Dent. J., Volume 9, Issue 2 (February 2021) – 13 articles

Background: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. Material and Methods: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. Results: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. Conclusions: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population. Full article

A dental hygienist performs various daily work-related tasks. The aim of this study was to elucidate the daily work-related tasks of Japanese dental hygienists and construct groups to understand the relationships between daily work-related tasks, the attractiveness of dental hygienist work, and the improvement of the working environment. The Japan Dental Hygienists’ Association has conducted a postal survey on the employment status of dental hygienists in Japan every five years since 1981. The data on the implementation of 74 daily work-related tasks in dental offices were analyzed from the survey carried out in 2019. The questionnaires were distributed to 16,722 dental hygienists and 8932 were returned (collection rate: 53.4%). The 3796 dental hygienists working at dental clinics were clearly classified into nine groups. Full-time workers requested a reduced workload. Part-time workers requested better treatment rather than reducing the workload. Salary and human relationships were common problems with the working environment. Full-time workers felt that job security was an attractive feature of the dental hygienist role. The data presented in this study may help with the improvement of working conditions for dental hygienists. Full article

The aim of the study is to compare the frequency and the distribution of molar incisor hypomineralization (MIH) in children with intellectual disabilities. Methods: Seventy-two children with intellectual disabilities and 72 healthy children were included in the study. They ranged in age from 5 to 18 years with the same distribution by age and sex. Standard clinical examination was performed, at a dental clinic or in the institution where the children lived, by using a dental mirror and a probe, according the European Academy of Paediatric Dentistry judgment criteria for MIH. Results: Among the 72 children with intellectual disabilities, eight children (11.1%) presented MIH with 19 affected teeth. In the control group, one child (1.4%) presented MIH with two affected teeth. The difference was statistically significant (p = 0.033). There were no statistically significant differences between boys and girls. The molars, especially the first right molars were the most affected tooth. Brown defects were less common than white defects. Conclusion: Children with MIH should be identified because this condition is a common problem in children with intellectual disabilities. Full article

Background: currently applied surface treatments for zirconia bonding may create undesired microcracks and surface flaws. The aim of the present study was to evaluate the efficacy of alternative surface treatments on the shear bond strength of high translucency zirconia to 10-Methacryloyloxydecyl dihydrogen phosphate (MDP)-containing resin-based cement. Methods: fifty disk-shaped specimens (10 mm × 5 mm) were fabricated from a commercial yttria-stabilized zirconia with 5 mole% yttrium oxide tetragonal zirconia polycrystal (5Y-TZP), and underwent air-abrasion with alumina particles (50 μm-AL50 and 90 μm-AL90), glass beads (GB 10–60 μm), and ablation with femtosecond laser (FEMTO). Shear bond strength was evaluated with a universal testing machine under a crosshead speed of 0.5 mm/min until fracture. Fracture type was evaluated with an optical stereomicroscope. Differences among groups were evaluated by one-way ANOVA and Bonferroni pairwise comparison tests (p < 0.05). Results: the highest shear bond strength values were presented by the laser treated group (23.97 ± 3.7 MPa). No statistically significant differences were found among the Cl, Al50, Al90 and FEMTO groups. The lowest mean value was presented by the glass-beads treated group (11.93 ± 2.88 MPa) which was significantly lower compared to all other groups (p < 0.001). Conclusions: under the limitations of this in vitro study, femtosecond laser treatment of High-translucent monolithic zirconia (HTZ) ceramics is a promising alternative method for the mechanical retention of resin cements. Full article

The use of radiographic indices is noticeably diminished due to the lack of simplicity and standardisation among the existing ones. The aim of this study was to introduce a radiographic index to aid clinicians in determining the extent and severity of interproximal alveolar bone loss (iABL), in relation to individual root lengths, among patients suffering from periodontitis. A retrospective analysis of 50 anonymised dental panoramic tomograms (DPTs) of patients with periodontitis was conducted. Visual interpretation of iABL was recorded by a single investigator and by 20 volunteering clinicians for the ‘worst site’ in each quintet. Results were compared to a gold standard quantification method. Intra-examiner and inter-examiner agreement were measured using the Kappa coefficient and the intra-class correlation coefficient, respectively. Validity was assessed using Cramér’s V test. The mean intra-examiner agreement on the severity and pattern of iABL was 0.808 (_K) and 0.802 (_K), respectively. A stronger overall inter-examiner agreement was noted when the severity in contrast to the pattern of iABL and presence/absence of furcation involvement were analysed. The statistically significant total mean agreement values from this correlation coefficient were 0.892 and 0.739, respectively. A very strong association between all the visual interpretations carried out by all participants and the gold standard measurements was evident. Within the limitations of this study, the proposed radiographic index may serve as a simple, yet valid and reliable, adjunctive screening tool to further assist clinicians in determining the extent and severity of iABL in patients with periodontitis. Full article

(1) Background: Treating dental luxation injuries is challenging for the clinician. Dental luxations account for 18–33% of injuries to permanent teeth and can be addressed using different therapeutic approaches. The present work was conducted with two aims: (i) to evaluate, through a scoping review, current knowledge of the orthodontic methods (repositioning and stabilization splinting) that can be used at the time of the trauma, and (ii) to investigate the frequency and type of pulp consequences arising after these traumatic injuries. (2) Methods: The literature search was conducted in the period June 2020–December 2020 using the PubMed/MEDLINE, SCOPUS and Web of Science databases. The research questions were formulated according to the PICO (Population, Intervention, Comparison, Outcomes) method and considered the following aspects: type of luxation injury and stage of root development; use of orthodontic repositioning and splinting techniques; frequency and type of pulp consequences; and compliance of treatments with international guidelines. (3) Results: The initial screening of the databases, using the selected search keywords, yielded a total of 587 articles, just 8 fully met the inclusion criteria. Closer analysis of these 8 publications revealed that they would not produce clear meta-analytical data. This made it necessary to limit the data collected to the following six items: number and type of injuries, initial therapeutic intervention, duration of follow-up, number, and type of different pulp consequences. (4) Conclusions: While orthodontic techniques are commonly used to treat dental intrusions, in the case of extrusive and lateral luxation injuries, they are less frequently used and the orthodontic approach is generally confined to the stabilization phase. Among the various possible pulp consequences, many authors consider only pulp canal obliteration (PCO) and pulp necrosis (PN), often tending to overlook physiological healing (pulp survival) and the possible development of PN after PCO. There is therefore a clear need for new, high-quality clinical studies of this topic based on systematic and standardized data collection. Full article

This longitudinal study aimed to clarify the relationship of oral health in infancy with that in adulthood among participants who were the subjects of the oral health promotion project (OHPP) conducted in Miyako Island, Okinawa Prefecture, Japan, since 1984. Twenty-seven subjects, around 35 years of age, were examined for dental caries, periodontal diseases (community periodontal index), dental plaque, occlusion, and bite-force and compared with those at 4 and 13–15 years of age. The dental caries status and maximum bite force in adulthood was significantly reflected for those at 4 and 13–15 years of age (p < 0.05). CPI in adulthood was related to the dental caries status at 4 and 13–15 years of age but not to the gingival score at 4 years of age, and it was weakly related to the gingival score at 13–15 years (r = 0.264, p > 0.05). Most of the normal occlusion at 4 years of age became normal permanent occlusion in adulthood (88.9%). Most of the cases involving the discrepancy factor retained the same condition in both the deciduous and permanent dentitions (83.3%) (p < 0.001). Those who participated in the OHPP soon after birth showed significantly fewer DMFT (p < 0.05) compared with those who did not. This study revealed that oral health at 4 years of age was related to that in adulthood, suggesting that fostering good oral health soon after birth is of great importance. Full article

The objective of the current study was to evaluate intra- and interobserver bone volume measurements and effect of orientation on the reliability of bone volume evaluation in as-acquired vis-à-vis oriented cone beam computed tomography scans using Osirix software and possible correlation between gender, age, and bone volume required. For this, 31 cone beam computed tomography (CBCT) scans of 14 girls and 17 boys (aged 9–13) with unilateral cleft lip and/or palate who met the inclusion criteria were analyzed. Efficacy and reliability of third party software Osirix for bone volume calculation was assessed using as acquired and oriented volumes by three specialists (a radiologist, an orthodontist, and an oral maxillofacial surgeon). The dataset and readings were anonymized to prevent any bias. Two-way mixed model analysis on as-acquired and oriented observations exhibited intra-class coefficient (ICC) values ≥ 0.90. Wilcoxon signed rank test (p = 0.10) and Kruskal–Wallis ANOVA (p = 0.46) indicated that although a clinical difference in volume assessment was seen between as-acquired and oriented observations (inter-observer and intra-observer), it was statistically insignificant. Spearman’s bi-variate correlation analysis revealed a significant relation between the type (side) of cleft and bone volume required to fill the defect (p < 0.05). Although there was clinical difference in bone volume measurement by the three observers, it was insignificant statistically. Clefts on the left side in the patients had significantly more bone required than the right side, whereas age and gender had no relation with bone needed to fill the defect. OsiriX software provided good reliability in measurements of bone volume. Full article

Dental trauma are the most common reasons for dental fractures in the anterior area, they have an incidence of 5% in the population, and in permanent teeth, they are mainly caused by sports. The most involved teeth are the maxillary anterior teeth. Direct composite restorations and indirect ceramic restorations are the therapy of choice for restoring anterior teeth after fracture when is not possible to reattach the tooth fragment. The treatment options in uncomplicated coronal fractures depend on various factors such as the amount of residual dentinal enamel tissue, the relationship with the gingival profiles, and the age of the patient. The purpose of this article is to discuss the option of using direct or indirect restorative techniques in the treatment of traumatically fractured anterior teeth and to analyze the advantages and disadvantages of the two methods. Full article

Brushing at least twice a day is one of the most effective methods for the prevention of dental caries and oral diseases. The aim of the present study was to determine the prevalence and correlates of poor oral hygiene in Mongolian school-going students. A secondary analysis of nationally representative data from the 2013 Mongolian Global School-based Health Survey (GSHS) was performed. In the survey, a questionnaire was completed by 5393 students aged 12–16 years old. The prevalence of poor oral hygiene and its association with some independent variables were analyzed by frequency distribution, chi-squared test, and logistic regression. The overall prevalence of poor oral hygiene was 33%. In the multivariate analysis, male students, inadequate fruit and vegetable intake, parents’ smoking, being exposed to second-hand smoke, poor parental supervision and connectedness, physical inactivity, and sedentary behavior were significantly associated with poor oral hygiene. Meanwhile, students who ate fast food and drank carbonated soft drink were found to be less likely to be poor tooth-brushers in 2013. Various determinants were identified in connection with poor oral hygiene. Based on these findings, it is recommended that an oral health promotion program should be combined with general health promotion and lifestyle intervention programs for this target population. Full article

(1) Background: Multiple myeloma is a rare cancer that primarily affects the bone marrow. Osteoclasts are responsible for increased bone resorption and, therefore, bone destruction. Bisphosphonates are a class of drugs that can slow down bone resorption by reducing the number and action of osteoclasts. Intravenous injections of bisphosphonates (generally Zoledronic Acid) are administered to patients affected by Multiple Myeloma, but BRONJ is described as a serious side effect. This 5-year retrospective study aims to evaluate the efficacy of appropriate dental treatment protocols prior to initiating bisphosphonate therapy to prevent the development of BRONJ. (2) Methods: A total of 99 patients with symptomatic multiple myeloma were involved in this study (41–90 years, mean age 65 years, standard deviation 5 years). The data relating to the visits were tracked using a specific server and consulting the clinical reports. The AAOMS (American Association of Oral and Maxillofacial Surgeons) position was applied for both diagnosis and treatment. A total of 79 patients were examined before the administration of bisphosphonates (group A) and 20 after (group B). (3) Results: The entire sample required dental treatment: 23.2% underwent restorative therapy, 8% endodontic treatments, 44.4% tooth extractions. Periodontal disease was present in 41.4% of the patients. No osteonecrosis was observed in the first group, whereas BRONJ was found in five patients of the second one (25%) and two patients (10%) showed osteosclerotic areas under investigation [OR 0.026 (CI 0.0027 to 0.2454)]. (4) Conclusions: In the literature, there are no precise data about the prevalence of BRONJ. Despite the limitation of the present study, we point out that dental treatment before the treatment with intravenous bisphosphonates can help in reducing the incidence of BRONJ and good dental status is necessary for BRONJ prevention. Full article