Ultrastructural analysis of bone formation around dental implants in nondiabetic rats, severe diabetics not controlled and controlled with insulin.

PURPOSE: To evaluate bone formation through ultrastructural analysis around titanium implants in severe alloxanic uncontrolled diabetic rats, and controlled with insulin, in comparison with nondiabetic rats. METHODS: Thirty-six male Wistar rats, weighing between 200 and 300 g, divided into three experimental groups: normal control group (G1), a diabetic group without treatment (G2), and a diabetic group treated with insulin (G3). The animals received titanium implants in the right femur, and osseointegration was evaluated at 7, 14, and 21 days after surgery, through ultrastructural analysis using scanning electron microscopy. RESULTS: The ultrastructural analysis showed a dense bone structure in the G1, few empty spaces and a small number of proteoglycans; G2 presented bone matrix with a loose aspect, irregular arrangement, thin trabeculae, empty spaces and a large number of proteoglycans; G3 obtained similar results to G1, however with a higher number of proteoglycans. CONCLUSION: Severe diabetes caused ultrastructural changes in bone formation, and insulin therapy allowed an improvement in osseointegration, but it was not possible to reach the results obtained in the control group.

Ultrastructural analysis of bone formation around dental implants in nondiabetic rats, severe diabetics not controlled and controlled with insulin

Abstract Purpose: To evaluate bone formation through ultrastructural analysis around titanium implants in severe alloxanic uncontrolled diabetic rats, and controlled with insulin, in comparison with nondiabetic rats. Methods: Thirty-six male Wistar rats, weighing between 200 and 300 g, divided into three experimental groups: normal control group (G1), a diabetic group without treatment (G2), and a diabetic group treated with insulin (G3). The animals received titanium implants in the right femur, and osseointegration was evaluated at 7, 14, and 21 days after surgery, through ultrastructural analysis using scanning electron microscopy. Results: The ultrastructural analysis showed a dense bone structure in the G1, few empty spaces and a small number of proteoglycans; G2 presented bone matrix with a loose aspect, irregular arrangement, thin trabeculae, empty spaces and a large number of proteoglycans; G3 obtained similar results to G1, however with a higher number of proteoglycans. Conclusion: Severe diabetes caused ultrastructural changes in bone formation, and insulin therapy allowed an improvement in osseointegration, but it was not possible to reach the results obtained in the control group.

Bone Behavior in Relation to the Depth of the Line of Marginal Cementation of Prostheses on Morse Cone Implants: Radiographic Evaluation in a Dog Model.

PURPOSE: This study was aimed at radiographically evaluating the effect of 3 different depths of the cementation line of prosthetic crowns on the bone response around Morse cone implants. MATERIAL AND METHODS: Five dogs underwent extractions of the lower premolars; after 3 months, placement of 30 implants, 3 mm apical to the bone level, was performed. Prefabricated cylinders of alumina, used as abutments, with 3 different transmucosal extension were cemented to the implants with zinc oxide-eugenol cement, determining the depth of the cementation lines (1.5 mm apically, and 0.5 and 2.5 mm coronally, respectively, to the bone level). In the control group, implants and abutments were placed without crowns, therefore, with no cementation line. RESULTS: The results showed no statistically significant differences between the control and test groups regarding the different depths of the cementation line both mesially (P = 0.18) and distally (P = 0.50). CONCLUSION: Different depths of cementation did not affect the behavior of marginal bone, indicating that crowns can be cemented with zinc oxide-eugenol cement at any distance or even at the bone level without disturbing bone healing around Morse cone implants.

Influência da elevação do retalho, durante a instalação de implantes imediatos, na remodelação óssea peri-implantar / Influence of flap elevation during immediate implant placement on peri-implant bone remodeling

Verificar a influência dos retalhos cirúrgicos na formação óssea peri-implantar. Métodos: quatro pré-molares da arcada inferior de sete cães, de raça não definida, foram extraídos, e quatro implantes imediatos foram instalados. Os grupos foram divididos em G1, sem retalho, e G2, com elevação de retalho de espessura total, totalizando 14 implantes em cada grupo. Após quatro meses, realizou-se a coleta das amostras e a análise histomorfométrica, a fim de se observar contato osso-implante (BIC) vestibular, BIC total, área vestibular e área total de todos os implantes. Para análise estatística intergrupos utilizou-se o teste de Mann-Whitney (p < 0,05). Resultados: observou-se que o grupo referente aos implantes instalados sem elevação de retalho apresentou melhores taxas de BIC, tanto na face vestibular quanto no BIC total. Os dados também mostraram-se superiores estatisticamente em prol do grupo sem retalho, quanto à área óssea na face vestibular dos implantes. Conclusão: conclui-se que a técnica cirúrgica sem retalho têm influência favorável na formação óssea ao redor dos implantes...

The aim of this study was to assess the influence of surgical flaps over boneformation around implants. Methods: Seven mongrel dogs had four mandibular pre-molars extracted and four immediate implants placed. The experimental groups were divided into G1 (flapless) and G2 (full-thickness flap), totaling 14 implants in each group. After four months, samples were collected and histomorphometric analysis was carried out with a view to assessing buccal bone-to-implant contact (BIC), total BIC, buccal area, and total area of all implants. For intergroup statistical analysis, Mann-Whitney test was applied (p < 0.05). Results: The group comprising implants without flap elevation had better BIC rates, both buccal and total BIC, than the flap elevation group. Additionally,data yielded better results in favor of the group without flap, which was statistically significant, particularly with regard to bone formation on the buccal surface of implants. Conclusion: The flapless surgical technique produces favorable effects on bone formation around implants...

Comparative histological and histomorphometrical evaluation of marginal bone resorption around external hexagon and Morse cone implants: an experimental study in dogs.

PURPOSE: Aim of this study was to evaluate the histological and histomorphometrical differences at the marginal bone level with the use of 2 different implant-abutment assembly designs (the traditional External Hexagon and the Morse Cone tapered connections). METHODS: Nine Morse Cone and 9 External Hexagon implants were inserted in 6 mongrel dogs. The Morse Cone implants were installed 2 mm below the crestal bone level, whereas the External Hexagon flush. The implants were retrieved after 2 months. Mean distance between the original level of coronal bone to the top of the implant and the mean distance between the top of the implant and the first bone-to-implant contact (fBIC) were recorded. RESULTS: No significant differences were found when the mean distance between the original level of coronal bone to the top of the implant was evaluated; however, there were statistically significant differences in the mean distances between the top of the implants and fBIC, suggesting a smaller amount of bone loss or remodeling in the Morse Cone compared to the External Hexagon group. CONCLUSION: Subcrestal placement had a positive impact on crestal bone remodeling in Morse Cone implants.

Evaluation of dry needling and 0.5% lidocaine injection therapies in myofascial pain trigger points in masticatory muscles

OBJECTIVE: The purpose of this study was to compare the effectiveness of trigger points injections using lidocaine 0.5% and dry needling without any kind of home-based rehabilitation program. METHODS: Sixteen patients with myofascial pain and trigger points in masticatory muscles were randomly assigned to two groups and received only one application session. The pressure pain threshold (PPT) was recorded before and after the injection: Ten minutes, 24 hours later, 7, 15, 21 and 30 days after the treatment. Visual analogue scale (VAS) was used to in all evaluation periods. RESULTS: There were no difference between groups for PPT, but for all groups the PPT during the time significantly increased when compared the before treatment. VAS showed differences between groups and during the time. The 0.5% lidocaine had the lowest VAS values when compared to dry needling, but at 30 days there were no differences among them. CONCLUSIONS: Despite the differences in VAS and considering there were no differences in PPT increases, we concluded that, in this study, both groups were able to disrupt the mechanisms of trigger point and relieve the myofascial pain symptoms.

Effect of experimental chewing on masticatory muscle pain onset.

OBJECTIVES: To evaluate the effect of a chewing exercise on pain intensity and pressure-pain threshold in patients with myofascial pain. METHODS: Twenty-nine consecutive women diagnosed with myofascial pain (MFP) according to the Research Diagnostic Criteria comprised the experimental group and 15 healthy age-matched female were used as controls. Subjects were asked to chew a gum stick for 9 min and to stay at rest for another 9 min afterwards. Pain intensity was rated on a visual analog scale (VAS) every 3 min. At 0, 9 and 18 min, the pressure-pain threshold (PPT) was measured bilaterally on the masseter and the anterior, medium, and posterior temporalis muscles. RESULTS: Patients with myofascial pain reported increase (76%) and no change (24%) on the pain intensity measured with the VAS. A reduction of the PPT at all muscular sites after the exercise and a non-significant recovery after rest were also observed. CONCLUSION: The following conclusions can be drawn: 1. there are at least two subtypes of patients with myofascial pain that respond differently to experimental chewing; 2. the chewing protocol had an adequate discriminative ability in distinguishing patients with myofascial pain from healthy controls.

Effect of experimental chewing on masticatory muscle pain onset

OBJECTIVES: To evaluate the effect of a chewing exercise on pain intensity and pressure-pain threshold in patients with myofascial pain. METHODS: Twenty-nine consecutive women diagnosed with myofascial pain (MFP) according to the Research Diagnostic Criteria comprised the experimental group and 15 healthy age-matched female were used as controls. Subjects were asked to chew a gum stick for 9 min and to stay at rest for another 9 min afterwards. Pain intensity was rated on a visual analog scale (VAS) every 3 min. At 0, 9 and 18 min, the pressure-pain threshold (PPT) was measured bilaterally on the masseter and the anterior, medium, and posterior temporalis muscles. RESULTS: Patients with myofascial pain reported increase (76 percent) and no change (24 percent) on the pain intensity measured with the VAS. A reduction of the PPT at all muscular sites after the exercise and a non-significant recovery after rest were also observed. CONCLUSION: The following conclusions can be drawn: 1. there are at least two subtypes of patients with myofascial pain that respond differently to experimental chewing; 2. the chewing protocol had an adequate discriminative ability in distinguishing patients with myofascial pain from healthy controls.

Estudo da precisão e fidelidade da técnica radiográfica convencional na avaliação do comportamento ósseo marginal em implantes Cone Morse e Hexágono Externo inseridos imediata etardiamente à extração e submetidos à carga imediata em cães / A study of precision and fidelity of conventional RX technique for theevaluation of marginal bone behavior in Cone Morse and External Hex Implantsinserted in immediate extraction and healed sockets and submitted toimmediate loading in dogs

Os estudos atuais dos implantes odontológicos visam diminuir o tempo dos tratamentos, através de procedimentos de carga imediata, e diminuir ou eliminar a perda óssea marginal imediata ou progressiva que acontece ao redor dos implantes. A presença do “Micro-gap” parece ser o causador desta perda óssea, bem como o acúmulo de bactérias próximas ao tecido ósseo. A proposta Cone Morse modificou as conexões protéticas, produzindo uma interface precisa que resulta em selamento hermético e virtual eliminação do “Micro-Gap”. O presente estudo propõe uma análise comparativa do comportamento ósseo ao redor de implantes do tipo Cone Morse e hexagonais instalados em alvéolos de extração recente e tardia e submetidos à carga imediata. Para tal estudo, foram utilizados seis cães, que tiveram todos os pré-molares inferiores direito extraídos numa primeira fase cirúrgica. Após três meses, foi realizada a segunda cirurgia nos animais, com a extração dos pré-molares esquerdos e a instalação dos implantes em ambos os lados da mandíbula. Desta maneira, no lado direito, considerando como grupo controle, os implantes foram instalados em sítios já remodelados e no lado esquerdo, considerado como grupo Experimental, os implantes foram instalados em sítios logo após a extração dentária. Foram realizadas tomadas radiográficas periapicais, através da técnica do paralelismo, em todas as fases do experimento. As radiografias foram escaneadas e analisadas através do programa AutoCAD. Foram utilizados os testes estatísticos “t” de Student para amostras pareadas e ANOVA a quatro critérios com o nível de significância de p<0.05. Os resultados mostraram que houve variação estatisticamente significativa entre os tempos Inicial e Final em ambos os implantes e grupos avaliados, no entanto, não houve diferença significante entre os implantes Cone Morse e Hexágono Externo e também não houve diferença significante entre a técnica cirúrgica de instalação...

Present studies in dental implantology are devoted to shorten treatment duration, by means of immediate loading or stimulation of the implants, as well as to diminish or eliminate the immediate or progressive marginal bone loss that is encountered around the implants cervical portion. A so called Micro-Gap seems to be the cause of this bone loss, as well as the presence of bacteria close to the osseous tissue. The Cone Morse implant modality has changed the traditional implant to abutment interface, creating a precise junction that virtually eliminates the micromotion and provides a tightly sealed connection. The present study comprehends a comparative analysis of osseous behavior around the Cone Morse and the external hex type implants installed in freshly extracted teeth sockets, as well as in healed extraction sockets, and submitted to immediate stimulation .For such purpose six Mongrel dogs were selected, which had all their right lower premolars extracted at an initial project stage Second surgical stage was performed after three months, that comprised the extraction of left premolars and implant installation at both sides of the mandible. From then on, the right side, now considered the control group had implants placed in a healed socket, and the left side, now called experimental group received implants placed directly in fresh immediate extraction sockets. Radiographic images were taken utilizing the parallelism technique in all phases of the experiment. These radiographs were scanned and digitalized and then analyzed by means of the AutoCAD Software. Student “t” test was performed for the paired samples and ANOVA at four criteria with significance level p<0.05.The results demonstrated that there was statistically significant variation between initial and final evaluation moments in both groups of implants considered. Nevertheless, there was no significant difference between Cone Morse and external hex group, as well as there was no significant...

Acompanhamento de dois anos de caso clínico realizado sobreimplante com interface cônica e hexagonal externa / A clinical report on the 2-year follow-up of implants with internal conical and external hex type systems

A possibilidade de se eliminar a reabsorção óssea pós-operatória ao redor dos implantes constitui um fator essencial na estabilização da papila. O objetivo deste relato clínico foi comparar a perda óssea e o resultado estético de dois diferentes sistemas de implantes após dois anos em função e, também, observar as complicações ocorridas durante este período. Uma situação clínica foi descrita onde dois implantes foram inseridos com o objetivo de substituir os dentes 12 e 22, respectivamente: um implante com interface do tipo cônica (Ankylos, Friadent, Alemanha) e um com interface do tipo hexágono externo (Conexão Sistema de Próteses, São Paulo). A redução ou eliminação da perda óssea na região da crista óssea pode resultar em significantes benefícios estéticos e clínicos. No acompanhamento descrito neste artigo, a comparação entre a perda óssea associada a cada implante mostrou que a diferença entre os níveis ósseos desde a segunda fase cirúrgica até dois anos de função, para ambos os sistemas, não são significativas ao ponto de comprometer o sucesso estético das próteses unitárias.

The avoidance of postoperative bone resorption around an implant collar constitutes a vital factor in papillary stabilization. The aim of this clinical trial was to evaluate the comparative bone loss and esthetic outcome of two different systems of implant after two years in function and also to observe any complications occurring during this period. A specific clinical situation is described in which two implants were placed substituting for missing teeth 12 and 22 respectively: a morse taper connection type implant (Ankylos, Friadent, Germany) and an external hex connection type implant (Conexão Sistemas de Prótese, Brazil). Reducing or eliminating crestal bone loss can result in significant esthetic and clinical benefits. In the follow-up described in this report, comparing the bone loss associated with each implant showed that the difference between bone levels from the second stage surgery to 2 years of function for both systems are not significant in such a way to compromise the aesthetic success in single implant prosthesis.

Estudos clínico e radiográfico randomizado (RCT) prospectivo com implantes Cone-Morse / Randomized controlled trial (RCT) prospective clinical study with Morse Taper implants

Com o objetivo de aumentar a estabilidade do conjunto implante-coroa, novos desenhos de interfaces protéticas entre a coroa e o implante surgiram no mercado para satisfazer objetivos estéticos, funcionais e técnicos. Os implantes de conexão interna, com característica de Cone-Morse, fornecem uma interface reforçada entre implante e abutment, gerando uma soldadura fria entre esses elementos, ausência de microgap e aumento da resistência aos micromovimentos proporcionando uma união rígida. O objetivo deste trabalho é avaliar o desempenho biológico e mecânico in vivo em humanos dos implantes e componentes protéticos do sistema Cone-Morse Neodent. Concluímos que os implantes que apresentam as junções tipo Morse devem ser os de primeira escolha para a reposição de dentes ausentes.

Ressonância magnética nos desarranjos internos da ATM: sensibilidade e especificidade / Ressonância magnética nos desarranjos internos da ATM: sensibilidade e especificidadeDiagnosis of TMJ disorders by magnetic resonance imaging: sensitivity and specificity

OBJETIVO: esta revisão de literatura visa avaliar, através de literatura específica, a sensibilidade e especificidade do exame de ressonância magnética (RM) para o diagnóstico dos desarranjos internos da articulação temporomandibular (ATM). METODOLOGIA: tanto artigos que utilizaram ATM de cadáveres para comparar achados anatômicos aos achados de ressonância magnética (RM), como artigos que compararam achados clínicos com achados de RM foram utilizados. Através dos achados desses artigos, as propriedades de sensibilidade e especificidade da RM para o diagnóstico de desarranjos internos da ATM foram calculadas. Com isso, a confiabilidade e a aplicabilidade do exame de RM no diagnóstico dos desarranjos internos da ATM foram discutidas. RESULTADOS: encontrou-se sensibilidade de 90 por cento e especificidade de 88 por cento da RM para desarranjos internos da ATM. CONCLUSÃO: o exame de RM de ATM possui ótima sensibilidade e especificidade para o diagnóstico dos desarranjos internos da ATM. Porém, tal exame deve ser solicitado com cautela, apenas nos casos onde a imagem seja indispensável para o plano de tratamento.

OBJECTIVE: the aim of this paper is to review the literature concerning the reliability and applicability of magnetic resonance imaging (MRI) in the diagnosis of temporomandibular joint (TMJ) internal disorders. METHODS: articles that have used TMJ from cadavers to compare MRI findings with anatomic findings, as well as some papers that have compared clinical findings with MRI findings were evaluated. According to the findings identified on these articles, the MRI sensitivity and specificity properties for the TMJ internal disorders diagnosis were calculated. Then, the MRI reliability and applicability for the TMJ internal disorders diagnosis were discussed. RESULTS: 90 percent of sensitivity and 88 percent of specificity were found. CONCLUSION: the TMJ MRI presents good sensitivity and specificity for the TMJ internal disorders diagnosis. But dentists should beware and request this exam only in cases where MRI will be essential to the treatment planning.

Association between sleep bruxism and temporomandibular disorders: a polysomnographic pilot study.

The aim of this study was to verify the association between sleep bruxism (SB) and temporomandibular disorders (TMD) in a sample of 14 TMD patients and 12 healthy control subjects. All participants were evaluated using a clinical questionnaire, visual analog scale (VAS) for TMJ/muscle palpation, and by functional examination. The experimental group was divided into three TMD subgroups: joint sounds and pain, muscular tenderness, and mixed diagnosis. All participants underwent polysomnographic recording (PSG). A second clinical examination was then carried out to verify the relationship between rhythmic masticatory muscle activity and pain/tenderness on the following morning. The experimental and control groups presented VAS mean scores of 36.85 +/- 23.73 mm and 0 mm, respectively. The presence of SB was neither associated with TMD (p > 0.05) nor with pain on palpation (p > 0.05). Further research with a more representative sample of each TMD subgroup is necessary to elucidate its interaction with SB.

Influence of the menstrual cycle on the pressure pain threshold of masticatory muscles in patients with masticatory myofascial pain.

OBJECTIVE: The aim of this study was to investigate the influence of the menstrual cycle and oral contraceptive (OC) intake on the pressure pain threshold (PPT) of masticatory muscles in patients with masticatory myofascial pain (MFP). STUDY DESIGN: The sample was composed of 36 women, divided into 4 groups, according to the presence of MFP and the intake of OC (15 patients had MFP [7 taking OC] and 21 were pain-free controls [8 taking OC]). The algometer-based PPT of masseter and temporalis, and the record of subjective pain by visual analog scale (VAS) were determined during 2 consecutives menstrual cycles at 4 phases (menstrual, follicular, periovulatory, and luteal). A 3-way ANOVA for repeated measurements, Kruskal-Wallis, Friedman, and Dunn tests, with a 5% significant level analyzed the data. RESULTS: PPT was significantly lower in MFP patients when compared with controls throughout the experiment (P < .001). The menstrual phases did not influence PPT (P > .05), while the intake of OC seems to raise PPT levels for the left temporalis (P = .01) and right masseter (P = .04). VAS was, in general, higher at the menstrual phase CONCLUSIONS: Different phases of the menstrual cycle have no influence on PPT values, regardless of the presence of a previous condition, as masticatory myofascial pain, while the intake of OC is associated with decreased levels of reported pain.

Provisionalização imediata na região anterior: protocolo clínico para implantes Cone-Morse / Immediate placement and provisionalization of maxillary anterior single implant: clinical protocol to Morse Taper implants

A popularidade dos implantes dentais tem aumentado nas substituições unitárias estéticas. Extração, colocação imediata do implante e restauração podem ser benéficos na manutenção da integridade dos alvéolos e contribuir para manutenção da papila interdental ao redor das próteses sobreimplantes. Este artigo descreve um protocolo clínico onde obtém-se uma resposta tecidual periimplantar e estética favoráveis através da colocação de implante imediato tipo Cone-Morse e provisionalização de dentes anteriores superiores.

Quantidade de pressão e padrão de dor referida em pacientes portadores de dor miofascial / Pressure pain treshold and referred pain pattern in myofascial pain patients

Os propósitos deste estudo foram: determinar a quantidade de pressão que estimulasse resposta dolorosaem pacientes com pontos gatilho (PG) quando comparado ao grupo controle assintomático; determinar umintervalo de tempo de manutenção de pressão para que houvesse o surgimento do processo de dor referida(DR) e verificar o padrão de DR provocada. Selecionou-se 24 pacientes portadores de dor miofascial e parao grupo controle, 20 indivíduos livres de qualquer sintomatologia de disfunção temporomandibular. Ambos os grupos foram examinados por um único examinador em pontos gatilho previamente diagnosticados. Noitem quantidade de pressão, o intervalo no grupo portador de dor miofascial foi significantemente menor queo grupo controle. O padrão de DR obtido confere com aquele descrito na literatura. Os autores deste estudoconcluíram que o limiar de dor a palpação em portadores de dor miofascial é menor que em indivíduos nãoportadores e o padrão da manifestação de DR semelhante ao descrito na literatura.

The purposes of this study were: to determine the amount of pressure necessary to create painful responsein patients with myofascial pain in head and neck when compared with a assintomatic control group; to determineone sustained pressure time that causes referred pain and to determine the referred pain pattern whenthe trigger points were stimulated. The group A was formed by 24 patients who had myofascial pain, andgroup B was composed by 20 myofascial pain free subjects. For both groups, examination was performed byonly an experienced and trained professional. Group A had lower pressure pain threshold when comparedwith group B.( p < 0,01) The referred pain patterns was very similar to those described in literature. It wasconcluded that the pressure pain threshold in myofascial pain patients is lower than pressure pain thresholdin non-patients.

Prevalência das facetas de desgaste e sua relação com aspectos oclusais e hábitos parafuncionais / Prevalence of dental wear and their relation to occlusal aspects and parafunctional habits

Este estudo avalia a prevalência, extensão e severidade das facetas de desgaste em 60 alunos do primeiro ano dos cursos de Odontologia e Fonoaudiologia da Universidade de São Paulo, campus Bauru, com idades entre 17 e 24 anos. Questionários e exames clínicos foram realizados sendo que as facetas de desgaste foram avaliadas intra-oralmente e através de modelos de gesso. Todos os alunos apresentaram facetas de desgaste, sendo os caninos os dentes mais afetados (26,46%). A variável gênero não apresentou associação estatística com as lesões avaliadas. Dentre os prováveis fatores contribuintes examinados observou-se uma relação estatística nos pré-molares esquerdos com as facetas nos estudantes que apresentavam função em grupo nos movimentos excursivos (p = 0,007). Com relação aos hábitos parafuncionais encontrou-se correlação estatística entre o hábito de apertamento (p = 0,044) e desgaste nos incisivos esquerdos e entre o hábito de ranger e o desgaste nos caninos esquerdos (p = 0,006) e direitos (p = 0,009).

This study aimed to evaluate the prevalence, extension and severity of dental wear in 60 students (age between 17 and 24 years-old), attending, the undergraduate programs of the Bauru School of Dentistry, University of São Paulo. Questionnaires about parafunctional activity, clinical evaluation and analysis of study models were performed for this purpose. All students presented dental wears, regardless of gender or aging. The canines were the more affected group of teeth (26.46%). A significant association was found between wear facets and group function in excursive laterals movements (p = 0.007) for left premolars. Significant association was also detected between clenching and the attrition on left incisors(p = 0.044) and between grinding and the attrition on left (p = 0.006) and right canines (p = 0.009).