Patterns of Facial Profile Preference in a Large Sample of Dental Students: A Cross-Sectional Study.

The objective of this study was to explore dental students' facial profile preferences in a large sample of students. Nine hundred and nineteen dental students of four dental schools were involved. As part of a larger study on dentofacial esthetics, six photo series consisting of one unaltered and four altered variants of the same female profile were distributed among the students. The altered features were ones that are esthetically significant according to the literature. The students had to indicate the photo in each series that they preferred. The data were analyzed in a regression model in which preference in the given photo series was the dependent variable and gender, grade of studies, and dental school were the factors. Eight hundred and sixty-one students (93.7%) responded. Gender and dental school were not associated with the observed preferences, but the grade of studies was associated for three of the modified parameters: chin prominence, the sagittal position of the maxillary dental arch, and the simultaneous modification of the prominence of the chin and the nose. This study has confirmed several earlier observations, and new observations have also been made. We have demonstrated that the anteroposterior position of the maxillary incisors may be an important determinant of profile esthetics, even if this position does not influence the situation of the soft tissues and if the forehead cannot be used as a reference. We have also shown that the harmony between the nose and the chin overrides the importance of their individual dimensions.

Dentofacial mini- and microesthetics as perceived by dental students: A cross-sectional multi-site study.

BACKGROUND: How dental education influences students' dental and dentofacial esthetic perception has been studied for some time, given the importance of esthetics in dentistry. However, no study before has studied this question in a large sample of students from all grades of dental school. This study sought to fill that gap. The aim was to assess if students' dentofacial esthetic autoperception and heteroperception are associated with their actual stage of studies (grade) and if autoperception has any effect on heteroperception. METHODS: Between October 2018 and August 2019, a questionnaire was distributed to 919 dental students of all 5 grades of dental school at all four dental schools in Hungary. The questionnaire consisted of the following parts (see also the supplementary material): 1. Demographic data (3 items), Self-Esthetics I (11 multiple- choice items regarding the respondents' perception of their own dentofacial esthetics), Self-Esthetics II (6 Likert-type items regarding the respondents' perception of their own dentofacial esthetics), and Image rating (10 items, 5 images each, of which the respondents have to choose the one they find the most attractive). Both the self-esthetics and the photo rating items were aimed at the assessment of mini- and microesthetic features. RESULTS: The response rate was 93.7% (861 students). The self-perception of the respondents was highly favorable, regardless of grade or gender. Grade and heteroperception were significantly associated regarding maxillary midline shift (p < 0.01) and the relative visibility of the arches behind the lips (p < 0.01). Detailed analysis showed a characteristic pattern of preference changes across grades for both esthetic aspects. The third year of studies appeared to be a dividing line in both cases, after which a real preference order was established. Association between autoperception and heteroperception could not be verified for statistical reasons. CONCLUSION: Our findings corroborate the results of most previous studies regarding the effect of dental education on the dentofacial esthetic perception of students. We have shown that the effect can be demonstrated on the grade level, which we attribute to the specific curricular contents. We found no gender effect, which, in the light of the literature, suggests that the gender effect in dentofacial esthetic perception is highly culture dependent. The results allow no conclusion regarding the relation between autoperception and heteroperception.

Heat Generation During Guided and Freehand Implant Site Preparation at Drilling Speeds of 1500 and 2000 RPM at Different Irrigation Temperatures: An In Vitro Study.

PURPOSE: The purpose of our study was to evaluate the impact of different irrigation fluid temperatures on intraosseous temperature increment during guided and freehand implant site preparation. MATERIALS AND METHODS: Bovine rib segments were used. Temperature was detected using K-type thermocouples. The studied groups were defined as combinations of the following: drilling speed (1500, 2000 RPM), drill diameter (2.0, 2.5, 3.0, 3.5 mm), surgical method (guided, freehand), and irrigation fluid temperature (10°C, 15°C, 20°C). The data were analysed with Kruskal-Wallis analysis of variance (ANOVA) and ANOVA, as appropriate. RESULTS: At 1500 RPM, guided drilling with 20°C irrigation fluid yielded temperature values exceeding the necrotic threshold (47°C) when performed with bits of 3.0 and 3.5 mm diameters. Meanwhile, 15°C irrigation managed to keep the mean increment below 8.0°C at the diameter of 3.5 mm for both guided and freehand surgery. However, 10°C irrigation cancelled every statistically significant difference between guided and freehand groups. At 2000 RPM and with 20°C irrigation, mean peak temperatures exceeded the necrotic threshold at the diameters 3.0 and 3.5 mm (guided) and 3.5 mm (freehand). When applying 10°C irrigation, though, all measurements indicated peak temperatures in the safe zone. CONCLUSION: Drillings at 1500 and 2000 RPM, in a guided setting, cause temperature elevations that exceed the necrotic threshold. A speed of 2000 RPM drilling may produce potentially harmful temperatures also in a freehand setting. 10°C and 15°C irrigation kept temperature increments in the safe zone at 2000 RPM and 1500 RPM, respectively.

Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve: An In Vitro Study.

OBJECTIVE: To investigate drill wear and consequent intraosseous temperature elevation during freehand and guided bone drilling, with attention to the effect of metal-on-metal contact during guided drilling. MATERIALS AND METHODS: Osteotomies were performed on bovine ribs, with 2.0 mm diameter stainless steel drill bits of the SMART Guide System, under 3 sterilization protocols, at 800, 1200, 1500, and 2000 rpm. Sterilization was performed after every 3 drilling. Temperature was measured after every 30 drilling. RESULTS: The studied contributing factors had a cumulative effect, and each contributed significantly to temperature elevation. Whether guide use led to a near-necrotic (47°C) temperature increment depended largely on the applied sterilization protocol. CONCLUSION: The metal sleeve is a significant contributing factor to heat generation during guided osteotomy, but its effect can be offset by keeping the other studied factors under control.

Effect of the Combination of Low-Speed Drilling and Cooled Irrigation Fluid on Intraosseous Heat Generation During Guided Surgical Implant Site Preparation: An In Vitro Study.

PURPOSE: Investigating the effect of the combination of low-speed drilling and cooled irrigation fluid on intraosseous temperature rise during guided and freehand implant surgery. MATERIALS AND METHODS: Bovine ribs were used as bone specimens. Grouping determinants were as follows: drill diameter (2.0, 2.5, 3.0, and 3.5 mm), irrigation fluid temperature (10°C, 15°C, and 20°C), and surgical method (guided and freehand). Drilling speed was 800 rpm. Results were compared with previous ones using 1200 rpm. Temperature measurements were conducted using K-type thermocouples. RESULTS: No mean temperature change exceeded 1.0°C if irrigation fluid cooled to 10°C was used, regardless of the drill diameter or the surgical method, with the highest elevation being 2.10°C. No significant reduction was measured when comparing groups using 15°C and 20°C irrigation fluids, regardless of both drill diameter and surgical method. CONCLUSION: The use of irrigation fluid being cooled to 10°C combined with low-speed drilling (800 rpm) seems to be a safe method for implant site preparation and drilling through a drilling guide in terms of temperature control.

Intraosseous generation of heat during guided surgical drilling: an ex vivo study of the effect of the temperature of the irrigating fluid.

We measured the rise in the intraosseous temperature caused by freehand drilling or drilling through a surgical guide, by comparing different temperatures of irrigation fluid (10°C, 15°C, and 20°C), for every step of the drilling sequence (diameters 2.0, 2.5, 3.0, and 3.5mm) and using a constant drilling speed of 1200rpm. The axial load was controlled at 2.0kg. Bovine ribs were used as test models. In the guided group we used 3-dimensional printed surgical guides and temperature was measured with a thermocouple. The significance of differences was assessed with the Kruskal-Wallis analysis of variance. Guided drilling with 10°C irrigation yielded a significantly lower increment in temperature than the 20°C-guided group. When compared with the 20°C freehand group, the reduction in temperature in the 10°C guided group was significantly more pronounced at all diameters except 3.5mm. Finally, when the 10°C-guided group was compared with the 15°C groups, the temperature rise was significantly less at 2.5 and 3.0mm than with the guided technique, and at 3.0mm compared with the freehand technique. We suggest that the use of 10°C pre-cooled irrigation fluid is superior to warmer fluid for keeping temperature down, and this reduces the difference between guided and freehand drilling.

Advanced Trauma Life Support (ATLS) in Hungary; The First 10 Years.

Advanced Trauma Life Support (ATLS) programs are recognized as the standard educational trauma program worldwide. Data suggest that ATLS has a positive impact on the value of trauma care. The ATLS Hungary program has been started in 2005, celebrating its 10-year anniversary this year. In the present brief communication a brief overview is provided on the program.Student evaluation and statistical data about the participants were collected throughout the 10-year history of the Hungarian program.Student evaluation shows a high level of satisfaction amongst the participating doctors. Most participants are working in higher level centers. The Hungarian program shows good quality according to the participants. Establishing at least one new center is crucial to be able to provide the course for every professional interested in it or required to take it.

Operative management of bilateral Salter-Harris type III fractures of the proximal phalanges of the great toes of a 10-year-old female ballet dancer: a case report.

Differentiation between the normal variant cleft epiphysis and Salter-Harris type III fracture of the first proximal phalanges of the foot in children might be challenging. The authors describe a case of a 10-year-old ballet dancer girl with bilateral epiphyseal segmentation of the first proximal phalanges of the foot, unresponsive to conservative treatment. Considered a nonhealing stress-induced fracture, operative treatment with closed reduction and Herbert screw insertion was chosen on both sides. Complete union was achieved, with significant reduction of pain. The presented case suggests that internal fixation can be a viable option in the treatment of the problem.

External cooling efficiently controls intraosseous temperature rise caused by drilling in a drilling guide system: an in vitro study.

The purpose of this study was to measure the rise in intraosseous temperature caused by drilling through a drilling guide system. We compared the rise in temperature generated, and the number of increases of more than 10 °C, between drills that had been cooled with saline at room temperature (25 °C) and those that had not been cooled, for every step of the drilling sequence. Cortical layers of bovine ribs were used as specimens, and they were drilled through 3-dimensional printed surgical guides. Heat was measured with an infrared thermometer. The significance of differences was assessed with either a two-sample t test or Welch's test, depending on the variances. The mean rises (number of times that the temperature rose above 10 °C) for each group of measurements were: for the 2mm drill, 4.8 °C (0/48) when cooled and 7.0 °C (8/48) when not cooled; with the 2.5mm drill, 5.2 °C (1/48) when cooled and 8.5 °C (17/48) when not cooled (2 mm canal); with the 3 mm drill, 3.3 °C when cooled (0/48) and 8.5 °C (18/24) when not cooled (2.5 mm canal); and with the 3.5 mm drill, 4.8 °C when cooled (0/24) and 9.4 °C when not cooled (10/23) (3 mm canal). The temperature rose significantly less with cooling at every step of the drilling sequence (p<0.001). We conclude that external cooling can maintain the intraosseous temperature within the safe range while drilling through an implant guide system, whereas drilling without irrigation can lead to temperatures that exceed the acceptable limit.