Titanium plate removal in orthognathic surgery: prevalence, causes and risk factors. A systematic literature review and meta-analysis.

The purpose of this review was to analyse the prevalence of titanium plate removal in orthognathic surgery, as well as the causes of plate removal, and to determine the associated risk factors. A thorough search of the PubMed, Scopus, Embase, and Web of Science databases was conducted. The inclusion criteria were studies of adult patients who underwent orthognathic surgery in which monocortical titanium plates and screws were placed. Of the 325 references identified, 19 were included in the qualitative synthesis and meta-analysis. Overall, 13.4% (95% confidence interval (CI) 9.6-18.3%) of the patients required the removal of at least one titanium plate; 9.7% (95% CI 6.3-14.6%) of the plates placed were removed. The main causes of removal were infection (6.6%), exposed plate (2.6%), thermal sensitivity (2.1%), palpable plate or screw (2.0%), and pain/tenderness (1.9%). Female sex, smoking, and plates placed in the lower jaw were the main risk factors, with odds ratios of 1.5 (95% CI 1.1-2.0), 2.5 (95% CI 1.4-4.2), and 1.8 (95% CI 1.0-3.2), respectively. In no case was a publication bias problem detected. Fixation using titanium plates has a relatively low prevalence of removal. Infection is the main reason for removal. Female sex and smoking, are the main risk factors for removal. Plates placed in the lower jaw is a non-significant risk factor.

Degree of severity of molar incisor hypomineralization and its relation to dental caries.

Molar incisor hypomineralization is a developmental defect of dental enamel associated with rapid caries progression. In order to discover whether molar incisor hypomineralization predisposes to dental caries, a cross-sectional cohort study was conducted in a sample of 414 children aged between eight and nine years. It was found that 24.2% of the children presented molar incisor hypomineralization. Of these, 72% had a mild form and 28% a severe form. Caries prevalence was greater among the children with severe form (60.7%) than in those with mild form (43.1%) or no molar incisor hypomineralization (45.5%). The caries indices were higher in out molar incisor hypomineralization (1.18) or with mild form (1.08). The tooth-surface caries ratio was significantly higher in surfaces with severe hypomineralization than in those with no hypomineralization or mild hypomineralization. A linear regression model showed that cariogenic food intake and the presence of severe molar incisor hypomineralization were significantly associated with DMFS. Consequently, an association was found to exist between dental caries and the presence of surfaces affected by severe molar incisor hypomineralization, which should be considered a risk factor within the multifactorial etiology of caries.

Implication of general anaesthetic and sedation techniques in temporomandibular joint disorders - a systematic review.

The purpose of this study was to conduct a systematic review of the literature on temporomandibular joint damage directly related to general anaesthesia and sedation. We searched MEDLINE, SCOPUS and the COCHRANE Library for titles and abstracts containing terms related to the subject. The search delimiters were analytical and descriptive studies with abstracts in Spanish, German, English or French, with no time limit. The search was updated in January 2015. Of the 398 articles found, 89 were duplicates and only 28 were of interest. Of these, 23 (82.14%) were case and case series reports, 4 (14.28%) were longitudinal studies and 1 (3.57%) was a cross-sectional study. General anaesthesia and sedation are risk factors for temporomandibular joint damage because of the drop in muscle tone caused by the drugs employed and because of airway management manoeuvres involving the joint. Joint complications have been described with spontaneous ventilation as well as with ventilation assisted by a face or laryngeal mask and with intubation. They are more frequent in women and/or patients with previous temporomandibular problems. Proper assessment is required both before and after anaesthesia or sedation in order to foresee and avoid or minimize temporomandibular complications. The data should be treated with caution, as the evidence of case and case series reports is not of a high standard and the small number of analytical studies is not entirely comparable. General anaesthesia and sedation techniques can influence the onset of temporomandibular joint disorders. More studies are needed to provide better clinical evidence.

Impact of functional mandibular advancement appliances on the temporomandibular joint - a systematic review.

BACKGROUND: Although many orthodontists have no doubts about the effectiveness of functional appliances for mandibular advancement, the impact on the temporomandibular joint (TMJ) is still in dispute. The objective of this systematic review is to examine the main effects on the TMJ of using functional appliances, both in healthy patients and in patients with a pre-existing disorder. MATERIAL AND METHODS: A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Only systematic reviews, meta-analyses, randomized clinical trials (RCTs), case-control studies and cohort studies were included. A detailed language-independent electronic search was conducted in the Pubmed, Scopus, Cochrane Library and Embase databases. All studies published between 2000 and 2015 were included. RESULTS: A total of 401 articles were identified. Of these, 159 were duplicates and were excluded. On reading the title and abstract, 213 articles were excluded because they did not answer the research question, leaving a total of 29 articles. These articles were read and assessed. Following critical reading of the full text, eight articles were excluded: seven because they were considered of low quality and one because it published redundant data. As a result, 21 articles were included. CONCLUSIONS: After treatment with functional appliances, the condyle was found to be in a more advanced position, with remodelling of the condyle and adaptation of the morphology of the glenoid fossa. No significant adverse effects on the TMJ were observed in healthy patients and the appliances could improve joints that initially presented forward dislocation of the disk.

Corticotomies as a surgical procedure to accelerate tooth movement during orthodontic treatment: A systematic review.

BACKGROUND: One of the main aims of orthodontists is to reduce the treatment time as much as possible, particularly in view of the rise in demand for orthodontic treatment among adult patients. The objective of this systematic review was to examine the effectiveness of corticotomy as a surgical procedure that accelerates orthodontic tooth movement, together with its possible adverse effects. MATERIAL AND METHODS: A systematic review of articles in 4 databases, Pubmed, Cochrane, Scopus and Embase, complemented by a manual search, identified 772 articles. The duplicates were eliminated and a critical reading of titles and abstracts led to the rejection of articles that did not meet the objectives of the review, leaving 69. After reading the full text of these articles, 49 were excluded because they did not meet the inclusion criteria. On applying the CONSORT criteria as a quality filter, a further 4 were eliminated due to low quality. Finally, 16 articles (4 systematic reviews and 12 controlled trials) were reviewed. RESULTS: All the studies agree that corticotomy prior to orthodontic treatment accelerates dental movement, reducing the treatment time. With regard to side-effects, no periodontal damage was found, although this was only studied in the short term. CONCLUSIONS: The evidence regarding the results of corticotomy is limited, given the small number of quality clinical studies available. Before this procedure is included as a routine practice in dental surgeries, studies of higher methodological quality are required, studying a greater number of individuals and examining the possible long-term adverse effects and the cost/benefit of the procedure.

Hypomineralized Second Primary Molars as Predictor of Molar Incisor Hypomineralization.

Molar incisor hypomineralization (MIH) is a developmental defect of dental enamel that shares features with hypomineralized second primary molars (HSPM). Prior to permanent tooth eruption, second primary molars could have predictive value for permanent molar and incisor hypomineralization. To assess this possible relationship, a cross-sectional study was conducted in a sample of 414 children aged 8 and 9 years from the INMA cohort in Valencia (Spain). A calibrated examiner (linear-weighted Kappa 0.83) performed the intraoral examinations at the University of Valencia between November 2013 and 2014, applying the diagnostic criteria for MIH and HSPM adopted by the European Academy of Paediatric Dentistry. 100 children (24.2%) presented MIH and 60 (14.5%) presented HSPM. Co-occurrence of the two defects was observed in 11.1% of the children examined. The positive predictive value was 76.7% (63.9-86.6) and the negative predictive value 84.7% (80.6-88.3). The positive likelihood ratio (S/1-E) was 10.3 (5.9-17.9) and the negative likelihood ratio (1-S/E) 0.57 (0.47-0.68). The odds ratio was 18.2 (9.39-35.48). It was concluded that while the presence of HSPM can be considered a predictor of MIH, indicating the need for monitoring and control, the absence of this defect in primary dentition does not rule out the appearance of MIH.

Effects of mandibular advancement surgery on the temporomandibular joint and muscular and articular adaptive changes--a systematic review.

The objective of this study was to assess the anatomical changes to the condyle and articular disc following mandibular advancement surgery, the adaptation of the masticatory muscles, and the improvement or worsening of temporomandibular disorders (TMD) in patients with pre-existing disorders and those who developed them following surgery. Four databases were searched systematically: PubMed, Scopus, Embase, and Cochrane Library. Of the 544 articles initially selected, 219 were duplicates and a further 165 were excluded on the basis of their titles and abstracts. On reading the full text, 89 were excluded because they were of no interest and 43 because they did not meet the inclusion criteria. Of the remaining 28 articles, six were excluded because they were considered of low quality and 22 articles were reviewed. Mandibular advancement surgery with condyle repositioning is associated with less TMD. Condylar resorption is a physiological process with a multifactorial aetiology. It is accelerated following mandibular advancement surgery but is not a contraindication to this procedure. Despite the large number of studies on the effects of mandibular advancement surgery on the temporomandibular joint (TMJ), this surgery can neither be said to improve nor to worsen TMJ health.

Cross-cultural adaptation, validity and psychometric properties of the Spanish version of the Dental Satisfaction Questionnaire.

INTRODUCTION: No dental patient satisfaction questionnaires have been validated in Spain. OBJECTIVE: To validate in Spain a translated version of the Dental Satisfaction Questionnaire. METHODS: A consecutive sample of 217 patients attending the dental clinic of the University of Valencia was selected. The internal consistency of the questionnaire was analysed using Cronbach's alpha and the internal structure using principal components analysis. Its reproducibility was tested both by using the test-retest method with 31 patients randomly selected from the sample and by analysis using the absolute agreement intraclass correlation coefficient. RESULTS: Cronbach's alpha for the questionnaire was 0.56. Seven principal components explain 60% of the variance. Test-retest obtained an intraclass correlation coefficient of 0.92 and the subscales obtained values higher than 0.7. DISCUSSION: The internal consistency of the scale is acceptable. The internal consistency of the pain management subscale is higher than that of the others. The original structure of five subscales is partially confirmed in our version because of quality and access subscales. The reproducibility is very good. Some items of Dental Satisfaction Questionnaire that show low consistency measure expectations that would have little effect on satisfaction scores. CONCLUSIONS: The Dental Satisfaction Questionnaire in Spanish can be considered an instrument for studying patient satisfaction in Spain as it has proved viable, has acceptable internal consistency and excellent reproducibility and covers different dimensions of the concept of satisfaction, such as pain management, accessibility, quality, availability/convenience and cost.

Relationship of children's salivary microbiota with their caries status: a pyrosequencing study.

PURPOSE: Different dental caries status could be related with alterations in oral microbiota. Previous studies have collected saliva as a representative medium of the oral ecosystem. The purpose of this study was to assess the composition of oral microbiota and its relation to the presence of dental caries at different degrees of severity. MATERIALS AND METHODS: One hundred ten saliva samples from 12-year-old children were taken and divided into six groups defined in strict accordance with their dental caries prevalence according to the International Caries Detection and Assessment System II criteria. These samples were studied by pyrosequencing PCR products of the 16S ribosomal RNA gene. RESULTS: The results showed statistically significant intergroup differences at the class and genus taxonomic levels. Streptococcus is the most frequent genus in all groups; although it did not show intergroup statistical differences. In patients with cavities, Porphyromonas and Prevotella showed an increasing percentage compared to healthy individuals. Bacterial diversity diminished as the severity of the disease increased, so those patients with more advanced stages of caries presented less bacterial diversity than healthy subjects. CONCLUSION: Although microbial composition tended to be different, the intragroup variation is large, as evidenced by the lack of clear intragroup clustering in principal component analyses. Thus, no clear differences were found, indicating that using bacterial composition as the sole source of biomarkers for dental caries may not be reliable in the unstimulated saliva samples used in the current study.

Caries diagnosis: agreement between WHO and ICDAS II criteria in epidemiological surveys.

OBJECTIVE: The aim of this study was to ascertain the equivalence between WHO caries diagnosis criteria and the ICDAS II caries classification scale for comparisons in epidemiological studies. MATERIALS AND METHODS: Two intraoral examinations, one using the ICDAS II caries codes and the other the WHO caries assessment method, were performed in a random sample of 101 children (29 aged 5-6 years, 32 aged 12 and 40 aged 15). Both examinations were performed not more than one month apart by two calibrated examiners (one for ICDAS II criteria, Kappa=0.86, and the other for WHO criteria, Kappa=0.91). The DMFT/dft, DMFS/dfs and caries prevalence (DMFT or dfs>0) indices were obtained in accordance with WHO assessment criteria and by applying 5 cut-off points on the ICDAS II scale. The differences between means were analysed with the Wilcoxon test and those between proportions with the McNemar test. Agreement was determined by the intraclass correlation index and the Kappa statistic. RESULTS: The least differences between the WHO and ICDAS 11 criteria were found at cut-off point 3 (ICDAS 11 codes 3 to 6). The greatest agreement was found at the same cut-off point. CONCLUSION: While the equivalence between both methods used in epidemiological studies does not appear to be clear, possible errors could be reduced by locating this equivalence at cut-off point 3 and not at cut-off point 4.

The use of occlusal indices in high-impact literature.

UNLABELLED: Malocclusion is difficult to define because individuals and cultures vary widely in their perceptions of what constitutes an occlusal problem. A number of occlusal indices have been devised but, probably because of this perceptual problem, none has ever emerged as a standard. OBJECTIVE: The main objective was to review the use of the principal occlusal indices. BASIC RESEARCH DESIGN: The PUBMED database was searched for the main occlusal indices employed, journals with an impact in dentistry and specialist orthodontics journals. RESULTS: The occlusal indices most frequently employed were IOTN (163 studies), PAR (132 studies), DAI (68 studies) and ICON (32 studies). The journals publishing the greatest number of studies using these occlusal indices are those specialising in orthodontics. CONCLUSIONS: In the high-impact scientific literature, the indices in greatest use are IOTN, followed by PAR, DAI and ICON. DAI and IOTN are mainly used in epidemiological or prevalence studies, while PAR is generally used for longitudinal studies. IOTN is used more in Europe. DAI is used worldwide; though least in Europe.

Efficacy of two antiplaque and antigingivitis treatments in a group of young mentally retarded patients.

INTRODUCTION: Chemical management of dental plaque for controlling oral hygiene becomes necessary in high-risk patients such as the mentally retarded. MATERIAL AND METHODS: Thirty-seven mentally handicapped patients aged 10-19 years and with severe plaque and gingivitis were divided into two treatment groups: Group I (daily mouthrinse with triclosan-zinc for 8 weeks) and Group II (0.2% chlorhexidine spray for 2 weeks). Both groups were evaluated at the start of the study and after 2 and 8 weeks. RESULTS: Significant reductions in plaque were observed in Group I after two weeks, with very significant improvements in both plaque and gingivitis after 8 weeks. In Group II, highly significant reductions in both indices were recorded after two weeks of treatment - significance persisting after 8 weeks. CONCLUSIONS: Triclosan-zinc mouthrinse and chlorhexidine spray can be effective adjuncts to tooth brushing for controlling dental plaque and gingivitis in mentally retarded patients.

Estudio de la eficacia de dos tratamientos antiplaca y antigingivitis en un grupo de discapacitados psíquicos / Efficacy of two antiplaque and antigingivitis treatments in a group of young mentally retarded patients

Introducción: La utilización de métodos de control químico de placa se hace necesaria en los pacientes de alto riesgo como los disminuidos psíquicos para controlar la higiene oral. Material y métodos: 37 individuos con retraso mental y con altos niveles de placa y de gingivitis fueron divididos en 2 grupos. El grupo I realizó un enjuague diario con Triclosánzinc durante 8 semanas, mientras que el grupo II recibió un spray de clorhexidina al 0,2 por ciento durante 2 semanas. Ambos grupos fueron evaluados al inicio del estudio, a la segunda semana y a la octava semana. Resultados: En el grupo I se obtienen reducciones significativas en el índice de placa a la segunda semana y reducciones altamente significativas a la octava semana tanto en el índice de placa como el gingival. En el grupo II se obtienen reducciones altamente significativas en ambos índices a la segunda semana, manteniendo una reducción todavía significativa a la octava semana. Conclusiones: El uso de colutorios de triclosán-zinc, así como de sprays de clorhexidina pueden ser eficaces como métodos coadyuvantes al cepillado dental para el control de la placa y la gingivitis en los disminuidos psíquicos (AU)

[Fissure sealants: clinical study]. / Sellantes de fisuras: estudio clinico.

A total of 132 sealants are applied to 55 children, over a period of one to five years. The results show a Complete Retention of 76.5%, a Partial Loss of 12.8% and Complete Loss of 10.6%.

[Radico-diagram: a technic for study of tooth root]. / El radico-diagrama: una técnica de estudio de la raiz dentaria.

The use of a simple measuring system such as the root diagram provides us with information about the morphology and the inclination of the roots of dental pieces. This system applied on x-rays taken with accurate and adequate techniques facilitates and enables one to study extensive groups of the population with common or divergent ethnic features and their subsequent comparative analysis.