Maxillary osteotomy complications in piezoelectric surgery compared to conventional surgical techniques: a systematic review.

A systematic review was conducted to investigate the available evidence on maxillary complications related to piezoelectric and conventional surgery. Seven databases were searched. A total of 996 maxillary osteotomies were analysed, 864 performed with conventional tools and 132 with a piezoelectric device. One hundred and fifty-six complication events were reported. The complications, in descending order of overall prevalence, were as follows: neurosensory disturbance (64.7%), haemorrhage (8.3%), oroantral communication (7.7%), soft tissue injury (7.7%), tooth injury (5.1%), infection (3.2%), osteonecrosis (1.9%), and permanent nerve injury (1.3%). Among the complications, the results showed the highest prevalence for neurosensory disturbance, and haemorrhage was the most reported complication and the second most prevalent complication. A three-fold meta-analysis was performed. Using GRADEpro, the level of evidence was determined for each complication. The current low level of evidence suggests that piezoelectric bone surgery reduces critical and important complications during maxillary osteotomy procedures, such as neurosensory disturbance, haemorrhage, oroantral communication, tooth injury, and permanent nerve injury. However, an effective comparison between the two techniques was difficult to perform with the current available literature. Due to the small sample sizes in the piezoelectric surgery studies, caution should be exercised when considering almost non-existent reported complications.

Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta-analysis.

The technical quality of root canal treatment (RCT) may impact on the outcome. The quality of education received during undergraduate school may be linked to the quality of treatment provided in general dental practice. In this context, the aim of this systematic review was to answer the following focused questions: (i) What is the frequency of acceptable technical quality of root fillings, assessed radiographically, performed by undergraduate students? (ii) What are the most common errors assessed radiographically and reported in these treatments? For this purpose, articles that evaluated the quality of root fillings performed by undergraduate students were selected. Data were collected based on predetermined criteria. The key features from the included studies were extracted. GRADE-tool assessed the quality of the evidence. MAStARI evaluated the methodological quality, and a meta-analysis on all studies was conducted. At the end of the screening, 24 articles were identified. Overall frequency of acceptable technical quality of root fillings was 48%. From this total, 52% related to anterior teeth, 49% to premolars and 26% to molars. The main procedural errors reported were ledge formation, furcation perforation, apical transportation and apical perforation. The heterogeneity amongst the studies was high (84-99%). Five studies had a high risk of bias, eight had a moderate risk, and 11 had low risk. The overall quality of evidence identified was very low. The conclusion was that technical quality of root fillings performed by undergraduate students is low, which may reveal that endodontic education has limited achievement at undergraduate level. A plan to improve the quality of root fillings, and by extrapolation the overall quality of root canal treatment, should be discussed by the staff responsible for endodontic education and training.

Pharyngeal airway changes in pre-pubertal children with Class II malocclusion after Fränkel-2 treatment.

AIM: To evaluate two-dimensional changes in pharyngeal airway dimensions in pre-pubertal children with a Class II malocclusion treated with a Fränkel-2 appliance compared to a matched non-treated control sample. MATERIALS AND METHODS: Lateral cephalograms obtained from 28 consecutively treated pre-pubertal children before (T0) and after (T1) a one-year Fränkel-2 treatment were analysed. Fränkel-2 appliance was used for at least 18 hr/day during 12 months. The control group was matched as closely as possible. All the cases presented normal facial growth pattern. Sagittal and vertical cephalometric measurements assessing maxillary and mandibular skeletal positions, as well as sagittal pharyngeal airway dimensions, were calculated. Intraclass correlation coefficient was calculated in order to determine reliability. Differences based on age for all the outcome variables at T0 were compared with an independent t-test. A MANOVA was used thereafter to determine if any factors and their interactions were associated with changes in the outcome variables. Differences between T1 and T0 were evaluated with either a t-student test or a Mann Whitney U test. RESULTS: At T0 differences between groups were noted for several variables. These differences were considered during the follow-up statistical analysis. Changes between groups after treatment (T1-T0) were noted for SNB, PNS to Ba, McNamara Low and Middle to S (increase in treatment group), and ANB and AD1 to Ba (decrease in treatment group). CONCLUSIONS: Some pharyngeal two-dimensional airway dimensions changed in Class II malocclusion pre-pubertal patients during a one-year treatment with Fränkel-2 appliances.

Digital Imaging Capability for Caries Detection: A Meta-analysis.

The objective of this study was to identify the diagnostic capability of photostimulable phosphor plates (PSPs) and direct digital sensors (DDSs) in the detection of interproximal caries. Studies were identified that evaluated the diagnostic capability of PSPs and DDSs in detecting interproximal caries in human teeth, in both dentin and enamel. Histologic sections were the gold standard. This systematic review searched several electronic databases. In addition, Google Scholar and reference lists of the finally included studies were screened. QUADAS-2 was applied to evaluate the risk of bias among included studies. Six studies were finally included; 4 of which were considered homogeneous enough to conduct a meta-analysis. The meta-analysis evaluated 668 interproximal human tooth surfaces. All studies used extracted human teeth ranging from no caries present to caries into dentin. Each tooth was radiographed by both PSP and DDS technologies and then submitted for histologic analysis as the gold standard. Meta-analysis showed that intraoral digital imaging is of high specificity but low sensitivity in the detection of interproximal caries. The sensitivity and specificity for different studies with PSPs varied substantially from 15% to 54% and from 84% to 100%, respectively. Direct sensor analysis sensitivity and specificity ranged from 16% to 56% and from 90% to 100%, respectively. Newer PSP and DDS technologies had statistically significant higher sensitivities, yet the differences in diagnostic capabilities between the older and newer technologies were clinically insignificant. Both digital systems were excellent in identifying surfaces without caries (specificity) but were not sensitive enough to reliably identify interproximal surfaces with caries. Clinicians must therefore remain vigilant in performing a careful clinical examination and other diagnostic tests rather than relying solely on radiographic imaging to diagnose interproximal caries. Knowledge Transfer Statement: This study will help clinicians make an evidence-based decision when deciding which digital radiography system to use when evaluating interproximal caries. Time, patient radiation safety, cost, and image quality are factors to be considered. The performance of the different available digital imaging systems was compared with the current gold standard-a histologic analysis-via meta-analysis.

Intra-arch dimensional measurement validity of laser-scanned digital dental models compared with the original plaster models: a systematic review.

A systematic review was undertaken to evaluate the validity of intra-arch dimensional measurements made from laser-scanned digital dental models in comparison with measurements directly obtained from the original plaster casts (gold standard). Finally included articles were only those reporting studies that compared measurements from digital models produced from laser scanning against their plaster models. Measurements from the original plaster models should have been made using a manual or digital caliper (gold standard). Articles that used scans from impressions or digital photographs were discarded. Detailed individual search strategies for Cochrane, EMBASE, MEDLINE, PubMed, and LILACS were developed. The references cited in the selected articles were also checked for any references that could have been missed in the electronic database searches. A partial gray literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item quality assessment tool for diagnostic accuracy studies (QUADAS). Only 16 studies were finally included for the qualitative/quantitative synthesis. The selected studies consistently agree that the validity of measurements obtained after using a laser scanner from plaster models is similar to direct measurements. Any stated differences would be unlikely clinically relevant. There is consistent scientific evidence to support the validity of measurements from digital dental models in comparison with intra-arch dimensional measurements directly obtained from them.