuals during standard tooth extraction. We obtained a clear cellular proliferation induced by the compounds mainly after 24 h of cultivation, in a dose-dependent manner. After 48 h of cultivation we registered activated proliferation, but slightly decreased compared to the 24 h profile. Our data confirm that the presence of the blood clot is involved in the regenerative processes. The migratory capacity of fibroblasts was statistically activated by the PL compounds while not affected by the tested PRFs. The chemical mediators present within the blood clot, either produced by inflammatory cells captive within, or by endothelial or mesenchymal cells induced fibroblastic proliferation and subsequent collagen deposition.

Variation in Expression of Inflammation-Related Signaling Molecules with Profibrotic and Antifibrotic Effects in Cutaneous and Oral Mucosa Scars.

Wound healing is a complex biologic process evolving in three phases: inflammation, proliferation, and tissue remodeling controlled by numerous growth factors and cytokines. Oral mucosa wounds heal with significantly less important scars with less numerous macrophages and mast cells and more numerous myofibroblasts than cutaneous counterparts. We analyzed 32 cutaneous and 32 oral mucosa scars for TGFbeta1, TGFbeta2, TGFbeta3, TNFalpha, PDGF BB and FGF1 expression in mesenchymal cells, endothelial cells, macrophages, and multinucleated giant cells. We identified differences in the expression of profibrotic and antifibrotic factors in oral mucosa and skin scars; TGFbeta2 was positive in cutaneous multinucleated giant cells, TNFalpha was positive in cutaneous macrophages, and both were negative in oral mucosa while TGFbeta3 was positive in oral macrophages and mostly negative in cutaneous ones. PDGF BB and FGF1 were positive in oral endothelial cells and oral macrophages and negative in macrophages with opposite positivity pattern in cutaneous scars. Based on these findings, macrophage seems to be the key player in modulating pro- and antifibrotic processes in wound regeneration.

Common and unusual dental development abnormalities in a patient with bicuspid aortic valve.

Bicuspid aortic valve (BAV) is the most common congenital abnormality of the heart. In this condition, instead of three cusps, the aortic valve has two cusps. Children with congenital heart diseases are at increased risk of developing oral diseases, such as: higher number of decayed teeth, developmental anomalies, periodontal disease, malocclusion, dental crowding, as well as susceptibility to develop infective endocarditis from bacteremia caused by chronic poor oral health. However, little information is available regarding oral manifestations and their management in patients with congenital heart defects, despite the importance of these diseases. This paper presents oral manifestations associated with BAV in a young patient, alongside the general features of the condition. The presented case with BAV brings together features of a complex pathology and multidisciplinary treatment, which was conducted over a long period of time and still continues nowadays.

An application of microscopic investigation on extracted premolar with dyschromia, related to the components of endodontic sealer.

The aim of this study was an assessment of the overall optical characteristics changes in volume of the dentin, after the diffusion of the chemical components included in the sealer throughout the endodontic space, in order to demonstrate the discoloration effect of the endodontic sealer on tooth crown of a recently extracted maxillary premolar. Thin sections were studied using the polarized transmitted light microscopy and under a stereomicroscope, operating in transmitted light and reflected light. There were performed serial images of magnitude 40×. Each image was covered by a grid aimed for microscopic sections volumetric measurements. Therefore, all the serial images were merged and resulted a global image of the entire section surface. Thus, we have analyzed a total of three sections of the same tooth. Based on these sets of images, there were made estimations of the areas affected by colorations, determinations that can be extrapolated to total tooth areas, in terms of volumetric color change of dentin. The proportion of low coloristic infiltrated dentin was very close to the deeply impregnated dentin and the overall impregnated dentin covered half of the total dentin analyzed area.

An optical investigation of dentinal discoloration due to commonly endodontic sealers, using the transmitted light polarizing microscopy and spectrophotometry.

The aim of this study was to establish the degree of tooth crown staining by commonly used endodontic sealers. Crown discolorations by tooth canal sealers [AH Plus (Dentsply DeTrey Gmbh, Konstanz, Germany); Endofill (Produits Dentaires SA, Vevey, Switzerland); Apexit (Dentsply DeTrey Gmbh, Konstanz, Germany); and MTA Fillapex (Angelus, Londrina, Brazil)] were tested on extracted human premolars. The samples were divided into five groups of five samples each, after root canal sealing. Five teeth were used as control groups. The spectrophotometric method was performed in order to quantify in terms of color change of the coronal part (it was also recorded a track on how the color changes over time). For the microscopic study of the extracted dental specimens subjected to this study, polarized transmitted light microscopy was used. This method involves the development of special microscopic preparations, called "thin sections". In our case, the thin section was performed on 20 prepared and obturated recently extracted teeth. The degree of discoloration was determined after one week and three months using spectrophotometry and polarized light microscopy. All sealers usually cause some degree of discoloration on the cervical aspect of the crowns that increases in time. AH Plus and Endofill caused the greatest discoloration, followed by Apexit and MTA Fillapex.

Considerations on morphological abnormalities of permanent teeth in children with cleft lip and palate.

Oral clefts are commonly associated with dental anomalies of number, size, shape, structure, position and eruption affecting both dentitions. Dental malformations may affect the development, growth and functions of the dento-maxillary apparatus (chewing, aesthetics, speech). The purpose of this paper was to assess the dental morphological variations in a group of patients with cleft lip and/or palate (CLP), as compared with a group of healthy subjects. The study sample included 48 patients with various types of CLP (15 girls and 33 boys) aged between 12.6 years and 17.3 years. The control group (without CLP) consisted of 1447 patients (545 girls and 903 boys). The proportion of patients with dental shape anomalies in the control group was 8.6%, while the proportion of patients with dental shape anomalies in the CLP group was 56.3% (p<0.01). With this regards, the frontal area was more affected in CLP group than controls. The most common morphological abnormality in the control group was supplementary cusp, while in the CLP sample it was dilaceration. Teeth from the dental hemiarch affected by CLP were most affected in their morphology.

Upper airway cavities morphologic features in facial asymmetries.

Facial asymmetries have an important impact on the cranio-facial structures morphology, being the result of the genetic, environmental and dysfunctional factors and their impact on the dento-maxillary complex. Asymmetries can be identified in all craniofacial structures, including the upper airway cavities. Craniofacial asymmetries can influence general growth and development by altering the respiratory function. The present study aimed to evaluate morphologic correlations of the upper airway cavities changes in facial asymmetries. Most of the cases included in the study showed on the underdeveloped side that the nostril and nasal fossa were narrowed, while the paranasal sinuses were frequently larger. However, no correlation could be established to answer whether these changes were determined by asymmetry, or if they appeared as compensatory, or if only some structures of the upper airway cavities changed morphologically in a compensatory manner.

Pharmacokinetic profile evaluation of di-µ-hydroxo-bis(quercetinatooxovanadium(IV)) complex.

The present study was designed to evaluate the pharmacokinetic (PK) properties of di-µ-hydroxo-bis(quercetinatooxovanadium(IV) (HOBQOV) complex, with hypoglycemic and hypolipidemic properties, in rats after a single i.p. dose of 100 mg/kg b.w. The HOBQOV complex pharmacokinetics is described by a bicompartmental model and the plasma concentration decrease is described by two phases that might be correlated to the distribution and elimination processes. The obtained results suggest a PK profile of the complex suitable for a profound distribution in the animal organism with possibility of interaction with the cytosolic enzymes.

Undesirable dental hard tissue effects hypothetically linked to orthodontics - a microscopic study.

Like any other medical intervention, the orthodontic treatment may have, besides the positive effects, also unwanted secondary consequences. The aim of this study was to evaluate the changes present in dental hard tissue associated with orthodontic treatment. The stereo-microscopic ex vivo analysis was performed on two sets of maxillary first premolars undergoing orthodontic treatment for a long period of time (12 and 23 months); five teeth with other clinical situations were used as controls. By analyzing the teeth undergoing orthodontics, enamel color alterations were mainly found adjacent to the bracket, more pronounced in the gingival area, suggesting the need for a correct oral hygiene around it. Roughness was higher on the enamel surface corresponding to the bracket's base, aspect linked to the resign impregnation during bonding procedures. At the apical part, changes regarding contour, appearance and surface roughness were noticed. These modifications were suggestive for the presence of apical root resorption. The severity of root resorption was not correlated with the duration of treatment. In conclusion, through microscopic analysis changes that may be associated with orthodontic treatment have been observed in both crown and apical level.

Influence of orthodontic treatment on oral streptococci.

UNLABELLED: Objective of this study is to evaluate the changes of the oral microbial flora, concentrating on the oral streptococci, after the first 3 and 6 months of orthodontic treatment. MATERIALS AND METHODS: 40 patients, aged 7-17, that presented for orthodontic treatment between April and September 2010 in the Department of Orthodontics and Dento-Facial Orthopedics of "Carol Davila" University of Medicine and Pharmacy, Bucharest have been selected. According to the protocol, coronary and subgingival plaque was collected from the dental surface before starting any orthodontic treatment (T0), 3 months after wearing orthodontic appliances (T1) and 6 months after wearing orthodontic appliances (T2). The samples were studied in Cantacuzino National Institute of Research-Development for Microbiology and Immunology [isolation on Columbia agar with 5% sheep blood, identification on morphotinctorial, growth and biochemical characteristics using API 20 STREP (BioMerieux)]. Bacterial concentration (colony-forming units/sample = CFU/sample) for the aerobic and anaerobic flora was calculated by the serial dilution method of counting bacteria. RESULTS: 106 strains of oral streptococci were isolated from dental plaque, belonging to 6 species (Streptococcus mitis, Streptococcus oralis, Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguis and Streptococcus acidominimus), 37 strains of oral streptococci in patients from group I (T0), 40 strains from group II (T1) and 29 strains of oral streptococci from group III (T2). After 3 months (T1) the aerobic bacteria percentage, detected at a concentration between 10(5) and 10(6), increased from 30 to 38.2%. The percentage of patients with a bacterial concentration higher than 10(6) CFU/sample increased from 5% to 8.8%. The samples colected at T2 (patients examined after 6 months of orthodonic treatment) presented a lower bacterial concentration, as compared to group II (T1). The most common isolated species of streptococci were S. salivarius, S. oralis and S. mutans (37.5%, 22.5% and 10%), whose frequency increased after 3 months of treatment to 41.14%, 32.3% and respectively 14.4%, returning after 6 months of treatment at values similar to those recorded before beginning the orthodontic treatment. CONCLUSIONS: Presence of orthodontic appliances may produce a transitory increase of bacterial concentration (CFU/sample) and isolation rate of oral streptococci, returning to the level prior to the application of these devices after a time interval of several months.

Orthodontically induced root resorption correlated with morphological characteristics.

UNLABELLED: Orthodontically induced root resorption is an irreversible process that can have medical, ethical and legal implications. AIM: The objective of this research was to identify morphological risk factors, in order to prevent it. MATERIAL AND METHODS: We realized a retrospective study on 50 patients and made correlation between the prevalence and gravity of radiological identified root resorption and multiple biological and anatomical features. RESULTS AND CONCLUSIONS: We found that, when removable orthodontic appliances were used, there were not found root resorption (0%), and in cases in which fixed appliances were used, the root resorption was found, and it generally presented a high prevalence (96%) and low severity. Prevalence of root resorption is influenced by the sex and age of the patients (is greater for males than for females and higher in older patients). Topographically, differences were found in prevalence of root resorption (79.33% in mandibullary frontal teeth and 74% in the maxillary ones). The highest prevalence of root resorption was found in the lower central incisor (86%). Prevalence of root resorption is higher when there are alterations of the normal anatomy (facial hypo- or hyperdivergence, Angle class II and III malocclusion, angulated roots). Some anatomical aspects may present a fact of prevision of the appearance of root resorption within the orthodontic treatment.