The influence of operator variability on adhesive cementation of fiber posts.

PURPOSE: The aim of this study was to evaluate the influence of the operator's experience on the outcome of fiber post cementation using an etch-and-rinse acetone-based adhesive. MATERIALS AND METHODS: Fifteen human anterior teeth were used in the study. One trained operator performed the endodontic procedures and prepared the roots for the insertion and cementation of the posts. At this point, teeth were divided into 3 groups and distributed to 3 operators to lute the posts: an expert operator (EO), a moderately experienced operator (ME), and an operator with a low level of experience (LE). Quartz fiber posts (DT Light Post #1 or #2, RTD) were used. Posts were cemented using Prime&Bond NT Dual Cure adhesive system (Dentsply Caulk) in combination with the dual-curing resin cement Calibra (Dentsply Caulk). The post retention was assessed with the "thin-slice" push-out test. One-way ANOVA was performed to examine the effect of the operator on push-out strength, followed by post-hoc multiple comparisons using Tukey's test, with the significance level set at alpha = 95%. RESULTS: The results of push-out strength testing were as follows: EO (12.44+/-3.63 MPa), ME (11.68+/-2.64 MPa), LE (11.18+/-3.12 MPa). No statistically significant differences were determined among the three groups. CONCLUSION: There was no statistically significant difference in the retention measured for fiber posts luted by operators with different levels of clinical experience. Given the parameters of this investigation, the level of operator experience in luting fiber posts does not affect post retention under laboratory conditions.

Ultrasonography of the temporomandibular joint: comparison of findings in patients with rheumatic diseases and temporomandibular disorders. A preliminary report.

OBJECTIVE: The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD). STUDY DESIGN: US assessment of the temporomandibular joints was bilaterally performed in 68 patients (22 with RA, 11 with PsA, and 35 with TMD). All the TMJs were assessed for the presence of disc displacement, effusion, and changes of the condylar profile, and the prevalence of such abnormalities was compared across the 3 groups of patients. To confirm generalizability of results, US findings were also compared with those of magnetic resonance (MR), taken as the standard of reference. RESULTS: Prevalence of disc displacement and changes in condylar profile were similar between patients with rheumatic diseases and temporomandibular disorders, while effusion was significantly more present in TMJs of TMD patients. Sensitivity of US to detect TMJ abnormalities was acceptable, while specificity was low for condylar alterations. CONCLUSIONS: Temporomandibular joint involvement in patients with rheumatic diseases seems to be similar to that described in subjects with temporomandibular disorders. Ultrasonography confirmed to be an accurate technique to detect disc displacement and effusion within the temporomandibular joint, but not to detect condylar abnormalities.

Quantification of the relative risk of multiple occlusal variables for muscle disorders of the stomatognathic system.

STATEMENT OF PROBLEM: There is no consensus on the association between occlusion and temporomandibular disorders (TMD). PURPOSE: The purpose of this study was to quantify the relative risk of multiple occlusal variables for muscle disorders of the stomatognathic system. MATERIAL AND METHODS: Eight occlusal features: retruded contact position (RCP) to maximum intercuspation (MI) slide length, vertical overlap, horizontal overlap, unilateral posterior reverse articulation, anterior open occlusal relationship, incisor dental midline discrepancy, mediotrusive interferences, and laterotrusive interferences, were clinically assessed by the same trained operator. The sample consisted of 81 women with a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I diagnosis of muscle disorder, for example myofascial pain, with or without limited opening, and 48 healthy women (control group). A stepwise multiple logistic regression was used to identify the significant associations between occlusal features and disease. RESULTS: A slide from the retruded contact position to maximum intercuspation > or =2 mm and mediotrusive interferences were the only 2 occlusal features significantly associated with the presence of myofascial pain according to the RDC/TMD criterion symptoms. The odds ratio for myofascial pain was 2.57 for a slide from RCP to MI > or =2 mm and 2.45 for mediotrusive interferences. The percentage of the total log likelihood for myofascial pain explained by the significant occlusal factors amounted to 10.8% (Nagelkerke's R2=0.108). The multifactorial model, including the 2 significant occlusal factors, showed an acuracy to predict disease of 66.7% (sensitivity 71.6%; specificity 58.3%). CONCLUSION: Occlusal features showed a low predictive value to detect muscle disorders of the stomatognathic system. Multifactorial complex pathologies, such as TMD, should be studied using multivariate statistical analyses, as univariate models may overestimate some resulting associations.

Predictive value of clinical findings for temporomandibular joint effusion.

OBJECTIVE: The aim of this work was to evaluate the predictive value of clinical symptoms for magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) effusion. STUDY DESIGN: Sixty-one patients with TMJ pain were assessed by means of a standardized clinical examination and MRI. A calibrated investigator evaluated the presence of 8 clinical indicators (predictors) of TMJ effusion (outcome variable). A logistic regression analysis was performed to detect significant associations between clinical symptoms and MRI findings of TMJ effusion. The accuracy of the final logit to predict effusion was compared with that derived from univariate analysis. RESULTS: A clinical examination based upon the assessment of pain in the TMJ with lateral palpation, with posterior palpation, during motion, and during maximum assisted opening, and the presence of click and crepitus sounds has an accuracy of 78.7% to predict TMJ effusion. Among the single clinical symptoms, the most reliable predictor of TMJ effusion is the presence of pain with lateral palpation (accuracy 76.2%; K =.525). CONCLUSION: The use of a multiple regression approach demonstrated that an extensive clinical assessment which considers 6 main indicators consents to predict accurately the presence of MRI TMJ effusion. Based on these findings, MRI assessment should be reserved for patients in which the exact disc-condyle relationship needs to be evaluated.