The Effect of Gravity on Marginal Integrity of Different Flowable Bulk-Fill Resin Composites.

Background and Objectives: The aim of this quantitative research was to investigate the effect of gravitational forces on the marginal integrity of different bulk-fill composites by micro-CT imaging. Materials and Methods: Fifty caries-free human third molars extracted for prophylactic purposes were used in this study. Each tooth was prepared with two proximal box cavities, with dimensions of 3 mm × 3 mm × 5 mm. Five distinct groups, each comprising 20 cavities, thus totaling 100 cavities for this study: (1, Group CON): Clearfil Majesty Flow + Clearfil Majesty Esthetic (as the control); (2, Group FBR): Filtek Bulk-fill Flowable Restorative + Clearfil Majesty Esthetic; (3, Group XTB): Voco Extrabase + Clearfil Majesty Esthetic; (4, Group SDR): SDR + Clearfil Majesty Esthetic; and (5, Group SNC): Sonicfill. When restoring the mesial cavities, the occlusal surfaces of the teeth in the mold were positioned upwards, counteracting the force of gravity. In contrast, for the restoration of the distal cavities, the occlusal surfaces were aligned downwards, to be parallel with the gravitational pull. After restorative procedures, each tooth was treated with 5000 thermal cycles. A solution of ammoniacal silver nitrate (AgNO3) was employed as a tracing agent. The micro-CT scans were conducted and the total volume of silver nitrate and the total volume of restorations within the relevant region of interest were calculated in "mm3" with software. Two-way ANOVA and Tukey tests were performed at a significance level of p = 0.05 with Graphpad Prism v 8.2.1 software. Results: Both gravity effect and interaction showed no statistical differences (p > 0.05). Statistically significant differences were observed in the restorative materials (p < 0.05). Conclusions: Gravitational forces do not emerge as a major factor affecting the marginal integrity of flowable bulk-fill composites in class II restorations. The chemical composition of the composites plays a more crucial role, with the XTB composite showing higher microleakage ratios compared to the others.

Retrospective evaluation of the morpometric and morphological anatomy of the occipital condyle, hypoglossal canal and foramen magnum in Turkish populaton with CBCT.

PURPOSE: The aim of this study is to morphometrically and morphologically examine the occipital condyle, which is an important anatomical region in terms of surgery and forensic medicine, and its surrounding structures, to evaluate the change in mean values according to gender and age, and to evaluate the correlation of the measurements obtained. METHODS: 180 (90 men, 90 women) CBCT images selected from the archive of Ankara University Faculty of Dentistry. Occipital Condyle length and width, Hypoglossal Canal-Basion distance, Hypoglossal Canal-Opistion distance, Hypoglossal Canal-Occipital Condyle anterior and posterior border distance, Occipital Condyle thickness, Hypoglossal Canal length, the widest diameter of Hypoglossal Canal, the narrowest diameter of the Hypoglossal Canal, the length of the Jugular Tubercle, the width of the Jugular Tubercle, the anterior intercondylar distance, the posterior intercondylar distance, and the Foramen Magnum index were measured. At the same time, the presence of septum or spicule in the hypoglossal canal and protrusion of the occipital condyle were evaluated. The relationship of age, gender, anterior and posterior intercondylar distance, and foramen magnum index measurements with all measurements were examined. RESULTS: In our study, all measurements were repeated 1 month after the first measurements to evaluate the intra-observer agreement, and the agreement between the obtained measurements and the first measurements was evaluated by calculating the intraclass correlation coefficient and 95% confidence intervals. Men's measurements were found to be significantly higher than women's measurements. When the coefficients of concordance in all measurements were examined, it was observed that there was a perfect concordance. CONCLUSION: When the results of the study are evaluated, it is seen that the values ​​obtained are generally close to the studies related to CT. Considering this, an idea can be gained as to whether CBCT, which has a lower dose and less cost, can be used as an alternative to CT in studies to be conducted with more comprehensive and different methods in skull base surgical planning.

Influence of Cone-Beam Computed Tomography Voxel Sizes in the Detection of Chemically Induced External Root Resorptions.

BACKGROUND External root resorption usually does not present a clinical sign or symptom, and, therefore, diagnosis is mainly based on radiographic examination. Many studies confirmed the advantage and accuracy of cone-beam computed tomography (CBCT) in evaluating root resorptions. We aimed to evaluate the diagnostic accuracy of CBCT images of chemically induced external root resorptions on extracted human teeth taken in different voxel sizes. MATERIAL AND METHODS In this in vitro study, 36 maxillary and 36 mandibular human incisor teeth, extracted owing to periodontal disease, were used. External resorption cavities were created on the buccal and proximal surfaces by using 10% hydrochloric acid with different application periods of 10, 30, and 60 min. Resorption cavities in different depths were induced to simulate different levels of external resorption. CBCT images were taken with Planmeca Promax 3D Max CBCT (Planmeca, Helsinki, Finland) in 4 different voxel sizes: 400, 200, 150, and 100 µm. RESULTS There was no statistically significant difference between interobserver and intraobserver reliability. Higher observer agreement was obtained for 100-µm and 150-µm voxel sizes. For detection of external root resorption defects, interobserver agreement was highest for the 100-µm voxel size and when defects were located on the proximal side of the samples. The highest k values were obtained for samples kept in hydrochloric acid for 60 min. CONCLUSIONS Chemically induced resorption cavities should be used for experimental studies to better imitate clinical conditions. CBCT requirement is still ambiguous for detection of external resorptions, and more experimental and clinical studies are needed.

Comparison of Kinesio Taping and manual therapy in the treatment of patients with bruxism using shear-wave elastography-A randomised clinical trial.

BACKGROUND: Bruxism is significantly associated with craniofacial pain, feeling of stiffness or fatigue of the jaw and neck pain. Various physiotherapeutic strategies are used in the treatment of bruxism; however, it is not clear which method leads to greater decrease in pain. OBJECTIVE: The aim of this study is to compare the effects of two physiotherapy methods (manual therapy [MT] and Kinesio taping with manual therapy [KTMT]) in patients with bruxism. METHODS: Patients were randomised into MT or KTMT groups. Evaluations were performed at baseline and following 4 weeks of physiotherapy. Muscle thickness and stiffness were assessed via shear wave elastography; pain thresholds were evaluated using algometer. Sleep quality was assessed using Pittsburgh Sleep Quality Index, and quality of life was assessed with Likert scales regarding the associated symptoms. RESULTS: Significant decreases were found in muscle stiffness, pain threshold, sleep quality and quality of life (P < .05) in both MT and KTMT groups. Pain in bilateral temporalis and right occipital region of the trapezius muscle decreased more in the KTMT group compared with the MT group (P < .05). No significant differences in muscle thickness (P > .05) were found in either of the groups. CONCLUSION: Both MT and KTMT methods were effective in the treatment of bruxism. Kinesio Tape used in conjunction with MT has additionally decreased jaw pain and temporal region pain compared with MT intervention only. Therefore, if jaw pain is the primary complaint of a patient, our results recommend including Kinesio Tape application in the physiotherapeutic treatment program.

Comparison of intraoral radiography and cone-beam computed tomography for the detection of periodontal defects: an in vitro study.

BACKGROUND: This study aimed to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) unit with digital intraoral radiography technique for detecting periodontal defects. METHODS: The study material comprised 12 dry skulls with maxilla and mandible. Artificial defects (dehiscence, tunnel, and fenestration) were created on anterior, premolar and molar teeth separately using burs. In total 14 dehiscences, 13 fenestrations, eight tunnel and 16 without periodontal defect were used in the study. These were randomly created on dry skulls. Each teeth with and without defects were images at various vertical angles using each of the following modalities: a Planmeca Promax Cone Beam CT and a Digora photostimulable phosphor plates. Specificity and sensitivity for assessing periodontal defects by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05. RESULTS: The kappa values for inter-observer agreement between observers ranged between 0.78 and 0.96 for the CBCT, and 0.43 and 0.72 of intraoral images. The Kappa values for detecting defects on anterior teeth was the least, following premolar and molar teeth both CBCT and intraoral imaging. CONCLUSIONS: CBCT has the highest sensitivity and diagnostic accuracy for detecting various periodontal defects among the radiographic modalities examined.

Metastasis of prostate carcinoma in the mandible manifesting as numb chin syndrome.

BACKGROUND: Numb chin syndrome is an uncommon but well-recognized symptom in medical oncology. This condition can be related to metastatic neurological manifestation of malignancy, often with no clinically visible pathology. About 1% of oral cancers, which are located in the soft tissues and jaws, are metastases of primary tumors located elsewhere in the body. The posterior mandible is the most common site of metastasis of the oral region because of its rich blood supply in active areas of hematopoiesis. This article describes prostate carcinoma metastasis located in the mandible and temporomandibular joint of a 78-year-old male. CASE PRESENTATION: A 78-year-old male patient presented to our outpatient clinic with a complaint of numbness and pain on the left site of the mandible. The patient stated that he had been suffering from this numbness for 1 to 2 months. In the medical anamnesis, it was discovered that patient had prostate carcinoma (CA) 5 years previous, and since then, he had visited his doctor periodically for an annual examination. In these examinations and on the basis of tests carried out at the hospital 1 year previous, it was stated that no CA relapse traces were detected. The patient had visited his dentist 2 months previous for pain and numbness of the left molar region. CONCLUSIONS: We report numb chin syndrome, which is an uncommon neurological manifestation of metastatic malignancy. The clinical course and rapid deterioration after the initial presentation of this syndrome is discussed. This clinical situation illustrates the importance of good medical history review prior to all procedures by the medical professions dealing with oncology patients. An awareness of this condition is crucial, especially in symptoms with unexplained facial pain and numbness.

Development and Validation of an Ultrasonography-Based Machine Learning Model for Predicting Outcomes of Bruxism Treatments.

BACKGROUND AND OBJECTIVES: We aimed to develop a predictive model for the outcome of bruxism treatments using ultrasonography (USG)-based machine learning (ML) techniques. This study is a quantitative research study (predictive modeling study) in which different treatment methods applied to bruxism patients are evaluated through artificial intelligence. MATERIALS AND METHODS: The study population comprised 102 participants with bruxism in three treatment groups: Manual therapy, Manual therapy and Kinesio Tape or Botulinum Toxin-A injection. USG imaging was performed on the masseter muscle to calculate muscle thickness, and pain thresholds were evaluated using an algometer. A radiomics platform was utilized to handle imaging and clinical data, as well as to perform a subsequent radiomics statistical analysis. RESULTS: The area under the curve (AUC) values of all machine learning methods ranged from 0.772 to 0.986 for the training data and from 0.394 to 0.848 for the test data. The Support Vector Machine (SVM) led to excellent discrimination between bruxism and normal patients from USG images. Radiomics characteristics in pre-treatment ultrasound scans of patients, showing coarse and nonuniform muscles, were associated with a greater chance of less effective pain reduction outcomes. CONCLUSIONS: This study has introduced a machine learning model using SVM analysis on ultrasound (USG) images for bruxism patients, which can detect masseter muscle changes on USG. Support Vector Machine regression analysis showed the combined ML models can also predict the outcome of the pain reduction.

Development and validation of intraoral periapical radiography-based machine learning model for periodontal defect diagnosis.

Radiographic determination of the bone level is useful in the diagnosis and determination of the severity of the periodontal disease. Various two- and three-dimensional imaging modalities offer choices for imaging pathologic processes that affect the periodontium. In recent years, innovative computer techniques, especially artificial intelligence (AI), have begun to be used in many areas of dentistry and are helping increase treatment and diagnostic performance. This study was aimed at developing a machine-learning (ML) model and assessing the extent to which it was capable of classifying periodontal defects on 2D periapical images. Eighty-seven periapical images were examined as part of this research. The existence or absence of periodontal defects in the aforementioned images were evaluated by a human observer. The evaluations were subsequently repeated using a radiomics platform. A comparison was made of all data acquired through human observation and ML techniques by SVM analysis. According to the study findings the ability of human observers and the ML model to detect periodontal defects was significantly different in comparison to the gold standard. However, ML and human observers performed similarly for the detection of periodontal defects without a significant difference. This study reveals that the prediction of periodontal defects can be achieved by combining particular radiomic features with image variables. The proposed machine leaning model can be utilized for supporting clinical practitioners and eventually substitute evaluations conducted by human observers while enhancing future levels of performance.

Evaluation of single session physical therapy methods in bruxism patients using shear wave ultrasonography.

OBJECTIVE: To compare the immediate effects of a single session of manual therapy (MT) or Kinesio taping following MT (KTMT) in patients with bruxism using shear wave ultrasonography. METHODS: Twenty patients were included in the MT group (mean age 27.3 ± 4.8), and 19 patients were included in the KTMT group (age mean 26.2 ± 5.4), randomly. Muscle thickness and stiffness were assessed via shear wave ultrasonography, and pain pressure threshold was assessed with an algometer before and after one session of MT or KTMT. RESULTS: Significant decreases were found in muscle thickness and stiffness of the bilateral masseter (p < 0.05). Significant decrease in pain was seen in the masseter and temporalis muscle PPT measurements in the KTMT group (p < 0.05) only. CONCLUSION: Kinesio taping in addition to MT is recommended in the immediate physiotherapy treatment of bruxism for acute pain.

Influence of voxel size and filter type on detecting vertical root fracture using cone-beam computed tomography.

Vertical root fractures (VRFs) can start at any level of the root and progress longitudinally to the coronal attachment. This study aimed to investigate the effects of different exposure parameters used when obtaining CBCT scans in detecting simulated VRFs. Hence, 80 intact human mandibular single-rooted pre-molar teeth without root fractures were included in the study. No statistically significant difference was found between the filters in terms of VRF detection in the group with the roots with only root canal filling (Groups 1 and 5); however, 100 voxels were found to be more successful in terms of VRF detection than other voxel sizes. Results of this study suggest that using lower voxel sizes leads to an accurate diagnosis of vertical root fracture, in addition, our results revealed that using AR filters did not improve the diagnostic accuracy in detecting VRFs.

In-vitro analysis of maxillary first molars morphology using three dimensional Micro-CT imaging: considerations for restorative dentistry.

PURPOSE: The aim of this study was to determine the differences between the positional relationship of the crown contour and the pulp chamber of left and right maxillary first molars, as well as their morphological characteristics by using micro-CT system with reconstruction from a volumetric rendering software. MATERIALS AND METHODS: In total, 21 extracted maxillary first molars, including 11 left and 10 right teeth, were used. The positional relationship between the crown contour, pulp chamber and morphology of the teeth were investigated three-dimensionally by means of micro-CT imaging. RESULTS: Closest distance of mesio-buccal pulp horn to enamel surface in mm was calculated as 2.5±0.20 mm for right and 2.29±0.17 mm for left teeth. This difference was statistically significant (p=0.017). The means of closest distance of disto-buccal pulp horn to enamel surface were also significantly different between left and right teeth (p=0.001). The mean pulp volumes of right side and left side teeth were, respectively, 32.94±3.19 mm3 and 33.71±2.82 mm3 but this difference was not statistically significant. CONCLUSION: These results suggest that right and left maxillary first molars should be treated differently during preparation of cavities. Further studies must be done with larger samples as well as for other molar teeth in different populations to reveal the morphology of the molar for further considerations in restorative dentistry.

Comparison of the burr and chemically induced periodontal defects using different field-of-view sizes and voxel resolutions.

OBJECTIVE: This study assessed the use of different voxel resolutions in a cone beam computed tomography (CBCT) unit for the detection of artificially induced periodontal bone defects created using burr, burr and chemicals, and only chemicals. STUDY DESIGN: Seven dry skulls were used in this study. In total, 65 dehiscence defects, 43 fenestration defects, and 76 control sites with no periodontal defects were examined. Images were obtained from a CBCT unit (3 D Accuitomo; J Morita Mfg. Corp., Kyoto, Japan), using 3 field-of-view (FOV) sizes (4 × 4 cm; 6 × 6 cm; and 8 × 8 cm) and 4 scan modes (standard, high-definition, high-fidelity, and low-dose). RESULTS: Overall, κ coefficients for interobserver agreement on burr-induced periodontal defects ranged from 0.336 to 0.795, with the lowest κ value (indicating a fair degree of agreement) obtained for images acquired in standard mode with a voxel size of 0.160 mm3. κ coefficients for the detection of periodontal defects were highest (indicating moderate to high degrees of interobserver agreement) for smaller voxel sizes and high-resolution images. Statistical comparison among groups (burr, burr + chemicals, and chemicals only) was performed using 1-way analysis of variance with post hoc tests. CONCLUSIONS: The CBCT scan mode may affect the diagnosis of periodontal defects. The technique used to create periodontal defects also affected diagnosis. For this kind of experiment, burr-induced or burr + chemical-induced defects should be used, rather than those induced solely using a chemical technique.

Preauricular pilomatricoma: An uncommon entity in a dental pediatric patient.

INTRODUCTION: Pilomatricomas are benign follicular skin appendage tumors, commonly occurring in children and young adults. Most patients admit to dermatologists to seek treatment and are well known by them; however, dental professionals, especially pediatric dentists are not familiar with these tumors. PRESENTATION OF CASE: This report presents a 16-year-old female with preauricular pilomatricoma, located beneath the overlying skin of the temporomandibular region. Clinical examination revealed an asymptomatic lump, the overlying skin revealed no abnormalities. Patient was unaware of the lesion. DISCUSSION: Pilomatricomas are commonly encountered in the maxillofacial region, although not considered in differential diagnosis by dental professionals. They usually present as, asymptomatic, subcutaneous masses; although symptomatic cases have been reported. In literature, common differential diagnosis for head and neck pilomatricoma includes sebaceous cyst, ossifying hematoma, giant cell tumor, chondroma, dermoid cyst, foreign body reaction, degenerating fibroxanthoma, metastatic bone formation, and osteoma cutis. We are of the opinion that temporomandibular joint disease should also be considered in differential diagnosis for preauricular pilomatricoma. CONCLUSION: Pediatric dentists should be aware of the condition and consider it in the differential diagnosis of pediatric conditions involving the temporomandibular joint.

Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment.

INTRODUCTION: Current research is concerned with discovering better scaffolds for use in regenerative endodontic treatment. This study aimed to clinically and radiographically evaluate the efficacy of platelet-rich plasma (PRP) used as a scaffold in regenerative endodontic treatment and compare it with that of a conventional blood clot (BC) scaffold. METHODS: A total of 20 necrotic, single-rooted immature teeth were randomly distributed into 2 groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created by using either PRP or BC and covered with white mineral trioxide aggregate. Clinical and radiographic follow-up examinations were performed once every 3 months during an 18-month period. Differences in root area were calculated from preoperative and postoperative radiographs. Fisher exact and Mann-Whitney U tests were used to evaluate differences between groups, with P value <.05 considered to be statistically significant. RESULTS: All 20 teeth were clinically asymptomatic during 18-month follow-up period; however, 1 tooth in the BC group exhibited periapical pathosis and was judged radiographically unsuccessful. Complete apical closure was observed in a mean of 8.1 months in the PRP group compared with 9 months in the BC group. The PRP group exhibited 9.86% increase in root area, compared with 12.6% increase in the BC group. The difference in success rates between the groups was not statistically significant (P > .05). CONCLUSIONS: PRP successfully created a scaffold for regenerative endodontic treatment; however, treatment outcomes did not differ significantly between PRP and conventional BC scaffold.