Diagnostic accuracy of the Diagnostic Criteria for Temporomandibular Disorders for children aged 8-12 years.

BACKGROUND AND OBJECTIVE: Objective of this study was to determine whether the diagnostic accuracy of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is sufficient for use among schoolchildren aged 8-12 years. METHODS: This prospective cohort study on diagnostic accuracy with calibrated examiners was conducted among 533 children of both sexes aged 8-12 years, with and without TMD symptoms, selected randomly from the Rhein-Neckar district. Self-reporting of non-dental facial pain was used as the reference standard, against which we calculated the following for the pain-related items of the DC/TMD (index test): sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, accuracy and 95% Wilson Score confidence intervals. We also calculated the area under the receiver-operating characteristic (AUROC) curve displaying sensitivity and specificity. RESULTS: Our final sample consisted of 282 children, half of whom reported having facial pain and 3.2% reported sounds from the temporomandibular joints (TMJs). Despite high specificity (90.78%; 95% confidence interval (CI): [84.86%; 94.53%]), sensitivity of the adapted DC/TMD for pain on maximum jaw opening was poor (37.59%; 95% CI: [30.02%; 45.81%]). For pain on palpation, more similar values were recorded for sensitivity (74.47%; 95% CI: [66.69%; 80.95%]) and specificity (70.21%; 95% CI: [62.21%; 77.14%]). The diagnostic odds ratio was >1 for both examinations. The AUROC for pain on opening was 68.39% (95% CI: [62.62%; 74.16%]), and for pain on palpation, it was 74.63% (95% CI: [69.45%; 79.81%]), whereas the combination of both resulted to an AUROC of 74.09% (95% CI: [68.96%; 79.21%]). It was not possible to measure the diagnostic accuracy of the DC/TMD regarding TMJ sounds or jaw-opening limitations, as they occurred too rarely in our sample. CONCLUSION: In this study, the diagnostic accuracy of the DC/TMD for TMD-related pain in children was lower than that recorded for adults in previous studies.

The dental esthetic screening index: A new tool for assessment of dento-facial esthetics in restorative dentistry.

OBJECTIVES: There is a lack of comprehensive indexes, which can measure conditions or changes in dento-facial esthetics before and after treatment. Therefore, the 12-item Dental Esthetic Screening Index (DESI) was developed and validated. MATERIALS AND METHODS: Reliability was tested by five dental professionals, who evaluated 30 standardized patient photographs baseline and after 14 days. Clinical validation was done on 52 patients before and after restorative treatment. For subjective assessment, patients completed a validated questionnaire before and after treatment. Statistical analysis included inter and intrarater reliability, Wilcoxon test and linear regression analysis. RESULTS: The single item analysis identified two weak extraoral items (κ = 0.15; κ = -0.05), that were removed from the DESI. After this modification, both inter- (κ = 0.83-0.86) and intrarater reliability (ICC1-5 = 0.75-0.86) were in excellent to good agreement. In the clinical validation, the DESI was significantly lower after restorative treatment (P < .0001). The patients' perception questionnaires showed significant improvement after restorative therapy (P < .0001). A correlation of the DESI and the results of patients' perception questionnaires could be assumed (P < .0001; R2 = 0.32). CONCLUSIONS: The DESI was found to be a reliable and valid instrument for the quantitative assessment of dento-facial esthetics. It correlated well with the subjective assessment of the patients. CLINICAL SIGNIFICANCE: This comprehensive index would allow for objective quantification of clinical situations, for reliable baseline and outcome assessment in esthetic dentistry. As patients' esthetic feelings and sensations are subjective, this objective index is also proven to be congruent to patients' individual subjective assessment of dento-facial esthetics.

Comparison of crevicular fluid cytokine levels after the application of surface sealants : A randomized trial.

PURPOSE: Surface sealants are widely used in orthodontic practice to avoid enamel decalcifications in patients treated with fixed orthodontic appliances. While their clinical benefit was tested in several studies, their biocompatibility has been evaluated to a lesser extent. Therefore, the aim of this randomized prospective study was to evaluate possible adverse biological effects of three commonly used surface sealants and a bonding primer on gingival tissues by analysing cytokines in crevicular fluid of orthodontic patients after the application of surface sealants. METHODS: A single centre parallel trial was conducted. Using a split-mouth design quadrants of 15 patients requiring orthodontic treatment with fixed appliances were randomized to one of three commonly used surface sealants (Pro Seal®, Opal®Seal™, Protecto®CaF2Nano) and a bonding primer (Transbond™ XT). Interleukin (IL)-8 and IL-10 levels in crevicular fluids of the individual quadrants were assessed at four different time points (before application, and at 30, 60 and 90 min after application). RESULTS: In all, 60 quadrants of 15 patients were randomized (Pro Seal® n = 15, Opal®Seal™ n = 15, Protecto®CaF2Nano n = 15, Transbond™ XT n = 15) and analysed. No significant changes for IL-8 or IL-10 levels in crevicular fluid after the application of surface sealants or bonding primer were detected. However, interpatient variability was high. No further clinical side effects were detected. CONCLUSIONS: Commonly used pre-bonding surface sealants (Pro Seal®, Opal®Seal™) do not appear to have a significant impact on inflammatory cytokines levels of crevicular fluid and do not appear to contribute to sensitization or hypersensitivity events.

Comparison of three different options for immediate treatment of painful temporomandibular disorders: a randomized, controlled pilot trial.

OBJECTIVE: The purpose of this study was to compare the short-term effectiveness of three different types of immediate, non-pharmacological intervention for alleviation of the painful symptoms of temporomandibular disorders (TMD). MATERIAL AND METHODS: Thirty-six patients (mean age 41.6 ± 16.7 years, 25 females) diagnosed with non-dysfunctional painful TMD received counselling and subsequently were randomly allocated to three treatment groups: patients in Group A received prefabricated oral splints with water-filled elastic pads (Aqualizer(®)), those in Group B were provided with vacuum-formed co-polyester oral splints and those in Group C were given appointments to receive Michigan-type hard splints. Clinical examination was conducted, at baseline and after 2 weeks, by use of the RDC/TMD. Current pain intensity was determined by evaluation of graded chronic pain status (GCPS) on a numerical rating scale (NRS). Active maximum mouth opening without pain (AMMOP) was also measured. Paired sample t-tests and one-way analysis of variance with a significance level of p ≤ 0.05 were conducted. RESULTS: After 2 weeks, overall mean current pain was reduced by 41.95% (p < 0.001). Current pain reduction was significant for Group B (66.6%, p < 0.001) but not for Groups A (37.88%, p = 0.56) and C (22.29%, p = 0.26). After 2 weeks, current pain level for Group B was significantly lower than that for Group C (p = 0.041). Overall, there was a statistically significant increase of AMMOP (p = 0.01). CONCLUSION: All therapeutic options were pain-reducing. The results from this study suggest that cost-effective and time-effective intervention of counselling combined with use of a vacuum-formed splint is a favourable option for initial, short-term treatment of painful TMD.

Inhibition of AXUD1 attenuates compression-dependent apoptosis of cementoblasts.

OBJECTIVES: Root resorptions are common undesirable side effects of orthodontic treatment. In most patients, these defects are repaired by cementoblasts. However, in 1-5 % of patients, the repair fails. The repair mechanism is not well understood. Apoptosis of cementoblasts might contribute to an impaired repair of root resorptions induced by orthodontic forces. MATERIALS AND METHODS: To gain insight into putative molecular pathways leading to compression-induced apoptosis of human primary cementoblasts (HPCBs), three independent cell populations were subjected to compressive loading at 5, 20, and 30 g/cm2 for 1, 6, and 10 h. The mRNA expression of AXUD1, a novel pro-apoptotic gene, was monitored by quantitative reverse transcription PCR (qRT-PCR). To identify a possible function in compression-dependent apoptosis, AXUD1 was silenced in cementoblasts using an siRNA approach. Apoptosis of cementoblasts was measured by annexin V staining and flow cytometry. The phosphorylation of c-Jun-N-terminal kinases (JNKs) was investigated by Western blotting. RESULTS: AXUD1 was significantly induced in a time- and force-dependent manner. The rate of apoptotic HPCBs increased by 20-40 % after 10 h of compression (30 g/cm2). Phosphorylation of JNKs was detected after 10 h at 30 g/cm2. SiRNA-mediated knockdown of AXUD1 led to decreased phosphorylation of JNKs and reduced apoptosis rates in compressed HPCBs. CONCLUSIONS: Compression-induced apoptosis of HPCBs is mediated by AXUD1 via a JNK-dependent pathway. CLINICAL RELEVANCE: AXUD1-dependent apoptosis of human cementoblasts might contribute to an impaired repair of root resorptions during orthodontic tooth movement. Further studies are needed to develop treatment strategies aiming to minimize root resorption during orthodontic tooth movement.

A comparative experimental investigation of torque capabilities induced by conventional and active, passive self-ligating brackets.

INTRODUCTION: A proper selected bracket-archwire combination displays a determining factor in the efficacy of torque applied to a tooth at the final stages of an orthodontic treatment. The objective of the current study was to assess the torque capabilities of various bracket systems combined with diverse archwire materials and cross-sections. METHODS: The study comprised of four different 0.018-inch slot orthodontic brackets: the passive and the active self-ligating 1. Swiss Nonligating Bracket (SNB) and 2. SPEED and the metallic and the plastic conventional ligating 3. Mini Mono and 4. Brilliant, respectively, and four different archwire types: stainless steel and Nitinol: 0.016×0.016 inch and 0.016×0.022 inch. A 20 degrees labial crown torque (+20 degrees) and then a 20 degrees palatal crown torque (-20 degrees) were applied gradually on the upper right central incisor. Maximum torquing moments and torque play were registered. RESULTS: Highest torquing moments were expressed by combining SPEED® with 0.016×0.022 inch stainless steel archwire. Lowest moments, but highest torque loss were registered by inserting a 0.016×0.016 inch Nitinol archwire in conventional ligating brackets. CONCLUSIONS: Active self-ligating system manifests the best torque effectiveness. An evident dependence of the torque expression is displayed both on the type of ligation and on the material of the archwire.