Proximity of the roots of posterior teeth to the maxillary sinus in different facial biotypes.

INTRODUCTION: Orthodontists consider facial growth pattern and oral function when developing a treatment plan. Less attention is given to the relationship between the maxillary posterior teeth and the maxillary sinus. We aimed to evaluate the relationship between the roots of the maxillary posterior teeth and the floor of the maxillary sinus. METHODS: Proximity of the roots to the maxillary sinus was scored for the left and right first and second premolars and molars (scores, 0-3). Mean scores per patient and per tooth type were calculated. The influences of age, sex, and facial biotype on mean scores per patient and tooth were analyzed. RESULTS: The mean scores per patient and the second molar scores were significantly lower in the normodivergent subjects compared with the hypodivergent subjects, and in the hypodivergent vs the hyperdivergent groups, indicating that the hypodivergent biotype had significantly fewer second molar roots into the sinus than the normodivergent and hyperdivergent biotypes. Age had no effect on mean score per patient, but in the hyperdivergent group, the second molar score increased with age, meaning that second molar roots tend to be closer to the sinus floor. CONCLUSIONS: In a young population (7-24 years), the positions of the apices of the maxillary second molar roots in relation to the maxillary sinus floor are associated with the facial biotype. In a hypodivergent biotype, the roots of the second molars are located farther from the sinus floor compared with the normodivergent and hyperdivergent facial patterns.

Therapeutic challenges in temporomandibular disorders.

Background and aims: This study aimed at evaluating the etiology and treatment challenges of temporomandibular disorders (TMDs). Methods: 160 subjects with TMDs, 38 males (23.8%) and 122 females (76.3%) were studied. A personalized coefficient was designated, which included the resolution of the main symptom, correction of secondary symptoms, patient collaboration (emotional parameter), treatment duration, and cost. Results: The most frequent cause for consultation was muscle impairment (42.5%), or limitation of mouth opening, followed by joint impairment (23.1%). Muscle pain was noticed, particularly in the masseter (57.5%) and lateral pterygoid muscles (51.9%). Tooth pain or gingival retraction was frequently associated with tooth wear (48.1%) and dental abfraction (31.3%). Remote symptomatology was dominated by otologic symptomatology. Iatrogenic etiology was highest (69.4%), followed by untreated missing teeth (66.9%). Treatment options included muscle relaxation, occlusal balancing (equilibration), kinesitherapy, medication, and swallowing re-education. Most patients benefited from four to seven different types of therapy, which resulted in a higher cost and a longer and more uncomfortable treatment. The primary symptom was relieved in 82.3% of cases, with recurrence occurring in 15.7%. Conclusion: The treatment of temporomandibular joint dysfunction is time-consuming, demanding, and intricate. Most patients required four to seven different types of therapy, which increased the expense, treatment duration, and suffering.

Studies on the use of glassionomer.

Background and aims: This study is focused on the analysis of the properties of glassionomers following the choice of the type of material by the dentists. The study evaluated the properties of glassionomers used for restorations directly by comparing those prepared manually with those prepared mechanically, to find an "ideal" glassionomer and to counteract the disadvantages of the material. Method: The study was conducted on the basis of a questionnaire and included 254 dentists from Romania. It took place between April 6 - 24, 2020 and the questionnaire was administered online. The questions focused on: the type of glassionomer chosen by every dentist, the doctor's opinion about the properties, type and clinical indications of the material. Results: The results showed that in Romania, the dentists use the glassionomer for a permanent filling in adults because of the financial aspect, as they stated. In their opinion the best advantages are the fluoride release and adhesion to dental tissues and, on the other hand the biggest disadvantage is aesthetics. Conclusions: Among the conclusions are the following: the glassionomer is frequently used in dental offices, especially the powder-liquid system, as a commercial product; no standard type of glassionomer was found.

Periodontal Health in Patients with Self-Ligating Brackets: A Systematic Review of Clinical Studies.

BACKGROUND AND OBJECTIVES: The aim of this systematic review with meta-analysis is to assess the available evidence from human clinical studies of using self-ligating brackets compared to conventional brackets in maintaining periodontal health. MATERIALS AND METHODS: The protocol details were registered in the PROSPERO database (CRD42022302689). This review was performed under the PRISMA guidelines. The electronic search was performed in PubMed, Scopus, Web of Science and grey literature databases, as well as manual searches to find relevant articles published until January 2022. The inclusion criteria consisted of human clinical studies which reported the use of fixed orthodontic treatment with self-ligating brackets (SLBs) or conventional brackets (CBs) in maintaining periodontal health. RESULTS: A total of 453 studies were imported into the Covidence Platform from the databases. Of these, six articles met the inclusion criteria. For plaque index, statistical significance was achieved for SLBs compared to CBs (0.31 (95% CI (0.15 to 0.48), p = 0.0001). For gingival index, probing depth and bleeding on probing no statistical significance was achieved. None of the included studies assessed clinical attachment level. CONCLUSIONS: The present systematic review with meta-analysis was considered to provide relevant data on periodontal health during orthodontic treatment in patients with SLBs in comparison with patients wearing CBs. Our findings indicated that SLBs are not superior to CBs in terms of periodontal health.

Comparative microleakage outcomes of different techniques used for creating the occlusal anatomy in occlusal direct restorations using the dental operating microscope.

OBJECTIVES: Microleakage in direct dental restorations is a primary causal factor in the restoration's failure. The aim of this study was to evaluate whether the technique for occlusal layering of the composite resin (the use of brush adaptation, the use of magnification, cusp build-up, stamp technique) has any effect on microleakage of direct restorations in occlusal cavities. MATERIALS AND METHODS: One hundred extracted human molars were restored using five restoration techniques (Packable Bulk technique, Occlusal Stamp technique, Successive Cusp Build-up technique, Successive Cusp Build-up technique + Brush adaptation, Successive Cusp Build-up technique + brush adaptation + Dental Operative Microscope magnification). The teeth were subjected to thermal aging for 800 cycles at 5°C and 55°C, infiltrated with basic fuchsin dye for 24 h, and then sectioned buccolingually in the middle of the crown. Infiltration was measured in four areas of the tooth section by five different observers and then given a score from 1 to 3, proportional to infiltration depth. RESULTS: The lowest mean scores for infiltration (meaning less infiltration observed) were present in Group A (1.41 ± 0.878) and Group C (1.46 ± 0.679), while Group D showed the highest infiltration scores (1.75 ± 0.853). When comparing the groups for differences, no statistically significant difference in infiltration was found between any technique p < .586. CONCLUSION: The techniques examined for placing the occlusal layer of composite in direct restorations do not differ significantly in terms of marginal infiltration, although a slight improvement was found when using the bulk technique and the successive cusp build-up.

Various Aspects Involved in the Study of Tooth Bleaching Procedure: A Questionnaire-Based Study.

A beautiful smile is an important feature when it comes to a pleasant appearance of the face, and one of the most common situations that drive patients to book a dental appointment is tooth discoloration. Tooth bleaching is the treatment of choice for extrinsic tooth discoloration, as it is a cheap, fast, and minimally invasive procedure. This study aimed to provide comparative information on the perceptions of both patients and dentists regarding different whitening methods and on the factors involved in people's willingness to recommend and use a bleaching procedure. In addition to this, this study evaluated the degree of satisfaction in relation to the bleaching methods and materials used; it also evaluated the following: negative side effects, economic characteristics and the patients' perceptions of the aesthetic appearance of their dental arches, especially tooth color. The subjects that participated in the present study were selected based on their background and were then divided into two categories. The first group consisted of 120 patients who had received tooth-bleaching treatments in dental clinics during the study and the second group consisted of 127 dentists. A conventional sampling method was used. The study aimed to define a relationship between multiple aspects of the tooth-bleaching procedure, including the patients' desires and their general knowledge of this procedure. Tooth color and the way it changes is a very important factor that motivates patients to come to the dentist for whitening procedures. Patients showed the highest levels of satisfaction with the results of in-office bleaching procedures. In the group consisting of dentists, satisfaction levels were higher for the procedure of home bleaching supervised by a dentist. Factors influencing the choice of bleaching materials are appreciated differently by dentists and patients. Furthermore, the rate of patients using OTC (over the counter) products was found to be high. Further research is needed to find more effective and safer alternatives to home tooth-bleaching procedures.

Assessing SARS-CoV-2 Infection Rate among Romanian Dental Practitioners.

Due to the impact of the Covid-19 pandemic on dental treatments, the present research aimed to assess the infection rate among dental practitioners from Romania and to analyze the economic impact of Covid-19 on dental offices. We designed a web-based survey distributed to dental practitioners from Romania. The survey included questions that assessed demographic data from the dentists who completed the questionnaire, along with economic aspects and epidemiological aspects related to the impact of the COVID-19 pandemic on dental practitioners. Five hundred and seven dentists completed the survey. Three-quarters of the assessed dental offices reported a decrease in the income and patient volume compared to 2019. More than half of the patients visiting the dental office paid more attention to the risk of infection and to prevention methods. Most dental offices implemented specific protective equipment for doctors. Three thousand seven hundred thirty-five dental practitioners were working in the 507 assessed dental offices, and among them, 238 COVID-19 cases of contamination were recorded. High contamination rates were registered in October (48, 20.1%), November (66, 27.7%), and December 2020 (52, 21.85%). Contamination mostly took place at home (114 cases, 47.8%) or resulted from event attendance. This study underlines an overall greater level of safety and an increased patient addressability in dental offices.

Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development.

Objective: Oral appliance therapy is a non-invasive treatment that offers a wide variety of oral devices for the treatment of obstructive sleep apnea (OSA). The present review focuses on the effectiveness of mandibular advancement devices for the treatment of OSA.Methods: A systematic review based on the PRISMA checklist was carried out. A detailed electronic database search was conducted using "Obstructive sleep apnea" AND "Oral appliance" AND "Dentistry" as keywords.Results: The initial search in the electronic databases resulted in a total of 262 papers. After the title and abstract analysis and full-text review, the number of eligible papers was reduced to 15.Conclusion: The mandibular advancement device is an effective treatment, improving the Apnea Hypopnea Index and the symptoms of patients with OSA in 92% of the subjects from all the investigated studies. The future may include the integration of a biosensor for the diagnosis and follow-up.Abbreviations: OSA: Obstructive sleep apnea; MADs: Mandibular advancement devices; CPAP: Continuous positive airway pressure; OAT: Oral appliance therapy; MRD: Mandibular repositioning devices; MAS: Mandibular advancement splints; MAA: Mandibular advancement appliances; OA: Oral appliances; AASM: American Academy of Sleep Medicine; AHI: Apnea-hypopnea index; EEG: Sleep-related breathing disorder SRBD; Electroencephalogram; EOG: Electrooculogram; ECG: Electrocardiogram; QOL: Quality of life; TMJ: Temporomandibular joint.

Impact of COVID-19 on Dental Emergency Services in Cluj-Napoca Metropolitan Area: A Cross-Sectional Study.

This study aimed to assess dental care needs in Cluj region during the State of Emergency, declared due to the COVID-19 pandemic, compared to the same period of the year 2019. A descriptive retrospective analysis was conducted, which retrieved patients seeking emergency dental services at the Emergency Department of County General Hospital and "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania, the only dental service available in April 2020. Recorded data cover the month of April 2020 and is compared with the same period of 2019. During April 2020, 724 patients received dental care, whereas only 160 patients were treated in April 2019 in the same facility. The number of patients with acute apical periodontitis, abscess, and acute pulpitis was significantly higher in 2020. The percentage of patients receiving sedative filling for the treatment of acute pulpitis in 2020 was significantly higher than in 2019, while the proportion of patients receiving pulpectomy was higher in 2019. The percentage of patients receiving endodontic drainage for the treatment of acute periapical periodontitis in 2020 was higher. This study demonstrates that the COVID-19 pandemic impacted the use of medical care services and could further impact the oral health and quality of life of patients.

A WHO Pathfinder Survey of Dental Caries in 6 and 12-Year Old Transylvanian Children and the Possible Correlation with Their Family Background, Oral-Health Behavior, and the Intake of Sweets.

To our knowledge, recent oral health data in Romania is poor, as no comprehensive oral health surveys have been carried out in the last five years. The present cross-sectional oral health survey aimed to assess the dental health status in 6 and 12-year old children from Transylvania, in correlation with their family background, oral-health behavior, and the intake of sweets. The study was conducted on 290 children from nine schools in the Transylvanian region of Romania. The study consisted of the clinical examination of children, recording of data in an International Cavity Detection and Assessment System (ICDAS) chart, and a questionnaire referring to the child's parental education, frequency, and motivation of visits to the dentist, dental care habits, and the intake of sweets. Our results indicated that the most prevalent ICDAS scores recorded in 6-year-old children were "0A" (p = 0.001464), "03" (p = 0.00366), "05" (p = 0.005563), "06" for rural areas. Restorations were statistically more prevalent in the urban population (p = 0.000076). The ICDAS score for 12-year old children was "03" (p = 0.003614) and prevalent in the urban area. The ICDAS score for the rural area was "04" (p = 0.0056). Comparing dental health status with family background demonstrated a strong correlation for the group of 6-year-old children, and a lack of correlation for the 12-year-old children. The number of dental visits corelated with the parents' backgrounds, and was higher in the urban population. Frequent hygiene habits (toothbrushing) were statistically correlated with lower ICDAS scores: "04" (p = 0.016482), "05" (p = 0.039127), "06" (p = 0.010785). Eating habits in both age groups were associated with statistically significant differences of "03", "04", "05", "06", "0A" in the ICDAS score. The obtained results provided clarification on the dental health situation in Romania and the potential risk factors of caries among the population, and therefore it could be used as a starter point for future studies to investigate, in depth, the effects of various variables on cavities found in Transylvanian schoolchildren.

Pit and fissure sealants penetration capacity and their correlation with fissure morphology.

BACKGROUND AND AIMS: Pit and fissure sealant placement corresponds to an effective approach of the prevention of caries on occlusal surfaces. Fissure morphology and dental material characteristics are the key factors for sealant effectiveness. The aim of this in vitro study was to compare the penetration ability of two commercially available pit and fissure sealants. METHODS: Twenty sound human premolars extracted for orthodontic purpose have been sealed according to manufacturer's instructions as follows: Group I (n=10), light-cured unfilled resin-based sealant, Admira Seal® (Voco GmbH); Group II (n=10), resin modified glass ionomer sealant without varnish, GC Fuji Triage® (GC Corporation). The teeth have been sectioned buccal-lingually in the middle of the occlusal surface, and the sections were examined at 40× with an inverted microscope. RESULTS: Penetration of the sealants was found to be greater in U-type fissure pattern (91.69%) followed by V-type (75.42%), IK-type (71.24%) and then in I-type (63.98%). The depth of penetration of GC Fuji Triage® (82.85%) demonstrated to be superior to Admira Seal® (76.28%). CONCLUSION: U fissure design was more common than other fissure patterns and showed significantly higher penetration for the two type of sealants evaluated. Resin modified glass ionomer sealant used in the present study perform comparably with the filled resin sealant.

Occlusion in the digital era: a report on 3 cases.

In the following case studies we wish to discuss the necessity of making use of digital technology in the occlusion-oriented dental practice. In the three presented cases, patients underwent complex orthodontic, implant and prosthetic treatment, the aim being to re-establish the functionality of the dento-maxillary apparatus. The patients were evaluated clinically at the completion of the treatment. Subsequently, during the follow-ups (which varied between 2 and 4 years), clinical analysis using articulating paper was carried out and possible signs of relapse were specifically searched for. Occlusal clinical analysis was later on compared with the occlusion recorded using the TRIOS® 3 intraoral scanner (3Shape) and the T-Scan™ Novus™ device (TekScan). Clinical and digitally obtained scanner results were similar. The results yielded by the T-Scan™ Novus™ device were different and they were also relevant for elucidating the cause of the symptomatology.

Current treatment modalities of orthodontically induced white spot lesions and their outcome - a literature review.

INTRODUCTION: White spot lesion is a demineralization of the enamel that appears as a white spot on the surfaces of the tooth. The cause of this spot is determined by the activity of the bacterial plaque and it represents the initial stage of a carious lesion. This lesion is a common side effect for patients with fixed orthodontic appliances mainly because of the brackets' position that favors the accumulation of plaque that ultimately leads to the formation of the white spot. METHODS: We conducted a search on a single database, PubMed. "Orthodontic", "white spot lesions", "enamel demineralization treatment" and "remineralization" were the search terms used. We found 324 articles, but we took in consideration only the ones from the last 10 years, which resulted in 223 articles. RESULTS: The first step after research was article selection: first by scrutinizing the title and secondly by reviewing the abstracts or full texts. The exclusion criteria were: meta-analysis, reviews, original articles regarding prevention of white spot lesions and their prevalence or incidence. We included the articles that seemed relevant for the treatment of white spot lesions, made either on extracted teeth either on orthodontic patients. We found 75 articles to be eligible for this research and we eliminated 5 because of the lack of an abstract or full text and a further 22 were rejected because they did not fit the aforementioned criteria. CONCLUSION: Although some traditional methods for the treatment of white spot lesions seem to have undesirable results, nowadays with new technologies and thorough investigations in nanotechnology, the eradication of the lesion appears to be short term.

Giomers in dentistry - at the boundary between dental composites and glass-ionomers.

INTRODUCTION: From the variety of direct restorative dental materials, composite resins are considered as having the most esthetic and functional properties. The conservative preparation, esthetic results, good mechanical qualities and surface finishing properties of dental composites, combined with the protective properties of fluoride from glass-ionomers, led to a new generation of dental materials: the giomers. OBJECTIVE: The purpose is to review the available literature about the giomers, regarding the chemical composition, handling properties and esthetics, adhesion and microleakage, fluoride releasing and protection offered, clinical indications. METHOD: The search was carried out using ScienceDirect and PubMed databases with the following keywords: giomer, esthetic properties giomers and fluoride releasing giomers. A total of 232 articles were initially selected, with the following inclusion criteria: full text articles, written in English, with topics on the properties and the clinical implications of giomers. Papers presented as abstract were not included. In the next step, review articles, duplicates, and articles in other languages were removed; as a result, a total of 44 sources published between 2004 and 2017 were selected. RESULTS: The selected articles referred to the following aspects about the giomers: chemical composition (8 articles), adhesion and microleakage (10 articles), fluoride releasing and pulp protection (15 articles), clinical indications (6 articles), effects of additional treatments and dietary habits (11 articles).

Oral health related quality of life and self-esteem in a general population.

BACKGROUND AND AIMS: The interest in the research of both Oral Health Related Quality Of Life and dental aesthetics has increased in the recent years. The aim of the current study consists in the evaluation of the perception of oral-health, dental aesthetics and self-esteem in a general population. METHODS: A group of students of the Faculty of Dental Medicine, Cluj-Napoca, were trained in the field of questionnaire interviewing. The students were asked to apply the following questionnaires to a number of maximum five close persons: the OHIP-14Aesthetic questionnaire, the Rosenberg self-esteem scale and a questionnaire evaluating demographic data. Each interviewed subject provided informed consent. The sample included 97 subjects with an age range of 18-75 years. For each of the three applied questionnaires overall scores were computed and used for the calculation of Pearson correlations and inferential statistical procedures: the t-test. RESULTS: Related to the complete sample (N=97), the highest OHIP-14Aesthetic scores were obtained for the functional limitation (mean score of 2.22), physical pain (mean score of 2.72) and psychological discomfort (mean score of 1.37) subscales. The highest Rosenberg self-esteem scale scores were obtained for the following questions: "I think I am no good at all" (mean score of 3.50), "feel useless at times" (mean score of 3.53), "inclined to feel that I am a failure" (mean score 3.77), "positive attitude toward myself" (mean score of 3.50). Statistically significant correlations were registered between the overall Rosenberg self-esteem scale score and the scores of the following OHIP-14Aesthetic subscales: psychological discomfort (r = -0.201, p = 0.49), physical disability (r = -0.219, p = 0.031), psychological disability (r = -0.218, p = 0.032), social disability (r = -0.203, p = 0.046). The t-test revealed statistically significant gender differences, in regard to the OHIP-14Aesthetic overall score t(95) = -2.820, p = 0.006. CONCLUSIONS: The current study indicates the existence of statistically significant gender differences in the perception of oral health and a series of dental aesthetics elements in a general population. Moreover, statistically significant correlations were obtained between the perception of oral health and the perception of self-esteem.

Development of a novel biomaterial with an important osteoinductive capacity for hard tissue engineering.

In this study we designed a composite biomaterial based on a high viscosity soft propolis extract (70% propolis) and shell clam, with antiseptic and osteoinductive qualities, that can be used in dentistry, orthopedics and other areas where hard tissue regeneration is needed. We assessed it in interaction with stabilized human cells isolated from dental papilla of wisdom teeth (D1MSCs). We performed detailed characterization of the obtained material by Scanning Electronic Microscopy (SEM), X-Ray Diffraction (XRD), Energy Dispersive X-Ray Spectroscopy (EDX), Fourier Transform Infrared Spectroscopy (FTIR) techniques. SEM investigation revealed the roughness and porosity of the shell, which acted like a scaffold, as it allowed cells to penetrate the pores, proliferate on the surface, spread and grow in the depressions provided by the substrate. in vitro cell viability, proliferation and differentiation assays showed that the newly obtain biomaterial presented low toxicity on D1MSCs and determined the development of numerous osteogenic nodules that were in a higher number even than in the specific induction medium. Our results demonstrated that the shell-propolis based biomaterial promoted and sustained human stem cells attachment, proliferation and differentiation, presenting an important osteoinductive effect essential for mineralized tissue reparation process.

The contribution of computerized axiography to the functional evaluation of the temporomandibular joint: a case report.

The aim of this case report is to give comprehensive information on the clinical use of computerized axiography (CA) in the evaluation of temporomandibular joint (TMJ) mobility in a patient who undergoes orthognatic surgery. A 20-year-old female patient with class III skeletal anomaly and who underwent orthognatic surgery is presented. Pre- and postsurgical CA recordings for the patient are compared in order to evaluate the functional modifications that appear. The CA is a functional investigation of the TMJ and records the border movements of the mandible: protrusion, lateral movements and open/close. The starting point for every movement is the centric relation position. This allows for very high reproducibility of the CA and the data can later become available for comparison of examinations performed at different times. The CA can offer data to programme an articulator or to evaluate the functional evolution of the TMJs after various occlusal interventions (prosthodontic, orthodontic or orthognatic). After comparing the pre- and postsurgical CA recordings, a significant improvement of the TMJ function after the repositioning of the maxilla and mandible through orthognatic surgery was confirmed. In conclusion, our case confirms the results in literature that CA is a reproducible and reliable investigation method in the evaluation of TMJ function in orthognatic surgery patients, that it facilitates the monitoring of the evolution of the functionality of the TMJ ever time and that it allows for comparative evaluation of the two TMJs.

Oral Human Papillomavirus Infection in Children.

Oral human papillomavirus infection is rare in children, but the presence of a villous lesion with slow but continuous growth concerns parents, who need information and therapeutic solutions from the physician. All these aspects are discussed based on a case report of a 9-year-old child with an oral human papillomavirus infection.

Modern management of dental decay in children and adolescents - a review.

Health is a right that requires responsible individual actions. Oral health corresponds to an important part of general health, even if for a large majority of people healthy teeth are equal with beautiful teeth. For children and adolescents "having an attractive smile" is synonymous with social acceptance and success. Dental decay has a high incidence in children in our country and progress in decay prevention, diagnosis and treatment is not reflected in children and adolescents' oral health. It is established by studies conducted by dentists and psychologists that dental decay can affect the quality of life by engendering specific eating behaviors, particular ways of speech or smile and unfortunately pain. The aim of this article is to emphasize the modern approach of dental decay in line with principles of non-invasive strategies. An important element to be considered - prophylactic methods - must be included in every treatment plan, in order to control individual caries risk. The time invested in prevention during childhood represents a real benefit for the future adult's oral health. Many a dental problems can be avoided if dental decay management relies on the link between medical science and every day practice.