Dent. J., Volume 11, Issue 8 (August 2023) – 19 articles

Objective: To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. Methods: This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon^® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus^® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow^® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. Results: The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. Conclusions: The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it. Full article

Data regarding the mechanical properties of three-dimensionally (3D) printed materials for occlusal splint manufacturing are scarce. The aim of the present study was to evaluate the flexural strength and surface hardness of modern 3D-printed occlusal splint materials and compare them with two control groups, namely, milled and conventional cold-polymerized occlusal splint materials. A total of 140 rectangular specimens were manufactured for the present study. The specimens were prepared in accordance with the International Organization for Standardization standards (ISO 20795-1:2013). Five 3D-printed (NextDent Ortho Rigid, Dental LT Clear, Dentona Flexisplint, Cosmos Bite Splint, and ProArt Print Splint), one milled (ProArt CAD Splint), and one cold-polymerized (ProBase Cold) occlusal splint materials were used to determine flexural strength and surface hardness values. The three-point flexure test was used for the determination of flexural strength values, while Vickers hardness was measured to determine surface hardness. Ten specimens (n = 10) of each material were tested using these procedures. One-way ANOVA and Tukey’s post-hoc test were used to analyze the obtained results (α = 0.05). The values of flexural strength ranged from 46.1 ± 8.2 MPa to 106 ± 8.3 MPa. The Vickers hardness values ranged from 4.9 ± 0.5 VHN to 20.6 ± 1.3 VHN. Significant differences were found among the tested materials (p < 0.0001). The milled and cold-polymerized materials yielded higher values for both flexural strength (only one 3D-printed resin had comparable results to cold-polymerized acrylics) and surface hardness. There are differences in the mechanical properties of the various tested occlusal splint materials. The flexural strength of most of the 3D-printed materials and their surface hardness values are still inferior when compared to the milled or cold-polymerized materials. Full article

The aim of this study was to assess, whether patients prior to endoprosthesis (EP) visit their dentist for need-oriented therapy and whether this would be associated with the occurrence of complications. Based on a cohort of patients, which was orally investigated prior to EP surgery between 04/2020 and 12/2021, a telephone interview was performed at least six months after EP implantation. Patients were classified into either low-risk (LR), moderate-risk (MR), or high-risk (HR) groups. Participants were interviewed based on a structured questionnaire regarding dental visits, dental therapy, and potential complications during the observational period. Out of the 311 patients from the baseline cohort, 96 patients after EP implantation could be included (participation rate of 31%). Nineteen patients were in LR (20%), 41 in MR (43%), and 36 in the HR group (37%). Overall, 79% (n = 76) of the patients followed the recommendation to visit their dentist; 94% of patients within the HR group visited the dentist (p = 0.02). Dental treatment procedures included tooth cleaning (57%), periodontal treatment (31%), restorative therapy/filling (28%), and tooth extraction (28%). In 64% of the HR patients (n = 23), the potential oral foci with a risk of EP infection were eliminated by their general dentist. Fourteen different complications occurred within the observation period, without any group effect (p > 0.05). In conclusion, most patients prior to EP visit their general dentist following referral, especially if they have a potential oral focus. The effect of dental clearance on infectious complications of EP remains unclear, whereby further clinical studies are needed. Full article

The heat produced during tooth preparation could be a source of damage for dental pulp, and many variables are involved in this process. The aim of this in vitro study was to evaluate whether the different degrees of wear of the diamond burs significantly influenced the temperature changes in the pulp chamber during tangential veneer preparation. The sample comprised 30 intact permanent monoradicular teeth, randomly assigned to three study groups of 10 teeth each, of which 5 had the pulp tissue preserved and 5 had thermoconductive paste in the pulp chamber. For prosthetic preparation, we used new burs in the first group, burs at their fifth use in the second group, and burs at their eighth use for the third group. The pulp chamber temperature was evaluated at the start, after one minute, and after three minutes of preparation, using a k-type thermocouple. The results of the three-way ANOVA and Tukey post hoc comparisons showed a highly significant effect of the time of measurement, while the pulp condition and the degree of wear of the burs had no effect. In conclusion, the different degrees of wear of conventional diamond burs do not produce statistically significant different changes in the pulp chamber temperature. Full article

After tooth extraction, the alveolar ridge undergoes a physiological process of remodelling and disuse atrophy. Socket augmentation (SA) has been shown to preserve alveolar bone volume in order to facilitate implant placement and reduce the need for staged grafting at a later date. Although autogenic grafting has been shown to be the gold standard in bone regeneration, it has significant disadvantages. To prevent post-extraction volumetric alterations and alveolar bone resorption occurring, alternative grafting materials, including xenografts, alloplasts, and allografts, have been used successfully in fresh extraction sites. However, these materials act mostly as bio-scaffolds and require a slower integration period of 6–8 months prior to implant placement. Recently, the use of autologous platelet-rich fibrin (PRF) has been advocated alongside socket augmentation as a method of bio-enhancement of healing of soft and hard tissues. PRF contains platelet-derived growth factors, hormones, and bioactive components such as cytokines that have been shown to promote angiogenesis and tissue regeneration during wound healing. The aim of this article is to review the evidence base for the SA technique Clinical benefits of SA will be discussed with a reference to two cases. Therefore, this narrative review will discuss the post-extraction bone changes, the importance of SA, and the bio-enhancement role of PRF in the management of extraction site defects when the alternative technique of immediate implant placement is not possible or contraindicated. Full article

Sports activities may induce long-lasting changes in mandibular trajectories. The aim was to compare condylar and mandibular movements in athletes with orofacial injuries with values measured in non-injured athletes. The group of 132 athletes without mandibular injury included asymptomatic athletes with a history of a blow to the right side (N = 43) and the group included asymptomatic athletes with a history of a blow to the left side (N = 41) of the mandible. The injured athletes suffered from stiffness/pain and/or limitation of jaw movements. The symptoms disappeared shortly after the injury. Athletes with a history of injury have smaller mean values of Bennett angle on the side of impact, and Bennett angle on the opposite side is greater than the mean found in non-injured athletes. Significantly smaller Bennett angle values in athletes with a history of a blow to one side of the mandible are due to the adaptability of the orofacial system. The larger Bennett angle on the opposite side of the injury is also due to the adaptive mechanism of the TMJ. Clinical Relevance: An individualized approach to TMJ values is mandatory in restorative procedures in every patient, especially in patients with a history of trauma to the orofacial system. Full article

Oral microbiota play a pivotal role in maintaining homeostasis, safeguarding the oral cavity, and preventing the onset of disease. Oral dysbiosis has the potential to trigger pro-inflammatory effects and immune dysregulation, which can have a negative impact on systemic health. It is regarded as a key etiological factor for periodontitis. The emergence and persistence of oral dysbiosis have been demonstrated to mediate inflammatory pathology locally and at distant sites. The heightened inflammation observed in oral dysbiosis is dependent upon the secretion of interleukin-17A (IL-17A) by various innate and adaptive immune cells. IL-17A has been found to play a significant role in host defense mechanisms by inducing antibacterial peptides, recruiting neutrophils, and promoting local inflammation via cytokines and chemokines. This review seeks to present the current knowledge on oral dysbiosis and its prevention, as well as the underlying role of IL-17A in periodontitis induced by oral dysbiosis and its impact on systemic inflammatory disease. Full article

Aim of this study was to demonstrate the diagnostic ability to differentiate odontogenic keratocysts (OKCs) from ameloblastomas (AMs) based on computed tomography (CT) or cone beam computed tomography (CBCT) scans. Preoperative CT and CBCT scans from 2004 to 2019 of OKCs and AMs were analyzed in 51 participants. Lesions were three-dimensionally (3D) assessed and Hounsfield units (HU) as well as gray scale values (GSV) were quantified. Calculated HU spectra were compared within the same imaging modalities using unpaired t-tests and correlated with participants characteristics by calculating Pearsons correlation coefficients. Within the CT scans, AMs had highly significantly higher HU values compared to OKCs (43.52 HU and 19.79 HU, respectively; p < 0.0001). Analogous, within the CBCT scans, AMs had significantly higher GSV compared to OKCs (−413.76 HU and −564.76 HU, respectively; p = 0.0376). These findings were independent from participants’ gender and age, anatomical site, and lesion size, indicating that the HU- and GSV-based difference reflects an individual configuration of the lesion. HU and GSV spectra calculated from CT and CBCT scans can be used to discriminate between OKCs and AMs. This diagnostic approach represents a faster and non-invasive option for preoperative diagnosis of such entities and has potential to facilitate therapeutic decision making. Full article

Background: The complex traditional treatment of inflammation diseases in oral cavity includes the prescription of antibiotic and antiseptic therapy. This systematic review aims to evaluate the effect of photodynamic therapy as a part of management of inflammatory diseases in oral cavity; Methods: The study is presented in accordance with the preferred reporting points for systematic reviews and meta-analyses (PRISMA). This systematic review was conducted using electronic databases such as Medline PubMed, Scopus and the Cochrane Central Register of Controlled Trials. All the studies in this systematic review, were randomized, the risk of bias 2 (ROB 2) were assessed; Results: Considering the inclusion and exclusion criteria, we included 10 randomized clinical trials, published up to 2023 investigating the application of photodynamic therapy as a part of management of inflammatory diseases in oral cavity. The diode laser was used in the oral cavity in the zone of inflammatory process (gingivitis, mucositis, periimplantitis, marginal periodontitis, abscess, periostitis, osteomyelitis etc.) in nine studies or in the zone before surgical procedures in one study; Conclusion: Based on the results of clinical studies, it can be stated that photodynamic therapy shows good results for operations performed in the oral cavity and pharynx. Full article

Introduction: Myobrace^® is an orthodontic device that has the purpose of correcting oral dysfunctions, thus predisposing the physiological growth of the jaws, aligning teeth, and optimizing face development. This device is usually associated with Myobrace^® Activities to reach this target. Considering the lack of studies in the literature about peripheral blood oxygen saturation (SpO₂) and the use of preformed oral devices, the aim of this study is to quantify the change in blood oxygen saturation (SpO₂) in patients treated with the Myobrace^® System in mixed dentition. Materials and Methods: In this study, 23 children (11 females and 12 males) were involved, who were affected by different oral dysfunctions and were treated with a Myobrace^®. Blood oxygen saturation measurements were taken at baseline and after every four months for a year. The SpO₂ measurements were taken in the rest position and with a closed mouth for a total of 12 min—6 min with and 6 min without the Myobrace^® oral device. All data points were anonymized and recorded on an Excel spreadsheet. A statistical analysis was carried out. Results: Therapy with a Myobrace^® in patients with mixed dentition resulted in a statistically significant increase in oxygen saturation. In particular, in patients with a closed mouth, a statistically significant increase in oxygen saturation was observed, bringing it from 97.66% to 99.00%, while in the rest position, the increase was from 98.03% to 99.07%. Conclusions: The use of Myobrace^® devices in patients with mixed dentition could lead to a significant improvement in blood oxygen saturation. Full article

Background: Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children. Methods: The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents’ knowledge and attitudes, while the DFA level was determined using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status. Results: The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R² = 0.545, F (4.215) = 64.28 p < 0.001. Conclusions: These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs. Full article

Oral diseases are largely preventable. However, as the number of older adults is expected to increase, along with the high cost and various barriers to seeking continuous professional care, a sustainable approach is needed to assist older adults in maintaining their oral health. Mobile health (mHealth) technologies may facilitate oral disease prevention and management through oral health education. This review aims to provide an overview of existing evidence on using mHealth to promote oral health through education among older adults. A literature search was performed across five electronic databases. A total of five studies were identified, which provided low to moderate evidence to support using mHealth among older adults. The selected studies showed that mHealth could improve oral health management, oral health behavior, and oral health knowledge among older adults. However, more quality studies regarding using mHealth technologies in oral health management, oral health behavior, and oral health knowledge among older adults are needed. Full article

Introduction: Thanks to the great development of digital technology, viaCAD (computer-aided design) and CAM (computer-aided manufacturing) systems, digital models canbe used as an aid for orthodontic planning decision-making processes as there are numerous studies in the literature that support the validity ofthe digital model measurements of anterior teeth and the total coefficient of Bolton analysis. The aim of the present study isto compare the average length value of the current upper and lower arches with that of a hypothetical nickel–titanium wire and to confirm the reliability and accuracy of digitally taken measurements of the anterior and total Bolton coefficients.In this retrospective study, dental casts of 138 Caucasian adolescent patients were scanned with an extraoral scanner, and Ortho3Shape software was adopted for the following dental cast measurements: actual and ideal lengths of the lower arches and anterior and total Bolton coefficients.In the present study, we found that the mean value of the anterior coefficients of the Bolton index was compatible with those of previous studies, confirming the reliability of digital measurements.Therefore, digital CAD/CAM models may be a viable alternative to plaster models, as they can facilitate model preservation and recovery. For future studies, it would be better to use intraoral scanners (IOSs) to ensure greater accuracy, since they only require one step and allow obtaining better results for the patients. Full article

Ozone has been successfully used in medicine for over 100 years due to its microbiological qualities. Its powerful oxidation impact, which results in the production of free radicals, and its ability to cause the direct death of nearly all microorganisms is the basis for its bactericide, virucide, and fungicide properties. Ozone also has a medicinal impact that speeds up blood flow and aids wound healing. Ozone may be applied as a gas or dissolved in water for medical purposes. Despite the benefits of using ozone therapeutically, concerns about its use in dentistry still exist. We aimed to provide a summary of the current uses of ozone in medicine and dentistry. An electronic search was performed for all English scientific papers published between 2012 and 2023 using PubMed, Cochrane, and Google Scholar search engines. Ozone, clinical applications, medicine, and dentistry were the search terms used. Seventy full-text articles describing the use of ozone therapy in medicine and dentistry were included in the present review. Ozone has shown several beneficial effects in the medical field. However, despite the encouraging in vitro evidence, the clinical use of ozone in dentistry has not yet been demonstrated as highly effective. Full article

Coronal torque is one of the key factors in orthodontic treatment. An adequate torque value has an impact on aesthetics and soft tissue profile. The aim of this quantitative, comparative and observational longitudinal cohort study was to analyze the efficacy of the maxillary central incisor coronal torque in the Invisalign^® system and evaluate the relation between coronal torque movement and patient’s facial biotype. In total, 27 patients were selected. The planned movements (TP) were obtained from the Invisalign Doctor Site^® using mathematical formulas that consider the T0 measurements. Pre-treatment (T0) and after full use of the first set of aligners (T1) scanners were evaluated using Geomagic^® Control X ^TM by superimposing T0 and T1 models using a transverse plane and the long axis of the tooth crown. IBM^® SPSS^® software was used for statistical purposes. We found statistically significant differences between T0 and T1 in pro-inclination and retro-inclination, as well as between achieved and planned values in pro-inclination (p = 0.011). We verified that hyperdivergent clinical cases presented higher mean values of coronal torque, and hypodivergent cases presented lower values. In pro-inclination, the differences between the planned and achieved values were greater in hypodivergent cases and smaller in hyperdivergent cases. In retro-inclination, the differences between the planned and achieved values were greater in normodivergent cases and smaller in hypodivergent cases. This study highlights that inefficacy is more accentuated in pro-inclination. Aligners are an effective tool for producing coronal repercussions of torque movement, being more effective in retro-inclination. Full article

Introduction: The aim of this prospective descriptive study was to analyse the possible variables associated with marginal bone loss in rehabilitated implants (Proclinic S.A.U, Zaragoza, Spain) two years after their prosthetic loading. Materials and Methods: Three clinical centres collaborated for a period of two years after the prosthetic rehabilitation of the implants (Proclinic S.A.U, Zaragoza, Spain), in which marginal bone loss and the possible associated variables were evaluated. The collection form comprised different variables throughout different stages of the implant procedure, from implant insertion to the subsequent prosthetic rehabilitation, over a two-year period. Data of the patients and implant characteristics were studied. Statistical analysis was performed with SPSS for qualitative (univariate logistic regressions, Chi2 test, and Haberman’s corrected standardised residuals) and quantitative variables (Kolmogorov–Smirnov test). Results: The total study sample consisted of 218 implants (Proclinic S.A.U, Zaragoza, Spain). The sample presented a frequency of 99 men (45.4%) and 119 women (54.6%). The mean age of the patients among the reported cases was 58.56 ± 10.12 years. A statistically significant association was found between marginal bone loss 2 years after prosthetic rehabilitation placement and several variables, including age (under 55 years, 0.25 mm ± 0.56; 55–64 years, 0.74 mm ± 0.57; over 65 years, 0.63 mm ± 0.55; p < 0.0001), gender (female, 0.74 mm ± 0.61; male, 0.34 mm ± 0.51; p < 0.0001), bone quality (D1, 0.75 mm ± 0.62; D2, 0.43 mm ± 0.57; D3, 0.65 mm ± 0.60; p < 0.01), implant diameter (up to 4 mm, 0.49 mm ± 0.58; more than 4 mm, 1.21 mm ± 0.30; p < 0.0001), prosthetic connection type (direct to implant, 0.11 mm ± 0.58; transepithelial straight, 0.67 mm ± 0.57; transepithelial angled, 0.33 mm ± 0.25; p < 0001), implant model (internal conical, 0.17 mm ± 0.24; external conical, 0.48 mm ± 0.61; external cylindrical, 1.12 mm ± 0.32; p < 0.0001), prosthetic restoration type (full denture, 0.59 mm ± 0.59; partial denture, 0.50 mm ± 0.85; unitary crown, 0.08 mm ± 0.19; p < 0.05), and insertion torque (>35 N/cm, 0.53 mm ± 0.58; <35 N/cm, 1.04 mm ± 0.63; p < 0.01). Conclusions: At 2 years, marginal bone loss following prosthetic rehabilitation was shown to be influenced by multiple factors. Correct implantological planning is of vital importance for successful rehabilitation. Full article

Osteomyelitis of the jaws presents a clinical challenge to conventional treatment, often requiring multiple surgical interventions resulting in significant deformity and presenting significant problems to satisfactory rehabilitation. While benign odontogenic cysts, such as the radicular cyst, are generally predictably treated, they can cause significant localized bone destruction and thus can present significant problems in satisfactory rehabilitation. In this case report, patients were treated combining conventionally appropriate surgical debridement and oral antibiotics with adjunctive plasma rich in growth factors (PRGF). Patients showed a complete soft tissue and osseous regeneration to their pre-pathologic state, with successful implant rehabilitation. PRGF appears to be highly successful in minimizing or eliminating osseous deformities normally associated with conventional treatment of osteomyelitis of the jaw and treatment of large odontogenic cysts. Future trials must be performed to confirm these results in comparison to controls using conventional treatment alone. Full article

This study aimed to evaluate the precision of the guided endodontic technique applied to calcified canals in anterior teeth in relation to demographic and dental variables. The present observational study was conducted during the period 2020–2021. The patients were consecutive referrals at the Department of Endodontics and Conservative Dentistry of the University Hospital of Siena. The guided endodontics protocol was applied using 0.75 mm diameter burs for the lower teeth and 0.90 mm for the upper teeth. The inclusion criteria were as follows: (i) teeth with pulp canal obliteration (PCO) associated with a periapical lesion (periapical index (PAI) ≥ 2); (ii) teeth with PCO that require the placement of a root canal post for the execution of a prosthetic treatment; (iii) teeth in which surgical treatment was not justified. Socio-demographic characteristics of the patients were recorded and related to the drill path accuracy through the guide in the calcified endodontic canal, evaluated through a radiographic analysis, and classified as optimal (in the center of the root canal) and acceptable (deviated peripherally/tangentially). A logistic regression model was built to predict the factors that influence the poor precision of the technique. Seventeen patients (mean age 48 years) with eighteen calcified single-rooted teeth were enrolled. All teeth were associated with periapical lesions with PAI scores from 2 to 5 (mean PAI: 3.055). From the model, it is evident that the presence of a calcification affecting the apical area of the root increases the probability of being off-center with the bur by about 15 times. In addition, a previous attempt at endodontic treatment and the position in the lower arch increases the probability of non-centrality of the drill, although in a non-statistically significant way. In any of the analyzed cases, the guided endodontic technique applied to PCO did not determine the presence of iatrogenic errors, such as perforations. However, the apical localization of the obliteration increases the probability of being off-center with the drill during the instrumentation phase by about 15 times. Full article

Objectives: This study sought to evaluate the remineralization of ex vivo human teeth using commercially available artificial saliva, SalivaMAX^®, a supersaturated calcium phosphate rinse (SSCPR). Methods: early enamel lesions were artificially induced on ex vivo human teeth by chemical means. The teeth were exposed to the SSCPR for two minutes (experimental) or dH₂O (control) four times per day for a total of 35 days. At time points of 0, 2.5, 21, and 35 days, micro-CT was utilized to determine the mineral density profile across the lesion and evaluate lesion depth. The relative percent remineralization was calculated from the initial lesion depth (Time 0) at each evaluation time. Student’s t-test was used to compare the extent of remineralization between the SSCPR and control groups for statistical significance at each time. To evaluate the changes in percent remineralization over time, a two-way ANOVA was used. Results: At Time 0 and 2.5 days, there was no difference in the percent remineralization between the SSCPR and control groups (p > 0.05). After 21 days, the teeth exposed to the SSCPR remineralized 56.7 ± 3.7%, while the control only remineralized 10.7 ± 11.0% (p < 0.0001). At day 35, the remineralization was 73.7 ± 5.4% and 18.2 ± 10.8% (p < 0.0001) for the SSCPR and control groups, respectively. Conclusions: A marked increase in remineralization occurred with the use of the SSCPR. Notably, the remineralization of the SSCPR occurred deep within the tooth and progressed toward the surface over time. Full article