Temporomandibular disorders in individuals with Marfan syndrome: an exploratory analysis.

BACKGROUND: This study aims to analyze to what extent patients with Marfan syndrome (MFS) are affected by temporomandibular disorders (TMD) and its impact on oral health-related quality of life (OHRQoL). To collect data, an online questionnaire was created to recruit participants from Germany, Austria, and Switzerland through social media and support groups. The questionnaire consists of free-text questions, the German versions of the Oral Health Impact Profile (OHIP-G14), the Depression Anxiety Stress Scale (DASS), and the Graded Chronic Pain Status (GCPS). RESULTS: A total of 76 participants with diagnosed MFS were included. Of these, 65.8% showed TMD symptoms, the most common being pain or stiffness of the masticatory muscles in the jaw angle (50.0%). Only 14.5% of the participants were already diagnosed with TMD. Of the participants with an increased likelihood of a depression disorder, 76.9% showed TMD symptoms. Of those with a critical score for an anxiety disorder, 90.9% showed TMD symptoms. 73.3% of participants with TMD symptoms reached the critical score for a stress disorder. TMD symptoms were associated with a higher risk for chronic pain. In the median, participants with TMD showed statistically notably higher OHIP-G14 scores than participants without TMD (11.5 [IQR 17] vs. 1 [IQR 3] points, p ≤ 0.001). CONCLUSION: TMD symptoms had a noticeable impact on OHRQoL in patients with MFS, i.e., chronic pain and psychological impairment. TMD seems underdiagnosed, and more research is needed to prevent the associated chronification of pain and psychological burden to improve the OHRQoL.

Magnetic resonance imaging for jawbone assessment: a systematic review.

PURPOSE: To evaluate the accuracy of magnetic resonance imaging (MRI) for jawbone assessment compared to reference-standard measurements in the literature. MATERIALS AND METHODS: An electronic database search was conducted in PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library in June 2022, and updated in August 2023. Studies evaluating the accuracy of MRI for jawbone assessment compared with reference-standard measurements (histology, physical measurements, or computed tomography) were included. The outcome measures included bone histomorphometry and linear measurements. The risk of bias was assessed by the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The review was registered in the PROSPERO database (CRD42022342697). RESULTS: From 63 studies selected for full-text analysis, nine manuscripts were considered eligible for this review. The studies included assessments of 54 participants, 35 cadavers, and one phantom. A linear measurement error ranging from 0.03 to 3.11 mm was shown. The accuracy of bone histomorphometry varies among studies. Limitations of the evidence included heterogeneity of MRI protocols and the methodology of the included studies. CONCLUSION: Few studies have suggested the feasibility of MRI for jawbone assessment, as MRI provides comparable results to those of standard reference tests. However, further advancements and optimizations are needed to increase the applicability, validate the efficacy, and establish clinical utility of these methods.

Oral health and oral-health-related quality of life in people with X-linked hypophosphatemia.

BACKGROUND: X-linked hypophosphatemia (XLH) is a type of vitamin D-resistant rickets. It is the most common form of it and is related with oral health problems. This study aimed to analyze the OHRQoL of people suffering from XLH and measure physical oral health to confirm or refute evidence of reduced oral health. METHODS: The German version of the Oral Health Impact Profile (OHIP-14G), was used to measure OHRQoL. All study participants underwent clinical examination, and oral health was scored using the Physical Oral Health Index (PhOX). RESULTS: A total of 26 people participated in the study, of whom five were male and 21 were female. The average participant age was 40.9 ± 12.8 years. The OHIP-14G score was 14.3 (± 12.1; 95% CI: 9.37. 19.16) points (range 0-44 points). The PhOX score was 77.1 (± 9.9; 95% CI: 73.10-81.13) points (range 61-95 points). CONCLUSIONS: The results of this study confirm that oral health and OHRQoL are both reduced in the studied cohort of people affected by XLH. Particular attention should be paid to perfect oral hygiene in people with XLH, as the impaired enamel mineralisation increases the risk of caries and thus also the occurrence of apical infections.

Prevalence and quality of temporomandibular disorders, chronic pain and psychological distress in patients with classical and hypermobile Ehlers-Danlos syndrome: an exploratory study.

BACKGROUND: The Ehlers-Danlos syndromes are a group of clinically and genetically heterogeneous hereditary diseases affecting the connective tissue. They are characterized by hypermobility of the joints, hyperextensible skin and friable tissue. According to current classification, 13 subtypes can be distinguished, of which the hypermobile and the classical subtype are the most prevalent. This study aimed to evaluate patients with classical (cEDS) and hypermobile (hEDS) Ehlers-Danlos syndrome regarding temporomandibular disorder (TMD), chronic pain, and psychological distress. METHODS: Support groups from Germany, Austria, and Switzerland were contacted, and social media were used to recruit participants. Free text questions, the German version of the Depression Anxiety and Stress Scale (DASS), and the German version of the Graded Chronic Pain Status (GCPS) were used. RESULTS: 259 participants were included (230 hEDS/29 cEDS). At least 49.2% of the participants had painful or restricted jaw movements, and at least 84.9% had pain in the masticatory muscles, with 46.3% already having a diagnosed TMD. Multivariate analysis showed a significant correlation between TMJ involvement and chronic pain with a 2.5-fold higher risk of chronic pain with a diagnosed TMD. 22.8% of participants had a critical score for depression, 53.3% had a critical score for anxiety, and 34.0% had a critical score for stress. CONCLUSION: There is a high prevalence of TMD problems and chronic pain in patients with cEDS and hEDS. The lack of knowledge about these problems can create psychological distress. More research is needed to provide adequate treatment for patients with EDS.

Artifacts in magnetic resonance imaging of the head and neck: Unwanted effects caused by implant-supported restorations fabricated with different alloys.

STATEMENT OF PROBLEM: Implant-supported restorations may cause artifacts in magnetic resonance imaging (MRI) of the head and neck area. However, the effect of different alloys remains unclear. PURPOSE: The purpose of this in vitro study was to assess artifacts in head and neck MRI caused by implant-supported restorations with different alloys. MATERIAL AND METHODS: Three dry mandibles were prepared to receive bilateral dental implants at the second premolar and second molar sites. Different alloy combinations were evaluated: titanium implants+cobalt chromium restorations; titanium-zirconium implants+cobalt chromium restorations; and zirconia implants+ceramic restorations. Specimens were imaged by using a 3-Tesla magnetic resonance scanner system (Achieva 3.0T TX; Philips GmbH) with a turbo-spin-echo sequence. Scan protocols were adjusted to optimize metal artifact reduction and shorten scan time. Artifact volumes were assessed and statistically analyzed by using the Kruskal-Wallis and Spearman tests (α=.05). RESULTS: A statistically significant difference was found among artifact volume caused by different materials (P=.002). The presence of titanium alloy was correlated with the artifact volume (r=-.87). Artifacts were greater for titanium and fewer for titanium-zirconium alloys, whereas zirconia implants found only minimal artifacts. CONCLUSIONS: The dimension of artifacts produced by implant-supported restorations varied according to the material.

Patients' perspectives on the use of artificial intelligence in dentistry: a regional survey.

The use of artificial intelligence (AI) in dentistry is rapidly evolving and could play a major role in a variety of dental fields. This study assessed patients' perceptions and expectations regarding AI use in dentistry. An 18-item questionnaire survey focused on demographics, expectancy, accountability, trust, interaction, advantages and disadvantages was responded to by 330 patients; 265 completed questionnaires were included in this study. Frequencies and differences between age groups were analysed using a two-sided chi-squared or Fisher's exact tests with Monte Carlo approximation. Patients' perceived top three disadvantages of AI use in dentistry were (1) the impact on workforce needs (37.7%), (2) new challenges on doctor-patient relationships (36.2%) and (3) increased dental care costs (31.7%). Major expected advantages were improved diagnostic confidence (60.8%), time reduction (48.3%) and more personalised and evidencebased disease management (43.0%). Most patients expected AI to be part of the dental workflow in 1-5 (42.3%) or 5-10 (46.8%) years. Older patients (> 35 years) expected higher AI performance standards than younger patients (18-35 years) (p < 0.05). Overall, patients showed a positive attitude towards AI in dentistry. Understanding patients' perceptions may allow professionals to shape AI-driven dentistry in the future.

SEMAC + VAT for Suppression of Artifacts Induced by Dental-Implant-Supported Restorations in Magnetic Resonance Imaging.

The purpose of this study was to assess the feasibility of SEMAC + VAT to reduce artifacts induced by dental implant-supported restorations, such as its impact on the image quality. Dental-implant supported restorations were installed in a dry mandible. Magnetic resonance scans were acquired on a 3-Tesla MRI system. Artifact suppression (SEMAC + VAT) was applied with different intensity modes (weak, moderate, strong). Artifacts assessment was performed by measuring the mandible volume increase in MRI images prior (reference dataset) and after installation of dental implant-supported prosthesis. Image quality was assessed by two examiners using a five-point scale. Inter-examiner concordance and correlation analysis was performed with Cronbach's alpha and Spearman's test with a significance level at p = 0.05. Mandible volume increased by 60.23% when no artifact suppression method was used. By applying SEMAC + VAT, the volume increase ranged from 17.13% (strong mode) to 32.77% (weak mode). Visualization of mandibular bone was positively correlated with SEMAC intensity degree. SEMAC + VAT reduced MRI artifacts caused by dental-implant supported restorations. A stronger suppression mode improved visualization of mandibular bone in detriment of the scanning time.

Oral Health-Related Quality of Life in Different Subtypes of Ehlers-Danlos Syndrome.

This study assessed differences in the oral health-related quality of life (OHRQoL) between subtypes of Ehlers-Danlos syndrome (EDS). For statistical analysis, participants were divided according to their subtype: classical EDS (cEDS), hypermobile EDS (hEDS), and vascular EDS (vEDS). All other subtypes were descriptively analyzed. Free-text questions and the German short form of the Oral Health Impact Profile (OHIP-14) were used. Finally, 295 questionnaires were included, representing 10 different EDS subtypes. The mean OHIP score of all participants was 19.6 points (standard derivation (SD) ± 12.3). The most predominant subtypes showed similar reduced OHRQoL, with 18.0 (cEDS, ±12.9), 19.5 (hEDS, ±12.0), and 15.2 (vEDS, ±11.6) OHIP points. For all other subtypes, the OHIP values varied. Participants waited an average of 21.8 years (±12.8) for their diagnosis. However, within the predominant subtypes, vEDS patients waited a noticeably shorter period of 13.3 years (±13.0; p = 0.004) compared to participants with hEDS. Additionally, this study showed no difference in OHRQoL for the predominant subtypes regardless of whether a participant was a self-help group member (18.8, ±12.0) or not (19.4, ±12.1; p = 0.327).

CAD-CAM natural restorations-Reproducing nature using a digital workflow.

OBJECTIVES: Natural restorations combine digital workflow and shell technique to create CAD/CAM restorations with the form and texture of natural teeth. This case report describes an interdisciplinary digital workflow combined with CAD/CAM natural restorations to achieve the naturalness of an anterior rehabilitation. CLINICAL CONSIDERATIONS: A 38-year-old patient attended to the office with esthetic issues. An interdisciplinary treatment plan was conducted, which included periodontal surgery to recreate the gingival contour, associated with bleaching and manufacturing CAD/CAM ceramic veneers to return an optimal teeth surface texture and shape. CONCLUSIONS: The design and manufacturing of CAD/CAM natural restorations using a digital workflow allowed a predictable result and overcame the limitations of conventional shell technique. CLINICAL SIGNIFICANCE: Conventional shell technique is used to create restorations with the form and texture of natural teeth. This article presents a combination of the conventional shell technique with a digital workflow, facilitating the design and manufacturing of CAD/CAM natural restorations.

Influence of marginal incision and Le Fort I osteotomy on periodontal tissues: a prospective longitudinal study.

The purpose of this prospective study was to evaluate whether the surgical protocol involving marginal incision and Le Fort I osteotomy affects the periodontal outcome. Twenty-nine patients requiring surgical correction of maxillary dysgnathia were selected for this study. Periodontal conditions of maxillary anterior teeth were assessed prior to the surgery (T0), one month (T1), and 6 months (T2) after the surgical procedure. Interdental papillae loss, periodontal parameters and aesthetic outcomes in the anterior zone were assessed. Statistical analysis was performed with Friedman´s test and within ANOVA (p ≤ 0.05) followed by post-hoc tests. Papilla height decreased from T0 to T1 (p = 0.003), followed by an increase from T1 to T2 (p = 0.040). PPD (T0 = 1.72 ± 0.46; T2 = 2.13 ± 0.43) and CAL (T0 = 1.24 ± 0.55; T2 = 1.99 ± 0.70) increased after 6 months. There were statistically significant differences in aesthetic score among T0, T1 and T2. Periodontal changes after orthognathic surgery were within acceptable biological levels. Although a change in papillae height was reported after the surgery, initial values were recovered after 6 months. Surgical incision design might improve the outcome of Le-Fort I osteotomy. Anterior aesthetic zone may benefit from a marginal incision design, as it respects vascularization principle and may ensure a wound healing without complications.

Evaluation of the 3D error of 2 face-scanning systems: An in vitro analysis.

STATEMENT OF PROBLEM: Facial scanning systems have been developed as auxiliary tools for diagnosis and planning in dentistry. However, little is known about the trueness of these free software programs and apps for facial scanning. PURPOSE: The purpose of this in vitro study was to evaluate the trueness of 3D facial scanning by using Bellus3D and +ID ReCap Photo. MATERIAL AND METHODS: A mannequin head was used as the master model. The control group was created by scanning the mannequin head with a noncontact structured blue light 3D scanner (ATOS Core). Two facial scanning methods were used for the experimental groups: a facial scanning app (FaceApp) and the Plus identity photogrammetry methodology (ReCap Photo). In both methods, image capturing was performed under the same natural lighting conditions with a smartphone (iPhone X) calibrated with an app. Trueness was assessed from the 3D measurement error, which was calculated with a 3D mesh analysis software program (GOM Inspect). Two comparison groups were created: ATOS versus Bellus3D (B3D) and ATOS versus +ID with ReCap Photo (+IDRP). The results were statistically evaluated by using the Shapiro-Wilk and paired t tests (α=.05). RESULTS: B3D had a greater error than +IDRP in measuring the regions of the upper and lower lips, nose, and mentum (P<.01). This error was statistically higher for +IDRP (P<.01) in the right face area, but the left face area showed no statistically significant difference between the evaluated scanning methods (P=.93). The 3D global trueness of B3D was 0.34 ±0.14 mm, and that of +IDRP was 0.28 ±0.06 mm. CONCLUSIONS: Both methods evaluated in this study provided a 3D model of the face with clinically acceptable trueness and should be reliable tools for planning esthetic restorations.

New Treatment Concepts in Implantology-The Role of Digital Innovations for an Individualized Dental Implant Rehabilitation.

In the last few years, technological innovations have been changing the field of implantology [...].

A Survey on the Use of Artificial Intelligence by Clinicians in Dentistry and Oral and Maxillofacial Surgery.

Background: Applications of artificial intelligence (AI) in medicine and dentistry have been on the rise in recent years. In dental radiology, deep learning approaches have improved diagnostics, outperforming clinicians in accuracy and efficiency. This study aimed to provide information on clinicians' knowledge and perceptions regarding AI. Methods: A 21-item questionnaire was used to study the views of dentistry professionals on AI use in clinical practice. Results: In total, 302 questionnaires were answered and assessed. Most of the respondents rated their knowledge of AI as average (37.1%), below average (22.2%) or very poor (23.2%). The participants were largely convinced that AI would improve and bring about uniformity in diagnostics (mean Likert ± standard deviation 3.7 ± 1.27). Among the most serious concerns were the responsibility for machine errors (3.7 ± 1.3), data security or privacy issues (3.5 ± 1.24) and the divestment of healthcare to large technology companies (3.5 ± 1.28). Conclusions: Within the limitations of this study, insights into the acceptance and use of AI in dentistry are revealed for the first time.

Epithelioid Rhabdomyosarcoma at the High Parietal Area of the Head: A Case Report.

Epithelioid rhabdomyosarcoma is a rare condition, which may be clinically misinterpreted as melanoma due to its morphological appearance. Careful morphological and immunohistochemical analysis play an important role in its diagnosis. This case report describes the clinicopathological features of an epithelioid RMS diagnosed at the high parietal area of the head. A 71-year-old male patient presented a red-brown pigmented ulcerative nodule in the high parietal region of the head. Previous biopsy and computer tomography imaging revealed a malignant melanoma in stage I (pT2, sN0, Mx). After tumor operation, histological and immunohistochemical analysis of the tumor were conducted. Histological analysis showed an erosive lesion with a monomorphic cell population containing small cells with prominent nucleoli. A positivity was confirmed for CD10, Vimentin, and Desmin. MyoD1 was detected, as well as a fluctuating signal for p53. Molecular analysis revealed a negativity for Sox-10, and a weak positivity for CK8/18 by absence of p40. Based on the morphological and immunohistochemical findings, the tumor was diagnosed as epithelioid RMS.

Artifacts in magnetic resonance imaging caused by dental materials: a systematic review.

OBJECTIVES: The purpose of this systematic review was to search in literature in which severity unintended effects are caused by dental materials in magnetic resonance imaging (MRI), such as to evaluate whether these artifacts hamper the diagnosis in the head and neck region. MATERIALS AND METHODS: Clinical studies showing the severity of artifacts which dental materials are capable of causing in MRI of head and neck, such as their influence on diagnostic accuracy, were included in this review. The searches were conducted in four electronic databases (PubMed/Medline, Embase, Scopus and Web of Science), and a manual search was made in the reference lists of papers screened for full-text reading. Risk of bias was assessed using "Quality Assessment Tool for Diagnostic Accuracy Studies-2" (QUADAS-2). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. RESULTS: From 151 studies selected for full-reading, 19 were considered eligible for this review. Artifacts caused by orthodontic appliances were well-documented, and stainless steel brackets were the materials most likely to cause artifacts in MR imaging of head and neck. The literature was scarce for dental implants and restorations. Diagnoses within the oral cavity, but also those of the brain and craniofacial structures, were affected. CONCLUSION: Artifacts caused by orthodontic appliances may affect the diagnosis in oral cavity and craniofacial structures. Data regarding dental implants and prosthodontics restorations were inconclusive. The severity of artifacts in MRI and their influence on diagnosis is dependent on dental material features, location in the oral cavity, and magnetic resonance parameters.

Digital Implant Planning in Patients with Ectodermal Dysplasia: Clinical Report.

Ectodermal dysplasia may severely affect the development of jaw growth and facial appearance. This case report describes the treatment of two patients suffering from ectodermal dysplasia, both treated with dental implant-fixed restorations by means of computer-guided surgery. Two patients presented to our clinic with congenital malformation of the jaw as a manifestation of ectodermal dysplasia, showing oligodontia and alveolar ridge deficit. Clinical examination revealed multiple unattached teeth and a need for prosthetic therapy. For both cases, dental implants were placed based on a computer-guided planning. A surgical guide was used to determine the positioning of the dental implants according to the prosthetic planning, which allowed for a satisfactory aesthetic and functional outcome. Computer-guided implant placement allowed predictable treatment of complex cases with satisfactory aesthetic and functional results. Adequate surgical and prosthetic planning is considered critical for treatment success.

Dental Implants in People with Osteogenesis Imperfecta: A Systematic Review.

The aim of this systematic review was to answer the question of whether patients with osteogenesis imperfecta can be prosthetically rehabilitated with dental implants. A protocol was prospectively registered in PROSPERO (CRD42021286368). The inclusion criteria were the presence of osteogenesis imperfecta and the use of implants for prosthetic restorations. Cases in which the inclusion criteria were not met were excluded. PubMed, Web of Science, and Scopus were last searched on 22 August 2021. Quality assessment was performed using the Methodological Quality and Synthesis of Case Series and Case Reports tool. The primary outcome was implant survival. Supporting data were analyzed descriptively. Twelve studies were included. Twenty-three patients received a total number of 116 implants, with 5.0 (±3.8) implants placed per patient. The implant survival rate was 94.0% with a mean follow-up of 59.1 months (±36.1). A limitation of this review was the relatively short follow-up time in some of the included studies; therefore, the survival rate may be overestimated. Nevertheless, the available data showed the loss of only seven implants, with two implants lost due to implant fractures not attributable to the patient. With the limitations of this review and based on the available data, dental implants have a high survival rate in patients with osteogenesis imperfecta. Therefore, dental implants may be a viable treatment option for replacing missing teeth. This research was not funded by external resources.

Digital approaches to facially guided orthodontic and periodontal rehabilitation in the anterior esthetic zone: A case report.

OBJECTIVE: The present case report describes digital approaches to plan an orthodontic and periodontal rehabilitation at the anterior esthetic zone. CLINICAL CONSIDERATIONS: A young patient attended to the dental practice with esthetic concerns. The facially driven digital planning showed the need of an interdisciplinary treatment to improve smile harmony. Orthodontic treatment was conducted with aligners, followed by periodontal and restorative approaches. Tooth alignment was performed with 31 aligners, whereas eight aligners were used for refinement. Harmony between pink and white esthetics was improved with crown lengthening, followed by bleaching. CONCLUSION: By using a conservative approach, a successful esthetic result was achieved respecting functional and biological principles. CLINICAL SIGNIFICANCE: Digital resources can be used to the interdisciplinary esthetic planning taking into consideration the harmony between smile and face. This approach allows a predictable outcome of the treatment.

Digital versus conventional workflow for the fabrication of physical casts for fixed prosthodontics: A systematic review of accuracy.

STATEMENT OF PROBLEM: A consensus on the accuracy of additively manufactured casts in comparison with those fabricated by using conventional techniques for fixed dental prostheses is lacking. PURPOSE: The purpose of this systematic review was to determine the accuracy of additively manufactured casts for tooth- or implant-supported fixed dental prostheses in comparison with that of gypsum casts. MATERIAL AND METHODS: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42020161006). Eight databases were searched in December 2019 and updated in September 2020. Studies evaluating the dimensional accuracy of additively manufactured casts for fixed dental prostheses in comparison with that of gypsum casts were included. An adapted checklist for reporting in vitro studies (Checklist for Reporting In vitro Studies guidelines) was used to assess the risk of bias. RESULTS: Eight studies evaluating tooth-supported fixed dental prosthesis casts and 7 studies evaluating implant-supported fixed dental prosthesis casts were eligible for this review. Gypsum casts showed greater accuracy (trueness and precision) in most studies, although additively manufactured casts also yielded highly precise data. One study was associated with a low risk of bias, 9 with a moderate risk of bias, and 5 with a high risk of bias. CONCLUSIONS: In vitro studies showed that additively manufactured casts and gypsum casts share similar accuracy within the acceptable range for the fabrication of casts. The quality of scanned data, additive manufacture technology, printing settings, and postprocessing procedures plays an essential role in the accuracy of additively manufactured casts. Clinical studies are required to confirm these findings.

Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept.

The esthetic rehabilitation of anterior ridge defects and achieving patient satisfaction have become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures that fail to meet patient expectations. The loss of hard and soft tissues in anterior ridges results in an esthetically compromised zone that affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment plan considering esthetic parameters, prosthetic needs, and morphological defects must be used to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects that focuses on digital evaluation systems and is guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for esthetic outcomes and treatment alternatives for anterior ridge defects are also addressed.