RESUMO
PURPOSE: Molar-Incisor Hypomineralisation (MIH) remains a widespread developmental disorder of the teeth with a still largely unknown etiology. Perinatal events were blamed in previous studies for the development of MIH. The aim of the present study was to evaluate the influence of perinatal hypoxia-determined by the pH value of the umbilical cord blood-and to investigate its correlation with severe MIH retrospectively. In addition, cesarean section was recorded as differentiation variable. METHODS: A total number of 138 children (mean age 8.0 years ± 1.7), who were treated for severe MIH in a dental office in Berlin between the years 2008 and 2019, were included in the study. The control group was comprised of patients with the same date of birth (44 children, mean age 7.7 years ± 1.7). Information on the pH value of the arterial blood from the umbilical cord taken immediately after birth, whose recording is mandatory in Germany, was received from the parents by letter survey requesting the entries from the German Child Health Booklet. RESULTS: In the group of the male children born without cesarean section, the pH value of the control group was significantly lower (7.19 ± 0.09) than the pH value of the MIH group (7.27 ± 0.07, p = 0.0008). In female children born with or without cesarean section as well as in male children born by cesarean section there were no significant differences between the MIH and control group. CONCLUSIONS: No significant association between MIH and the pH value of the umbilical cord blood or birth by cesarean section could be found in the examined patient population.
Assuntos
Hipoplasia do Esmalte Dentário , Incisivo , Cesárea/efeitos adversos , Criança , Hipoplasia do Esmalte Dentário/epidemiologia , Hipoplasia do Esmalte Dentário/etiologia , Feminino , Sangue Fetal , Humanos , Concentração de Íons de Hidrogênio , Hipóxia/complicações , Masculino , Dente Molar , Gravidez , Prevalência , Estudos RetrospectivosRESUMO
OBJECTIVES: The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. MATERIALS AND METHODS: Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. RESULTS: The sensitivity (84%, CI 81-86%), specificity (94%, CI 93-96%), PPV (92%, CI 90-94%), and NPV (90%, CI 88-91%) of FIT was significantly higher than that of CONV (47%, CI 44-50%; 82%, CI 79-84%; 66%, CI 62-69%, and 69%, CI 68-71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. CONCLUSIONS: FIT is more reliable for detecting composite restorations than the conventional illumination method. CLINICAL RELEVANCE: FIT can be considered an additional or alternative tool for improving the detection of composite restorations.
Assuntos
Resinas Compostas , Restauração Dentária Permanente , Assistência Odontológica , Fluorescência , HumanosRESUMO
AIM: The aim of this study was to quantitatively compare conventional composite removal and composite removal supported by the fluorescence-aided identification technique (FIT) regarding the completeness, selectivity, and duration of the procedure in directly restored permanent posterior teeth. METHODS AND MATERIALS: Two operators removed standardized direct class II composite restorations (n=32 per operator) in human tooth models under simulated clinical conditions. According to a randomized allocation scheme, removal was performed with either the conventional technique (contra-angle handpiece) or supported by FIT. The duration of each removal procedure was recorded. The completeness and selectivity were volumetrically assessed through superimposition of three-dimensional surface scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CI). Multiple comparison was performed with Tukey tests for each variable. RESULTS: Compared with the conventional technique, composite removal with FIT was faster (329 seconds [95% confidence interval (CI): 268-390 seconds] vs 179 seconds [95% CI: 150-208 seconds]), generated less tooth substance loss (4.53 mm3 [95% CI: 3.77-5.30 mm3] vs 2.77 mm3 [95% CI: 2.11-3.43 mm3]), and left behind less composite residue (1.58 mm3 [95% CI: 1.23-1.94 mm3] vs 0.53 mm3 [95% CI: 0.39-0.67 mm3]). CONCLUSION: Within the limitations of this in vitro study, FIT facilitated the selective and expeditious removal of tooth-colored composites in directly restored posterior teeth.
Assuntos
Resinas Compostas , Restauração Dentária Permanente , Dentição Permanente , Fluorescência , HumanosRESUMO
BACKGROUND: Piezoelectric technology has existed for many years as a surgical tool for precise removal of soft tissue and bone. The existing literature regarding its use specifically for otolaryngology, and head and neck surgery was reviewed. METHODS: The databases Medline, the Cochrane Central Register of Controlled Trials, PubMed, Embase and Cambridge Scientific Abstracts were searched. Studies were selected and reviewed based on relevance. RESULTS: Sixty studies were identified and examined for evidence of benefits and disadvantages of piezoelectric surgery and its application in otolaryngology. The technique was compared with traditional surgical methods, in terms of intra-operative bleeding, histology, learning curve, operative time and post-operative pain. CONCLUSION: Piezoelectric technology has been successfully employed, particularly in otology and skull base surgery, where its specific advantages versus traditional drills include a lack of 'blunting' and tissue selectivity. Technical advantages include ease of use, a short learning curve and improved visibility. Its higher cost warrants consideration given that clinically significant improvements in operative time and morbidity have not yet been proven. Further studies may define the evolving role of piezoelectric surgery in otolaryngology, and head and neck surgery.
Assuntos
Cabeça/cirurgia , Pescoço/cirurgia , Otolaringologia/instrumentação , Piezocirurgia/métodos , Perda Sanguínea Cirúrgica , Endoscopia/instrumentação , Endoscopia/métodos , Desenho de Equipamento , Humanos , Curva de Aprendizado , Duração da Cirurgia , Seios Paranasais/cirurgia , Piezocirurgia/educação , Piezocirurgia/instrumentação , Complicações Pós-Operatórias/prevenção & controle , Rinoplastia/instrumentação , Rinoplastia/métodos , Base do Crânio/cirurgiaRESUMO
OBJECTIVE: The aim of the study was to compare the diagnostic predictive values of a Fluorescence-aided Identification Technique (FIT) with those of the conventional diagnostic method regarding the identification of resin composite restorations. MATERIALS AND METHODS: Twenty examiners, 10 students, and 10 dentists were asked to identify composite restorations in a full-mouth model using both the FIT (405-nm light source) and the conventional method in combination with a common diagnostic light source. Each dental examination was repeated three times to calculate inter-/intra-operator agreement, repeatability, and reproducibility using kappa statistics. Predictive values were calculated using a filling prevalence of 42 % and the sensitivity and specificity of each method. Pearson's test and the 99 % confidence interval (CI) were used for comparison. RESULTS: The sensitivity (97 %, CI 94-99 %) and specificity (100 %, CI 98-100 %) of the FIT were significantly higher than those of the conventional method (27 %, CI 21-31 %, and 65 %, CI 58-72 %, respectively). Consequently, the positive (100 %) and negative (98 %) predictive values of the FIT were significantly higher than those of the conventional method (35 and 55 %, respectively). As expressed by the kappa statistics, the repeatability (0.96) and reproducibility (0.95) of the FIT were significantly better than those of the conventional method (0.49, CI 0.42-0.56, and 0.34, CI 0.26-0.43, respectively). CONCLUSION: Compared to the conventional technique, the FIT was significantly more reliable as shown by higher sensitivity, specificity, repeatability, and reproducibility values. CLINICAL RELEVANCE: The FIT should be considered as a reliable and practicable alternative in contrast to the conventional method, which was hardly sufficient as a diagnostic procedure.
Assuntos
Resinas Compostas/química , Restauração Dentária Permanente , Fluorescência , Humanos , Técnicas In Vitro , Modelos Dentários , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To establish whether nasal bony landmarks on computed tomography could be utilised reliably in endoscopic approaches to the sphenopalatine foramen. METHODS: A prospective analysis of 102 consecutive helical computed tomography scans of the paranasal sinuses was carried out by 2 senior ENT surgeons. Distances from the sphenopalatine foramen to endoscopically palpable bony landmarks were measured. RESULTS: There were a total of 102 patients (45 females and 57 males), with a mean age of 62 years. The mean distance from the posterior fontanelle to the sphenopalatine foramen was 14.1 mm (standard deviation = 2.13). The average vertical distance of the sphenopalatine foramen opening from the bony attachment of the inferior turbinate was 14.13 mm. There were no statistically significant differences between any of these measurements (foramen width p-value = 0.714, distance from fontanelle p-value = 0.43 and distance from inferior turbinate p-value = 0.48). CONCLUSION: Determination of reliable bony landmarks is clinically useful in endoscopic surgery and can aid identification of the sphenopalatine foramen. The inferior turbinate concha and posterior fontanelle may be used as reliable computed tomography landmarks for endoscopic approaches to the sphenopalatine foramen.
Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Osso Nasal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/cirurgia , Artérias/anatomia & histologia , Criança , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osso Nasal/anatomia & histologia , Osso Nasal/cirurgia , Mucosa Nasal/irrigação sanguínea , Seios Paranasais/anatomia & histologia , Seios Paranasais/diagnóstico por imagem , Estudos Prospectivos , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/irrigação sanguínea , Fossa Pterigopalatina/cirurgia , Tomografia Computadorizada Espiral/métodos , Tomografia Computadorizada por Raios X/métodos , Conchas Nasais/anatomia & histologia , Conchas Nasais/diagnóstico por imagemRESUMO
BACKGROUND: Measurements of amniotic fluid volume are used for pregnancy surveillance despite a lack of evidence for their predictive ability. OBJECTIVE: To evaluate the association and predictive value of ultrasound measurements of amniotic fluid volume for adverse pregnancy outcome. SEARCH STRATEGY: Electronic databases (inception to October 2011), reference lists, hand searching of journals, contact with experts. SELECTION CRITERIA: Studies comparing measurements of amniotic fluid volume with adverse outcome, excluding pre-labour ruptured membranes or congenital/structural anomalies. DATA COLLECTION: Data on study characteristics, design, quality. Random effects meta-analysis to estimate summary odds ratios (prognostic association) and summary sensitivity, specificity and likelihood ratios (predictive ability). MAIN RESULTS: Forty-three studies (244,493 fetuses) were included demonstrating a strong association between oligohydramnios (varying definitions) and birthweight <10th centile (summary odds ratio [OR] 6.31, 95% confidence interval [95% CI] 4.15-9.58; high-risk population [author definition] n = 6 studies, 28,510 fetuses), and mortality (neonatal death any population summary OR 8.72, 95% CI 2.43-31.26; n = 6 studies, 55,735 fetuses; and perinatal mortality high-risk population summary OR 11.54, 95% CI 4.05-32.9; n = 2 studies, 27;891 fetuses). There was a strong association between polyhydramnios (maximum pool depth >8 cm or amniotic fluid index ≥25 cm) and birthweight >90th centile (OR 11.41, 95% CI 7.09-18.36; n = 1 study, 3960 fetuses). Despite strong associations, predictive accuracy for perinatal outcome was poor. AUTHOR'S CONCLUSION: Current evidence suggests that oligohydramnios is strongly associated with being small for gestational age and mortality, and polyhydramnios with birthweight >90th centile. Despite strong associations with poor outcome, they do not accurately predict outcome risk for individuals.
Assuntos
Líquido Amniótico/diagnóstico por imagem , Oligo-Hidrâmnio/diagnóstico por imagem , Poli-Hidrâmnios/diagnóstico por imagem , Ultrassonografia Pré-Natal , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Razão de Chances , Oligo-Hidrâmnio/mortalidade , Poli-Hidrâmnios/mortalidade , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Prognóstico , Reprodutibilidade dos Testes , Ultrassonografia Pré-Natal/métodosRESUMO
OBJECTIVES: Chromosomal microarray analysis (CMA) is utilized in prenatal diagnosis to detect chromosomal abnormalities not visible by conventional karyotyping. A prospective cohort of women undergoing fetal CMA and karyotyping following abnormal prenatal ultrasound findings is presented in the context of a systematic review and meta-analysis of the literature describing detection rates by CMA and karyotyping. METHODS: We performed a prospective cohort study of 243 women undergoing CMA alongside karyotyping when a structural abnormality was detected on prenatal ultrasound. A systematic review of the literature was also performed. MEDLINE (1970-Dec 2012), EMBASE (1980-Dec 2012) and CINAHL (1982-June 2012) databases were searched electronically. Selected studies included > 10 cases and prenatal CMA in addition to karyotyping. The search yielded 560 citations. Full papers were retrieved for 86, and 25 primary studies were included in the systematic review. RESULTS: Our cohort study found an excess detection rate of abnormalities by CMA of 4.1% over conventional karyotyping when the clinical indication for testing was an abnormal fetal ultrasound finding; this was lower than the detection rate of 10% (95% CI, 8-13%) by meta-analysis. The rate of detection for variants of unknown significance (VOUS) was 2.1% (95% CI, 1.3-3.3%) when the indication for CMA was an abnormal scan finding. The VOUS detection rate was lower (1.4%; 95% CI, 0.5-3.7%) when any indication for prenatal CMA was meta-analyzed. CONCLUSION: We present evidence for a higher detection rate by CMA than by karyotyping not just in the case of abnormal ultrasound findings but also in cases of other indications for invasive testing. It is likely that CMA will replace karyotyping in high-risk pregnancies.
Assuntos
Transtornos Cromossômicos/diagnóstico , Análise em Microsséries/métodos , Diagnóstico Pré-Natal/métodos , Feminino , Humanos , Hibridização in Situ Fluorescente , Cariotipagem/métodos , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal/métodosRESUMO
Congenital dermoid cysts are benign developmental lesions and are a well-recognised entity in head and neck surgery. First reported in 1828 by Berger et al., these lesions have been referred to as dermoids, hairy polyps, teratoid tumours with varying classification systems. This has caused confusion in the medical literature with a lack of consensus regarding optimal diagnosis and management. Within the Eustachian tube, there have been 16 reported cases in the English literature demonstrating the rarity of these lesions. The aim of this report is to present a case of histopathologically confirmed Eustachian tube dermoid, confirm the current classification system and demonstrate the challenges they can pose given the relative inaccessibility of such lesions.
Assuntos
Cisto Dermoide/cirurgia , Tuba Auditiva/cirurgia , Nariz/cirurgia , Pré-Escolar , Cisto Dermoide/diagnóstico , Tuba Auditiva/patologia , Feminino , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Streptococcus pneumoniae is a frequent cause of acute mastoiditis. Despite the recent (2005) introduction of pneumococcal vaccination, mastoiditis incidence and severity may be increasing. This study aimed to assess the incidence, severity and microbiology of acute mastoiditis over an 11-year period. METHODS: Retrospective review of paediatric acute mastoiditis cases seen at our institution (2000-2010), comparing patients seen prior to vaccination introduction (period one, 2000-2004), around the time of vaccine introduction (period two, 2005-2007) and post-vaccination (period three, 2008-2010). RESULTS: We reviewed 84 children. In periods one, two and three, respectively: mean annual case load was 8.4, 5 and 9 children; pneumococcal isolates were seen in 40.5, 6.7 and 29.6 per cent of cases; highest recorded fever was 38.6, 38.9 and 38.2°C and highest leukocyte count 18.9, 15.0 and 15.6 × 109/l; incidence of intracranial complications was 11.9, 0 and 7.4 per cent; mean duration of intravenous antibiotics was 6.0, 4.1 and 4.2 days; proportion treated surgically was 71.4, 60.0 and 48.1 per cent; and mean length of in-patient stay shortened. CONCLUSION: Pneumococcal mastoiditis admission rates appeared to fall when vaccination was introduced, with concomitant reduction in overall mastoiditis incidence and intracranial complications; subsequently, however, admission rates rapidly returned to pre-vaccination levels.
Assuntos
Mastoidite/prevenção & controle , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Índice de Gravidade de Doença , Streptococcus pneumoniae/isolamento & purificação , Vacinação , Doença Aguda , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Pré-Escolar , Feminino , Febre/epidemiologia , Hospitalização/tendências , Humanos , Incidência , Lactente , Contagem de Leucócitos/estatística & dados numéricos , Masculino , Mastoidite/epidemiologia , Mastoidite/microbiologia , New South Wales/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Estudos RetrospectivosRESUMO
The aim of this study was to analyse the predictive power of several clinical baseline parameters and the de-/remineralisation properties of in vivo etched sites measured with quantitative light-induced fluorescence (QLF) for subsequent 2-year caries increment. At baseline, in 44 children (8.23 ± 1.5 years) two areas (diameter 2 mm) of the buccal surface of a primary posterior tooth were etched with 36% phosphoric acid gel for 1 and 4 min, respectively. The etched sites were analysed immediately after etching (ΔQ1) and 24 h (ΔQ2) later by QLF. Additionally, caries status (deft/DMFT and initial caries), approximal plaque, bleeding on probing, and the patient's current use of fluorides were recorded. In the 2-year follow-up, 29 children were re-assessed. After clinical examination, the caries increment was calculated (ΔDMFT) and correlated with the baseline clinical variables and the QLF readings. Results showed a significant positive correlation between ΔQ(1 min) and the ΔDMFT (r = 0.44, p = 0.02). The ΔDMFT was significantly correlated with the baseline deft (r = 0.56, p = 0.002), cavitated active caries lesions (r = 0.52, p = 0.003), and filled teeth (r = 0.53, p = 0.003). In a regression analysis the use of fluoridated salt (SC = -0.10) and fluoride gel (SC = -0.14) were negatively associated with ΔDMFT. In conclusion, these findings suggest that the demineralisation properties of the etched sites and the outcome of the 24-hour measurements with QLF are significantly associated with caries increment. Previous caries experience strongly correlated with caries increment in this group of children.
Assuntos
Índice CPO , Testes de Atividade de Cárie Dentária/métodos , Cárie Dentária/patologia , Condicionamento Ácido do Dente/métodos , Cariostáticos/administração & dosagem , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Esmalte Dentário/patologia , Índice de Placa Dentária , Restauração Dentária Permanente , Feminino , Fluorescência , Fluoretos/administração & dosagem , Fluoretos/uso terapêutico , Seguimentos , Previsões , Géis , Humanos , Luz , Masculino , Dente Molar/patologia , Índice Periodontal , Ácidos Fosfóricos/química , Cloreto de Sódio na Dieta/administração & dosagem , Remineralização Dentária , Dente Decíduo/patologia , Cremes Dentais/uso terapêuticoRESUMO
Whilst preparing undergraduate students for a clinical course in paediatric dentistry, four consecutive classes (n = 107) were divided into two groups. Seven behaviour-modifying techniques were introduced: systematic desensitization, operant conditioning, modelling, Tell, Show, Do-principle, substitution, change of roles and the active involvement of the patient. The behaviour-modifying techniques that had been taught to group one (n = 57) through lecturing were taught to group two (n = 50) through video sequences and vice versa in the following semester. Immediately after the presentations, students were asked by means of a questionnaire about their perceptions of ease of using the different techniques and their intention for clinical application of each technique. After completion of the clinical course, they were asked about which behaviour-modifying techniques they had actually used when dealing with patients. Concerning the perception of ease of using the different techniques, there were considerable differences for six of the seven techniques (P < 0.05). Whilst some techniques seemed more difficult to apply clinically after lecturing, others seemed more difficult after video-based teaching. Concerning the intention for clinical application and the actual clinical application, there were higher percentages for all techniques taught after video-based teaching. However, the differences were significant only for two techniques in each case (P < 0.05). It is concluded that the use of video based teaching enhances the intention for application and the actual clinical application only for a limited number of behaviour-modifying techniques.
Assuntos
Atitude do Pessoal de Saúde , Controle Comportamental , Comportamento Infantil , Odontopediatria/educação , Estudantes de Odontologia/psicologia , Ensino/métodos , Gravação em Vídeo , Adolescente , Criança , Pré-Escolar , Condicionamento Operante , Relações Dentista-Paciente , Dessensibilização Psicológica , Crianças com Deficiência , Feminino , Humanos , Intenção , Masculino , Participação do Paciente , Desempenho de Papéis , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine the prevalence of oral pathologic findings in an ancient culture that inhabited the Atacama Desert. MATERIALS AND METHODS: A systematic examination was performed on the remains of 83 individuals unearthed from a prehistoric burial ground. A total of 57 skeletal remains achieved appropriate inclusion criteria, from which estimated age at death, gender, ante- and postmortem tooth loss, prevalence and location of caries, apical periodontitis sequela, alveolar bone resorption and attrition were recorded. RESULTS: From the analyzed skeletal remains (13 male, 22 female and 22 not identifiable), the mean age estimated was 29.9 +/- 13.8 years. A total of 89.4% of them presented permanent dentition with a mean ante-mortem tooth loss of 9.0 teeth and a postmortem mean tooth loss of 14.4 teeth per subject. In all, 46.4% of the postmortem remaining permanent teeth (n = 237) showed caries lesions. Interproximal caries was most frequently observed (31.5%), followed by occlusal (25.9%) and cervical caries (19.4%). Root remnants were found in 23.1% of the cases. In addition, 58.0% of the adults presented attrition, 26.0% signs of apical periodontitis and 44.0% loss of alveolar bone support >5 mm. CONCLUSION: The remains of jaws and teeth of the individuals examined in this study presented sequelae of severe oral health damage due to caries and periodontal disease.
Assuntos
Doenças Periodontais/história , Doenças Dentárias/história , Adulto , Fatores Etários , Perda do Osso Alveolar/história , Chile , Cárie Dentária/história , Feminino , História Antiga , Humanos , Masculino , Periodontite Periapical/história , Fatores SexuaisRESUMO
The aim of this 3-year longitudinal study was to analyze caries increment and the caries-preventive effect of sealants in adolescents in the setting of the German national health system. 434 pupils (193 male, 241 female) took part in compulsory school examinations at age 12 (mean 12.3 +/- 0.4 years) and 15 (mean 15.6 +/- 0.3 years) according to WHO criteria, including the examination of sealants. Mean DMFT increased from 1.78 (+/- 2.15) to 3.97 (+/- 3.68), mean DMFS from 2.79 (+/-4.07) to 6.94 DMFS (+/- 8.34), respectively. Logistic regression analysis showed that high caries incidence at the individual level was mostly associated with the type of school ('Gymnasium', RR = 0.3), gender (female, RR = 2.08) and high baseline DMFS (RR = 1.2 per surface), but not with the number of sealants. In an interaction model, adolescents with high baseline DMFS values had an even higher risk of caries increment with an increasing number of sealants compared to adolescents with fewer sealants (p = 0.047). At the tooth level, this effect was detected for first permanent molars, while sealants in premolars and second permanent molars did not result in a statistically significant caries-preventive effect due to the low caries incidence on these surfaces. Thus, sealants on occlusal surfaces of first permanent molars were only protective in individuals with low or moderate caries activity (p = 0.006), which indicates the need for other measures to reduce caries activity in high risk adolescents. In addition, rates of 19% lost sealants and 18% carious or filled surfaces in 3 years suggest a discrepancy between sealant retention under real-life conditions and the results of controlled clinical trials.